CHETANA

Awareness Campaign for Cancer – a Lifestyle Disease

Institute for Sustainable Livelihood and

Entrepreneurship Development An initiative of Durgapur Institute for Sustainable Livelihood

Acknowledgements

CHETANA – 2013, the maiden advocacy program of DISL has been launched on

17th

March, 2013. We wish to thank and acknowledge the contributions of various

people who made this program and this report presentation possible. We heartily

appreciate the contribution of Dr. Runu Mukherjee for her moral and technical

support about the domain of cancer control. We thank Mr. Rupak Das and the

members of The Lions Club, Durgapur Steel City Chapter for their motivation and

support all the way. We pay our special thanks and gratitude to the sponsors who

extended their generous help and assistance without which the project could not be

materialized. Finally we appreciate all the participants of CHETANA whose

presence and involvement has been instrumental in enriching the program.

Let us Pledge to Hold Hands and Fight Cancer

Together

Prologue… The need for statistics sometimes comes from the daily lives,

incidences and surroundings. A few years back, may be when

we were in our college days, we hardly came to know about

someone dying of cancer. The reason may be two – the

disease itself was not that common or the facilities of treatment

were such that it could not be detected. Compare that with

today’s scenario. In many families, among their relatives or in

known circles we get to know about the prevalence of cancer. It

is almost everywhere and increasing. The very next day after

our first interaction with Dr. Runu Mulkherjee at Breast Cancer

Awareness Clinic of DSP, one of our students applied for leave

in college as her mother was to be taken for a treatment of

breast cancer. We preferred not to waste time and looked into

the data, facts and tried to get the big picture about the

problem. The questions were basic. Can we prevent it? Can an

early detection save lives? CHETANA has been launched on

the affirmative answers of these questions. This report

presents everything about the journey called CHETANA. The

goal can only be reached with your support and good wishes.

“One in Two Countries Unprepared to Prevent

and Manage Cancers” - WHO

Background Note…

Cancer is a leading cause of death worldwide. The World Health

Organization estimates that 7.6 million people died of cancer in 2005

and 84 million people will die in the next 10 years if proper action is not

taken. In India the situation is grave. In 2010 around 555,000 people

died of cancer in India. Out of this tobacco-related cancers represented

around 42% of male and 18% of female cancer deaths. Cervical,

stomach and breast cancers accounted for 41% of cancer deaths in

women in urban and rural areas.

So, it is high time to combine our voices to deliver the powerful

message for comprehensive and integrated cancer control.

Detecting Cancer Early Can Save your Life!

Cancer is to a large extent avoidable. Many cancers can be prevented.

Others can be detected early in their development, treated and cured.

Even with late stage cancer, the pain can be reduced, the progression

of the cancer slowed, and patients and their families helped to cope.

More than 70% of all cancer deaths occur in developing countries,

where the preparedness for prevention, diagnosis and treatment of

cancer is limited or nonexistent.

So the primary step should be early detection and for that extensive

awareness about the disease is a must.

“Cancer should

not be a death

sentence

anywhere in the

world as there are

proven ways to

prevent and cure

many cancers” –

Dr Oleg Chestnov,

Asst. Director-

General,

Noncommunicable

Diseases and Mental

Health, WHO.

Contribution of Selected Risk Factors to all Cancer Deaths

Cancer Prevention:

Cancer prevention is an essential component

to fight against cancer because about 40% of

all cancer deaths can be prevented. Many of

the important cancer risk factors arise due to

lifestyle problems such as tobacco use,

alcohol use, unhealthy diet including low fruit

and vegetable intake, physical inactivity,

overweight and obesity.

Other risk factors include physical

carcinogens like ultra violate and ionizing

radiation, chemical carcinogens that may

come from contaminated food and biological

carcinogens such as infectious virus, bacteria

and parasites (WHO report on Cancer

Control: Module – 2; 2007).

The following graph clarifies it all by

showing the contribution of selected risk

factors to all cancer deaths:

Source: WHO report on Cancer Control: Module – 2 (Prevention)

The prevention of cancer should be

considered in the context of actions to

prevent other chronic lifestyle diseases such

as diabetes, cardiovascular diseases, chronic

respiratory problems and alcohol

dependence. This is because cancer shares

common risk factors with these lifestyle

diseases.

The interventions should be aimed at the

reduction of these risk factors in the

population that will not only reduce the

incidence of cancer but also prevent other

lifestyle diseases. The relation between these

lifestyle problems and cancer is evident. For

an example we have put forward the graph

showing the relation between tobacco

consumption and death rate of lung cancer

using US data from 1900 – 2006.

Tobacco Use in the US, 1900 – 2006 and Lung Cancer Death Rate

Source: Outdoor of Breast Cancer Awareness Clinic, Durgapur

Steel Plant Hospital

“My mother died

after having been

detected of

Cancer Breast

within one month.

I don‟t want to die

the same way.

Please help”

Prevention and Early Detection is the Key to Effective Cancer Control

WHO has set a goal of reducing

death rate of chronic diseases by 2%

per annum, over and above projected

trends from 2006 – 2015. Achieving

this goal means avoiding 8 million

cancer deaths over the next decade.

The control of major cancer risk

factors and early detection will have

a major role in achieving this goal.

Source: Cigarette Consumption – US Department of Agriculture, 1900 – 2007. *Age-adjusted to 2000 US standard population

Project CHETANA – 2013 Purpose and Goal

“Health is an area of great promise but also great frustration.

There seems to be plenty of „low-hanging fruits‟ available, from

vaccines to bed nets, that could save lives at a minimal costs,

but all too few people make use of such preventive

technologies” – A V Banerjee & E Duflo, Poor Economics.

Project CHETANA has been

undertaken as a year-long activity for

2013, focusing on the issues of chronic

lifestyle problems that lead to cancer

and other lifestyle diseases.

The treatment or cure of cancer is often

expensive. Preventive measures by

following healthy lifestyle means a lot

to the control of cancer and other

lifestyle diseases. Controlling tobacco

use means reducing 1.5 million cancer

deaths per year, 60% of which accounts

for people from low and middle income

countries. Leaving harmful alcohol

completely, increasing fruit and

vegetable consumption, avoiding

overweight, obesity along with physical

inactivity can reduce as much as 15%

cancer deaths worldwide.

So the primary thrust of CHETANA

has been to understand the gravity of the

problem, to formulate policy through

advocacy and to identify the

implementation strategy for the outreach

programs. The ultimate goal of

CHETANA is to reach out to the target

population as much as possible and

aware them about lifestyle problems,

preventive measures and early detection

to combat cancer.

Gathering

knowledge about

the area of

intervention (Cancer

& Lifestyle diseases)

Advocacy to share

the problem with

key resources and

decision makers

Output:

Implementing

outreach programs

as the outcome of

advocacy

Purpose:

Reaching out to the

people at different

pockets of the

society

Goal:

Creating awareness,

Helping early

detection, reducing

cancer deaths

Components of

CHETANA

Plan and implement in controlled environment

Intended

results in

uncontrolled

environment

CHETANA – 2013 Our Maiden Advocacy Action…

With the thematic priority of cancer

control the strategic advocacy of

CHETANA is synchronized with non-

communicable lifestyle diseases and

other related problems. The basic

objective of the maiden campaign has

been to share the problem with the

people from different sectors like

healthcare professionals, academicians,

corporate and NGOs. The success of

the program greatly depends on how

stakeholders value the action for

comprehensive cancer control and

become the catalyst for the effective

outreach programs to reach out to the

maximum number of beneficiaries in a

cost effective manner.

So for the very nature of advocacy, we

have done this program in a controlled

environment. First ‘Why CHETANA’

and what is expected from the event is

explained to all the participants.

Broadly the program was devided in

two segments – one for doctors

elaborating on the issue technically and

the other segment belongs to the

trainers as well as motivational speakers

to see the other facets of different

lifestyle issues. The technical keynote

lecture is given by Dr. Runu Mukherjee

followed by Dr. Alok Sanyal and Dr.

Sudipto Ghoshal. With great clarity the

speakers explained about lifestyle

diseases, lifestyle problems of younger

generation, and increasing concern for

cancer. Several vital statistics on cancer

“Advocacy is the effort to

influence people, primarily

decision-makers, to

create change”

Topic of the Event:

CHETANA Awareness Campaign for Cancer – a Lifestyle Disease

Venue: Bonolata, City Centre, Durgapur Date: 17th March, 2013; Time: 10:30 AM

Goal of the Event: Advocating for Creating awareness about lifestyle diseases, taking preventive measures and helping early detection to combat cancer.

Target Population of the Event: Healthcare profs, Corporate, academicians, NGOs Technique of Interaction: Participative management Technique Communication Method: Barrier free two way communication method

Total no of Participants: 54

Reflection of the Event Schedule

Sequencing of the

Events Sessions Focus of the Sessions

I Registration/Networking

II Inauguration of the Event Purpose of the event explained

A brief background note on DISL

III (Keynote Speech)

Presentation by Dr. Runu Mukherjee, Dy Director, DSP Hospital, In charge Breast Cancer Awareness Clinic, DSP Hospital

Thoroughly explained about lifestyle diseases.

Shared statistics on cancer and other lifestyle diseases

Special focus on breast cancer with cases and examples

I V Feedback slips on the events are distributed to the participants which is to be collected after next two sessions and will be distributed to the presenters.

V

Presentation by Dr. Alok Sanyal, a renowned Gynecologist at Durgapur

Lifestyle problems of the younger generation is emphasized

Focused on increasing concern for cancer

VI Presentation by Dr. Sudipto Ghoshal, Paramedical College, Dgp

Cancer awareness in general Lifestyle diseases and remedies

VII Feedback slips are collected from the participants and given to Dr. Runu Mekherjee to check participants’ suggestions and takeaway.

VIII

Art papers titled “Janchetana: the most desired action area” are given to participants for putting down pictorial/schematic presentation of problems and action area. These to be collected after next 2 presentations Purpose: Thematic Apperception Test

IX

Presentation by Mrs Manisha Hati, International Trainer

Mostly focused on urban lifestyle problems

Do’s and Don’ts of living Focused on addictions and diseases

X Presentation by Mr. Jiban Banerjee, Faculty of Stats, Bidhan Institution

Motivational speech to reinvent the way of life by healthy living

XI Open discussion Forum Brief open discussion about future roadmap

XII Concluding speech by Mr Pravat Chatterjee, Hon. Mayor in Council, DMC XIII Vote of Thanks

and other lifestyle diseases has also been

shared. Dr. Mukherjee specially emphasized

on the breast cancer problem and expressed

her concern that the cases are increasing

rapidly. All the healthcare experts emphasized

that it is better to go for cheaper prevention

than expensive cure and at the same time for

many types of cancer, early detection can save

lives.

After first presentation gets over feedback

slips were distributed to the participants and

collected after third presentation and shared

with the presenters. A few glimpses of

participants’ take-away and suggestion are

shared here.

Take Away:

“A very good learning platform,

an awareness campaign, about

the hazards of modernized

lifestyle and what preventive

measures we can adopt” – Dr.

Arindam Modak

Take Away:

“Dr. Sanyal‟s

warning that

industrial

emissions have

become more

dangerous

than personal

habits like

smoking” –

Shankha Guha

Take Away:

“1. Knowledge about cancer

2. Present scenario of cancer

3. Preventive measures” – Dr

Debdas Karmakar

Suggestions:

“It requires more people of

every walks of life to associate

with the whole venture. Thanks

to CHETANA” –Mr. D. D. Sen

Suggestions:

“More initiatives should be

taken to communicate the views

and suggestions through the

media/NPO/NGO/Govt.

institutions…..” – Mr. Soumen

Routh

Suggestions:

“Vulnerable group

like students, how

can be stopped

from such risks

can be elaborated”

–Dr. Srikanta

Banerjee

The two final presentations by Mrs Hati and

Mr. Banerjee were a change of taste and

proved equally effective like other

deliberations. Mrs Hati on the capacity of an

international trainer interestingly focused on

more of urban lifestyle problems and

elaborated ‘Do’s and Don’ts’ of living. She

also focused on addictions and related diseases.

The speech of Mr Banerjee has been truly

motivational. The core of his entire discussion

was actually reinventing the way of life by

healthy living. His presentation was backed by

examples and full of enthusiasm all through.

Thematic Apperception Test:

A Thematic Apperception Test has been tried

in one of its form to get inputs from

participants about the most critical points of

concern. The seating arrangements were in

groups according to tables. Each table/groups

were provided with sketch pens and a colored

art paper with a heading ‘JanCHETANA;

Lifestyle Problems: The Most Desired

Action Area’. The papers were given

before the final two presentations and

collected it back after the deliberations of

speakers Mrs Manisha Hati and Mr Jiban

Banerjee. The outcome of TAT was quite

interesting. With pictorial and schematic

presentations participants has raised several

actionable issues of lifestyle, such as long

working hours, fast lifestyle, smoking habits

etc. One sectoral or macro view was also

presented in the way that low back pain, eye

disorders, vascular diseases for people from

IT sector; chest or lung diseases for people

in construction fields; stress for healthcare

providers. The fast-food habits of young

generation is also considered by the

participants as the immediate actionable

area, as comes out from TAT.

.

Open Discussion Forum:

The final but very important part of

CHETANA as an advocacy program was a

brief but effective Open Discussion Forum.

The idea central to this discussion was how to

take the campaign to the maximum number of

people in an efficient and cost effective way.

The contribution in this open discussion by

the participants was rich and practical in terms

of efficient and cost effective implementation

of the outreach programs for CHETANA.

Participants or rather stakeholders of our

maiden advocacy initiative have expressed

their willingness to take this campaign to

their own field of operations, may it be

academic institutions, shop-floor of

factories, business executives and

panchayats.

The program finally concluded with the

concluding remarks of Mr. Pravat

Chatterjee, Mayor-in-Council, Durgapur

Municipal Corporation. The organizers

expressed their sincere thanks and gratitude

to all the participants for their inclusive

cooperation and enthusiasm for effectively

carrying out the maiden advocacy

campaign.

CHETANA – 2013 Implementation Modules for Outreach

Focal Point

CHETANA

Advocacy Action

Doctors NGOs Academicians Corporate Civil

Servants Others

Planning for Outreach

(Bottom-up Approach) Facilitating Outreach

Reach out to maximum number of beneficiaries

Purpose: Prevention and Early Detection

Implementing

Outreach for

CHETANA

“Save Yourself by Yourself” - Swami Vivekananda

Interventions for Prevention:

The comprehensive prevention of cancer

requires a range of interventions at individual

as well as population level in a stepwise

manner – core activities, expanded activities

and finally to include all other desirable

activities. Interventions those are immediately

feasible and at the same time areas of highest

concerns are to be implemented first as the

immediate core activities. The expansion of

activities comes in the next step. The

campaign CHETANA – 2013 desires to focus

on some core risk factors for cancer control as

its immediate priorities. The schematic flow-

chart shown here presents a systematic

implementation module for a campaign

focusing cancer prevention. All the outreach

programs will be joint initiative of

CHATANA and the implementing agency.

The outreach model of CHETANA is based

on the intensity of communication of the

partner organization with their immediate

beneficiaries. For example if a college

becomes a partner organization for outreach

then students become the beneficiaries. As the

epidemic of cancer is prevalent among the all

sections of the people irrespective of their

culture, education and economic strata, so

wider the scope of partnership, better will be

the outcome in the sense that larger number of

people can be reached. The campaign for

prevention is less resource intensive and

advocacy and planning is the prerequisite for

the successful implementation. The chart

beside is only an indicative one and feedbacks

will be taken to make it more meticulous.

Lifestyle diseases in General

Unhealthy diet, physical inactivity,

overweight and obesity

Tobacco and alcohol use

Environmental and occupational

exposure to carcinogen

Decide the form of intervention:

Meeting, Seminar, Media

campaign, survey, workshop,

others

Decide target population:

Estimate number of beneficiaries

to be addressed

Program Design

Exploring sources of funding

Budget allocation

Admin Support

Media Relations and

communications

P

L

A

N

N

I

N

G

Implementation of

Outreach Campaign

Short Term Outcome: Public awareness, Engagement, Strategic

communication of the message, Media

coverage, increased capacity, trust,

cooperation, new partnerships (including

govts.)

Long Term Outcome:

Achieving Cancer Control

CHETANA for Cancer Control (CCC)

Priorities CCC Outreach

Interventions for Early

Detection: There are various

interconnected components in an early

detection program that makes it really complex

to implement. This complexity further

intensifies in a resource constrained

environment. The early detection program of

CHETANA intends to intervene at the

community level and the primary level only

looking at the feasibility which depends on the

resources, skills and infrastructure available.

Given the present constrained resource setup,

low cost approaches to early diagnosis and

screening is to be taken up for breast and

cervical cancers initially as the core/feasible

activity under early detection campaign.

The high mortality of the breast and cervical

cancer can be attributable to the fact that

more than 80% of the patients are diagnosed

in very late stages due to late referral from

primary health centers and late healthcare

seeking behavior among women. So,

CHETANA ideally promotes to focus on

the activities of early diagnosis and

screening of breast cancer and cervical

cancer in 2013 and to expand the campaign

in 2014 onwards.

Scope of Intervention for CHETANA

Example: Cervical Cancer

Intervention for CHETANA in

Early Detection Programs

Source: Cancer Control (Early Detection), WHO Report

CHETANA Focus for Early

Detection Campaign

Breast Cancer Awareness

and Early Detection

Cervical Cancer Awareness

and Early Detection

The Journey Begins… The problem may be huge but a systematic approach towards the problem is

always helpful. Knowledge is the key to success. The campaign CHETANA is all

about transforming this knowledge into action. The ideation of CHATANA has

been materialized following a bottom up approach which, we believe, is going to

be helpful throughout the lifecycle of the comprehensive cancer control, may it be

planning, implementation, monitoring or evaluation. The critical success factor of

CHETANA solely depends on the partnership with different stakeholders. We

value our partners as the primary change agents and key stakeholders of

CHETANA. We believe that, regardless of the resource level, by joining hands

together, we can take actions to curb cancer epidemic, save lives and prevent

necessary sufferings.

References:

Planning; Cancer control: knowledge into action: WHO guide for

effective programmes (module 1)

Prevention; Cancer control: knowledge into action: WHO guide for

effective programmes (module 2)

Early Detection; Cancer control: knowledge into action: WHO guide for

effective programmes (module 3)

Policy and Advocacy; Cancer control: knowledge into action: WHO

guide for effective programmes (module 6)

Selig W et al. (2005). Advocacy and comprehensive cancer control.

Cancer Causes and Control,16(Suppl.1):S61–S68

‘Indian cancer statistics, a model to be followed‟, Press Release by

International Agency for Research on Cancer. Date: 28th

March, 2012

American Cancer Society, www.cancer.org

Be Clear on Cancer: Know 4 Sure Campaign,

www.cancerresearchuk.org

ANNEXTURE – 1.1: Campaign for Prevention:

Template for Deciding on the Possible Areas of Concern to be taken up by

Partner Agency for the Outreach of CHETANA -2013

Concern areas to be

covered

Target

Population

Your strengths

in this issue Weaknesses

Required

resources

Cancer in General

Lifestyle Diseases

in General

Breast Cancer

Cervical Cancer

Colon and Rectum

Oral Cavity

Larynx

Other related

areas

ANNEXTURE – 1.2: Campaign for Prevention:

Template for Post-Decision Administration of the Outreach Program by Partner

Agency for CHETANA - 2013

Area finalized for the

outreach program

Total

estimated

cost of the

program

Possible

sources of

fund

Means to make

it cost effective

Risk factors

Cancer in General

Lifestyle Diseases

in General

Breast Cancer

Cervical Cancer

Colon and Rectum

Oral Cavity

Larynx

Other related

areas

ANNEXTURE – 2: Format for Post-program Report or Documentation for

the outreach of CHETANA - 2013

The Event:

CHETANA Awareness Campaign for Cancer – a Lifestyle Disease

Venue: Date: Time (from – to):

The Areas of Concerns Addressed: eg. General, Breast cancer etc………

Goal of the Event:

Nature of the Event: eg. summit/workshop/camp/campaign etc.

Technique of Interaction: Communication Method:

Target Population:

Total Number of Participants:

Physical Resources used (for early detection campaign):

Key Resource Persons: 1. 2. 3. Non-technical Resource Persons:

Reflection of Event Schedule

Sequencing of the Event

Activity Focus of the Activity

Short Term Outcome of the Event:

Expected Long Term Outcome:

Future Prospect of the Event:

An Initiative of

Durgapur Institute for Sustainable Livelihood

Durgapur, West Bengal

Registration No: 99167 under West Bengal Societies

Registration Act, 1961

Contact: + 91 9434250582

+ 91 9614588301

Email: isledinitiatives@gmail.com

Author of the report: Abhijit Roy

Event Ideation and Coordination: Bhaswati Roy

Abhijit Roy

Technical Consultation about the Domain: Dr. Runu Mukherjee

Special Thanks to: Arnab Kumar Mondal

Swastika Banerjee

Mohana Majumdar

Prasenjit Sahoo

At the Back Stage