Susmita Barman explains how young people in India do not realise how chewing sweet gutkha could lead to oral cancer later in life
It was one of those busy days when you have no time for yourself in the morning. I was late for the 9 am radiology lecture and felt a bit nervous because the professor will not let you in if you are just a minute late. I cursed myself for studying late as the taxi got stuck in front of the boys' school about half a mile away from the gate of my college.
A few dozen young boys had spilled on to the road and created a traffic snarl, flocking around four or five mobile vendors selling colourful pouches of gutkha--a sweetened form of smokeless tobacco. The melee blocked rush hour traffic for half an hour--as long was the school break (or "tiffin hour") lasted. This was almost routine, since the school authorities had banned gutkha hawkers from its premises. But the ban could not prevent kids, hardly in their teens, from slipping out to these mobile vendors, who knew exactly where to place their long colourful strips of gutkha, at the far corner of the school.
The kids were nothing more than a nuisance to me until I began to notice a new breed of patient in our radiology department. Most of these men would wear strange looking tattoos specifically marked over their face to help position the radiotherapy. Some of these patients would don a porous mesh mask and wait patiently at the department. The most striking aspect of the scenario was that many of these people were hardly in their mid-20s; they had obviously got mouth cancer (to be precise, squamous cell carcinoma of the head and neck). I remembered Professor S Ganguly, the head of the department of radiology, mentioning this brewing new epidemic of mouth cancer in the Indian youth--fuelled by seemingly innocuous addiction to gutkha.
He explained to me the problem with gutkha--a mixture of areca, catechu, betel nut, lime, tobacco, and mint--is that chewing tobacco is somewhat socially acceptable in India. Wrapped inside a betel leaf and placed in the side of the mouth, tobacco has been chewed for centuries in India as harmless mouth fresheners. But it is only in the '90s that tobacco companies began selling the dried version of the concoction in smartly packaged pouches or sachets. It costs as little as a rupee (£0.01; $0.02; a0.02) and is available virtually everywhere, thanks to street vendors and roadside shops.
In addition, some manufacturers package gutkha as if it were a sweet--bright colours and pictures of skimpily clad Bollywood actresses lure the young.
The children at the traffic snarl were only a fraction of millions who have fallen under the grips of the deadly fad. According to Pankaj Chaturvedi, a head and neck surgeon in Mumbai's Tata Memorial Hospital, a survey of school children in a coastal village in the state of Kerala in southern India showed as many as 29% of school children chewed tobacco. Another survey in Mizoram, in the far eastern fringes of India, showed a rate of 57%. Chaturvedi's letter to the BMJ says children get addicted to gutkha when they are aged between 8 and 14.1 Another survey of 1800 boys of ages 13 to 15 in 1998 found that a fifth of them used three to five packs of gutkha each day. As mouth cancer can take up to a decade to develop, the adolescents will not feel the damage until they are in their early 20s. Which means hundreds of thousands of young adults will crowd the hospitals complaining of pain and tightening of mouth within the next 10 years. The diagnosis will be either a precancerous lesion or a full blown cancer.
Out of sheer curiousity, I decided to ask the kids near my college what draws them to the packs of poison. A 13 year old boy called Rajesh had just bought five packs of a popular brand of gutkha and was just about to put the entire contents of one of them in his mouth. As I approached him he seemed quite reluctant to field my queries. He'd been buying gutkhas since he was 10 and it was not unusual for him because almost every other uncle, cousin, or nephew would have several packs in a day. Rajesh hailed from a family connected to big business in which tobacco chewing has been a tradition for generations. The guardians in such families view gutkhas as nothing more than sweets. When I mentioned that eating gutkhas could cause cancer the teenager had a derisive smile, "My 80 year old grandpa eats at least 10 tobacco laced paan a day and he's still as stout as a young man," he said, "After all, I am not smoking or drinking alcohol."
Just like Rajesh's guardians, most adults in India are unaware of the dangers of chewing tobacco. Parents even buy sweetened gutkhas for their children. I met one such woman outside the radiology department of my college. She had bought sweetened gutkha for her son since he was 12 years old. Shobha Agrawal, a woman in her late 40s, had never imagined that seemingly innocuous gutkha could be so dangerous until her 21 year old son Arun's mouth suddenly got clamped one night after dinner. They took him to a doctor, who rescued him from his locked jaw and were told that Arun had a precancerous condition called submucous fibrosis. He was referred to our college's radiology department.
According to Chaturvedi's study, three out of five submucous fibrosis cases in India turn into cancer.2 The day I spoke to Arun was the day of his third session of ultrasound therapy at the hospital. Shobha was in tears because she holds herself responsible for her son's addiction. "Now I ask everybody in our community to shun tobacco and save themselves from such a miserable condition."
Rajesh and Arun are just two faces of the brewing epidemic. Last week I saw a newspaper article saying that on the next "no tobacco day," the government was going to implement a strict ban on selling gutkhas within a 100 metre radius of schools, hospitals, and public places. But I doubt if such restriction will work, because of clandestine vendors and people who do not happen to work in a radiology department of a public hospital and are unaware of the dangers.
