World Head and Neck Cancer Day in Russia and healthcare challenges
Dr Somasundaram Subramanian - Eurasian Federation of Oncology, Moscow, Russia
Our organisation does a lot of focussed events like multidisciplinary cancer forums on particular topics, life surgery masterclasses, oncopathology seminars, tobacco control events and oncology seminars for non-oncologists, oncology seminars for patients, survivors, policy makers, politicians. But at present, on 27th July, we are going to do the World Head and Neck Cancer Day which is going to be commemorated worldwide for the first time. It was announced last year in New York on 27th July and I have been appointed as the national co-ordinator for the Russian Federation. So as it is the first time we have decided to do it locally in and around Moscow where we are gathering a few head and neck cancer survivors. Most important, we are doing a one week cancer detection campaign in the outskirts of Moscow, in the small city of Korolyov which is very close to Moscow city. It’s called a science city and there there will be a group of cancer specialists, together with me, we’ll be looking at volunteers. Conditionally healthy people will be coming to us so we will be just screening them for cancer and giving them… if there are any investigations needed we’ll just give them the proper advice regarding that. It will be a free campaign for five days, five working days, and we are doing it in a small family clinic where there are no cancer specialists. We just come in from different cities, specialists are coming in and doing that on a voluntary basis. But we won’t be doing only head and neck cancer, as it is a cancer detection camp we’ll be looking at all cancers. So there will be a dermato-oncologist, there will be a breast specialist, there will be a gynaecologic oncologist, there will be two head and neck specialists and there will be somebody who is specialised in abdominal oncology and uro-oncology. So basically we’ll be covering the whole spectrum of oncology in terms of early detection and we’ll be giving some short seminars for the healthy individuals who come, some videos and how they have to look at their own health to really detect cancer at the right time.
Apart from that, on the 27th in the afternoon we are going to do, in Moscow city centre in a hotel, we are going to gather a few of cancer’s survivors, head and neck cancer survivors, and the key head and neck cancer experts from all over Russia and the ex-Soviet states plus a lot of journalists, policy makers and politicians. We’ll be doing a short programme where we will talk about the significance, about the suffering caused by this disease and about the problems which these patients face with proper, real examples. And the main issue of the lack of medication because head and neck cancer, unfortunately, is so far a more surgical cum radiation treated disease, less of a medical oncology disease. We hardly have less than a handful of trained head and neck medical oncologists in some countries and that is a challenge. So we are going to focus on all these issues which our patients are facing and our speciality is facing such that to create an awareness about this. Of course we’ll be talking about tobacco control. Our team was the one in Russia which facilitated and reached out with all other tobacco control advocates in the country to our President, Vladimir Putin, and convinced him to sign the law for Russia to join the Framework Convention on Tobacco Control in 2008. That has really given enormous effect in society today and we’ll be talking about that also. That will end with the reception and that is what we are planning for 27th July.
Are there any issues specific to Russia?
Russia is a unique, I would say, system; the Russian cancer care system is a unique system. There are many things the world can learn from Russia because by the time President Nixon signed the National Cancer Act in the United States in 1971 the Soviet Union already had the largest network of comprehensive cancer centres in the world which were, if I’m not mistaken, more than 160 cancer hospitals throughout the world covering the entire population; that was the coverage. So access to basic cancer care was there for everybody. It’s a different question about the quality today, it’s very variable. There are centres like the Blokhin Cancer Centre in Moscow that I was trained, treated, where I worked for fifteen years, and the Hertzen Cancer Centre and a few more other cancer hospitals in Moscow, like the 62nd Cancer Hospital and many others, which are really very good. There is one in Tatarstan and another in Samara which are also really very good, world class, cancer centres. But we have the next level of many other cancer centres. There are a few more very good centres also, I’m not going to name all of them, and there are another category of centres because we can just put them in a hierarchy in terms of their quality and in terms of also what they can do.
We do have challenges and the biggest challenge in Russia that we have today is the magnificent distances which people have to travel in spite of the number of centres we have. Even though Russia has one of the largest... if I’m not mistaken, Russia has the highest per capita number of doctors in the world. We have 49 doctors for 10,000 individuals, it is even almost double than the United States. But still we have do a challenge in terms of sub-speciality training. We do have very highly skilled trained doctors and an acceptable level of training for the rest so there are big challenges there.
We do have other challenges like in terms of tobacco control where we are already progressing very well in the last… after Russia joining as a party to the Framework Commission on Tobacco Control. Another big barrier we have is that even though Russian is the most spoken language in Europe, Russian is not a medium in 99.99% of international meetings worldwide except those which are done by the Eurasian Federation of Oncology and a few more organisations in the post-Soviet region. So the interaction of Russian doctors with the rest of the world is highly minimal. We have, as Alberto Costa, the director of the European School of Oncology, always says, less than 5% of doctors in Russia know poor English. The reality is that less than 1% of them know good English. So for this situation to change it will take generations to change. The younger generations are learning English but we have to deliver knowledge today. That is the reason why we are doing all the simultaneous translation.
Another biggest challenge, which is the biggest limitation for the interaction of Russian healthcare professionals with the rest of the world, is that the wages of Russian doctors are not yet to the mark. One year ago it was still OK when the rouble was stronger; now the rouble has gone weaker and once again the wages are… as per international standards, once again has dipped. One way, thanks to the sanctions, Russia is going to be… the economy will be getting stronger with local production and many other things. That is a different thing, economic and political issue, as doctors we don’t touch that but that is not, unfortunately, helping us. The reality, as of today, is that once again our doctors are poorer. So that makes the work we are doing in delivering knowledge, bringing the best experts from all over the world to Russia and the ex-Soviet states and doing these seminars and meetings and training courses, life surgery masterclass and other things, in-house there, delivering that in-house and not charging a big amount of money like the big international meetings where €500 or €800, which is very expensive for our doctors.
So we are addressing our best what we could do and most important which I want to say is our organisation in the last five years has been thriving in most projects with zero pharmaceutical funding, in just a few projects with some pharmaceutical funding. That is a very different model because I, as a cancer survivor, I committed a good amount of my own wealth to the organisation and every year I keep doing that and we give a stipend and other things from that money and keep it running. I’m not alone, there are some of my former patients, my friends, some of my colleagues in different countries who also commit to that. That is how, with professional, social responsibility, we are running this organisation.
