Achievement

Kannapuram – Cancer Vimuktha Gramam Project: A Success Story in the Fight Against Cancer

When the present government took charge in 2015-16, a novel project of making Kannapuram cancer free was initiated. The project was named as CANCER VIMUKTHA GRAMAM PROJECT. They barely had any idea as to how the project could be implemented in their panchayath. But their goal was fixed. They wanted to make their panchayath free of cancer. The panchayath members approached Director of MCC for discussion regarding implementation of the project. A novel approach for cancer control by involving all sections of the society was thought of. Main thrust was given to awareness generation and elevation of fear and stigma related to cancer, in the society.

The project was inaugurated by honorable MLA V. Rajesh in presence of Dr. Satheesan Balasubramanian .Director emphasized the importance of involvement of Panchayath in cancer control activities and gave directions on how to move forward.

Core committees at panchayath and ward level took  leadership of activities.

Activities conducted in the panchayath to achieve the goal of “Cancer Vimuktha Gramam”

Phase 1. Base line Data collection 

In the preliminary stage, general health, lifestyle and social factors were collected. In the second stage cancer related risk factors were surveyed. 

1. House to house health survey

Health workers and Kudumbasree workers were trained and were utilized in conducting the survey. The survey was recorded in a special survey form about general health and habits of the people of the panchayath, prepared by MCC. Completed survey data was evaluated by the Department of Cancer Registry and Biostatistics of MCC and a detailed report was prepared by Community oncology department and submitted to the President. This report gave an idea in general about the panchayath and the areas which needed improvement.

2. Risk based survey

A second survey was conducted from October 31, 2016 to find out high risk subjects who needed a screening for cancer by trained volunteers This program was inaugurated by former MLA Sri P Jayarajan.3838 houses were visited as part of the survey, but the response was not as expected. Lack of awareness and fear prevented them from giving the right information. This highlighted the importance of creating awareness in the society regarding cancer and elevating the fear, myths and stigma about the disease.

Phase 2. Awareness programs

The panchayath conducted various awareness programs in association with MCC, other social service organizations and hospitals in order to decrease fear and stigma associated with cancer. 

Health exhibition 

Awareness exhibition on cancer conducted from April 15th to 19th, 2016 at Cherukunnu Primary Health Center was attended by many people. Further exhibitions were also conducted during social religious and cultural gatherings.  Exhibits containing information on various aspects of cancer prepared by MCC were used for creating awareness. The first awareness program was inaugurated by Jilla panchayath president Sri K V Sumesh. Awareness classes on early detection, life style and cancer, overall aspects of cancer and modern treatments available were also conducted in different areas of the panchayath. A get together of cancer survivors called ‘winners meet’ was also conducted. It was inaugurated by Srimathy KV Janaki teacher on 19/6/2016.

Chithrayathra –awareness painting exhibition

The district level inauguration of Chithrayathra led by Ebi N Joseph was in Kannapuram .There was a painting exhibition of 25 artists with the goal of creating awareness on cancer and elevating myths.

Awareness IEC materials

About 5000 pamphlets about early detectable cancers, cancer myths and cancer prevention through diet prepared by community oncology department of MCC were distributed in the houses.

4. Kanfest 2018 –cancer prevention food fest 

As a part of spreading the message of cancer prevention through locally available fruits and vegetables, Kanfest 2018 was conducted in Kannapuram south UP School from April 27 to 29 .The emphasis was on promotion of locally available seasonal fruits like jack fruit and mango   and food items prepared from them, which are rich in dietary fiber and antioxidants as these were free of pesticides and easily available seasonally. The event was inaugurated by honourable MP Sri Karunakaran in presence of MLA Sri T.V.Rajesh.

Painting and drawing competitions based on topic of cancer, cooking competitions using jack fruit, tapioca, panel discussion on the subject of cancer prevention and diet with Director MCC and Dietician from MCC as panelists were also organized.

Workshop on organizing a kitchen garden was also conducted as a part of promoting cultivation of pesticide free own vegetables and fruits. This was attended by public and students in large numbers. 

5. Chakkamaholsavavam(Jackfruit Festival)

Chakkamaholsavam (Jackfruit Festival) was also aimed at popularizing the traditional food habits and use of locally available fruits and vegetables with special emphasis on jackfruit was organized from May 17th to 18th, 2019. Awareness classes were taken on cancer prevention and cancer myths.

6. Awareness classes for students 

School based tobacco and cancer awareness classes, exhibition and short film screening were conducted in various schools in the panchayath.

7. Awareness classes for general public and LSG members, PHC staff

Cancer awareness classes and training programs were conducted for general public, PHC staff, ASHA workers, panchayath members and volunteers 

8. Observation of days related to cancer 

Days like national cancer day, world cancer day, world no tobacco day, international day against drug abuse were observed with various awareness programs and public rallies. 

9. Testing of water samples

Water samples from drinking sources were tested on 17/4/18.Samples from 21 wells from each ward were submitted for testing.

Phase 3: Cancer control activities

Early cancer detection camps

Four early cancer detection camps were conducted in 2017-18 during the months of July, November, December and February by Community oncology department of MCC. The camps had good participation .Screening for oral, breast and cervical cancer was done. Organizing committees were formed at ward level for implementation of the programe. Kudumbasree ADS meetings were held at ward level and publicity and awareness regarding the camps was done through meetings of “AYALKKOOTTAM” 

Early cancer detection clinic at Cherukunnu PHC

An ECDC functioning once a week, the first of its kind in health sector in Kerala was inaugurated in Kannapuram on 20/5/17 by honorable health minister Smt K.K.Shailaja teacher. The training for 2 nurses in the clinic was given by Community oncology dept of MCC. Screening for oral and breast cancer and Pap smear tests are done here regularly. The Pap smear tests are reported at MCC.

3. Breast cancer detection program

A special project was submitted in 2018 by the panchayath for breast cancer screening of all women of the entire panchayath above 30 years of age. They also allotted funds for further follow up mammograms and USG of referred ladies. Anybody detected to have breast cancer will be treated at MCC by utilizing the available government treatment funds

The publicity campaign was done through a “sandesha yathra” inaugurated by Jilla panchayath vice president Miss Divya on 15/5/18 Awareness talks were held at 17 centers in different wards.

Registration for the camp was done by combined effort of ASHA workers, Kudumbasree members, panchayath representatives, health workers and NSS unit of KANOSA nursing collage on 17/5/18.The were organized into 54 squads and registration slips were distributed by visiting 3800 houses as a single day program.

The camp was inaugurated by Director of MCC.The closing ceremony was inaugurated by Hon’ble Kannur M P P.K Sreemathy teacher on 30/5/18.
Breast examination for all ladies from 14 wards of panchayath above 30 years using ibreast exam technique which detects changes in the breast from variations in tissue density was done. The 10 day camp was conducted in Kannapuram south UP School  from  21/5/18 to 30/5/18 by MCC.3247 women were examined and 203 who needed further mammograms were referred to MCC. The camp was a great success in terms of participation.

All those requiring further follow up at MCC are accompanied by a special squad from the panchayath organized for the same and 10 ladies underwent mammograms each day from MCC as per list given by MCC.

A Panchayath level core committee with The Panchayath president K V Ramakrishnan as Chairman, C V Sureshbabu as convener is the strength behind the success of this program.

3247 women above 30 years participated in the camp. 203(6.2%) were found positive on ibreast exam and none of them had any palpable abnormality on clinical breast examination. All were referred to Tertiary Cancer Centre for further evaluation, of which 135  underwent further investigations.109 (79.6%) had BIRADS 1 or 2.Ten (7.3%) subjects with BIRADS 3 were advised follow up at 6 months .Out of 15(11%) with BIRADS 4, 14 underwent wire guided biopsy, of which two were detected to have carcinoma. One with BIRADS 5 had early stage infiltrating duct carcinoma.

All BIRADS 1 or 2 women were advised routine screening. All BIRADS 3 women were advised follow up at 6 months .All 3 cancer patients have completed treatment and are disease free now.97% of the participants reported test as acceptable and recommendable to relatives. Awareness levels of the participants were found to be high. 67.5% reported for further evaluation either at Malabar Cancer Centre or elsewhere as a result of continuous intervention and motivation.28% of the positive cases failed to undergo further investigation in spite of continuous motivation by panchayath members, posing challenges to the successful implementation of the program.

Following the project, an iBreast exam facility was arranged at the PHC. This is one of the first PHC to have this facility

4. Cervical cancer eradication program

Cervical cancer eradication program at Kannapuramwas inaugurated by MLA T V Rajesh on 30-11-19

Objectives:

1. To detect cervical cancer in early stages and provide appropriate treatment
2. To detect precancerous lesions and treat accordingly
3. To avoid death from cervical cancer
4. To develop a community participatory screening model for cervical cancer and to implement a cervical cancer control protocol

Proposed plan is to screen women using Pap smear and treat positive cases using cryotherapy at the as a single-visit approach. They may be referred for other investigations and management to MCC. Plan was to set up a cryotherapy unit in Cherukunnu PHC for screen and treat facility. Those requiring further investigation will be referred to MCC. The required training for Doctors, nurses and other health workers will be done at MCC. 

Kannapuram Grama panchayath cancer control program second phase (cervical cancer eradication program). The volunteer training program was inaugurated on December 16 by Dr Satheesan Balasubramanian.

Following restrictions imposed by COVID pandemic the project could not be proceeded further, although screening with Pap smear is still going on at the PHC.

The project for “cancer vimuktha gramam” with its activities spanning for 4years since its inauguration in 2016 has definitely gone a long way in elevating fear about cancer in the society and has attained self-sufficiency in cancer control activities, through community participation.
Kannapuram model can be taken up by other panchayaths as a successful model for cancer prevention.

Conclusion:

This model of community participation in cancer control and prevention activities has become a model. The way the Grama panchyath under the visionary leadership of President Shri.K.V.Ramakrishnan is exemplary. During the iBreast examination, vice president was the first lady to volunteer for the examination and she was always in the fore front. All the members of the panchayath cooperated with the project in an inimitable way. The success of the model was all written on the wall when over 3000 ladies volunteered for breast cancer screening in a 10 days camp. Such a turn out is almost unheard in this part of the world as stigma and fear of cancer is highly prevalent. In order to supplant this, community participatory model – Kannapuram Model shall be considered.