HEALTH LIBRARY

This year’s International Women’s Day theme is ‘Embracing equity which stands for embracing diversity, inclusion and being fair. It stands for success for all. Equality is the goal, and equity is the means to get there.

While we continue to pursue one dream after another, let us take a moment to reflect on the things we have done at Balco Medical Centre (BMC) that have made a difference in the lives of many.

I am a cancer specialist and medical director of Balco Medical Centre which is an integral part of the Vedanta group. We see patients from a diverse socio economic and cultural backgrounds and we try and make sure that cancer care is individualized for each patient so that the end result is the same for all, which is increasing the cure rate and improving every patient’s quality of life. This is best for an individual patient and best for our country, as we improve our benchmarks and outcomes for a productive society. I am really proud to be part of this institution, which gives me an opportunity to provide equitable access to care to all those we have the privilege of treating.

Despite the challenges involved mainly relating to out of pocket expenses and financial toxicity, we are providing the best evidence based treatment to all patients. The Anil Agarwal Foundation (AAF) has played a significant role in addressing gaps in healthcare provision and promoting equitable access to healthcare for all.

We entered into a memorandum of understanding with Tata Medical Centre (TMC), Mumbai for exchange of knowledge, and enhancement of skills, capabilities and core practices. With this MoU, both hospitals are collaborating for mutual learning, staff training, educational sessions, and institutional fellowships, cross-referrals of patients and joint research, which will shape the future of cancer care in India. Being associated with TMC- Mumbai also helps us set up local and regional benchmarks for cancer care along with peer-review of our institution.  Together we strengthen our resolve against cancer. After practicing for more than two decades in UK, I am all for the promotion of Heal in India – a medical tourism initiative of our country. This seeks to reduce the burden on patients and families who may be facing financial, logistical, and emotional challenges associated with traveling abroad for medical treatment. This will support the growth and development of the Indian healthcare system by promoting investment, innovation, and collaboration among healthcare providers, policymakers, and other stakeholders. At BMC, we are also improving healthcare access and outcomes for all Indians by promoting high-quality medical treatment within the country and reducing the need for patients to seek treatment abroad or outside of the home states – bringing cancer care closer to home!

We are actively engaged with NandGhar projects under the AAF that serve both rural and urban populations throughout Chhattisgarh. Through these initiatives, we are committed to providing health check-ups, cancer screening, and raising cancer awareness, while also helping to tackle non-communicable diseases like sickle cell anaemia, diabetes, hypertension, and malnutrition through our involvement in NandGhar projects under the AAF that serve both rural and urban populations throughout Chhattisgarh. Additionally, our cancer awareness sessions with Mitayan and anganwadi workers in the state focus on educating them about tobacco cessation, menstrual hygiene, nutrition, and vaccination for cervical cancer.

We are working on a tobacco-free village initiative, which is a public health program that was developed by researchers at the Harvard Medical School in collaboration with local communities in India. Our aim is to reduce tobacco use and promote healthy lifestyles in rural areas of the country by creating smoke-free and tobacco-free environments. Tobacco is the main cause of the commonest cancer of head & neck we see in India especially Chhattisgarh.

We have an excellent bone marrow transplant program and are actively contributing to the International Bone Marrow Transplant Registry. The database helps us to improve the safety and effectiveness of transplantation procedures and to advance our understanding of this important area of medicine. BMC is part of the Hemovigilance Program of India (hvPI) to ensure the safety and quality of blood transfusions and to contribute to ongoing efforts to improve the healthcare system in the country. By being part of HvPI, healthcare professionals can help to identify and address gaps in blood transfusion practices, improve patient outcomes, and promote better health for all. To help capacity building for the nation, we are in the process of expanding the BMT unit and are also actively educating local professional in good practices of transfusion medicine , flowcytometry etc.

We work in close collaboration with TMC- Navya- the second opinion portal which gives our patients access to the best advice across the country for site specific cancers. This provides personalized cancer care services through its clinical decision support system and helps us deliver the best for our patients. On this path of driving healthcare excellence for our country, we will be starting the education program for cancer specialists in our hospital which will provide an opportunity to enhance the quality of medical education and training, as well as the overall standard of healthcare provided in the country.

BMC is fast emerging as a national leader in India’s cancer program as we commission our second latest state of the art radiotherapy machine this year by May 2023. This will allow for precise targeting of the cancers while minimizing exposure to healthy tissue. A combination of treatments are included in the plan, which meets high standards of patient care accredited by NABL and NABH. The precision oncology program with molecular tumour boards also gives our patients access to the latest technology every step of the way. Participating in the national cancer grid virtual tumour boards with TMC, Mumbai every week is another step in the direction of bringing the best expertise to our patients locally.

We embrace equity in all we do every single day to make India a strong nation!

Dr. Bhawna Sirohi

World Cancer Day is marked as a global event that takes place annually on February 4. The day is commemorated to raise awareness about cancer prevention, detection, and treatment. This year the theme for this day is "Close the Care Gap," which is what Balco Medical Centre (BMC) has been striving for since the day of its inception under the aegis of Anil Agarwal Foundation and Vedanta Medical Research Foundation. The focus is on the need to address disparities in cancer care and make sure that everyone has access to quality cancer care irrespective of their economic status or area where they live in. Currently, it has active operations across Central India while it aims to spread its wings, PAN India.

Based on recent data, 1 out of every 5 individuals happen to develop cancer in a lifetime and this global burden mainly seems to be borne by low and middle income group countries like India. Nevertheless, such common cancers as head &neck, breast & cervix are not only preventable in our country but also easily treatable if detected early by methods which are accessible to most of the population and are cost-effective.

BMC, since the time of its establishment has taken all comprehensive steps to  close the care gap for its patients so they not only receive quality but equitable care. The centre raises cancer awareness through an unlearn- learn process of the ABCs of cancer prevention that expands as

A: avoid tobacco and alcohol

B: breastfeed, be breast aware, and get vaccinated against hepatitis B and HPV

C: calm

D: diet which is balanced – local and fresh

E: exercise 30-45 minutes daily

F: family history that you need to know everything about

S: screening for cervix (HPV/Pap smear), breast (mammogram, clinical exam), head and neck (clinical exam), colon (stool occult blood) and cancer alert signs for early diagnosis.

It further aims at promoting preventions through tobacco cessation clinics, vaccination clinics with an objective to work with all local schools, create awareness and reduce the risk of preventable diseases along with an easy access and availability of indigenous HPV vaccine.

BMC organises free screening camps to enhance its access by working with Nand ghars in driving training and education of anganwadi workers, ASHA, Mitayan at rural level including villages and semi-urban areas. Patients diagnosed are treated at BMC irrespective of their financial status. The mammography van which is going to be launched this year that will further help in bridging the gap by providing access to cancer screening at the doorstep in villages.

To contribute to the national efforts, patients under the PM-JAY, Ayushman Bharat and all government schemes are treated at BMC despite the challenges faced. Patients not covered under any scheme are treated under the BMC charitable fund. BMC provides every aspect of cancer treatment including bone marrow transplants and radionuclide therapy which is unique in central India. This closes the care gap for patients as they do not have to travel to tertiary cancer centres like TMH, Mumbai. Though the centre has made sure to continue to better its concept of learning from each other and hence under a MoU signed with Tata Memorial centre, it conducts virtual NCG tumour boards to drive excellence in cancer care and give the centre a national benchmark to strive for. BMC also adheres to the national cancer guidelines and is part of the Indian council of Medical Research and National cancer grid (NCG) which supports the centre in delivering unified cancer care nationally and helps take the lead.  

Patient advocacy is at the heart of culture of BMC for which patient support groups are developed which not only help in empowering patients but also drive patient education, strength, and better compliance rates to cancer treatments. These are run regularly at BMC. This has been a strong and a wise initiative to close the care gap actively as this would save patients from undergoing unnecessary tests or treatment and improve outcomes.

World Cancer Day serves as a powerful reminder of the collective efforts required to address the global cancer crises. Each one of us has the power to make a difference and to help create a world where cancer is no longer a threat to life. Let us all take action and pledge to do our part in the doing the best for our patients and destigmatising cancer. This will close the care gap.

Dr. Bhawna Sirohi,

Medical Director, Balco Medical Centre

Therapeutic apheresis is an emerging treatment modality, which improve the outcome of susceptible clinical disorders. These techniques includes, therapeutic plasma exchange (TPE), therapeutic leucoreduction, Therapeutic Red Cell Exchanges (RCE) treatment. Some of these applications are the primary therapy for certain disease processes, and many others are considered to be secondary or adjunctive therapy, but both categories of apheresis treatments are considered to be effective and beneficial.

Therapeutic plasma exchange (TPE): It’s an extracorporeal blood purification technique in which the plasma is separated from the blood, discarded in total, and replaced with a substitution fluid such as an albumin or with plasma collected from healthy donors. This is generally performed to remove high-molecular-weight substances such as pathogenic autoantibodies, immune complexes, cryoglobulins and toxins that have accumulated in the plasma.

Therapeutic Red Cell Exchanges (RCE): Thalassemia and Sickle Cell Anemia are two most prevalent genetic blood disorder worldwide with 5% of world’s population and approx. 3% of Indian population is affected. Chhattisgarh state is one of the pre dominant zone for this genetic disorder with prevalence of approx. 10% (I.e. approx. 28 lacs of state population).Red Cell Exchange is considered as a critical and important management in Sickle cell disease (SCD) to prevent associated complications like stroke, acute chest syndrome, and sickle hepatopathy. RCE may be indicated prior to planned surgical procedures, may be necessary during pregnancy in women who have a history of severe SCD-related complications, and is indicated prior to stem cell mobilization.

Granulocytapheresis: Granulocyte transfusion has evolved as an accepted therapeutic approach for immunocompromised, severely neutropenic, myelosuppressed leukemic patients or hematopoietic stem cell transplant (HSCT) with life-threatening infections despite appropriate antibiotic therapy. The combination of Growth-stimulating colony factor (G-CSF) and dexamethasone to stimulate granulopoiesis in normal donors has facilitated the collection of larger cell doses of granulocyte concentrations (GCs) via automated apheresis.

Many haematologic, neurologic, renal, rheumatic, and metabolic disorders have been successfully treated with the help of therapeutic apheresis. Balco Medical Centre’s team of well-trained transfusion medicine specialist, nurses and technicians provide exceptional care to every patient using state-of-the-art machinery and equipment to safely filter a patient’s blood and monitor transfusions.

बालको मेडिकाल सेंटर, जो की मध्य भारत का सबसे बड़ा एवं आधुनिक कैंसर अस्पताल है, अपने मरीज़ो के न सिर्फ़ सटीक इलाज का ध्यान रखता है बल्कि उनके खान-पान की ओर भी उतना ही सतर्क एवं प्रयत्नशील है । बालको मेडिकल सेंटर में एक अत्यधिक संयोजित रसोईघर है, जो खाद्य स्वच्छता पर पहले स्थान पर है । शरीर को सेहतमंद बनाए रखना जरूरी है। इसी के होने से सभी का होना है अत: शरीर की रक्षा और उसे निरोगी रखना मनुष्य का सर्वप्रथम कर्तव्य है। पहला सुख निरोगी काया।

भारत में अनेक प्रकार के व्यंजन बनते हैं और हर क्षेत्र में अलग तरह से इन्हें बनाया जाता है। पर सब में एक बात सामान्य हैं की हम तरह-तरह के व्यंजनों में सब्जियों और फलो को भरपूर इस्तमाल करते है। इस समय हमें अपने स्वास्थ्य का अधिक ध्यान देना है ताकि हमारी रोग -प्रतिरोग क्षमता अच्छी रहे। इसलिए हमें सभी सब्जियों और फलो को शामिल करना हैं क्यूंकि फलो और हरी सब्जियों में भरपूर मात्रा में ज़रूरी मिनरल और विटामिन पाए जाते हैं जो की शरीर के रोग - प्रतिरोधक क्षमता को बढ़ाता है। अगर बात करें फलो की, तो खट्टे फल जैसे की संतरा , निम्बू , मुसम्बी , आवला, इमली , जामुन , सहतूत , अमरूद आदि फलो में भरपूर मात्रा में विटामिन सी और फाइबर होता है जो शरीर के लिए बहुत अच्छे होते हैं । साथ ही गर्मी में आने वाले फल जैसे की तरबूज , खरबूज , शारदा शरीर के तापमान को नार्मल रखती है और शरीर से विश्ले पदार्थो को बाहर निकलने में भी मदद करता है।

इसी प्रकार सभी हरी पत्तेदार सब्जियों में अधिक मात्रा में पोटैशियम और एंटी ऑक्सीडेंट मोजूद होते है जो की स्वास्थ्य के लिए बहुत अच्छे माने जाते है , सब्जियों को सब्जी के जैसे तो खाना ही है परन्तु सलाद के रूप में खाने से और सूप बनाकर पीने से शरीर को फाइबर अच्छी मात्रा में मिलता है जिससे हमारी पाचन क्रिया को फायदा मिलता है। पुदीने -धनिया और निम्बू को मिलकर स्वादिष्ट शरबत बनाया जा सकता है या जलजीरा बना कर भी पिया जा सकता है।

सदियों से भारतीयों की भोजन में लहसुन , अदरक , मेथी , हल्दी, दालचीनी , काली मिर्च , हींग , अजवाईन जैसे गुणकारी मसालों का प्रयोग होता रहा , यह भोजन का स्वाद तो बढ़ाते ही हैं साथ ही यह मसाले बेहद गुणकारी भी होते है क्यूंकि इनमे मौजूद एंटी ऑक्सीडेंट, फ्लवोनोइड्स, पोटैशियम, आयरन आदि हमारे शरीर की रोग प्रतिरोधक क्षमता को और मज़बूत करता है।

भारतीयों को दूध और दही का बड़ा चाव होता हैं और इनसे अनेक प्रकार के व्यंजन भी बनाये जाते हैं । रोजाना १-२ गिलास दूध तो हर किसी को पीना ही चाहिए ताकि हमारा स्वस्थ्य उत्तम स्तर पर रहे और इसमें अगर हम चुटकीभर हल्दी मिला ले तो दूध और पौष्टिक बन जाता है । सर्दी खासी में यह हल्दी वाला दूध बेहद लाभदायक होता है साथ ही अगर किसी को दूध पसंद नहीं हो तो दही एक उत्तम विकल्प है इसमें हमें अच्छी मात्रा में प्रोटीन तो मिलता ही है साथ ही पाचन शक्ति भी मजबूत करता हैं क्यूंकि इसमें पाए जाने वाला प्रोबायोटिक यानि गुड़कारी बैक्टीरिया हमारे पेट के लिए बहुत अच्छा माना जाता है। दूध के साथ ड्राई फ्रूट्स भी मिलाकर पिया जा सकता है जो की हमे अधिक प्रोटीन देता है जो की हमारे शरीर की कोशिकाओं को मजबूत बनता है।

इस समय हर जगह साफ़ -सफाई को ध्यान में रखने को बोला जा रहा हैं। उसी तरह भोजन में भी हर चीज ताज़ा होनी चाहिए। अगर फल और सलाद खाना है तो उसे काटने के बाद तुरंत खाना है, क्यूंकि हवा के सम्पर्क में आने के बाद फल और सलाद काले पड़ जाते है जो कि खाने और देखने में अच्छे नहीं लगते है। इस समय अगर हम मांसाहारी भोजन का सेवन कर रहे है तो उनको अच्छे से पकाना है और तुरंत खाना है, हो सके तो रेड मीट न खाया जाये एवं माँसाहारी भोजन अधिक दिन तक घरों में न रखे ।

इसी के साथ हमें अपने और अपने परिवार के स्वास्थ्य का ख्याल रखना है और हमारे आसपास के वातावरण को साफ़ और सकारात्मक ऊर्जा को बनाये रखना है । साथ ही अगर व्यायाम भी किया जाये तो हमारा शरीर और मन दोनों ही स्वस्थ रह सकते हैं।

In our day-to-day lives, we use a variety of materials and utensils in our kitchen, which are not natural and can strongly cause damage to our health. Let’s know some of the commonly used materials in our kitchen that are carcinogenic or cancer-causing.

PLASTICS

Plastics have become so common in our daily routine life that we hardly consider living without use of plastics in one or the other way. Well, this whole battle against the use of plastics started in 2009 when a viral email claimed that celebrity, Sheryl Crowe, developed breast cancer after leaving her bottle of water in the car. The email was falsely attributed to Johns Hopkins University and claimed that plastic bottles and food containers contain chemicals called dioxins, Phthalates and Bisphenol A, which are a group of chemicals used to soften plastic in food packaging and a wide range of other industrial and consumer products that can leach into food and drink, causing reproductive and developmental problems, liver damage and cancer, which led to a revolution among many to have a plastic free zone, kitchen, home or rather country.

What can you do?

a. Do not use plastic wraps or containers, which are not labelled microwave safe or rather use glass or ceramic containers

b. Do not use plastic containers not meant for food storage like cosmetic containers or chemical containers

c. Do not use store hot foods or hot water in containers not meant for it (e.g. Plastic containers for ice-cream or yogurt etc.)

d. Avoid using plastic containers having No. 7 written underneath ( No. 7 likely to contain BPA )

e. Wherever possible try to use glass, ceramic or stainless steel containers for hot foods and liquids.

TEFLON COATED PANS (NON-STICK COOKWARE)

PFOA (Perflourooctanoic Acid) which is used in preparation of Teflon coated pans is the culprit in causing various cancer (Testicular, Ovarian and Kidney). Although, it is burned off during the process and is not present in significant amounts in the final products it stays in the environment and blood for longer time periods. Higher levels can be found in community residents where local water supplies is contaminated by PFOA (Industrial wastes) and among people exposed to PFOA in the workplace. PFOA can be released by overheated nonstick pans and also by pans, which have lost its coating or is breached.

What can you do?

a. Try to use cast iron pans wherever possible.

b. Do not use nonstick pans if the coating is cracked or has come out.

c. Try not to overheat the pan and not to use sharp objects while working on it or cleaning.

ALUMINUM UTENSILS AND ALUMINUM FOILS

On cooking food (mainly acidic) in Aluminum utensils gets leached out and is absorbed into blood through gut mucosa causing harmful effects like Alzheimer’s disease, testicular and liver carcinomas.

What can you do?

a. Try to avoid Aluminum utensils instead use stainless steel or cast iron utensils

b. Use Parchment Paper instead of aluminum foil

c. Avoid tetra pack products or sauces sold in refill pouches or tube, canned food products instead use ones stored in glass bottles

d. Avoid using cosmetic products ( Antiperspirants, sun screen and toothpaste ) containing aluminum

e. Antacids and vaccines also contain aluminum.

f. Avoid drinking water which is being treated with ALUM

g. Various Baby foods and Infant formulas contain significant amount of aluminum and should be avoided instead make home based purees for weaning babies

REFINED OIL

In the process of making refined oil various chemicals are used (Hexane, bleach etc.), which are harmful to our body. In order to get a desirable consistency, often these vegetable oils undergo hydrogenation, which in turn leads to formation of Trans fats. These trans fats contributes to disorders such as that of the liver, diabetes, obesity, gastrointestinal disease and even cancer mainly breast cancer and colon cancers.

What can you do?

a. Try to use cold pressed oils and natural seed oils viz. ground nut oil, Extra virgin Olive oil, Coconut Oil, Mustard oil

b. Use butter from raw milk grass fed cows and the second choice, which is more accessible to most of us, is organic, which is from milk of grass fed cows with NO rBGH injected into them.

c. Try to avoid re-heating left over oils again and again

d. It is better to buy oil from a local store that specializes in oils.

MILK AND MILK PRODUCTS

In order to get more milk, cows and buffaloes are being injected with hormones, which, in turn, get secreted in their milk causing infertility, thyroid diseases and endocrinal diseases and should be avoided instead drink milk from grass-fed cows and dairy products which are organic.

Not everything is bad or cancer causing.

CANCER-FIGHTING FOODS

There are as such no cancer fighting foods rather there are foods which contain certain vitamin, minerals and compounds, which reduce the risk of cancer.

a. Fruits: Apple as the saying goes ( An apple a day keeps the doctor away ) contains Polyphenols and berries ( Blueberry, Strawberry etc.) containing Vitamin C, Minerals and dietary fibers help in reducing the risk of cancer

b. Cruciferous Vegetables like Broccoli, Cauliflower and Kale contain Vitamin C, Manganese and Sulforaphane which reduces the risk of Colon Cancer and Breast Cancer

c. Carrots with its rich content on anti-oxidants and beta carotene are fighters against cancer

d. Walnuts with pedunculagin in them gets metabolized to Urolithins and thereby reduced cancer risk

e. Legumes with dietary fiber content and vitamins and minerals reduces the risk of cancer

Balco Medical Centre recommends that everyone should live a healthy lifestyle and keep an eye on their diet and also watch out for the carcinogenic items in their kitchen and eliminate it, or at least, reduce its usage.

The human brain has a tremendous inclination towards finding an association. One won’t be wrong in saying that the foundation of our cerebral evolution was laid down on its capability to establish associations.

Could cellular (mobile) phones cause cancer? Patients often ask whether excessive use of these devices increased their chances of developing cancer in general, and brain tumours specifically? In all those years of “conventional” oncology training, because the evidence is so scanty, specialists are hardly ever taught about the association between cellular phones and cancers. Healthcare professionals spend most of the time thinking about either tobacco, alcohol, or genetics.

The concern

Cellular phones have practically existed for only 30-40 years, and have gained widespread popularity since the last two decades only. It has become an irreplaceable part of people’s daily lives, and now that human cannot (neither do we plan to) get rid of it, there’s a very basic concern. Is it safe for humans? As we dive deeper into our psyche to investigate its safety, we come to associate it with our scariest trepidation - the risk of cancer.

The device

Cellular phones communicate with each other via radio-frequency waves. These devices are considered a very weak source of radio-frequency (a type of electromagnetic radiation similar to “cancer-causing” ionising radiation such as X-ray and gamma rays, but far less energetic). Considering how long we keep them close to our body, even these weak sources become significant biologically. The “radiation” they emit and their proximity to the brain form the basis of the suspicion that these devices may actually be a cause of cancer! These waves are absorbed into the body parts in the vicinity and may bring about detrimental changes. The true nature of these changes, and whether these changes could be a starting point of a tumor formation are still debatable.

The research

Unlike the very energetic ionising radiation, radio-frequency waves are not an established, direct cause of cancer. Based on all the data that has been gathered from various studies concluded till date, almost all the agencies working on cancer have categorised radio-frequency waves (and thus cellular phones) as either non-carcinogenic or “probably” carcinogenic. This uncertainty in the categorisation is due to the lack of sufficient amount of data that is needed for a precise conclusion and risk estimation. As mobile phones are used by more people in the future, it is expected that we will reach an unambiguous conclusion in a decade or two. Remember, it took us over 300 years to put definite scientific blame on smoking as a cause of cancer!

The solution

Humans surely can’t stop using mobile phones and can comfortably put them in the category of “necessary evil”. But exposure to the radio-frequency wave emissions by some of the following measures while using them can be reduced by:

• Using it for a lesser duration.
• Avoiding using a cell phone when the signal is weak.
• Using it over speakers.
• Using headphones rather than putting it directly over the ear.
• Keeping cell phones away from your body when not in use (avoid keeping it in pockets).
• Providing children with a mobile phone as late in life as possible.

Making the call

Nevertheless, there is sufficient proof supporting cellular phones to be a cause of non-cancer conditions like anxiety, sleep, and attention, societal and cognitive disorders. The choice is finally yours to make. Do you want to limit cellphone use considering these already proven harmful effects? Or do you want to wait until it is established as a sure cause of cancer?