Sunday, February 17

Fear, myths and a disease

In old times, they tickled the earth with a hoe, and it laughed with a harvest. But the Punjabi farmer tickled it a bit too hard and in many desperate ways. In an ironic mirroring of meaning, cancer, the malignant growth of cells, has become an apt metaphor for what has happened to agriculture in Punjab, writes Dharminder Kumar in The Indian Express
About a dozen men, both old and young, sit by the road outside the village, gossiping in the sun. "How many cancer patients do you have in this village?" They turn their faces away. An old man breaks the silence: "There were a lot of them two-three years ago. Now there is no cancer. The last death took place two years ago." That's odd for Giana village of Talwandi Sabo block, the buckle of the bimari belt. A youth speaks up, "No, no. One or two die every month." The old man shouts at him, "Oye kanjar deya, eh khangh taap naal mare hoyan baare thoda puchhda (Rascal, he is not asking about deaths due to fever but cancer!)." The youth gets the cue and falls silent.
Fifty years ago, Rachel Carson imagined in her book Silent Spring a future ecological dystopia where no birds sang because they had died of pollution. The Malwa region of Punj-ab is nearing another ecological dystopia where cancer has become an evil which thrives in a web of silences. Here, instead of the birds, it's the people who have fallen silent. Families don't want to tell patients, patients don't want to tell families, families don't want to tell relatives or other villagers, and villagers don't want to tell the outsiders or the government. And the government wasn't too keen to tell anyone—at least till two weeks ago when the state health minister came out with the first credible government survey on cancer, which shows a big spurt in the disease in the last few years. The government decided to break its silence when it saw cancer becoming the biggest issue in the Malwa region.
When Ranjeet Kaur, the wife of Kaka carpenter of Bhangchari village in Muktsar district—the worst affected, according to the government survey—was diagnosed with cancer, the family hid it from her. "We thought telling her would put her under a lot of pressure. But she was educated. She could find out. When her hair started falling, she knew what it was," says Kaka. Mehma Singh, a fellow villager, says, "Women used to scare her, saying who would take care of her son after her. Kaake di bahu taan hauke naal hi mar gi (Kaka's wife died of grief and shock)." Mehma Singh himself has lost five of his relatives to cancer—father-in-law, mother-in-law, two brothers-in-law and a nephew.
Iqbal Singh, an ex-serviceman of nearby Tamkot village, says even when government representatives come, many people don't tell them the truth. "When the ANMs (auxiliary nurse midwives) conduct surveys, they go back with clean reports," he says. "People hide cancer from others because it stops all kinds of social and business transactions. Everyone starts waiting for you to die. But most can't hide it once the chemotherapy starts." These days, he says, more people are coming out at early stages because of the financial assistance offered by the state government.
"Len-den ruk janda (the dealing stops)," says Inderjit Singh, sarpanch of Jhabelwali village in the same district. "No one is going to lend you any money. People count you out. For the society, you are dead well before you actually die." He says a youth from a neighbouring village was diagnosed with cancer but did not tell his family about it. "He wanted to die after having a son. He told others about the disease long after the wedding and did die after producing a son," he says.
Silences are easy to maintain, Inderjit explains, because most of those who are dying are children, women and the elderly, whose loss is not too difficult to bear in material terms. "Fewer youths and family bread-winners are dying so there is no hue and cry in the villages," he says.
Beera Singh, a Dalit youth of Tamkot village, says his father died of cancer three years ago but doctors did not tell him about the cause. "We had taken him to Muktsar government hospital. We were not given any reports," he says. Beera says he admits he is illiterate and wouldn't have understood much but doctors should have at least told him about it. Bohar Singh, another Dalit villager, says his son too died of cancer 10 years ago but doctors did not tell him the cause. "Later, when I came to know from the hospital and asked the doctors why they hadn't told me, they asked me, 'What could you have done with that information?'"
While Beera is angry at one more kind of social exclusion he had to face, Bohar says if he had the hospital reports, he could have got some financial compensation.
At Bhangchari, villagers talk at length about people who died of cancer in the last three years but clam up at the mention of cancer patients. Perhaps they are afraid to locate cancer in the present, as if acknowledging it in the present will invoke it and make it more active. It is somewhat reassuring if cancer is imagined only in the past. In the present, it is addressed only in whispers or just wished away.
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As far back as in 1995, a study by the Guru Nanak Dev University, Amritsar, had found alarming amounts of uranium in water samples from Bathinda and Amritsar districts. South African toxicologist Carin Smit found unusually high uranium in hair samples of children in Faridkot district in 2009. For years, hundreds of cancer patients took a train daily to a charitable hospital in the neighbouring state of Rajasthan. But the state remained in denial. Only about two years ago, it started speaking. It took the state more than a decade just to tell the people roughly how many had died and how many are suffering. Today, the Akali government is in an overdrive. Perhaps, it hopes to make a visible difference by the next Lok Sabha polls. The government has collaborated with a big private hospital at Bathinda. It is also building modern cancer treatment facilities at its own hospitals. There are RO plants in a large number of villages. People have started benefiting from the Mukh Mantri Cancer Rahat Kosh which offers Rs 1.5 lakh to a cancer patient for treatment.
But when the state and science were keeping themselves scarce, cancer grew bigger than them in the minds of the villagers. As the state refused to acknowledge the extent of the epidemic, people were left to understand the disease the way they could. Cancer was no longer a mere fatal ailment. It became a magical, malevolent evil, so unpredictably dangerous that it could not even be named. Even today, most villagers don't use the word cancer. They call it bimari or dooji bimari (the other disease), as if it were a phantom that would turn on them if they even named it.
For many, cancer is also infectious. Mehma Singh of Bhangchari village says when women visit a cancer patient, many cover their faces with dupattas. Karamjit Kaur of the same village, whose four-year-old daughter, Rajveer, died of cancer in the eye, is worried about other kids in the joint family. "Children used to wipe secretion from her eye. Now we are afraid they might also develop the disease," she says.
If cancer is understood in magical, tribal ways, sometimes it is also tackled in that manner. Fearing that the parent's disease may pass on to the child, many villagers have a special way of burning the body of a cancer patient—they also burn a peerhi with the body. Peerhi, a low, woven stool, also means a generation in Punjabi. For the villagers, the burning of the peerhi with the dead ensures that cancer does not descend to the next generation. Ex-serviceman Iqbal Singh of Tamkot village recalls he couldn't understand when they fished out a peerhi to put on the pyre of his sister's father-in-law who had died of cancer a few years ago. "I have also noticed people take great care to avoid the smoke from the pyre of a cancer victim," he says.
What made cancer an insurmountable evil for villagers were the deaths of many VIPs from cancer in the last few years. At Bhangchari, people are hopeless because the wife of the numberdar (a village official), Basant Singh, has died recently. Jaswinder Kaur, 50, had throat cancer and the numberdar spent Rs 10-12 lakh on treatment. "Where did he not take her for treatment! The numberdar spent crores on his wife but she died. How do we poor people matter?" says a Dalit labourer.
With not enough medical and environmental solutions, villagers caught at whatever came in sight. At Bhangchari, old women with aching bones make a beeline for an acupressure camp. Organiser Sukhbir Singh Tamkot, a social worker, uses on them machines that have various ways of pricking, massaging and heating the head, neck, knees and feet. Handing over a bottle of water to a woman, Sukhbir says, "This is special, magnetised water. The water treated in an RO plant loses vital minerals. That's why old women have pain in joints." The women who come to his camp say they do get relief from pain. The whirr of an electric machine working on a knee or neck is quite assuring. Perhaps the shiny, plastic gadgets inspire more confidence than ramshackle government dispensaries the villagers are accustomed to.
If ignorant villagers mythologised cancer, educated people found urban legends. Rahul Rupal is a young, progressive farmer of Ramditte Wala village in Mansa district who has diversified into growing guar (cluster beans). He had read in the papers that it had low input cost but fetched a high price because it was used in petroleum exploration. He says one reason behind the spread of cancer might be the Bathinda thermal plant using coal from Australia which has high uranium content, and then spewing out the ash. Earlier, there was the talk that uranium dust was blown into Punjab by winds from Iraq and Afghanistan where the US forces used low-grade nuclear weapons. How else would Carin Smit find uranium in the hair samples of children? You could not argue with these people. If they could not cite any study, nor could you. There is no large-scale survey that links or delinks high amounts of uranium in water with cancer.
Though the health minister said while releasing the survey report that cancer was due to excessive use of pesticides, the government has conducted no definitive study yet that links pesticides to cancer. Ask Surinder Singh, the father of four-year-old Rajveer who died of cancer in the eye, how she came to develop the disease. He thinks cancer happened after she fell down and hurt her eye. His brother says sometimes people get injured, blood clots and a tumour forms. Cancer, he says, mostly happens after an injury. Of course, he adds, the highly saline water in the village might also be causing it. Since the state was in no hurry to count the dead and the suffering, it also did little to find out the exact cause of cancer.
Surinder and his two brothers own an acre each, which makes them subsistence farmers, but it's hard to notice. A shiny tractor is parked in the courtyard and the children wear nice clothes. The cost of agriculture and lifestyle has gone up, narrowing the profits. Surinder and his brothers live from crop to crop. The yield has to be had at any cost, even if it means an overdose of pesticides, fertilisers and other inputs. In the absence of diversification, farmers have to force the maximum out of wheat, paddy and cotton. The government has realised the problem but little has been done to wean the farmer away from input-intensive wheat and paddy crops. In old times, they tickled the earth with a hoe, and it laughed with a harvest. But the Punjabi farmer tickled it a bit too hard and in many desperate ways. In an ironic mirroring of meaning, cancer, the malignant growth of cells, has become an apt metaphor for what has happened to agriculture in Punjab.