Just three months ago, Raju and Sumati Mullick were thinking hard how to end their wretched lives. It wasn’t just their younger daughter Sanjana’s leukemia that was killing them. The family, in trying to meet the cost of her treatment, had lost everything they had earned and were in deep debt. Then there were the two other children they had to fend for.

The couple from Madhubani district in Bihar had already quit farming in their native village to look for a job in Delhi so that they could be close to Sanjana. The best they could do was work as daily wage labourers. Then, as all hope ended, a cancer support group volunteered to bear the cost of treatment of the eight-year-old girl.

“Sanjana has developed infection again and is admitted at AIIMS,” Sumati said on Monday. “She is not able to eat and can barely speak. My husband and I have not been able to go to work for over a week now due to the deterioration in her condition. We have almost no money left.”

The mainstay of treatment for acute leukemia, the type of blood cancer Sanjana suffers from, is chemotherapy. Doctors say treatment costs can vary between Rs 5 lakh to Rs 10 lakh in private hospitals. In government-run centres, though, it can be availed for free. But invariably there are additional costs which patients have to bear.

Gitanjali Bhalla, head of the NGO Pall-CanCare, says that over the years treatment options for cancer have increased. But so have care costs, a big hindrance for many in a poor country like India. “First, government-run facilities that offer cancer treatment remain few. Secondly, there, too, patients have to spend from their own pocket for indirect expenditures like transport, food and lodging, and direct expenses on medicines not available at the hospitals. Newer treatment options like targeted therapy are not available in most government hospitals,” she says.

A report on the ‘Economic burden of cancer at tertiary care public hospitals’ -- conducted on 432 patients who visited AIIMS for treatment between October 2006 and December 2007 -- substantiates this. It says that on an average a patient has to shell out Rs 36,812. Of this, Rs 14,597 is spent before coming to the hospital, Rs 14,031 at the hospital and Rs 8,184 during the prolonged radiotherapy course. In private, it can go up to anywhere between Rs 5 lakh to Rs 40 lakh or more.

Unavailability of cancer care centres across the country is another major problem. India has a requirement of 1200 radiotherapy machines. As of now, we have an abysmal 450 such machines. Modern radiotherapy facilities are concentrated in private hospitals but the cost of the course is prohibitively high -- from Rs 60,000 to Rs 1, 20,000 and beyond, out of the reach of common Indians.

The fact that in 80% of the population is not covered under any insurance scheme makes it even harder for people to deal with the crisis. But do the ones who are insured fare any better? In a 2006 survey in America, almost a quarter of insured patients reported using most of their savings during treatment; a similar proportion said their insurance plan paid less than expected for a medical bill. And this is the US we are talking about.

“There are about 30 lakh cancer patients in India and every year 10 lakh more such cases are detected. With increased longevity and unhealthy lifestyles, the incidence is likely to go up. We will have to focus now on the preventive aspect of the disease,” says a worried Dr G K Rath, heads of the cancer centre at AIIMS.