India is the second largest producer and consumer of tobacco in the world. Tobacco cessation experts say during the pandemic, more people from our cities and villages are lighting up cigarettes and beedis or chewing tobacco. On World No Tobacco day, we take a look at how tobacco has burnt a hole in people’s lives and their pockets.
Anil Kumar was detected with oral cancer in 2014. Doctors told him his love for tobacco got him into trouble. “I was shocked when I heard from the doctor that I had cancer. After radiotherapy, my face had turned black. My body became senseless. I was depressed and I had suicidal tendencies.”
Hari Om – another cancer survivor – recalls with horror, how he was diagnosed with cancer thrice and his cancer relapsed twice. Tobacco, he says, caused him irreparable damage.
“I was detected with cancer three times and it resurfaced twice. I have suffered a lot. You won’t find people like me on the streets. They isolate themselves in their homes. I have seen people who have lost their entire facial features to oral cancer. There are people with no skin on the side of their cheeks. Their jaws and teeth can be seen. There are people with incisions on their throat. It’s not just me. I have seen many people suffer.”
In India, at least 146 people die every hour because of tobacco consumption, 3500 people die every day and tobacco kills close to 1.3 million people every year. Dr Sajeela Maini, Head of the Tobacco cessation department in Sir Ganga Ram Hospital says children are falling victim to the addictive effects of tobacco.
“As per statistics, we have more than 5 million children who are addicted to tobacco. I have seen children who are less than 15 years of age come to me with addiction problems. 5, 6, 7-year-old children have problems related to tobacco addiction. The other day I had a patient who was 10-years-old and he already had fibrosis and was in the early stage of cancer.” Dr Sajeela Maini is also the author of The Last Puff, a rule book on quitting.
Tobacco consumption is a major risk factor for non-communicable diseases like cardiovascular disease, cancer, chronic lung disease and diabetes. Research says that tobacco puts people with these conditions at higher risk for severe illness when they are affected by Covid-19. Tobacco also contributes to infectious diseases like tuberculosis and lower respiratory infections. The smoke from tobacco contains toxic chemicals that cause damage to the linings of the airways and the lungs
Joy, a tobacco addict, says that more than the physiological toll, it is the social and psychological trauma that is overbearing. “I became a loner. I was happy to be alone because I wanted the company of the substance. I knew what was happening was wrong but I was so deeply lost in nicotine addiction that I was not able to come out of it.”
Amit, another tobacco addict, says his tobacco cravings made him despise people. “Because of tobacco consumption, I got into such a stage in life that till the time I didn’t consume tobacco I couldn’t do anything. Without tobacco, I didn’t like food. I didn’t like people. I used to get irritated when people used to talk to me. I wanted people to leave so that I could consume tobacco.”
According to the World Health Organisation, tobacco kills up to half of its users. Tobacco consumption is one of the biggest public health threats in the world. As per research, tobacco smoke contains over 7000 chemicals out of which more than 69 are capable of causing cancer with nicotine being the main addictive chemical compound in tobacco.
Rajan, another tobacco addict who we met at a rehabilitation centre says tobacco consumption changed his life for the worse. “When I used to take nicotine, I was unaware that I would be dependent on nicotine. After dinner I needed nicotine. I would feel that my food wouldn’t get digested without nicotine. In the morning, when I used to go to the washroom, I needed nicotine.”
There are many who have also overcome the addictive effects of tobacco and have turned over a new leaf. We met Dushyant Chopa, who started smoking at the age of 15. He says he was a chain smoker, an alcoholic and a drug addict. Today, he works at the Tapasya foundation in Delhi NCR and is helping many tobacco addicts to quit.
“I smoked cigarettes till 10th standard and after that I started consuming alcohol. I also started consuming drugs. I was completely addicted to multiple things. It took a lot of effort and time to get out of my addiction problems. Today, I am happy that I am helping other addicts to quit.”
The World Health Organisation reports that without cessation support only 4 percent of attempts to quit tobacco will succeed. Dr Dharav Shah, a Tobacco Cessation Consultant with the Centre for Health Research and Education says that awareness campaigns and cessation support is the key to getting people to commit to quit.
“Covid has killed around 3 lakh people in India. Tobacco kills more than 12 lakh people every year in this country. So, in a good way, Covid has given a very strong reason for people to quit and those who are deciding the policy, if they want to bring down the death rate, they must give importance to tobacco cessation services.”
Dr Puneet Gupta, a Director with the Oncology Services department of Metro Hospital and Cancer Centre says that much more needs to be done to help people quit. “We have to implement policies and programmes of international bodies like WHO, UNICEF and UICC. We should work closely with cardiac bodies and healthcare teams in hospitals. We should educate patients and give counselling, psychological, and de-addiction support to people who need it.”
Ashish, a 30-year-old man, was diagnosed with cancer a month and a half ago. He says he is under treatment for cancer but he still cannot shun tobacco. “I am trying a lot to quit. To some extent, I have been able to reduce the quantity but it feels like I have hit my rock bottom. I am still trying to get out of nicotine addiction but I get craving calls. I am only able to stay away for 2 to 4 hours but after that I just take nicotine. Today, I have reached such a stage that nicotine is more important to me than my disease itself.”
Anupam Manur, an Assistant Professor of Economics with the Takshashila Institution says much needs to be done by the government. “Over the years, the government has done various things. During every budget there is an extra tax put on cigarettes but the whole bunch of things that the government can do which it’s not doing very well, is in the aftermath area. What if once the person has started smoking, how do you get the person to stop and how do you help him to quit smoking? This is where I think the government in India is not doing very well. So, one of the things it can do is use a lot of the tax money that it collects from cigarettes and use it for rehabilitation and on cessation programmes.
The Indian government in 2019 banned electronic cigarettes. The government prohibited the production, manufacturing, import and export of e-cigarettes but many feel much more needs to be done to help people quit.
Dr Bageshri Gogate, a Senior Education Advisor with the Centre for Health Research and Education says cessation programmes must be included in medical curriculum. “I teach in a medical school. In our medical curriculum there is no subject on tobacco cessation. MCI or the NMC now has come with a new medical curriculum and it will be good if they include cessation programmes in the new medical curriculum so that all the medical graduates are equipped with the knowledge to deal with such problems.”
Anil Kumar, says, quitting is now not an option. “I have suffered a lot. Therefore, I want to request all smokers and tobacco users with folded hands: please quit now. It’s now or never. Tobacco might seem good today but it is not good for your tomorrow.”
(The copyright of this social impact project belongs to Centre for Health Research and Education, UK)
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