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The Shifting Burden

For Bangkok’s Poor, a Chance to Fight Breast Cancer With Dignity

In Thailand, the cost of breast cancer care means many women never get the help they need. In the latest part of our series “The Shifting Burden,” we look at how one cancer center in Bangkok aims to give poorer women the same chances of survival as the privileged.

Written by Ruth Carr Published on Read time Approx. 5 minutes
Finola Chatamra, who helps run the Slum Outreach Project, meets with a breast cancer patient at her home. Supported by the Queen Sirikit Centre for Breast Cancer Foundation, the project works with local organizations to bring the center’s services to women in Bangkok who can’t afford treatment. Courtesy of Finola Chatamra

BANGKOK – “Look at this, please look! That’s the first installed tomosynthesis machine in the world. Not in the Royal Marsden, not in the States, but right here! We were the first!”

Dr. Kris Chatamra is guiding a reporter around his cancer center, the Queen Sirikit Centre for Breast Cancer (QSCBC) in Bangkok, like an excited child. Past the room housing the state-of-the-art 3D digital mammography machine, a team of technicians sits in another room, peering at mammogram X-rays, while on an upper floor renovations are underway to create a retreat filled with natural light for chemotherapy patients. Down below, a door opens to reveal a small group of women in rehab, learning to belly dance. “Isn’t this wonderful?” says Chatamra, smiling broadly.

Thirty years ago, when Chatamra returned from London after stints at the Royal College of Surgeons of England and the Royal Marsden Hospital, the idea that women in Thailand should have access to the best equipment and the most up-to-date procedures – let alone belly-dancing classes – was considered revolutionary. The hospital in Bangkok that Chatamra worked at, the King Chulalongkorn Memorial Hospital, had only one mammogram machine, “and it was covered in dust,” he says. “And there was no concept of breast conservation. A friend of mine, another doctor, told me that Thai women didn’t care so much about their appearance and full mastectomies were the norm. But I said, ‘Rubbish! Thai women are just as conscious of their appearance as women anywhere.’ So I set about trying to change things.”

A technician reads a mammogram at the Queen Sirikit Centre for Breast Cancer. (Ruth Carr)
A technician reads a mammogram at the Queen Sirikit Centre for Breast Cancer. (Ruth Carr)

With breast cancer the leading cause of natural death among Thai women, Chatamra was determined to show that a holistic approach to detecting and treating breast cancer could save more lives. And that a higher standard of care was possible for all Thai women, not just those who could afford private hospital fees or the airfare to get treatment abroad. “Dr. Chatamra was the first doctor in Thailand to promote breast conservation over mastectomies as the standard form of treatment,” says Dr. Khunying Kaesorn Vajarapongse, associate professor at the BNH Breast Health Centre. “He really pioneered modern therapy for breast cancer patients in this country.”

But despite his years spent pushing for improvements and raising the bar across the industry, Chatamra could still see a yawning gap in the kind of treatments and preventive screenings available to women in Thailand’s most disadvantaged communities. At a private dinner with the country’s Queen Sirikit in 2001, Chatamra described his vision for a specialized breast cancer facility that catered to all women but, most importantly, offered free treatment to those who couldn’t afford to pay.

The queen immediately pledged 2 million Thai baht ($58,000) of her own money to get him started and agreed to come on board as the honorary patron. Four years later, QSCBC was up and running in the grounds of King Chulalongkorn Hospital, which is operated by the Thai Red Cross, in a donated building.

Although Thai women can get breast cancer treatment at government hospitals, they can receive free care only at the hospital where they are registered, which could be in a province far from their home or work. That access to free treatment is available to women only once they have been screened and diagnosed. But in a country with no national screening program, the responsibility falls on women to get themselves checked, which many don’t have the time or resources to do. For those living a subsistence life and who rely on their jobs in Bangkok to support themselves and their families, the costs and time involved in getting diagnosed and treated mean many never get the help they need.

“We are talking about the poorest of poor people. What they earn in the morning is what they need to feed themselves in the evening,” says Chatamra. “So they put things off; they’re terrified of what it will cost. I’ve seen tumors here that I’d never seen in all my years in London. The textbook just doesn’t cover it.”

Working with Chatamra – and, like him, taking no salary – is his British-born wife Finola, who acts as an honorary advisor to QSCBC. She is also the driving force behind the QSCBC Foundation, the center’s charitable arm. As well as providing regular seminars and training for practitioners, and support for patients, the foundation runs the Slum Outreach Project, which brings QSCBC’s services to disadvantaged communities throughout greater Bangkok.

“The women in these slum communities really have nothing and I felt it was our responsibility to be proactive and get out there,” says Finola. “It was clear, given their circumstances, that they weren’t going to come to us. So we just had to get out there and get to them.”

Every three months, the Slum Outreach Project joins up with local foundations already working in the slums to promote awareness about breast cancer, educate people about prevention and treatment and provide screenings back at QSCBC. If anyone has a test result that comes back positive, all the services of the center, including treatment, are available to them for free.

The foundation also brings in social workers to help patients with the process, provides childcare and gives out goodie bags sponsored by Avon. “Because these women are our P.R. agents,” says Finola. “They go back into their communities and they gossip and they talk and they tell other women, ‘You must go.’”

And Chatamra and Finola are not done yet. Next on their agenda is the plan to open Pink Park Village, a specialized hospice and convalescent care home in Minburi province. Estimated to cost around 500 million baht ($14.4 million) to build and run for the first two years, it will double as an education, diagnostic, rehab and daycare center. With 300 million baht ($8.6 million) still to raise, Chatamra and Finola are aiming for an opening date in August 2017.

Chatamra wants Pink Park Village to be an extension of his vision for QSCBC as a place where Thailand’s women, regardless of income, can access holistic breast cancer care, from their first mammogram to their last round of chemotherapy. Or, if treatment is unsuccessful, to their last moments.

“I don’t want to send them home to lie on a floor to die. I can’t do it,” he says. “So we have this concept – to build a sanctuary where people can be treated, perhaps for the first and last time in their lives, with dignity.”

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