Citizen News Service (CNS)

Chewing Tobacco: A Lethal Menace On The Block

Photo credit: Shobha Shukla-CNS

Jyoti (name changed) hails from rural Uttar Pradesh which has a high prevalence rate of smokeless tobacco. Two years ago she became addicted to paan masala (a popular form of chewing tobacco) of a particular brand, under the influence of her friends. She began with one or two pouches a day, but the number quickly increased to 25. With one pouch costing one rupee (less than 2 cents) she had to cook stories to get money from her parents for this. She says, “I would ask them for money to buy eats and spend it on tobacco. I would eat outside the house, never in front of my parents. Then I would brush my teeth.” Eating tobacco put her on a high giving her momentary respite from the perpetual tension in the family. Her own marriage had broken and her father ill treated her mother. At the end of one year she started having difficulty in opening her mouth fully—‘It was difficult for me to open my mouth to put my three fingers inside it.’

I am alive because of my children: Story Of Vani

This is the story of Vani (name changed), a 43 years old mother of two bubbly kids—Kajal and Tarun (names changed) aged 13 years and 10 years respectively. She is one of the lucky few who could eventually manage to access and successfully complete her treatment of MDR TB, outside the woefully inadequate government DOTS Plus programme. It is the story of the grit and determination of a mother who conquered all odds for the sake of her children. Her concern and love for them gave her strength to not only grapple with her infection of HIV/AIDS and drug resistant TB (MDR TB) but also to face singlehandedly the stigma and discrimination at the hands of her apathetic family and society.

A study titled Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region was released in Bangkok today (17th May, 2012) to mark the International Day Against Homophobia and Transphobia. According to this research, which was jointly released by the United Nations Development Programme (UNDP) and the Asia Pacific Transgender Network (APTN), transgender persons are among the most socially ostracized in this region and lack fundamental rights, including basic access to health care and social protection schemes. So there is need for concerted action by governments, civil society, development partners and the transgender community itself to design and conduct further research to fill the lack of information about transgender people and their environments.

A beautiful healthy smile is an enviable asset one can possess but, despite longing for pearly white teeth, we willingly fall prey to some habits which not only trap us in their dangerous clutches but also deprive us of our health and happiness and sometimes even our life. Commonly, tobacco is consumed in two forms-smoking and smokeless. There is a strong scientific evidence that tobacco causes cancer and the commonest association of ‘spit’, ‘chew’ or ‘snuff’ forms of smokeless tobacco is with oral cancer.

India currently holds the dubious distinction of being the second largest producer and the second largest consumer of tobacco in the world. Not a particularly dignified title, considering that tobacco kills half of its dedicated users prematurely in their productive years! According to the Global Adult Tobacco Survey-2010, 47.9% of males and 20.3% of females currently use tobacco in some form in India. Globally, smoking prevalence is declining in developed nations while it is on the rise in developing countries. India is currently on an upward swing both in terms of tobacco use and mortality thereof.

By Jittima Jantanamalaka, CNS Thailand

Part 2: Take Control of Asthma - Assure Access to Quality Affordable Medicines [Thai version]

Special thanks:

International Union Against Tuberculosis and Lung Disease (The Union); Prof Nadia Ait-Khaled, Union advisor on asthma, ISAAC Steering Committee and ISAAC Africa Regional Coordinator, Executive Committee, BOLD (Burden of Lung Disease) study. Co-author of asthma management chapter, GAR, Muthita Trakultivakorn, MD, Associate Professor. Division of Allergy & Clinical Immunology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand, and The Asthma Foundation of Thailand.

Part 1: Taking Control - Understand Asthma and Its Triggers [Thai version]

What does making TB a notifiable disease mean to us?

[हिंदी] On one hand the Indian Revised National TB Control Programme (RNTCP) needs to be complimented for making tuberculosis (TB) a notifiable disease (read the government order issued on 7th May 2012 here), but on the other hand there are words of caution and oft-repeated list of actions RNTCP should consider to reach the unreached populations who need TB services. Probably in response to the alarm bells that went ringing when Mumbai reported ‘total drug-resistant TB cases’ the government has taken the step to make TB a notifiable disease.

The key to fighting the tobacco menace is engaging youth at the forefront of the battle, with both youth focused tobacco control programs and policies and youth-led health advocacy. According to the World Health Organization, nearly 80 percent of the all adult smokers begin before 18 years of age. In India, 5500 youth initiate smoking every day. Of the 1000 teenagers smoking today, 500 will eventually die of tobacco related diseases - 250 in their middle age and 250 in their old age. The most susceptible time for initiating and experimenting with tobacco use in India is during adolescence and young adulthood, between 15-24 years of age. Estimates from the Global Tobacco Youth Survey (GYTS) show the growing concern of tobacco use by youth in both developed and developing countries. Nearly 15 % of Indian youth use tobacco in one form or the other – smoking or smokeless forms.

Tobacco is the only legal consumer product that kills when used exactly as indicated by the manufacturer. This catastrophe called tobacco gives out a scary factsheet. According to the estimates of the World Health Organization (WHO) about 1 billion people around the world will die from smoking in the 21st century, which is ten times the numbers killed throughout the 20th century. The World Health Organisation's 2012 Global Report on Mortality attributable to tobacco shows that seven percent of all deaths for age 30 years and over in India are attributable to tobacco.

Chewing Tobacco Chews Away Your Life

Tobacco was considered as an alien product in India and was not welcome to begin with. However, the widespread uptake of tobacco habit as we see it today marks a huge victory for the tobacco promoters. In a milieu of social changes in India, fuelled by foreign news media, influence of foreign films and global economic players, a tug of war is going on in the women’s minds between the tobacco pushers on one hand and societal values on the other. In a country where smoking is generally not socially acceptable for women, it is increasing among certain social groups. The aspirations of some independent and so called liberated women match with what the tobacco companies are promoting and they are getting hooked to smoking cigarettes.

According to the The Global Asthma Report 2011, published by The International Union Against Tuberculosis and Lung Disease (The Union) and the International Study of Asthma and Allergies in Childhood (ISAAC): Asthma is the most common chronic disease among children and also affects millions of adults. The burden of asthma has been growing over the past 30 years, particularly in low- and middle-income countries, where a large majority of asthma patients are treated only on an emergency basis – when they arrive at a health care facility with an acute attack of asthma. Part of the problem is that quality-assured asthma inhalers, that are essential to well-managed asthma, are either not available or are prohibitively expensive. Another barrier is that the health services lack the strategy, systems and trained staff for providing good asthma care. The Union urges the international community and countries to make sources of funding rapidly available, so that access to quality-assured essential asthma medicines and asthma care can be scaled up and improve the patients’ quality of life, significantly reducing costs for patients and health systems.

By Jittima Jantanamalaka, CNS Thailand

Part 1: Taking Control - Understand Asthma and Its Triggers [Thai version]

Special thanks: International Union Against Tuberculosis and Lung Disease (The Union); Orapan Poachanukoon, MD, Associate Professor. Department of Pediatrics, Faculty of Medicine, Thammasat University, Thailand, and The Asthma Foundation of Thailand.

Part 2: Take Control of Asthma - Assure Access to Quality Affordable Medicines [Thai version]

You can manage your asthma!

(In the lead up to World Asthma Day 2012)
“The suffering and waste of resources caused by not managing asthma effectively are much greater than the cost of effective action.” Dr Nils E Billo, MD, MPH, Executive Director, International Union Against Tuberculosis and Lung Disease (The Union). 42 years old Raashid Ali (name changed), a former TB patient, has been living with asthma since 2004, when he first developed symptoms of breathlessness. Raashid comes from a middle class family and is engaged in his business of 'zardozi' (embroidery with golden threads), the famous work of Lucknow. He underwent an 18 months anti TB treatment in 1990. His uncle died of TB a few years ago and his mother was also suspected of it when he was a kid. “I am okay and fit now, but am in constant touch with the doctor. He has given me an inhaler which I now use intermittently— may be once a week or less. I do not take any oral medication. I spend around Rs 150 (3 US $) per month on my treatment. I do not have any problems in my daily routine. I am indebted to my doctor who has helped me manage the disease and keep it under control.”

Close to the heels of the Indian Patent Controller order granting a compulsory license to an Indian company to produce and market a generic version of a patented cancer drug, (thus bringing down its cost by 97%, from US$5600 to US$176 per month) we have another landmark judgement delivered by the Kenyan High Court, with a view to safeguard the interests of people living with HIV (PLHIV) in accessing low cost generic HIV drugs.