Vietnam is a country in transition. Massive urbanisation, accompanied by changes in lifestyle and diet, is leading to a sharp increase in chronic diseases, including cancer.
In Vietnam's surging economy, the bicycle is making way for the motorbike. Recent studies show that in Hanoi, a city of some four million people, there are now nearly two million motorcycles—and they are causing severe air pollution.
The National Cancer Hospital in Hanoi, also known as the 'K' Hospital, has strong historic links to the use of radium for cancer treatment. Among its most prized possessions, a letter from Marie Curie, who was awarded the Nobel Prize for her role in the discovery of radioactivity and, later, for her work with radium.
The 'K' Hospital is the only centre for cancer diagnosis and treatment in north Vietnam. It is one of just two cancer centres in this country of 84 million, meaning that many patients travel long distances from far-flung rural areas. The second centre is in Ho Chi Minh City in the south of the country.
Each day the 'K' Hospital handles more than 1000 patients. Its wards and facilities are over-crowded and its human resources stretched to the limit to cope with the massive workload, which still covers only a fraction of the region's cancer needs.
Vietnam is facing a growing cancer crisis. Each year, up to 75,000 people die of the disease and around 150,000 new cases are diagnosed. No one is spared: it strikes men, women and children.
Breast cancer is the most common form of cancer in women in Vietnam. Lack of knowledge of the disease, especially among women in rural areas, means they frequently ignore the symptoms. Xuong, 50, and Lieu, 55, both waited for more than a year before seeing a doctor about breast lumps. The lumps were painless, so they thought it was nothing serious.
Up to 80% of patients in Vietnam seek help only when their cancer is far advanced, making it much more difficult to treat. The 'K' Hospital uses a multi-modality approach to advanced breast cancer: modified radical mastectomy, followed by chemotherapy and radiotherapy treatment. Hair-loss is a common side-effect of chemotherapy, so the women wear brightly covered scarves until their hair grows back.
Like many patients, Xuong, Tuejet, Lieu and Ky traveled long distances to be treated at the National Cancer Hospital. Following mastectomy and chemotherapy, they are now undergoing radiotherapy treatment. But with little money and nowhere else to go, they live and sleep in the hospital corridors. Cut off from home and family, the women form strong bonds of support and friendship to help each other cope with the situation.
Radiotherapy is an important tool in the treatment of breast cancer. It can kill off any cancer cells remaining after surgery and enhance survival in advanced cases. Tuejet, 38, will receive a total of 25 fractions of radiotherapy spread over five weeks.
At the 'K' Hospital, radiotherapy machines are often in service around the clock to cope with the number of patients. Currently, Vietnam has 22 cancer treatment machines and falls drastically short of WHO's recommended one machine per million population. Last year the IAEA's Programme of Action for Cancer Therapy, PACT, negotiated the donation by India of a radiotherapy machine destined for the southern city of Can Tho, where the Oncology Hospital has no radiotherapy facilities.
Dr. Do Huyen Nga is a Medical Oncologist and one of the 600-strong staff of the National Cancer Hospital in Hanoi. She says that cancer incidence has increased dramatically in Vietnam over the last ten years. Dr Nga believes the prognosis is slowly improving, but she says because Vietnam lacks so many of the radiotherapy machines and facilities needed to treat patients, it still lags behind many other countries.
The most commonly found childhood cancers in Vietnam are leukemia, lymphoma, bone cancer and retinoblastoma. Five year old Luyen lost an eye to retinoblastoma while still a baby. The cancer returned to his second eye when he was three years old and he has since undergone several courses of chemotherapy to try and defeat the disease. His mother says Luyen, her only child, is now profoundly blind.
Chau, 5, and Hieu, 4, both have acute lymphoblastic leukaemia. The little boys are being treated at the 'K' hospital and are responding well to treatment. And like children everywhere, they love to play.
