Gutkha, gudakhu, bhang, pikka, sutta, mishri, gul… What is common to all of them? If the question is put to a person from the city, the answer may not be forthcoming so easily. But in rural India, these are words as familiar as toothpaste and soap. The answer is Tobacco. This is a story about a specter haunting the tribal belt of Odisha, the specter of tobacco where smoking beedis is as common among women as men and they just cannot stay without chewing some form of tobacco or the other. Most of them are not aware of the consequences, of the danger of lives being cut mercilessly short. It is not even being seen as a problem and the government has done little to curb the practice by raising awareness. The result in the long-term can be tragic.
Metropolitan India is battling tobacco use through taxation policies, by stepping up antismoking interventions and banning the marketing of gutkha (similar to chewing tobacco) in portable plastic pouches. However, in the 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 the Potangi, Nandpur, Dasmantpur, Narayanpatna, Chandragiri, Gunupur and Kashipur blocks of the poverty stricken districts of Koraput and Rayagada. Indeed, 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.
Tribal women and the form of tobacco
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 up 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 views, “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 a packet, which lasts them for about a week. Other tobacco-based products are also popular.
Jamana Gadaba, 45, of Badli Maliguda Village, has been chewing bhang from childhood. She recalls her mother chewing bhang slowly after placing it between her cheek and gum. Today, Jamana uses both bhang and gudakhu. “Since five years old, I have been 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 unaffordable for her – 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.”
Where do they get it?
Every village haat (market) in the 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.
“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,” Muduli Explains. 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 doesn’t have her daily quota of gudakhu and bhang. On an average she spends Rs 5 a day on bhang and Rs 3 on gudakhu. A sum of Rs 8 may seem paltry for those who earn in thousands, but for Kusuma it means a big hole in her monthly income that averages less than Rs 500.
India is the second largest consumer of tobacco. All sections of Indian population consume tobacco though the prevalence of habit and the types predominantly used vary across different geographical areas. In India, tobacco consumption, mainly in the nonsmoking and application forms, is culturally accepted even among women. Hence, smokeless forms of tobacco use by women are widely prevalent.
According to the National Family Health Survey (NFHS-3), more than 54 million women use some form of tobacco. Apart from smoking, women in India, particularly in rural areas, use smokeless tobacco such as gutkha, paan masala with tobacco, mishri, bhang, gul and gudakhu. Nearly nine in a hundred women chew tobacco in contrast to two in a hundred who smoke.
Take the figures alongside those put out by the Global Adult Tobacco Survey (GATS) – India, which says that smoking kills one million 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 such chilling statistics.
They have hardly ever been told in simple language that what they chew or smoke in a carefree manner in their pristine village forests will kill them prematurely. That’s not all. Medical officers here point out that baby in the wombs of women who smoke are at a higher risk of being born with a low baby weight. They are also likely to suffer from various respiratory tract infections.
“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 said adding 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? Dr Kumar Pravash, an oncologist attached to the Mumbai Tata Memorial Hospital, explains, “Tobacco contains nicotine that is highly addictive. There are about 3095 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.”
Need of awareness
A Union Health Ministry’s monograph has categorised Odisha 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, tobacco use and they argue that creating such awareness is crucial.
“To date, neither state government officials nor any civil society organisations have 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,” says, Sarat Kumar Dhal, an activist from Potangi Block of Koraput District.
There is a specter haunting the tribal belt of Odisha, 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.