The World Health Organisation provided the funds for our project on ‘Community Oral Cancer Control & Prevention' in Ratlam district, 80 km from Indore. As a part of this project, scientists from the Tata Institute of Fundamental Research and members of the Indore Cancer Foundation trained medical practitioners, dentists and basic health workers in early detection of oral cancer. 63,900 high-risk persons above the age of 35 years who had some tobacco habit were also surveyed. Cancer detection camps were held. Cancer awareness publicity was conducted through hoardings, cinema slides, pamphlets and newspapers. The findings of this study were presented at the 16th International Cancer Congress at New Delhi in October 1994. The WHO accepted the final report in December 1995.

A second grant from the World Health Organisation was received to conduct a survey on the ‘incidence of cancer pain in the rural areas' of a few districts in Madhya Pradesh. We made a poster presentation on the findings of the survey at the World Congress of Psychiatry in Madrid, Spain, in August 1996. As a matter of fact, the findings of this survey helped us identify one of our later projects namely the creation of a district-based model for Palliative Care.

The Community Oral Cancer Control & Prevention project
The project for prevention and early detection of oral cancer was undertaken in Ratlam district, Madhya Pradesh, India. The World Health Organisation through the Ministry of Health & Family Welfare, Government of India, provided the funding for this project.

The project was implemented in association with the Basic Dental Research Unit, Tata Institute of Fundamental Research, Mumbai, and the Ratlam district administration.

The work on the project started on 10.02.1993 and six training programmes were conducted on awareness, mouth self-examination, detection of pre-cancerous conditions and identification of high-risk population.

• A 3-day programme for government doctors, private practitioners and medical field health workers was held at Ratlam. Drs. PC Gupta & PR Murthy of the Tata Institute of Fundamental Research conducted it.
• The nodal officer of this project, Dr. S N Mehra, a retired civil surgeon, conducted a programme for rural health workers.
• A programme for urban workers was held in the civil hospital.
• Training seminar in a rural village of the district.
• A refresher programme.
• A final training and refresher course held on 22.02.1993
• 3 cancer detection camps were held in which 51 cases were identified. A sample survey of 2 schools was carried out in which it was found that 75 students out of 386 were using tobacco in some form or the other. As a part of a publicity program, hoardings against the use of tobacco were set up at different places, handbills were distributed through newspapers, advertisements were published in the newspapers, slides were shown in cinema halls.
• As a part of this project 69 000 individuals were interviewed and examined within a period of one year. This warranted regular field visits, which started from 09.03.1992. Survey work was completed in November 1992.

99% of those interviewed were tobacco users. The ratio of men to women was 3.3 to 1. 92% of the women were tobacco chewers while 75% of the men were smokers. 61% of the smokers smoked bidis.

Amongst the chewers, the most common combination was tobacco and lime followed by betel leaf and tobacco. A small percentage of chewers (4.5%) but a larger percentage of smokers (8%) started their habits before 15 years of age.

In his comments on the study, Dr. Helmut Sell, Regional Advisor on Health and Behaviour for Regional Director of the WHO, has focused on the striking finding of the report, namely the reluctance of those in whom some lesion was detected to come for examination. He felt that there is little chance of improving compliance and thereby reducing cancer mortality substantially, unless some information on the motivational patterns in compliance and non-compliance is available.

137 health workers carried out the survey. About 16 doctors worked actively by guiding and helping the health workers.

The Scientific Committee of the 16th International Cancer Congress (UICC) approved the findings of the survey for presentation.

Incidence of cancer pain in the rural community of central India
This project was again funded by the World Health Organisation. The proforma for the survey provided by the WHO was translated into Hindi and a medico-social worker was assigned this job. The survey was carried out in two phases. The 1st phase was carried out in Ujjain district (60 km. from Indore) and 100 cases in rural Ujjain and Ujjain proper were selected. The 2nd phase was carried out in Indore.

The findings of the survey were:

• The maximum incidence of cancer pain was seen in the age group above 50 years. The ratio of female to male incidence was marginally higher.
• 66% of the patients were married
• 64% were illiterate
• 38% were daily wage earners
• 50% had to forego their jobs due to cancer
• 62% were aware that they had cancer
• 92% were suffering from pain at the time of the survey
• In 74% of cases, the pain led to the diagnosis of cancer
• 30% of the village population had marital disharmony.
• In 20% of the cases the pain had affected the mood of the patient
• In 35% of the cases the pain had had an impact on sleep
• In 10% of the cases pain had affected interpersonal relations.

Several demographic factors have emerged out of the assessment of the result the survey. The study showed that incidence of cancer pain in a village-based community is a serious health problem with a direct impact on the social and family structure. The data showed the need for outreach counseling and the availability of pain relief measures.

In 1996, the findings of this survey were presented on a poster at the World Congress of Psychiatry in Madrid, Spain.

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