The "cancer express" is a train on which cheap cancer treatment is offered to people suffering from the dreaded condition in India.
It's a 10-hour ride from a district in Punjab with a high prevalence of the disease blamed on excessive use of pesticides to a charity cancer hospital in neighbouring Rajasthan.
AdvertisementA study released last year, backed by the government pollution control body, found 103 people with cancer in a sample of 100,000 in one area of Bathinda region compared to 71 in an area nearby with lower pesticide contamination.
New Delhi's Centre for Science and Environment (CSE) found unacceptably high quantities of pesticides in blood samples from across the cotton-growing district.
The presence of the chemical lindane -- a "possible cancer-causing substance" used in pesticides and insecticides and banned in several countries -- was found to be 605 times higher in Bathinda than in the United States.
Both studies called for the regulation of pesticide use and pointed out a dire need for further research. There are no national figures for cancer prevalence in India.
"The situation is absolutely frightening. And it's not just cancer that people are suffering from," said scientist S.G. Kabra, who is leading a study on the effect of pesticides.
Local doctors say kidney problems, skin infections, heart attacks, birth defects, premature greying of children's hair and reproductive disorders have shot up dramatically since the mid-1990s.
At the Bathinda town station, almost every other group waiting on the platform is undertaking the same journey.
"We meet many cancer patients on this train. It gives us comfort and strength when we see others who have recovered," says Singh's daughter-in-law Balwinder Kaur, who is making the trip for a fifth time.
A few feet away, 55-year-old Joginder Kaur sleeps on a bedsheet spread on the concrete, watched over by her daughter-in-law and brother-in-law.
"The doctors have asked us to come every 22 days," says brother-in-law Phool Singh, taking Kaur for the fourth time to the Bikaner hospital in Rajasthan.
Cancer treatment at private hospitals is prohibitive even for the affluent, while state-run hospitals provide only basic services, leaving most with little choice but to undertake the 400-kilometre (250-mile) journey to the low-cost Acharya Tulsi Region Cancer Centre in Bikaner.
Despite the relative prosperity of Punjab many still struggle to buy medicines.
"We have to spend 70 rupees (under two dollars) daily for the two of them," says Charanjeet Kaur, whose parents-in-law have cancer. Two of their extended family have already died of tumours.
"Since 2001, around 40 people have died of cancer in our village," said another family member and activist Jarnail Singh in the region's Jajjal village, which has a population of nearly 3,000.
One of the 19 districts of Punjab, Bathinda with a population of over a million, forms part of the region's cotton belt, where cancer is said to be widely prevalent.
Cotton is planted just a few days after wheat is harvested and back-to-back cultivation gives insects an opportunity to thrive on the farm, farmers say.
Worldwide, cotton requires extensive use of pesticides, but Punjab farmers say chemical sprays were used on an unprecedented scale in the mid-1980s after hybrid seeds were introduced to boost output.
"We have 10 acres of land. In one year, we sprayed pesticides worth 60,000 rupees (1,500 dollars) and got a yield worth 70,000 rupees," said Jarnail Singh, who first drew the attention of the authorities to the health problems.
Farmers say pesticides were needed only in small quantities when native cotton seeds were used.
"Agriculture scientists used to bring these private, multinational companies in the 1980s and they would push the use of pesticides," Singh said.
Hybrid seeds would attract several types of pests, and required a combination of up to four pesticides, which made the pests more immune and led to greater pesticide use.
And when the American bollworm destroyed crops on a large scale in 2000 even the neighbourhood shopkeeper was selling pesticides, according to Singh.
"Farmers sold their jewellery, land, everything to buy pesticide and save their crop," the 67-year-old farmer added.
The chemicals contaminated ground water and food and directly affected farmers and farm labourers, many of whom used them indiscriminately without reading instructions.
But now, the "cancer epidemic" has motivated nearly 1,000 farmers to turn to chemical-free "natural farming" -- which emphasises the use of traditional Indian methods of farming.
"Our Indian farmer is an agriculture scientist, water specialist, marketing professional -- all rolled into one. We don't need experts who have destroyed our agriculture," said the natural farming movement's founder Umendra Dutt.
Under the practice, farmers use native seeds, fertilisers and "pesticides" made of cow dung and urine, and efficient local irrigation methods.
While chemical farming requires inputs worth at least 3,000 rupees (75 dollars) per acre, natural farming costs not more than 100 rupees, farmers say.
"Our movement is about farming for liberation," said Dutt.