My mother was first diagnosed with breast cancer, stage 2 in 2017, just few days before I appeared for my first UPSC CSE interview. I remember she coming to Delhi and being with me as a support system for my UPSC journey. I couldn’t have managed clearing exam without her. Now when I think of it, she was living with the disease since then. Immediately after the interview, I rushed back home. Her treatment was being done under the able hands of Mr Pathak, in Nagpur. We would travel every week to Nagpur for her follow ups, her chemotherapy and radiotherapy sessions. The whole process lasted more than 3 months. Considering we lived in the remotest corner of our district, it would take us more than 4 hrs of one way journey to Nagpur. Driving our way through potholed roads. She was (and still is )so brave and positive during the entire period, that it still amuses me as to how she breaks stereotypes so easily. Since then we regularly carry out her check ups and any signs of relapse.
There were and still are so many myths, ifs-buts that surround breast cancer that I myself always thought that occurrence of it, needs a history in one’s family. Also the whole idea of incidence of disease and the taboos that surround women’s body are so rampant that it hardly makes it easier for women to report any symptoms. I recollect talking to one of the women in Solapur district as to why she wanted to get checked. She said that she had been carrying the lump for along time but hardly had any botherence or courage to share with her immediate family. Also the fact the financial burden of surgery and treatment involved is so immense that most women are overwhelmed at the very thought of reporting any health issues that bother them.
As CEO of Zilla Parishad Solapur therefore I wanted that breast cancer awareness, diagnosis and treatment be carried out in a mission mode and time bound manner. The whole idea around Project Nidan therefore was based on the fact that it is important and an imperative to reach out to women of all age groups for their physical check up, raise awareness and at the same time lesson their psychological and economic burden. Therefore the very name Nidan suggesting diagnosis and screening.
I happened to stumble upon the start up called Niramai which had come up with thermal based AI operated mobile machine. It is non invasive and cost effective. After procuring the machine, we trained our team of MO, ANM, MPW and ASHA for the same. We made roadmaps taluka and PHC wise wherein ASHA would bring forth the suspected cases found in physical examination to such camps. The highlight of the entire project definitely and surely are our Asha Taais, who visited door to door and made women comfortable with the idea of self examining breast for given symptoms. In such manner we could in 3 months time examine 10,467 women. Out of which 462 were found suspected in thermal based screening. They were further sent for biopsy or mammography after consultation with oncologists. Today we have reached a number of 35,559 screening and 721 women have undergone mammography, 309 being examined by special oncologists and 31 diagnosed and being treated for breast cancer.
While the procedure does sound simple but it was equally difficult to get where we are now. In the first month the project did not receive the response we had hoped. The trained Medical officer screening teams were confused. Also we were not able to immediately screen women found of suspected cases for mammography. Which somewhere made women more vulnerable and insecure. Difficult to garner support, scaling up was something I couldn’t have dared in entire district. It is at this point I decided to start from scratch. We carried out training for all Ashas and taught them what symptoms to look for. We further Selected active PHCs and active Taluka headed by a good Taluka Health Officer (THO). These taluka team then planned local visits and created line listing of patients along with phone numbers. They were sent to nearby oncologist for consultation and mammograms/biopsies.The cost of which was borne by Zilla Parishad.
Therefore the most important thread was generating trust in the entire process. Once we successfully completed a chain of treatment, a word of mouth was automatically spread. So much so that many Gram Panchayat wanted the Project Nidan team to visit villages and organise camps.
Project Nidan is not an innovative concept it is rather an extension of an already underperforming Non-Communicable Disease (NCD) program of Government of India under Nationalist Health Mission (NHM), the central and state governments are spending immensely on Information, Education and Communication (IEC) as well as diagnosis but not able to penetrate enough. Perhaps what we tried is bring out women out of their homes, instil confidence and make sure that it doesn’t feel like a burden on them. Because for women, taking care of their own health is a luxury, one which seems to be a far fetched and selfish idea propagated by our patriarchal society. What we tried is simply nudge them and it became their movement!
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