Professor Syed, Professor Akram Hussain Syed, you’re here representing Bangladesh, you’re very important in the cancer field in Bangladesh at this National Cancer Institute Directors’ meeting. What’s happening in Bangladesh and how is the landscape of cancer different in your country as compared with, say, Europe or North America?

We’ve found in our data in our Bangladesh Bureau of Statistics for cancer is the sixth leading cause of death in Bangladesh. Though the global people are not very aware of it, most of them they’re looking for infectious disease and other child mortality, maternal mortality still. But we need to look into that, at the very huge number of cancer patients that are coming every year. The second thing that is important is actually the number of cancer management and prevention, everything in the same basket, because most of the cancer cases in Bangladesh are due to tobacco. In cases of males it is smoking tobacco uses, number two in the case of males is actually lung cancer and head and neck cancer. Females it is cervical cancer and breast cancer.

Now, Bangladesh internationally has a superb reputation for having done a great deal for health in recent years. Now obviously infectious diseases are very important, has this progress been good in cancer control as well and cancer management?

No, no, actually this is not for the cancer management. Bangladesh is getting this reputation for reducing the child mortality, reducing the maternal mortality.

So what’s been going wrong with cancer care in Bangladesh then?

Because government policy making is still not looking into this area but after the meeting of September 2011 of the United Nations meeting of the non-communicable disease, I have attended that meeting, so after the government is going to look into the whole issue seriously.

Bangladesh has many priorities, what right do you have to say cancer should be higher up that list of priorities? What’s your case, what’s your reason for saying that?

Because actually it the sixth leading cause of death in Bangladesh. Because we take care in so many things but we are not giving adequate cure at this moment in this area. It is similar to most of the countries of the world.

So what’s happening then in your country in cancer management? What’s the present situation with how you treat specific cancers?

Specifically in our country most of the patients are coming at the late stage or the advanced stage. We don’t have the number of facilities because in most of the advanced cases we need to have radiation therapy for the palliative radiation therapy. But unfortunately we don’t have so much machines in our country, at least we need 320 telecobalt and 160, around 160, brachytherapy machines but we have only 16 teletherapy machines and only 8 brachytherapy machines.

We’ve been hearing at the conference here in Lyon that getting some of these cancers even a little earlier in the stage of the disease can bring a big benefit.

Yes, of course. This is very important for us, actually. That is important, the questions of early detection and the prevention.

So in your situation, what can be done? Obviously resources are limited so what practically could be done? Can you get government help or must it come from other directions?

Yes, one thing actually we can do actually looking for the prevention, looking for early detection.

OK, you’ve got some interesting things on prevention, haven’t you? I know tobacco is the number one, as you said, so what are you doing in smoking control? I’ll ask you about other things also.

Yes, we have a Tobacco Control Act in Bangladesh; we have regulations and rules but people are not used to following the rules but they are accustomed to over the time, it is increasing, the tobacco prevention is going on better form than before.

So are you winning the war against smoking at the moment?

Yes.

People are beginning to accept it?

Yes, they are gradually accepting it.

So interestingly in diet you’ve got some other issues, haven’t you, with toxins. Tell me about those.

Yes, this is not in general terms because in some cases some farmers have some alterations, people are doing mixed stuff with some toxins and this is very unhealthy which could cause cancer.

Now, some of this is being done to preserve foods but in fact the substances are toxic?

Exactly, right.

So what are you doing about that?

About our government has machinery to stop it. The government are going for… they have the legal measures and they are taking these people, because they caught these people, and send them to jail. They are punishing them regularly.

And in Bangladesh you have to use private medical services quite a bit as well. Can you tell me how that integrates in to the overall care of cancer management if patients are paying for their own care?

Actually we have the public facilities run by the government. These facilities are almost free of cost but the number of facilities are very few. But in cases of private, most of the services given at this moment are in the private facility and people have to pay everything by themselves.

How well does that go?

They are going very well.

But does this mean that a lot of people do not get management of their disease?

Actually many people are not able to because they cannot have access to the services because they don’t have the money to get in the services.

You’re describing to me a very difficult situation for cancer management and care in Bangladesh. What is the message that you would like to give and what is your call for action?

Because our government were formulating a national cancer control strategy in 2009 with the help of the World Health Organisation, I was directly involved in this formulation process. I feel that actually we need to implement the process. The second thing, we need to have low cost radiation therapy machines such as the cobalt machines so we can give the periphery of the country so most of the people can get access to the services. Starting the health insurance scheme so government and private partnership can be possible to make, public-private partnership could be helpful to support all these things.

Now, is the shortage of money the only issue or is it a question of organisation and planning?

Yes, actually, not the shortage of the money actually, shortage of money is not a big issue. The planning because one time you are taking a high tech machine, a linear accelerator, because you can buy six cobalt machines for one linear accelerator. So that means it is not down to the issue of money, it is the issue of the organisational planning process. We have to follow strictly some rules and regulations such that we can follow the cancer. That will be helpful for us to continue and maybe in that way, if we go for that way, maybe in the next ten years we will be able to control the whole scenario than before.

But great progress has been made, as we know, in infectious diseases. So do you think this could happen and what’s the way it’s going to happen in Bangladesh with non-communicable diseases and, in your case specifically, cancer?

Yes, of course. Of course it’s possible because in Bangladesh actually in 2007 we formulated the non-communicable disease strategy; actually I was mainly the person working, focal person for the working for this. Then we go for the cancer control strategy and at that time the government doesn’t care about the non-communicable disease. But right now the scenario is going to be changed and the government interested to support cancer control because infectious disease control and maternal mortality control and many other mortalities are reducing day by day. You find in the last Bangladesh maternal mortality survey in 2010 you found the single cause of death in cases of reproductive females is cervical cancer. So we have a different small initiative going on in Bangladesh such as the cervical cancer, breast cancer screening programme; the cervical cancer vaccination programme we went through, particularly me, I was involved. The cervical cancer vaccination programme is going on; we have trialled and successfully done and we are continuing to start. The government are able to take this initiative to support all over the country. I think the international community can support us doing this prevention of cancer because cervical cancer is the number one cause of death of females in Bangladesh.

Right, you’re a doctor and a scientist but it seems to me that in your situation, a difficult situation, you do need to become a politician too.

A cancer politician, yes.

But you need to push, don’t you, as doctors? What advice would you give to other doctors elsewhere in the world faced with difficult situations where the government isn’t getting the priorities that the doctors think are the right ones? What do you suggest?

Actually most of the cases we try to write in the newspaper, we try to talk to the policy makers and their people. Policy makers feel awareness when any relatives are suffering from the cancer but after six months they just forget everything. But this is the right time and right moment for Bangladesh to take care of the non-communicable disease and cancer issue as a priority because the United Nations have declared within 2025 we have to reduce 25% of the cancer cases and communicable diseases. So it becomes binding for the Bangladesh government; the government are not able to avoid it.

So the government has done very well in other fields so now is the time to go for cancer?

Yes.

Yes. Well it’s great to see you here and thank you very much for joining us Akram.