Behind the elegant French colonial-style exterior of the National Cancer Hospital in Hanoi, the capital of Vietnam, a battle is raging. In the hospital´s crowded wards, treatment rooms and corridors, doctors are struggling against a powerful and insidious enemy: cancer. And right now the disease is winning.
Each year in this country of 84 million as many as 75,000 people die of cancer and another 150,000 new cases are diagnosed. Figures are expected to rise a further 25 percent by 2020. Among the reasons: environmental pollution, changing lifestyles and diets, and increased longevity.
Health Care Only for Some
But Vietnam´s health system is ill-equipped to meet the demands. "We lack the capacity," says Dr. Tran Van Thuan, Vice Director of the National Cancer Hospital. "Right now we have only two cancer centres; one in Hanoi in the north and one in Ho Chi Minh City in the south. This means we can meet only 10% of the country´s cancer needs."
At the same time, low cancer awareness results in around 80% of patients seeking help only when the disease is at an advanced stage and therefore difficult to treat. This is particularly true in rural areas where health education is lacking and, for most people, medical check-ups are an unaffordable luxury.
Nguyen Thi Xuong, 50, a farmer from Ha Tinh province, about 450 kilometers south of Hanoi, first felt a lump in her breast in 2006. "It wasn't painful, so I didn´t think it was anything serious. Anyway, I didn´t have any health insurance," Xuong recalls. "I just hoped it would go away."
It didn't. Eighteen months later, when the lump had reached the size of a plum, Xuong borrowed money and started a cancer journey which ended at the National Cancer Hospital. The diagnosis: advanced breast cancer. The treatment: radical mastectomy, followed by chemotherapy, then 25 fractions of radiotherapy spread over five weeks.
Women Most at Risk
Breast cancer is the leading cause of cancer death in women in Vietnam. In Hanoi, it strikes 30 women in every 100,000. Yet with early diagnosis and appropriate treatment, breast cancer is curable.
At the hospital, Xuong met many breast cancer patients like herself. Wearing brightly coloured scarves over their sparse hair - the result of chemotherapy - they sit around the hospital in small groups, whiling away the time until their next radiotherapy session. Most have taken loans to pay the patient´s contribution towards their treatment, so they live frugally - buying food from sellers outside the hospital gates and sleeping on day-beds in the corridors. Like Xuong, many are far from home and haven´t seen family or friends in months.
Enlisting Partners in the Fight
Radiotherapy is a powerful tool in the treatment of breast cancer. It can shrink tumours, kill off stray cancer cells, and enhance survival in advanced cases. But with only 22 radiotherapy machines nationwide, Vietnam falls parlously below the World Health Organization (WHO) recommendation of one machine per million people. That´s why the International Atomic Energy Agency (IAEA) has stepped up efforts to help Vietnam expand its radiation medicine capacity and ensure the safe, effective use of the technology.
The IAEA´s Programme of Action for Cancer Therapy (PACT) designated Vietnam as one of its six pilot project countries, or PACT Model Demonstration Sites (PMDS). Last year, PACT negotiated the donation by India of a Bhabhatron II teletherapy machine to the Oncology Hospital in the southern city of Can Tho, which currently has no radiation medicine infrastructure at all. At the beginning of July, a PACT officer was in Vietnam, together with an expert from India, to prepare for the installation of the machine.
At the same time, together with the WHO and other international partners, PACT is helping the Vietnamese Ministry of Health to develop and implement an ambitious cancer control programme, which aims to reduce cancer incidence and mortality, and improve quality of life for cancer patients.
"Partnering with other leading cancer organisations from around the world and our excellent collaboration with the Vietnamese authorities have been critical elements to our assistance to Vietnam," says Dan Malin, PACT's Programme Officer for the Vietnam PMDS. "We believe that only a united, comprehensive effort covering all aspects of cancer care and control can be truly effective in fighting this terrible disease."
Already that effort is paying dividends. Doctors say cancer awareness in urban areas is slowly growing, resulting in greater numbers of people coming to the National Cancer Hospital. Today, its radiotherapy machines are in use from four in the morning until midnight, its doctors are overworked, and out-patients like Xuong must get by as best they can. Still, no one expects the battle against cancer to be easy. All, on the other hand, are confident that one day it will be won.