By Susmita Sharma, MD
Not everyone in my country, Nepal, is fortunate enough to fulfill a dream of visiting a land like the United States. I was able to do so thanks to the International Development and Education Award and Long-term International Fellowship awarded by ASCO and the Conquer Cancer Foundation. I am blessed with opportunities to expand my knowledge under the guidance of wonderful mentors like Dr. John W. Sweetenham and Dr. Daniel Couriel at Huntsman Cancer Institute, Utah, and to learn about a culture so different from my own. At the same time, I aspire to provide a service like the one here in the United States and to ease the immense suffering of patients with cancer and their families in my home country.
During the clinical rounds with my mentors in the U.S., when I witness a patient with blood cancer undergoing bone marrow transplant or a treatment under clinical trial, with all the support they receive from their government, social services, case management, pharmacists, physiotherapist, psychologists, and many more, in addition to their treating physician, my heart aches for the patients back in my country. I watched a father of a 16-year-old son with blood cancer crying and blaming himself for not being able to pay for his son’s treatment, waiting for him to die. I watched a mother of a 26-year-old patient with lymphoma forcing him to stop treatment, not because she wanted him to die—she was afraid that with all the money she had spent in educating the very child who was now was ill, and now treating his (in her opinion) incurable disease, her other 4 children would die of poverty. I start cursing myself for not being able to help, my country for not being able to protect its citizens, and our fate for not being born in a rich country with all the resources needed for improving the life of those in need.
Then, somehow, I remember the faces of my patients with their family and their friends, learning to smile in the toughest of situations, always supporting each other, laughing and crying together. I remember a 9-year-old girl who learned to cook so that she could help her mom who had metastatic breast cancer, complaining to me with a childish innocence that her mom was not motivated enough to eat and to live, yet showing a courage and maturity even many adults lack in such a situation. I remember a patient fighting last-stage lung cancer bringing me a homemade ghee while I was heavily pregnant, worrying that I was not gaining enough weight for pregnancy. This makes me somehow feel good, feel blessed to be surrounded by people so vulnerable yet so strong. My heartache eases as I realize that this is what we fight for: not for a long life, not even for a rich life, no, but for a life worth living. Once again I feel motivated and once again I dream.
But, dreams don’t come true by themselves; we have to work hard to achieve what we want. Though I am here in the U.S. learning new things from one of the very best oncologists and clinical researchers in a state-of-the-art cancer center, my dream of one day starting a similar center at my country with a stem cell transplantation facility still faces many challenges. With 25% of Nepal’s total population living below the poverty line and with infectious disease like tuberculosis, cholera, and hepatitis still highly prevalent, the challenge is not only establishing such a cancer center with all the facilities but also providing such quality service to those who cannot afford to pay, and training the necessary care providers who are willing to devote their time and energy to the cause. The other step, even more challenging, is to build a team with a common goal. In a country where there are hardly 50 oncologists, no social and psychological support for patients and family, no system of hiring a pharmacist to consult regarding possible drug interactions and side effects, and no insurance to pay for the bills, a country where a single oncologist has to treat all kinds of cancers, it is a tough dream to chase. But it’s not at all impossible.
The awards and fellowships provided by Conquer Cancer and ASCO are a blessing to people like myself, not only from my country but from countries around the world like mine, for those who want to do something for their people, who want to learn and to share their experience and knowledge, and for those who want to make a difference. I hope that many more physicians like myself will benefit from such programs in the future.
Dr. Sharma is a research fellow at Huntsman Cancer Institute in Utah. She is a 2016 recipient of ASCO and Conquer Cancer’s International Development and Education Award (IDEA) and 2017 Long-term International Fellowship (LIFe). In her home country of Nepal, she practices at Bir Hospital in Kathmandu.