Dr V. Shanta , chairperson of the Cancer Institute (WIA), Chennai, who made cancer treatment affordable to the poor and the needy, placing the medical requirements of patients above everything else, and who demonstrated how much a private sector entity could contribute to furthering public health and research, died in Chennai early on January 19 morning. At 93, she was active until the last day of her life despite being aware of the condition of her health.
Perhaps the most influential Indian oncologist and cancer educator ever, Dr Shanta ran one of the country’s largest cancer registries at the Institute, conducted pioneering research on paediatric leukaemia, and was instrumental in pushing the government to organise cancer screening camps as a first step towards early detection and prevention of cancer. R. Poornalingam, former Tamil Nadu Health Secretary, said: “It was because of her persistence that we [the Tamil Nadu government] organised the first cervical cancer camps in 1995.”
From the day she joined the Adyar Cancer Institute in 1955, Dr Shanta never stopped working. In fact, she had lined up a meeting for January 23 and had sent out mails on her own, and no one who knew her is surprised by this fact. Keshav Desiraju, former Union Health Secretary, who joined the board of the Cancer Institute after his retirement, at her request, said: “How many people do you know who have never stopped working? She never thought ‘my work is done, now is the time to rest’.” He added that nothing mattered more to her than caring for the people and that she always did whatever it took to get a job done.
Born on March 11, 1927, in Chennai, Dr Shanta completed her MBBS from the Madras Medical College. She completed her post-graduation in gynaecology and joined the Cancer Institute, built by Dr Muthulakshmi Reddy, at a time when women doctors preferred the steady working hours and pay of government service.
At the Cancer Institute she was only paid a small honorarium; the actual benefit was getting trained by Dr Muthulakshmi Reddy and her United States-returned son, Dr S. Krishnamurthy. It was a small effort to help those in suffering a great deal after being afflicted by cancer: a 12-bed facility with just the three of them as doctors.
Also read: Progress against cancer
Dr Shanta and her mentor Dr Krishnamurthy embarked on a journey to expand the scope and reach of the hospital and, more important, to make cancer care affordable while ensuring that the best medical facilities were available at the Institute. A former senior bureaucrat said: “When my father was afflicted with cancer, he went to the Cancer Institute. He was asked for his income details, and he paid a fraction of what it would have cost in a private medical facility…I think it was about Rs.20,000 or so. The fee that he had to pay was based only on his income.”
This was the crucial aspect of treatment and care at the Institute: it was affordable for everyone and there was no squeeze on one particular class of people. Of course, the Institute was perennially short of funds, often made good by contributions from the State and Central governments. Although the government allotted “gap or deficit funding,” this was often delayed inordinately. The Institute largely depended on senior bureaucrats to speed up the process.
Even though Dr Shanta was a much feted and recognised name in India, having received the Padma Shri, the Padma Bhushan, the Padma Vibhushan and the Magsaysay Award, among other awards, laurels sat lightly on her. She would spend hours in the corridors of power both in Chennai and Delhi to speak to junior bureaucrats to patiently clarify their doubts and work with them on their concerns. She continued to meet such officers all through her life.
Research in paediatric cancer
Because of the overwhelming importance of what the Institute did, it is easy to lose sight of the fact that she was deeply involved in the most important and pioneering research in paediatric cancer in India, which led to a tripling of the patients’ chances of disease-free survival. On the establishment of the first paediatric oncology unit in India at the Institute, she wrote: “Our ethos in paediatric care has been: “They shall always have a Tomorrow”.” ( Indian Journal of Pediatric Oncology ; July-September, 2010; 31(3); pages 101–102.)
She added: “It was in our search to enhance therapeutic results in paediatric leukaemias that started the collaborative protocol with the paediatric division of NCI, Bethesda, U.S., and Dr Magrath, which started initially with the Cancer Institute (WIA), Chennai, and then extended to many other centres in the country. It raised the DFS [disease-free survival] in acute paediatric ALL [acute lymphocytic leukaemia] from a dismal 20 per cent to over 60 per cent. The collaboration also made possible many research projects like the impact of socio-economic class in leukaemia sub-type and others.”
On Dr Shanta’s contribution to research, Dr Nikita Mehra, a faculty at the Cancer Institute, said that the first cobalt tele-therapy unit in Asia was installed at the Institute. She said: “What she will truly be remembered for is for her contribution to cancer prevention and screening, and the management of acute leukaemia. Madam was incredibly passionate about breast and gynaecological oncology, and paediatric oncology.... She realised very early that the needs of children are very different.... The other important contribution is the cancer registry. The Tamil Nadu Cancer registry [which assimilates information on cancer across the State] was very close to her heart.... Tamil Nadu became the first State in India where cancer is a notifiable disease, just like a communicable disease. A lot of the developments in this field are because of her.”
Dr V. Maithreyan, former Member of Parliament, honed his skills as an oncologist when he worked for Dr Shanta from 1982 to 1996. He said that Dr Shanta encouraged medical professionals to engage in research that would be of direct benefit to the lower strata of society, which accounted for the largest chunk of patients at the Cancer Institute. “She was very keen on research.... She sent me for several conferences and seminars and I got many opportunities to learn from these.” Dr Shanta concentrated on the larger cause of cancer care and was never discouraged by the fact that she ran an institution that was constantly in need of funds, competent personnel and her personal attention on a range of issues.
Venkatraman Ramakrishnan, a medical and paediatric oncologist, said on Twitter that among Dr Shanta’s major contributions were getting duty exemption for cancer drugs, free travel for cancer patients in trains and buses, starting the first super speciality course in oncology in India, the first cancer registry in the country, the first screening programme in India for cancer, the first multi-disciplinary tumour board care and conducting the first limb salvage surgery in India.
Service during pandemic
Dr Shanta and her colleagues kept the Institute running during the COVID-19 pandemic as hundreds of poor patients depended on the care that the Institute provided. She ensured that it was safe for the medical personnel to work in the Institute. Everyone had to wear personal protective equipment (PPE), and she would call the stores department every day in the evening to check if it had enough stocks for the next day. The Institute followed the ‘15-day-on-duty and 15-day-off-duty’ protocol initially, and then the ‘one-week-on and one-week-off’ protocol until recently. No one’s salary was cut, an employee said. Morale was high even during the pandemic: she would know if any employee was afflicted by COVID and would write a personal note, reassuring the employee.
Dr Shanta never neglected any development, small or big, at the Institute, and was a constant source of encouragement and support for the faculty and staff. Everyone at the Cancer Institute has a personal story to narrate about how offered help and support. A. Sarath, a doctoral student, noted a line of hers on Twitter: “I don’t need more than this. I like to spend all my time with my patients.”
Dr V. Mohan, chairman and chief diabetologist of the Dr Mohan’s Diabetes Specialities Centre, said that she was never concerned about her personal glory. “[She] just lived, breathed and died in the Cancer Institute,” he wrote on Twitter.
Dr Shanta’s work, in some ways, adds a new dimension to private-sector based healthcare. Keshav Desiraju said: “You should never forget that the Cancer Institute is private.... During this whole discussion about public versus private care, let us not forget that we can have private institutions like the Cancer Institute which play a most important public health role. Their rates, everything about the place.... for all practical purposes, it is a public institution.”
But what happens to an institution that depended on one individual for so long, and so much? For many, the Cancer Institute without Dr Shanta is unimaginable.
But one of her colleagues said: “Dr Shanta knew that she was not immortal. She has left a long list of instructions on the path forward. She had planned for a future for the institute without her.”