In an interview with Zee Punjabi in 2021, the singer Shubhdeep Singh Sidhu, better known by his stage name Sidhu Moosewala, said if he had one superpower he would “cure all cancer patients”.

Moosewala was shot dead on May 29 in an act of what the Punjab police have described as gang violence.

A week later, his home at Moosa village in Mansa is still thronged by relatives, neighbours, fans, and politicians mourning his death.

The singer had chosen his stage name as a tribute to his village. “He put Moosa on the map,” said Navdeep Singh, who was at Moosewala’s house to pay his respects. That wasn’t his only contribution, however. Several villagers Newslaundry spoke with said that they were most grateful to Moosewala for helping set up “cancer camps” every year.

It isn’t hard to see why. The disease has ravaged the village. “It is said here that whoever leaves our village for cancer treatment doesn’t come back,” said Sukhchain Singh, 28, a BTech student.

As of 2013, Punjab had more cancer patients than the national average and saw an average of 18 deaths from cancer per day. The Malwa region, which includes Moosa, was the worst-affected with 136 cancer patients per lakh population. In February 2022, data collected by the Advanced Cancer Institute in Bathinda which treats patients from across the Malwa region as well as Haryana and Rajasthan, shows an “almost fivefold increase in patient inflow” in the last four years. In spite of its high incidence of cancer, Punjab’s screening rate is abysmally low, with just 2 percent of the women aged 30-49 screened for breast and cervix cancer and only 7.9 percent of the population screened for oral cancer. This has led to two things – late detection of the disease and the lack of up-to-date data on cancer incidence in the region.

There are multiple reasons for the high incidence of cancer in Punjab. In 2013, JS Thakur, additional professor of community medicine at the Postgraduate Institute of Medical Education and Research in Chandigarh, told Down to Earth that high levels of arsenic and uranium in water and increased usage of pesticide during the green revolution had caused high chemical toxicity in the food belt of India. Alcohol consumption and smoking among labourers had further increased the risk of cancer in the region.

So dire is the situation that a train from Bhatinda to Bikaner, Rajasthan, which until a few years ago had the closest cancer treatment centre, Acharya Tulsi Regional Cancer Treatment and Research Centre, is known as the “cancer train”. The ticket for a cancer patient is free and the accompanying caretaker gets a 75 percent discount.

By 2021, Punjab had established state-run cancer hospitals in Bhatinda, Sangrur, Faridkot, and Fazilka, reducing the flow of patients leaving the state for treatment.

Nevertheless, in April 2022, Bharti Pravin Pawar, union minister of state for health, told the Lok Sabha that according to research conducted by the Indian Council of Medical Research’s cancer registry, at 38,636 cancer patients in 2020, Punjab’s cancer count was still high compared to the neighbouring states.

Specifically for Moosa, population 7,000, there’s no data on cancer patients and deaths, said Sukhchain, who is now trying to maintain a register. “Anecdotally, it looks like the number of cases has come down. We hear about it a little less but the financial and emotional pain of losing people still weighs down families,” he added.

Disease and debt

Sewak Singh lives with his 9-year-old daughter and 12-year-old son in a half-built house. In early 2016, Sewak’s father, Bira Singh, 55, was diagnosed with advanced liver cancer at the Mansa Civil District Hospital, which sent him for treatment to Guru Gobind Singh Medical College in Faridkot.

The father and son made two fortnightly journeys to the state-run facility, two and a half hours away by public transport. “Then my father became too weak to travel and the trip was too expensive, so I took time off work and we moved to Faridkot and lived in a gurdwara for three months,” Sewak said.

They returned home after Bira Singh had surgery in May 2016. They still needed to visit Faridkot afterwards to do follow-up tests and buy medicines, and each trip cost at least Rs 12,000. “We had to take a car because we could not risk taking him by bus or train,” Sewak said.

On June 14, 2016, six months after his diagnosis, Bira Singh died.

Sewak is a Mazhabhi Sikh, a scheduled caste in Punjab. Along with Ramdasia and Ravidasia, who are also Dalit, Mazhabi Sikhs mainly work as labourers on land owned mostly by upper caste Jat Sikhs.

The economic costs of cancer are especially debilitating for them, said Sukhchain. “They spend their lives in debt to their zamindar, and often can’t afford treatment.”

For his father’s treatment, Sewak had taken a loan of Rs 1,70,000 from his landlord which he is still repaying. In 2017, Sewak lost his wife too, to kidney failure. Three years later, heavy rains felled his house.

“My landlord takes a certain amount from my salary every month towards repayment of the loan,” he said. “I will work for him until I have repaid the loan.” So he is not able to save much to pay for the construction of the house.

Had there been a good cancer facility nearby, Sewak contended, his father could have been “diagnosed earlier and treated better”, and he would have saved on expenses. Only once in all that time his father was undergoing treatment – he doesn’t remember the date – did Sewak not have to make the expensive trip to Faridkot. He could instead get his father’s tests done at a “cancer camp” in the village, organised by Moosewala.

Balwinder Singh, 44, also a Mazhabi Sikh, lost his mother to cancer in 2016. Balwinder had left his job as a schoolbus driver to take her to Guru Gobind Singh Medical College, Faridkot, for treatment. She died two months later.

The Mansa Civil Hospital, where she was diagnosed, had referred them for treatment to the Advanced Cancer Institute in Bathinda, Balwinder said, but “they didn’t have good facilities so we went to Faridkot”. In May 2022, the Faridkot hospital too was subject to an investigation for allegedly not providing basic facilities to patients.

By the time Balwinder returned from Faridkot the school had hired a replacement driver, and he never got his job back. A year ago, he lost his father to Covid. He now works as a farm hand to repay a Rs 60,000 bank loan he had taken for his mother’s treatment.

On the back cover of Balwinder’s phone is a picture of Moosewala. “He was really troubled by cancer cases in our village. He promised all of us that he would make it go away and now he’s gone,” he said.

A short walk down the road from Balwinder’s home, Gurjeet Kaur, 55, lies on a charpoy in her courtyard. She is a Ramdasia. Gurjeet, diagnosed with cancer in April 2021, can barely stand on her own. “I can only have juice, dalia water and watery dal. I can’t eat much,” she said.

Gurjeet’s family had to sell some of their jewellery to pay for her treatment, which has cost around Rs 3 lakh so far. She underwent surgery in a private Ludhiana hospital because her family “did not want to take the risk at a government hospital”.

Gurjeet’s son takes her to Faridkot twice a month for post-surgery treatment and tests. She has had one session of chemotherapy and is likely to require more. “Each trip to Faridkot costs us at least Rs 20,000,” she said, adding, “Sidhu was the only one who ever cared about any of us. He was the only one who spoke of cancer.”

A few streets away, Sarvajeet Kaur, 36, a Jat Sikh, has been undergoing cancer treatment for over six months. She was diagnosed at the Bathinda cancer hospital and is now being treated with chemotherapy. “When I found out I had cancer, I was so scared. Most people in our village haven’t recovered from the disease and become a financial burden to their family,” she said. Her husband, Baljeet Singh, added, “The fear is very real. Thirty years ago, I lost my great aunt to cancer.”

Moosewala, Baljeet said, was one of the few politicians – the singer was a Congress party leader – to make a serious attempt to tackle the problem.

“These are never election issues. No politician even visits us unless it’s election time,” Baljeet complained. “Sidhu was the only one who raised the issue of cancer in our village.”

Of the six families affected by cancer that Newslaundry spoke to, five have benefitted from Bhagat Puran Singh Sehat Bima Yojna, a health insurance launched by the Akali Dali government in 2015 to provide cashless treatment upto Rs 30,000 in 240 public and private hospitals. The scheme was extended by the Congress government in 2018.

Then, in 2019, it was brought under the central government’s flagship health insurance scheme, Pradhan Mantri Jan Arogya Yojana, or Ayushman Bharat. Sarvajeet is one of the Ayushman Bharat beneficiaries in Moosa.

But more than government schemes, Sukhchain said, it was Moosewala that the villagers looked up to for help. Indeed, every house in Moosa that Newslaundry visited had posters, stickers or photos of Moosewala.

In 2018, after Moosewala’s mother Charan Kaur became the sarpanch, the village’s dispensary started functioning again, Sukhchain said. “Even though he lost the Assembly election this year, his focus on developing Moosa was undeterred,” he added. “He was planning to build a cancer hospital here.”

Pictures by Nidhi Suresh and Ashwine Kumar Singh.