“My tooth was aching on and off for a year, so I used to take painkillers and keep working,” says Murugan*. “When I went to get it extracted, the dentist in Ariyalur asked to me to get tested for oral cancer. I didn’t know chewing tobacco was so harmful,” the former mason says, eyes welling up as he lisps painfully through a mouth disfigured by cancer.
At another ward in the same city cancer hospital in Tiruchi, the wife of a newly diagnosed lymphoma patient relates a similar story.
“My husband used to work in the Electricity Board, and then took up farming in Thuraiyur after retirement. He started chewing tobacco just for the heck of it two years ago. For the past four months, he had been complaining of toothache. When we went to the dentist, we were asked to come to this hospital,” she says. What makes this patient’s situation more precarious is that he has also tested positive for Aids.
As yet another World No Tobacco Day gets marked on May 31 by the World Health Organisation (WHO), the numbers of those addicted to the leaf continue to assume alarming proportions.
Usually, tobacco use is combined with alcoholism or recreational drug abuse.
A study in the journal Addiction in mid-May found that more than 1 billion of the world’s adult population smokes tobacco, and almost 240 million people have an alcohol use disorder.
This week, The Global Burden of Cancer 2013 study published in JAMA Oncology reported that the number of new mouth cancer cases in India more than doubled between 1990 and 2013 from 55,480 to 127,168, mostly due to chewing tobacco.
Lethal effects “We are seeing more of the young lower middle-income group workers, construction workers, masons and market loadmen, who are engaged in hard physical labour, addicted to a smokeless variety of tobacco that they make into a paste, and keep inside the lip. They don’t chew it, but the essence that it produces erodes the area. Chronic (repeated) use produces ulcers which becomes a cancer,” says Dr. K. Govindaraj, Director, G. Viswanathan Speciality Hospitals.
Patients with oral malignancies caused by smokeless tobacco (that which is not burned before or at the time of consumption), are usually the last to discover that their socalled safe and cheap alternative to cigarettes or bidis is actually as lethal a killer.
“The difference between smokeless tobacco and cigarettes is the point of contact,” says Dr. Govindaraj.
The abrasive juice of smokeless tobacco wears down the mucosa layer of the lip and gum area, making it vulnerable to oral cancer. Smoking a cigarette, on the other hand, can cause at least 14 types of cancer, starting with the larynx (voice box), oesophagus (food pipe), mouth and pharynx (throat), bladder, pancreas, kidney, liver, stomach, bowel, cervix, ovary, nose and sinuses and some types of leukaemia.
Strong drug
So why do people get hooked to tobacco? When asked about his habit, Murugan, the mason says, “I used to keep a wad of tobacco in my cheek and go to work in the morning. I didn’t feel hungry or tired, and could work for long periods.”
The real reason is that tobacco has a strong drug called nicotine whose effects are as powerful as ‘hard’ narcotics like heroin or cocaine. “Initially when people start smoking, they don’t really like it,” says Dr. Govindaraj. “Over time, out of peer pressure and habit, they start liking the smoke and inhaling all of it. It gets into the common area of the food pipe and the windpipe. From there it is being sucked into the lungs,” he adds, describing the process that essentially has coal tar being systematically dumped into the body. It takes less than 20 seconds to get a nicotine hit by inhaling cigarette smoke.
Addiction issues
The growing tobacco dependence has proved to be a major challenge for the healthcare sector, and rehabilitation workers especially in Tier II cities like Tiruchi. “Smoking is usually one in a big combination of problems,” says T. Leela Thiagarajan, Honorary Supervisor, Sigaram Social Service Trust. Associated with the de-addiction and rescue centre since 2008, Ms. Leela has helped 3,500 people to get rehabilitated through its 21-day counselling sessions, but she admits that only 2,500 of them could be expected to stay clear of alcohol, drugs and tobacco forever.
“Addiction issues are starting commonly from age of 13 years in Tiruchi,” she says. “We get a lot of complaints from teachers that students are drunk or using paan masala and not paying attention in class.”
Of late, growing numbers of women, especially those who work as domestic servants, have been approaching the centre for counselling to kick their tobacco habit, she says. “They come to us because they realise that the tobacco juice is causing uterine problems and hampering pregnancy. One mother confessed she wanted to stop because she had seen her daughter chewing tobacco just like her.”
Gender has nothing to do with tobacco use, agrees Dr. Govindaraj. “Parents of girl children can’t just close their eyes and say that only boys smoke. We have to educate the male and female child very early on,” he says.
Warnings
That task is made more difficult when smoking and tobacco products already have a firm grip on public imagination. Cinema’s use of cigarette/cigar smoking (accompanied by an alcoholic drink) as a scene setter or a character indicator of heroism or villainy is a well-entrenched trope. Running a fine-print warning each time such scenes appear on screen is hardly going to make a difference.
“Statutory warnings and counselling are not enough. It depends on the addict to quit,” says Ms. Leela.
“Many countries in the West have replaced the brand name of the cigarette with graphic warning pictures of mouth ulcers, lung cancer ulcers, infertility, premature death of the baby, and so on,” says Dr. Govindaraj.
The best way to avoid falling prey to tobacco would be an exposure to its ill-effects, he suggests.
“If every school takes its senior-level students to hospitals that treat oral malignancies, they will not touch smoking at all. In fact, even if adult smokers can see 10 such cases, they will stop smoking,” says Dr. Govindaraj.
“It is so gruesome when you see people with lips and cheeks eroded due to tobacco use. You can also see flesh-eating maggots on the affected parts, and the smell is so foul that even medical professionals have difficulty in bearing it. There is nothing glamorous about tobacco.”
(*Name changed on request)
