Harvinder Ahuja
A 71-year-old doctor recently underwent a high-end robotic surgery for his prostate cancer. Weeks later, first the left leg and then right one, started swelling up. “This is lymphedema, but we can do nothing about it”, he was informed by the treating doctor.
Most patients are never told that cancer and its treatment can cause lymphedema. This changed somewhat in 2018-19 when due to canvassing by Lymphatic Education & Research Network (LE&RN), a law was promulgated in the USA that all patients undergoing treatment of cancer be warned about the possibility of lymphedema occurrence.
This rule, says renowned surgeon Dr Shashi Gogia, is unknown in India. Globally, he says, lymphedema is a staggering public health crisis, affecting an estimated 170 to 250 million people – between 20 and 40 million in India alone. It is the second highest cause of morbidity, he informed further.
Delhi-based Dr Shashi Gogia, along with his wife Arun Rekha, is running the only LE&RN-recognised Centre of Excellence (CoE) in the country.
While the West grapples primarily with cancer-related and genetic lymphedema, India faces a dual burden. Historically, it has been the epicentre of Lymphatic Filariasis (elephantiasis), a mosquito-borne parasitic infection. The country still carries approximately 40 pc of the global filariasis burden. Despite high prevalence, lymphedema is plagued by systemic medical neglect.
According to Dr Gogia, though lymphedema is incurable, it is manageable. The global gold standard is Complete Decongestive Therapy (CDT) – a daily regimen of specialised massage, compression bandaging, meticulous skin hygiene, and exercise. However, a massive ‘skilling gap’ remains.
To combat this, the Society for Administration of Telemedicine and Healthcare Informatics (SATHI) and LE&RN India chapter are collaborating with Healthcare Sector Skill Council (HSSC) to train a grassroots workforce of caregivers, nurses, and ASHA workers in basic CDT protocols.
Besides, LE&RN India-SATHI have also been organising World Lymphedema Day every year on March 6 with a view to spreading awareness about this tropical disease.
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