By Dr. Toniya Raut
Tailor: are you a student or doctor at BPKIHS?
Toniya: I am a oral pathologist.
Tailor: what’s that?
Toniya: I check the biopsy, meaning the sections/tissues from the mouth to tease out if it has cancer or not.
Tailor: you doctors have done all this research too, and it’s proved that oral cancer happens from drinking/smoking/chewing tobacco, right?
Toniya: yes! Also, from what you are chewing now. (He was chewing gutka at that moment).
Tailor: what are you saying Doctor Saab, even doctors drink/chew/smoke!
Toniya: but always do what your doctor says, not what they do. Also, I know you are the bread weaner of the family, so don’t you care about your parents/kids/spouse? Think about it.
I left but the introspection kicked me hard.
I, being an oral pathologist come across 6-7 cases of oral cancer in every 10 biopsy cases of oral lesions per week. Amongst these majorities are associated with the habit of chewing or smoking tobacco or drinking alcohol.
The very innocence that I came across was “doctor I don’t drink, nor I smoke I just take gutkha and supari occasionally after meal” and then I must invest the next 20 minutes explaining to him/her how gutkha, is another form of tobacco and equally harmful and strong enough to cause oral cancer.
A study conducted in Nepal has shown most tobacco users know the harmful effect yet is not convinced to avoid or quit. I had come across many times when my patient finds it difficult to admit that they chew or smoke tobacco and its product which clearly indicate the ignorance of their own knowledge of healthy life strategies.
The use of tobacco and its unwholesome consequences is a global concern and fortunately, our government is working on it by imposing a tax on tobacco products, incorporating a “smoke-free zone”, imposing health warnings on packages of tobacco products, etc. We can proudly say that our country received a prestigious “Bloomberg Philanthropies Award for Global Tobacco Control 2015” for its tobacco control program. But the fact is that lung cancer and oral cancer are the two most common cancer prevalent in Nepal and is caused by using tobacco and its products.
The use of tobacco is primarily seen in groups of populations with low socioeconomic status; however, this is equally prevalent in populations of high economic status and among highly educated people. The irony is that tobacco has not spared the medical group who not only experience the ill impact of tobacco use in day-to-day life rather are responsible to convince the patient and society to avoid and quit using tobacco and its products.
“I am struggling to get a scholarship for MD/MDS it’s really stressful, so I started smoking”
“Final year of MBBS/BDS is so tough, had a 24-hour duty and on top of everyday directions from the professor; to deal with it I started smoking”
“Thank God final exam got over let’s party today, drinks on me”.
These are the comments I am used since my medical school days. Sometimes I ask myself does a medical practitioner also requires smoke and alcohol to socialize. My heart replies “YES” because this question is for those who are well educated, economically stable, intelligent, and experienced!!! How many dignitaries would support doing something which should not be done actually? Right??
I am a doctor, yet I hesitate to ask my patient “do you chew or smoke tobacco? Do you take alcohol” I am reluctant to suggest “please stop using it that’s injurious and you might get oral cancer”
I am fearful of getting the reply “doctor I saw you doing the same” from my patient.
When I think with my naive mind, I believe, we have recognized the problem and we have recognized its cause as well. But can we ban entire tobacco and its product throughout the country? Can it break the vicious chain of the consumer-producer cycle? Then the country’s economic condition, the business strategy, and many things come into the picture which my naïve brain can’t comprehend. What next then?? Can we be responsible not to overdo at least be its drinking or smoking or chewing gutkha??
I am not moral policing but then I do care about my patients. I can’t express my feelings when I see the slides of my patient’s sample who have incurable cancers, which could have been prevented. Although doctors are not as withholding high in standards now as they used to be, we being doctors have not put in our best either to redeem that standard. But there are still some who care about their patients and not only consider being a doctor as an 8 am-5 pm job. I am not penning down this article to redeem anything because unless I practice it in my actions, it’s not worth even talking about. Also, I can’t blame anyone for the repercussion that we are getting, because medical malpractices are it for money or for fame are definitely increasing as per the statistics.
Talking about my experiences, I also do get mocked for not drinking. “You are a saint! you going to live long, you know! we all going to die one day!!!” etc. and etc… which I find very funny; but then, drinking alcohol or smoking is boring for me, because I am high on life ?.
Let’s try to be educated than to be literate. What I am trying to say is that “let’s educate ourselves and at least our near ones”. We have the knowledge that tobacco is harmful so let’s change our attitude that it should not be used and then practice it in our daily life. It’s very easy to disseminate knowledge to others but extremely tough to apply to yourself. And if we can apply our knowledge to improve our health then only, we can boast about being educated. So, let’s convert ourselves from literate to educate such that we establish ourselves as role models for our patients.
