Cases of cancer are on the rise in Oman, but fighting the deadly disease is not just a case of enduring long and rigorous treatment. The trials faced by patients, and the toll it takes on them and their families can be devastating. Team Y reports.
The human spirit can be far more resilient than anything that can ever befall its owner.
But it’s the challenges that can have life-changing consequences that can truly make or break you.
It’s something Steven Clarke, a British expat working as the lead health and safety inspector in an Oman oil plant, can relate to.
Steven, 55, says he only came face-to-face with his emotions and body when he was diagnosed with one of the rarer forms of cancer – acute lymphoblastic leukaemia (ALL).
The news of the cancer, which had already reached the advanced stages, he says, devastated his family – his wife and four children – more than it affected him.
However, he decided to fight even as he was told by doctors that there would be less than a 25 per cent chance of survival and that he’d be required to fly to India for his routine chemotherapy every two weeks.
But it’s not just Steven who must now fly out of the country for routine treatments.
Several residents – both expats and Omanis – are now required to travel outside Oman for routine checkups and chemotherapies for rarer and more dangerous types of cancer due to a lack of availability of experienced doctors or treatments.
Today, Steven struggles to talk, and much of our conversations are conducted over email. He has undergone 14 chemotherapy sessions so far in his fight against Mature B-Cell ALL, and is bed-ridden.
His nails and hair, he writes in an email to us, have all fallen off and his teeth and skin have become dark.
“But I’m still here,” he adds, before typing out the answers to our questions.
“A human being can only determine his real strength when he fights against his own body and mind.
“It’s something I’ve learnt over the past few months,” he says.
Steven, who was diagnosed with cancer in September 2018, tells us that he’d thought of pulling the plug on the “hard-wearing chemotherapy” treatments several times – all a part of a personal battle he has had with himself.
“Sometimes, I wish I could turn back the hands of time while other times I just want it all to end, but I’m a fighter… much like my mother, who too fought cancer bravely but valiantly.
“But every time I come close to doing it, all I can see are the faces of my children and wife.”
Steven will have several rounds of chemotherapy in the month of April and May, in the city of Kochi, in Kerala, India, but he says that the news has been grim all along and that he’s hoping to hear about a remission.
Although as a British-born citizen of the UK, he would be entitled to treatment under that country’s National Health Service, which is publicly-funded by taxes, attending chemotherapy sessions every two weeks would mean funding flights to the UK every fortnight for both him and a family member.
The cost of that is prohibitive so going to India is his preferred option.
He says: “One of the toughest factors for us through all this, aside from all the medication is the cost and the fact that I’m away from my family.
“I’m being taken care of by my eldest son now – God bless him – but we’re struggling to make ends meet and I can’t do the chemotherapy in Oman as it would just pile on to the costs. Even my Omani doctor suggested that I do the surgery here in India.
“One reprieve is that a portion of my expenses are paid by my insurance from the UK but my Omani insurance won’t take care of serious illnesses such as this – and it’s a great shame.
“I even lost two weeks in running back and forth insurance companies, and the Royal Hospital and Sultan Qaboos University for diagnosis and treatment advise, when I should have immediately been given diagnosis and the treatment,” he adds in his email.
We also learn that Steven’s symptoms were often overlooked by doctors and cancer scares were warded off for a whole year when the initial tests were being conducted – until the day they decided to conduct a bone marrow aspirate test.
Shankar (name changed to protect identity), 54, is another patient symptoms were overlooked by doctors in Oman until he was diagnosed with Stage-IV bowel cancer in Bengaluru, India.
However, it’s not just Steven and Shankar that have been left wounded by the system. Several people are now complaining of a lack of support – from insurance companies coupled with a healthcare system that is still only developing – which is taking a toll on several patients who are now seeking treatments outside the country.
And this is a matter of concern as the report issued by the Ministry of Health (MoH) in 2018 (with statistics compiled only until 2015) titled, ‘Cancer Incidence in Oman’, states that there were 1,840 cases of cancer reported in the country in 2015 – which is a two-fold increase from the numbers in 2002. Of the total cases, 1,615 were Omani (749 male and 866 female) and 185 expats.
It (the sharp increase) is a trend that is expected to continue too in Oman, according to Dr. Wahid al Kharusi, the president of the Oman Cancer Association (OCA).
Speaking at a press conference to mark the World Cancer Day founded by the Union International for Cancer Control (UICC), he is quoted as saying: “Oman has been witnessing a growth in the number of cancer patients every year.
“And the number of patients is expected to double by 2025, so raising awareness is very important.”
This also brings to question whether Oman is actually ready to take on cancer patients and if its detection framework is in place and running.
Even Dr. Bassim al Bahrani, the director of Oncology and the head of Medical Oncology at the Royal Hospital, asserts: “There are more than 600 cancer patients for one million people in Oman (in 2016).”
Though, with only a handful of public and private hospitals, and the OCA’s early detection units operating with the necessary test equipment and having authority over issuing pathology reports, it’s clear that Oman is now witnessing a shortage of early detection facilities for some specific types of cancers.
Dr. al Bahrani asserts that in such a scenario (adjusting for population growth), the number could rise to as much as 3,500 cases of cancer every year – which is in line with Dr. Wahid’s disclosure.
Currently, and as per the revelations of Dr. Saeed al Zadjali, an oncologist with a leading government facility in Oman, only Omanis are currently offered free treatment for cancers, leading to great worry among expats – like Steven – for health coverage.
Steven has spent more than RO6,200 in hospital fee and treatments alone – all from his own pocket while RO2,500 has been taken care of by his ‘premium’ international insurance.
All our efforts to contact insurance agencies on the topic are in vain.
However, one insurance agent – who comments in return for complete anonymity – says: “A lot of the expats living here in Oman work under private firms, and they do not opt for insurance services that cover cancer.
“There are insurances in the country that do offer sums of up to RO10,000 and RO20,000 depending on the type of cancer. This can definitely be had but it’s a premium purchase for the company.
“That’s why a lot of expats complain about how they need to pay.”
All of this comes as a shock, as nearly 10.05 per cent of all diagnosed cancer cases are expats, and more importantly, the disease is quickly rising as a matter of nationwide apprehension as it quickly rises in ranks as one of the greatest causes of death in Oman.
However, Dr. al Zadjali also believes that the numbers of detected expat patients are low due to overseas diagnosis and treatments but goes on to reveal how “charitable doctors” help patients by slashing prices and making cuts in bills; sometimes even taking salary cuts in the process.
Today, cancer is ranked fourth in Oman among the leading causes of death – with a toll of 566, which is just a touch below the mortality rates arising from cardiovascular diseases, infectious diseases and respiratory diseases.
The current mortality rate from cancer is 24.14 deaths per 100,000 of the Oman population.
The Sultanate is currently ranked fourth among Gulf Cooperation Council (GCC) nations in terms of registered cases of cancer – albeit, Dr. al Zadjali believes that the numbers could be higher owing to a growing number of Omanis who don’t frequent health centres and hospitals for treatment.
In Oman, breast cancer is the most common type of cancer among females, followed by thyroid and colon cancer. Meanwhile, men are most prone to prostate and colon cancer.
However, we’re told that lung cancer – a disease in which 97 per cent of those diagnosed are smokers – is expected to become the most common cancer in Oman over the next five years.
Dr. al Zadjali then points out an alarming finding: the rise of rare cancers in Oman.
He says: “The rise of diseases such as breast cancer, colon cancer, and lung cancers in the country meant everyone was focusing their attention on them.
“However, we’ve been noticing some other mutations of the illness that can have very different and life-threatening complications by attacking different parts of the body that are often overlooked.
Some of the rarer forms of cancer being reported in Oman are Hodgkin’s lymphoma and liver cancer.
When told about Steven and his fight with ALL, Dr. al Zadjali says it is one of the cancers that is coming quickly coming under the spotlight in the Sultanate.
While no distinct cause of illness can be pegged with ALL, as per the doctor, it could be caused due to a person’s proximity to electromagnetic radiation released by mobile phone towers although we have found, in a separate investigation, that this has been disputed by foreign researchers.
“This is just one of the hypotheses surrounding ALL,” the doctor clarifies. “Cancer itself is an illness that is very easy to define but very difficult to understand. It is caused by the mutations to the DNA within the cells of a human being.
“It has a lot to do with the genes that categorise the DNA in each cell, too.
It is the DNA that then tells the cells what functions to perform. In short, cancer is caused when there’s an error in the instructions that are transmitted – these can be both man-made errors or natural ones.
As per the internet medical research portal, Mayo Clinic, a cancer refers to any one of many diseases characterised by the development of abnormal cells that divide uncontrollably and can infiltrate and destroy normal body tissue.
Cancer often can spread throughout your body and is already the second-leading cause of death in the world.
But, the doctor then goes on to reveal that a great reason for the increase in cancer incidence is the change in lifestyle among the people around Oman.
He explains: “A change in your lifestyle is one of the reasons for the increase in cancer cases in the country.
“These include smoking, drinking alcohol, eating fast food laced with grease and other red meats, excessive exposure to vehicular exhaust gases, and the sun; and even excessive use of low-grade plastics that can leech in contaminants into the drink.
“Your family history can also result in you inheriting the condition. If, for instance, cancer is a common incidence in your family, there’s a slight likelihood of a mutation of the gene being passed on to different generations.
“However, there are so many ways you can protect yourself – like having regular screenings or even taking a gene test.”
While we learn that there’s a lack of general awareness among the public about early detection and its benefits, and a lack of resources, one organisation that is staying ahead of the game is the OCA and its sister wing Dar Al Hanan.
The OCA boasts one of the most advances early detection centre in the Middle East, currently, with a mobile mammography unit (MMU) – for the detection of breast cancer – that travels around the country offering free screenings to women over the age of 40.
With more than 22,000 screenings under its belt, the non-profit organisation has also saved over RO1.5m of the public’s wealth, since its inception in 2009.
Moreover, it also has an ultrasound unit for the screening of women under the age of 40.
Meanwhile, Dar Al Hanan offers free treatment to children diagnosed with cancer and stays for 14 families through the course of the care.
“Awareness is the key factor when it comes to early detection of cancer,” says Nadir al Azri, the acting-CEO of the OCA. “We cannot force anyone to come for a screening. It must be done through their own accord.
“This mindset is slowly changing, and for implementing this in the minds of the people in the country, we organise regular events in public spots, talks with international panels of experts, and even have the annual Walkathon – which sees up to 9,000 people take part,” he says.
Early detection is a message that Steven is keen to convey too as he fights for his life, but it’s the words of his son, Justin, that paint a picture of the pain his father and the family is going through.
In a telephone conversation with Y, he says: “Many things in life come for free, and there’s a saying that you don’t know what you’ve got till it’s gone. But, how many of us look at life and think how lucky we are to have it (?)
“There’s nothing worse than having the feeling of losing your life and people you love behind – and that’s what my dad talks about. It is tearing me apart but we’re going to fight through this.
“He’s a fighter – and he’ll get through this. And to all those people reading this; please, please take your symptoms seriously and have your tests and screenings done.
“The saying ‘Prevention is better than cure’ only stands true if you actually act on it. So, take that first step and stop cancer from ruining your life. That’s the best form of fight against this horrible and all-consuming illness.”
– By Alvin Emmanuel Thomas