Winter 1995 (3.4)
That Dreaded "C-Word"
Azerbaijanis' Attitudes Toward Cancer
by Dr. Jamil Aliyev
When it comes to matters of health and disease in the Republic of Azerbaijan, the most dreaded word is "cancer" ("kharchang khastaliyi" pronounced as khar-CHANG kha-sta-li-YI). Despite the fact that statistics indicate that far more Azerbaijanis die of heart disease, cancer is still more feared. In both English and Azerbaijani as well as numerous other languages, the word "cancer" means "crab". It seems this word entered medical vocabulary quite by accident when the advanced form of cancer in the breast tissue was seen to resemble a crab.
There is such fear related to this disease that people fear even to say the word. This attitude itself contributes to death. People are so afraid that they postpone seeking professional help. That delay, in turn, results in the disease becoming so far advanced that little can be done. When we ask cancer patients why they didn't come to us earlier, they reply that they were afraid. It's clearly a case of denial; as if failing to admit the possibility of the disease would prevent it from becoming a reality. It's a big problem for us. We have to deal with it all the time.
Left: The future Oncological Center of Azerbaijan was a project initiated by Heydar Aliyev, now President. The construction began in 1986, came to an abrupt stop with the dissolution of the Soviet Union. The complex was intended to treat cancer for the entire Caucasus and was to be the largest building in Azerbaijan with 70,000 cubic meters. The building is twice as large as the photo shows. October 1995.
In Azerbaijan, when someone has cancer, it is generally kept a secret. Unfortunately, most people aren't convinced that cancer can really be cured and when they get such a diagnosis, they lose hope. In our country, as well as in the FSU (Former Soviet Union), doctors usually don't tell their patients that they have cancer. The practice is related to the fact that in the past cancer was never completely cured. Doctors are concerned that giving a diagnosis of cancer directly to the patient will result in earlier death since the patient is likely to become depressed which will suppress his immune system even further. Generally, medical personnel do tell nearest of kin.
This creates a paradoxical situation. Since patients are rarely told that they have cancer, if they recover, they're not aware they recovered from cancer. On the other hand, when somebody dies of cancer, the news spreads everywhere, once again reinforcing the belief that cancer is incurable. People never learn about the successes of oncology, but everybody can tell you about its failures.
Breast and Lung Cancer Most Prevalent
Approximately 10,000 people out of a population of 7+ million are diagnosed annually with cancer in Azerbaijan. Currently, there are about 40,000 cases.
For women, breast cancer is the most prevalent. Unfortunately, its incidence seems to be increasing. There are many reasons. Some, no doubt, are linked to food and the polluted environment. It has been proven that more than 700 carcinogen elements enter the human organism together with food. Often this occurs in food preservation or processing. It has also been proven that cancer is likely to occur ten times more among people using animal fat than those who use vegetable oil.
In men, the highest incidence is lung cancer, primarily because men smoke so much. We don't have so many cases of liver cancer, though intestinal-related cancer is quite common. Stomach cancer is not as prevalent here as it is in Russia, perhaps because our diet traditionally includes lots of fruits and vegetables all year round.
In the past, enormous amounts of insecticides, fertilizers and sprays were used on our collective farms for growing fruits and vegetables. We even manufactured some of the chemicals in factories here in Azerbaijan. Fortunately, these days their use is limited because they're too expense and not readily available. Factories are producing at much lower rates. Fertilizers are known to cause liver diseases which can develop into cancer.
Of course, no one in the world has yet been able to identify all the complex factors which contribute to cancer. That's the universal mystery. Once we identify the causes, we'll be on the road to find a sure cure.
Baku has the only Oncological Center in the entire Republic although there are nine regional oncological hospitals in Nakhchivan, Ganja, Ali Bayramli, Lankaran, Mingyachevir, Sumgayit and Baku. Our Center coordinates the activities for all of these hospitals. We're equipped with 350 beds here.
Our Center employs 80 doctors plus 70 researchers. Our specialists are highly qualified. Eleven have Doctor of Science degrees (equivalent to post-doctorate degrees) and 35 have "Candidate of Medicine" degrees (like Ph.D.) in Oncology. Most scholars have been educated in Moscow, Leningrad (now St. Petersburg), or Kiev (Ukraine). The Oncology Center in Moscow is the largest in the world.
Of course, it was possible to receive initial oncological training here in the Republic but most doctors tried to become more highly qualified and the best way during the Soviet period was to study in Russia. We didn't have the chance to go to foreign countries. I, myself, studied in Moscow and lived there quite a long time as it provided the best chance for me to advance.
The main goal of our Center is to diagnose cancer early and provide prophylaxis. We also have an experimental lab carrying out research. Currently, we are doing unique experiments with mice, rats and woodchucks in relation to hepatitis B which has been identified as a causative factor in liver cancer.
New Oncological Center Under Construction
Since cancer was so widespread in the former Soviet Union, more than ten years ago, the Soviet Council of Ministers passed a resolution to set up a major Oncological Center for the entire Caucasus. At that time Heydar Aliyev, who is currently our President, took the initiative in 1984-85 to get the Center established here in Azerbaijan. Construction began in 1986. The building, when finished, will be the largest structure in the entire Republic with 70,000 cubic meters of space.
Unfortunately, because of the dissolution of the Soviet Union, construction has had to be suspended. Funding was abruptly cut off, of course. Now four years after independence, leaders are again trying to initiate this project and a tender has been announced to continue construction. We believe credit will be extended by Turkey. We're planning to acquire state-of-the-art equipment which we estimate will cost about $50 million.
Not so long ago, I was at the Houston Oncological Hospital which is named after Anderson. As I had never heard of such an oncologist, I inquired only to discover that he was a cotton businessman who had invested in the hospital. That's what we need in Azerbaijan these days.
In the past, we had very good methods of diagnosing even pre-cancerous conditions. We used mammography, X-ray, ultrasound, endoscopy, nuclear magnetic resonance imaging (MRI), tomography (CT scan), thermography and iridology. But the truth is, we are no longer administering many of these programs. We are incredibly limited and handicapped these days even in our ability to deliver services that we used to take for granted. Much of our equipment is outdated or broken. Often we don't have film or reagents.
For example, we have one X-ray machine for mammograms but we don't have film. Our X-ray equipment is antique, dating back to 1956. Endoscopic equipment should be limited to 2,000 examinations. We use ours for 4,000. We only have four endoscopes to use for bronchial, lungs, stomach and intestinal examinations. Then there's the usual maintenance of equipment. That costs money, too. Many of the elevators in our buildings, for example, haven't worked for a long time and patients have to slowly climb the stairs or be carried up to their rooms on the seventh and eighth floors. Doctors have to climb the steps, too.
Another serious shortcoming is that we have no way to extend our services outside the major cities. This wasn't so much a problem in the past but with the war, many people who used to live in towns and cities and had access to health services, are living beside highways in organized tent camps or in shelters they have managed to improvise.
Under the Soviet system, we regularly visited state enterprises throughout our country. It was just part of our overall health plan. Now we don't have the necessary means. It's a tragedy. With cancer and other life-threatening diseases, prophylaxis and early detection are absolutely essential.
Treatment of Breast Cancer
In the case of breast cancer, if we catch the disease in the early stages, we carry out mastectomies. Women consider it a great tragedy to lose their breasts but they have little alternative if they want to live. We follow with chemotherapy if necessary. We know that more modern procedures exist, using laser techniques to remove only the tumor. We hope one day that we'll have the equipment and ability to do this in our new Center.
Cancer Statistics Down; Incidence Up
Officially, since independence in 1991, the number of patients with cancer is fewer. On the surface, the statistics are encouraging but one should not look at hospital admissions to determine prevalence of a disease. The fact that we have fewer patients doesn't necessarily mean that the incidence of cancer has diminished. In fact, it probably has increased. People have to deal with much more stress these days.
Admissions are low simply because people can't afford treatment which used to be free. These days our usual charge for outpatient care is 15,000 manat (about $3). Mammograms cost about $6. One course of chemotherapy costs $300 and six dosages are normally required. That may sound cheap to a Westerner but on average, the salary of a state worker in Azerbaijan is less than $10-15 a month and, therefore, such treatments are prohibitive even after relatives have pooled their life's savings.
People naturally seek alternative treatments, including this new phenomena of extrasenser treatment that is sweeping our country. Extrasensers are less expensive so people put their faith in them. Some practitioners claim to be following the methodology of Shelton, an American extrasenser.
But, in my opinion, their treatment is essentially quackery. Some patients have come to us after being treated by them and were in such critical condition that we could offer them nothing. The result is tragic. Advertisements for extrasensers appear on television. It's really a crime. The Ministry of Health should have it stopped because so many people are being misled.
Apart from equipment, we need access to current research. It's true that the walls of the Soviet Union have come tumbling down, but for us in the medical profession, they might as well still be there in terms of information exchange. We simply don't know about the latest research that is going on in the world. The barriers are down but we don't have enough money to travel. Some of us maintain contacts with Russia and go back and forth to attend conferences. But even our experienced doctors draw salaries less than $20 a month so it's impossible for us to travel abroad. We don't receive scientific journals and reviews on a regular basis-not even Russian ones. Everything costs money. Essentially, we are still victims of an information blockade. We'd like to publish our own "Azerbaijan Journal of Oncology and Related Science" but for starters, we don't even have computers and diskettes.
Despite all these difficulties, we continue to patiently hope for the day when our economical situation will enable us to get back to the business of making serious contributions to the field of Oncology.
Dr. Jamil Aliyev, a well-known scientist, is Director of the National Center of Oncology in Azerbaijan. He has authored ten monographs and approximately 200 articles related to Oncology.
Dr. Ahliman Amiraslanov, Rector of the Medical University, also contributed to this article.
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