Stop Smoking Campaign’ Crucial To Battle Large-Scale Tobacco Use in Odisha

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Metropolitan India is battling tobacco use through taxation policies, the stepping up of anti-smoking interventions and banning the marketing of gutkha in portable plastic pouches.

But in the distant hinterlands of Odisha, home to a large number of tribal communities, tobacco in various forms continues to be an intrinsic part of life. For instance, smoking, using bhang (tobacco powder) and cleaning one’s teeth with gudakhu (a kind of tobacco paste) is very common among tribal communities in Potangi, Nandpur, Dasmantpur, Narayanpatna, Chandragiri, Gunupur and Kashipur blocks of the poverty-stricken districts of Koraput and Rayagada.

In fact, women here enjoy a quiet smoke using handmade cigars locally known as ‘sutta’ and ‘pikka’. Ignorant about the noxious effects of tobacco, they maintain that it is a means of relaxation for them. Galartha Naik, an elderly tribal woman of Bandhugaon village, puts it this way, “I exactly don’t remember when I started smoking but I know I have learnt it from my parents. Now I cannot live without smoking. If someone comes and tells us to give us eating rice, is it possible?” She reveals that she buys the handmade ‘pikka’ and ‘sutta’ from the market and makes two or three cigars at a time. When one is over, the other is lit up.

Elderly Pamia Lachhma, from an adjoining village echoes Galartha, “We get relief by smoking ‘sutta’. We do such hard work; don’t we need to smoke to warm up our bodies? I certainly won’t give up smoking and will do so till I die.”

Tobacco leaves, locally called ‘dhungia’, are used to make ‘pikka’ and ‘sutta’ – handmade cigars about five to eight inches in length. The women also buy tobacco at Rs 20-25 (US$1=Rs 47.4) per packet, which lasts them for about a week.

Other tobacco based products are also popular. Jamana Gadaba, 45, of Badlimaliguda village, has been using ‘bhang’ from childhood – she recalls that her mother would chew ‘bhang’ slowly after placing it between her cheek and gum. Today, Jamana uses both ‘bhang’ and ‘gudakhu’. “Since five years I am using ‘gudakhu’ because I had pain in my teeth and there was bleeding as well.” The doctor she consulted at a local hospital prescribed some medication which was prohibitive – it cost Rs 200. So she decided to massage tobacco paste into her gum – one container of ‘gudakhu’ costs Rs 10 and lasts four or five days, she says. “It gives me instant relief. When I don’t use this paste the pain starts all over again.”

Every village ‘haat’ (market) in this region has ‘gudakhu’, ‘bhang’ and ‘dhungia’ (a local cigarette) being sold openly. A small-time vendor in ‘dhungia’ and ‘gudakhu’, Madhab Muduli, 50, who has been in the trade for over a decade, has certainly prospered over the years, having risen to his present status from being a wage labourer. Now his two sons have joined him, and the trio supplies tobacco products to different villages in Koraput and Raygada. Explains Muduli, “I know selling tobacco is illegal, but what can I do? There are just no other sources of income available to us. When government officials come by, we hide this merchandise or bribe them to keep quiet.”

But keeping Muduli in business means widespread impoverishment. Take Kusuma Gadaba, 25, of Ramgiri village, who argues that she will not be able to work if she does have her daily quota of ‘gudakhu’ and ‘bhang’. On an average she spends Rs 3 a day on ‘bhang’ and Rs 2 on ‘gudakhu’. A sum of Rs 5 may seem paltry for those who earn in thousands, but for Kusuma it means a huge hole in her monthly income that averages less than Rs 500.

According to the National Family Health Survey (NFHS-3), over 54 million women use some form of tobacco. Apart from smoking, women in India, particularly in rural areas, use smokeless tobacco like ‘gutkha’, ‘paan masala’ with tobacco, ‘mishri’, ‘bhang’, ‘gul’ and ‘gudakhu’. Nearly nine-in-100 women chew tobacco in contrast to two-in-100 who smoke.

Take these figures alongside those put out by the Global Adult Tobacco Survey (GATS) – India 2010, which says that smoking kills 900,000 people every year in the country and that about 62 per cent of women who smoke can expect to die between the ages of 30 and 69, compared to 38 per cent of non-smoking women. Women who smoke ‘bidis’ shorten their lives by about eight years on an average, while smoking one to seven ‘bidis’ a day raises mortality risks by 25 per cent. Then there is a World Health Organization (WHO) Survey Report, which reveals that India has the highest number of oral cancer cases in the world, 90 per cent of which are caused by tobacco consumption.

Unfortunately, tribal women like Galartha, Pamia and Kushuma are completely unaware of these chilling stats. In fact, they have hardly ever been told in simple language that what they chew or smoke in a carefree manner in their pristine village forests is all set to kill them prematurely.

That’s not all. Medical officers here point out that babies in the wombs of women who smoke are at higher risk of being born with a low baby weight. They are also likely to suffer from various respiratory tract infections. Says Shanka Sekhar Chowdhury, district medical officer of Koraput, “In a pregnant woman, oxygen is supplied to the baby through the placenta and when women smoke, the oxygen flow gets restricted, affecting the growing embryo adversely.” Bhubaneswar-based gynaecologist, Veena Panda, adds that diseases such as chronic bronchitis and even cancer of the urinary bladder or stomach can be caused by excessive smoking.

Why is tobacco so toxic? Explains Dr Kumar Pravash, an oncologist attached to the Tata Memorial Hospital, “Tobacco contains nicotine that is highly addictive. There are about 3,095 chemicals in tobacco out of which 28 are proven carcinogens and increase the risk of cancer. Scientific evidence has proved that chewing tobacco causes cancers of mouth, oesophagus, larynx, pharynx, pancreas, stomach, kidneys and lungs. It can also cause high blood pressure, leading to cardiovascular diseases.”

A Union Health Ministry’s monograph has categorised Orissa in the intermediary low bracket (prevalence range between 1.1 – 2.9 per cent) with regard to the ‘bidi’ consuming population but the danger lies in the high usage of ‘gudakhu’. What’s worse is that ‘gudakhu’ consumers are also likely to be illiterate and from the poorest communities.

A few activists have tried to make the tribals more aware of the ill effects of smoking and tobacco use and they argue that creating such awareness is crucial. Says Sarat Kumar Dhal, an activist from Potangi block of koraput district, “To date, neither state government officials nor any civil society organisation has come forward to point out the dangers of smoking here. The government is keen to be seen to be addressing the backwardness of the local population, but it has overlooked the specific tobacco use problems in the region.”

There is a spectre haunting the tribal belt of Orissa, the spectre of tobacco. And unless the authorities wake up to its hugely detrimental impacts on the health of population, women like Galrtha, Pamia and Kusuma are destined for early deaths.

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