Treatment in Singapore: What I learn from treating my father’s cancer?

In March 2007, a very bad news hit me when I learnt that my father might have a stomach cancer. It was that time of the year when a lot of news hit the media in Dhaka about abuse of formalin to preserve fishes and fruits. This abuse can cause various deadly diseases including stomach cancer. Tons of fishes has been disposed to underground or burnt.

There have been no traces of cancer in my family or my ancestor as far as I know. So this was a shock to me living abroad. My younger brother lives with my parents in Narayanganj. I asked him to see some more specialists and do x-rays, biopsy to multiple laboratories to be certain.
He followed my directions and did all the necessary lab works in three renowned laboratory and hospitals in Dhaka. All the reports have some doubts and nobody was certain that my father has cancer; however nobody is ruling that out. The biopsy in one medical university in Dhaka could not bring out the samples confidently form the affected tissues of the stomach.

Recently there has been a lot of talk in the town that, most of our politicians fly to other country for their treatments and hence local treatment facilities did not get enough attention and investments to meet our local demand. There is some truth in that. Moreover, enforcement for basic standard of medical practice and protection of the rights of the patient are also lacking. This can be tested any time by doing a simple lab work of blood in several laboratories randomly and then compare the chemistry.

Anyway, going back to my father’s cancer growth in his stomach. I was fortunate enough that I live and work in USA and earn decent amount to provide the medical expensed for my father. So I was looking for all the options available out there. I had three options except bring him in USA.
Bringing him in USA would cause a significant amount of delay as he does not have a visa and the process now a days take 4-6 weeks. Moreover treating in USA without insurance will cost a fortune. So here are my three options: (1) take him to TATA cancer center in Bombay http://tmc.gov.in/ ; (2) Bumrungrad Hospital in Bangkok www.bumrungrad.com/; (3) MT Elizabeth in Singapore http://singapore.parkwayhealth.com/hospitals/meh.asp .

First two options have some complicacy on logistics, visa, finding the right doctors and availability. And we did not have local support and time. The doctors in Dhaka recommend that if we want to treat it; we should do it pretty soon as my father was loosing blood with his stools and weight is dropping very fast. So if it were cancer; then it is spreading pretty fast. These are scary news and not helping the logistics. I feel helpless in my Portland home. The third option was pretty simple. Although it was costly and all our politicians as well as high up civil servants makes their first stop to MT Elizabeth Hospital in Singapore. The business is so good that MTE (short for MT Elizabeth Hospital) has a local agent in Dhaka, who arrange all the Visa, admission to the hospital, transportation and what not. I used my family connections and got everything lined up in couple of days. My brother took off with my father from Dhaka to Singapore and I was in Singapore one day early to join them.

A MTE contracted cab picked up my father and my brother from the airport to the MTE admission counter. I was waiting for them at the counter. After the initial pre payment, we went to his designated hospital bed. For the next several hours, we let the MT Elizabeth doctors to do X-ray, endoscope, and laser burning to the damaged area after a sample of biopsy. They delivered several photos of the affected stomach where bleeding was obvious. Then the doctor in charge use laser to burn some affected area to slow down the bleeding and shoot some photo for us.

The photos were such convincing that the leading doctor told us that he is almost certain that cancer is present; however we will get the biopsy result next day and the treatment will start after that instantaneously. My father was under a leading doctor of Parkway Cancer Center, which is integrated with Gleneagles hospital chain that includes MTE. He told us in the evening that if cancer is identified by the biopsy, then he will start a chemo right away; however he will also bring in one of the best surgeon to evaluate the possibility of surgery before chemo. It was a long day.

I was also skeptical for the fact that Mt Elizabeth is part of a mega healthcare management system and a for profit company. They are not part of the Singapore Government’s healthcare system, which is also very good; but non profit in the core of their business. So I was watching the doctors of MTE cautiously. I talked to the surgeon and the Surgeon evaluates the lab results and the images of the scope and concludes that the surgery may be done but may not considerably successful. He agreed with the lead doctor that several chemo followed by a surgery may give better chance. He argued that if there is a positive response from the chemo then we will know for sure that the cancer is controllable.

Next day we got biopsy result proving cancer and Dr Tiam immediately admitted my father in his Parkway cancer center; But before doing that he started the first chemo in the MTE hospital that day. The doctor gave me 80% chance of shrinking the cancer and 20% chance for not shrinking it. Baba got released from the hospital on the 3rd day. We took him to a partially rented apartment nearby.

Now that we have a handle on the situation, I started looking for other opinions and validate the treatment plan. I went to see NUH National University Hospital and consult with head of Oncology Dr Robert Lim. Robert Lim happen to be also a specialist on intestinal and digestive system Oncologist. Earlier his profession, he worked in NIH (National Institute of Health in USA and did some good work on cancer research. He is now running TCC (The Cancer Center of NUH), which is under the ministry of health. I showed him all the test report from Dhaka and Mt Elizabeth. He explained the tests and agreed the treatment plan; but he disagree the composition of the chemo based on his research experience with French and USA. He gave me 40-40-20 chance; where the chemo can shrink the cancer 40%, the other 40% case the chemo may stop the growth but may not shrink and the remaining 20% chance for no response.

Now I am confused. So I paid my next trip to Singapore General Hospital SGH. This hospital has a very good cancer pre screening center. This would be a good place to find out for sure if somebody has cancer or not. I highly recommend this pre screening program for those who are at risk. Anyway, I consulted with the head of the Oncologist of National Cancer Center Dr Koo Wen Hsin. He is expert in Hematology and Upper Gastrointestinal cancer. He gave me a depressing analysis. He knows the surgeon and thinks highly about him. He thinks the course of action may work and there is only very slime chance of total cure and in his opinion it is 5%. He recommends that we take him home. Send him to nice vacation to nice place and spend my fathers’ last 3-6 months in a happy environment. He may prescribe some medication to comfort my father.
At this point I was very confused and I felt helpless deeply disturbed. I was in shock. I feel disoriented while I find myself walking haphazardly in the subway station. However I bring myself under control and trying to think logically and scientifically. I talked to couple of people that I admire and was close to me to get some perspective and comfort.

I went home take rest; spend the rest of the day thinking the alternatives. Finally I decided to get the treatment done at the cancer Institute at the NUH under Dr Robert Lim. Robert lim was on a conference and he responded with an email. He directed his coworker Dr Benjamin Chow to arrange a consulting session and start the next chemo.

My father went through 2 months of chemo. During the 3rd month, a very confident surgeon took my father to a total gastrectomies for 10 hours. The procedure removed my father’s stomach, 80 lymph nodes and spleen. After the surgery they analyzed all the staff that they bring out of my fathers’ body and did not found any trace of cancer. This was due to the excellent response to the chemo; however they continue to put my father under chemotherapy for next 2 months to make sure that it does not come back right away.

Now it has been a year, my father is living with me in my Portland home today. He is almost adjusted with out a stomach; just he has to take small portion of meals, several times a day to compensate the absence of a big stomach to store more food.

What I leant form the journey of my father’s cancer fight and survival is phenomenal. These three hospitals in Singapore are best on what they do. They implemented the integration of computer and information system technology to take the healthcare system, in some aspect better then average USA hospitals. Moreover the cost of healthcare is almost one third for USA in general. For example, consultation fee with a specialist could run between SGD 100- 200; where in USA it could be around USD 150-300. For chemotherapy, it ran between SGD 2000-3000 per course and here in USA for the same formula I received a discounted quote USD$ 3000; however the cost depends on the combination of drugs in the chemo. I am giving this numbers as an example from my personal experience. I consulted with three top consultants from these three Cancer facilities. There is lots of information about them in the egoverment webpages of Ministry of health as well as those institutions. I changed the direction of the treatment based on my personal analysis of those three consultations, financial situation, and long term sustainability of the actions. There were a lot of blessing from Allah, as well as good wishes and pray from my friends and relatives’ were at the center of my father’s fight against cancer.

If I would have know, what I know now. Than I would have gone directly to Singapore National Hospital for a cancer pre screen to find out want exactly went wrong. It is known as NCC, National Cancer Center. Then I would have gone to NUH’s TCI, The Cancer Institute, for the chemo and Surgery. However the surgeon that did the surgical procedure now works in MTE. Singapore was number one destination for medical tourism in Asia in 2007 and I am sure it will be repeating that in 2008.

I am glad and optimistic that Dr Yunus is paying lot of attention on our health care system. Recently I met him after his meeting with Bill gates. He told me at a diner in Portland’s Typhoon restaurant that he urged Bill Gates to invest in healthcare sector of Bangladesh. He urged Bill to extend his work in Africa to Bangladesh. Dr Yunus has a dream of building a mega hospital and medical research center in Bangladesh. We need this kind of leadership from Dr Yunus. We hope and pray that he deliver a solution of this problem. We will support him for such a noble goal.