Neichü Dz. Angami
Some facts about chewing Talab, Dilbagh, Rajah Mix, Rajni Ganda, Paan, Khaini……
All Paan Masalas mentioned above are commonly known as ‘GUTKHA’, which is cheap, brightly packaged and slightly sweetened to appeal to young people as mouth fresheners. It has a strong combination of tobacco, betel nut and palm nuts. The dangers of Gutkha go unnoticed and most of the packages do not carry any health warning. It is shocking to note that children as young as 8 are beginning to use this substance – most due to abundant availability; others due to parental influence and peer pressure.
Most people who chew Gutkha may not know that this substance figure aggressively in Oral Submucous fibrosis (ODF), a common cause of Oral Cancer. In a research in Mumbai amongst regular users of Ghutka, it is found that it only takes about 4 to 5 years to develop OSF and that 7.6% of OSF patients develop Oral Cancer. In an interesting study done at Nagpur Dental Hospital, 57 out of 200 Gutkha users were diagnosed with Oral Submucous fibrosis (OSF). Those who develop symptoms of OSF earlier than others are found to be people who are often malnourished and whose immune system is low and weak.
In Delhi, out of 50 schools sampled for a research on tobacco use, it is found that 1 out of 10 students use tobacco (cigarettes etc) or products of tobacco(Gutkha) and 4.5% of them get hooked to it. 4 out of 10 are found to be able to purchase any of the products freely in the store, despite the law that bans the sale of these tobacco products to those under 18.
Health activist Kalyan Ganglwal who strongly opposed the sale of any form of Gutkha, send 22 samples of Gutkha to John Hopkins Medical Centre, USA. Of these, 21 showed high Carcinogenic (an agent causing cancer) incidence.
Dr. Rajani Bhise, head of Carcinogenesis department, Centre Research Institute, Mumbai, conducted extensive animal studies to determine the effects of non-tobacco Paan Masala and reached a dramatic conclusion. The study involved feeding 500 Mice of three different genetic strains, varying quantities of Paan Masala. Says Dr. Bhise, “ Some of the Mice developed skin papilloma and Oral cyst, Others sprouted gastric and Oesophaegal Tumours. The worst affected animals developed malignant liver, lung and stomach tumours”. He said that they did not use Gutkha or Zarda which contains high amount of tobacco but only those sweetish Paan Masalas which claim to be tobacco free. He was astounded to find that even these concoctions are highly carcinogenic.
India ranks highest in the production of non smoking tobacco products in the world. It is no surprise that it has the world’s highest prevalence of Oral Cancer. It is found that 29% of the population in Kerala and 57% of Mizoram use non-smoking tobacco products. Most of them started using between the ages of 8 to 14. The survey showed that a 5th of these regular users use 5 to 8 packets a day.
According to the estimation of Indian Council of medical Research (ICMR), 8 lakhs people die every year from tobacco related causes that is one death every 40 second. WHO predicts that within 10 years, hospitals in India may find itself flooded with 20 to 30 year olds with complaints of pain and tightening of the mouth. The diagnosis may be precancerous lesion or a full blown cancer.
I was once invited by a principal of a private school in Kohima to talk about the dangers of Gutkha chewing to the high school students. I thought it was a great opportunity to do some studies and present the facts to the students so that they can make informed choices while they still have the freedom to do so. Out of really wanting to know the effects of the substance, I decided to experiment the taste of it. I got hold of a packet of ‘Talab’ and emptied it into my mouth. I found that the effect, whatever it was – whether psychological or physical, stayed with me, at least for a few hours. I also realized that I didn’t like the taste of it. I learnt later that one has to develop a taste for it. It is perhaps similar to any other addiction. Most drug addicts do not like the taste of the chemical, but they like the effect very much and that is why they continue to use it even despite the awful taste.
Out of curiosity, I ask a young girt at a pan shop the other day how many packets of Talab she consumes in a day and for how long she is been taking it. Shyly, she said, ‘about 7 to 10 packet a day’ and that she is been using it since she was in class 5. Presently she is studying in class 8. I ask her if she ever read or heard anything about Talab, she said none. I ask her if she believe it can cause her mouth cancer in 10 to 15 years time, she grinned and wanted to change the subject. When I insisted on continuing the dialogue she snapped by saying everyone in school uses it and it is like any other sweet. Nagaland, although no specific study are carried out yet, do not lack behind in this addiction.
Medical experts say that Oral Submucous Fibrosis (OSF) is a silent ailment. It may begin with difficulty in opening the mouth, protruding the tongue and difficulty in eating spicy food. The disease affects the oral mucosa where the masala is kept. Persistent red or white patches and non healing ulcers may require urgent medical examination. When the disease develops into cancer, it will require a very painful and expensive treatment. And since most patients seek medical help at a much later stage, it may even turn fatal.
Education and awareness campaign against tobacco use needs to be intensified, particularly in schools. Health hazards caused by tobacco use are definitely preventable. Children have a right to be educated and informed with facts. With proper information and awareness they can make informed choices which are the most effective prevention measure. Government and voluntary organization may ban the product or put restrictions around the sale of the product but it may not work because those clandestine vendors and people who consume them may never understand the dangers of the substance and will continue to demand its availability.
I personally feel Tobacco use is a vital health issue and the whole community including parents and teachers need to be thoroughly informed, upon which they will facilitate their participation in its prevention.
Besides being a serious health issue, the colourful Packets of Gutkha are a terrible environmental issue. They are everywhere – in private as well as in public places. Our roads, drainages and rivers are flooded with them. They are non-degradable and therefore, cannot be decomposed. We still have not found a creative way of disposing them.
Perhaps a public discourse around this issue can be a good beginning for a total prevention and early treatment.
The writer is an HIV/AIDS counsellor and a consultant for various international organizations.
