Monthly Report, June 2000

Tobacco Usage in Mumbai

CPAA’s May report covered the activities organised to observe World No Tobacco Day, namely the Early Detection and Awareness camps held at various locations in Mumbai focusing exclusively on tobacco related Head and Neck cancers; the two surveys among 1500 college going students and 800 street children and the website initiative. Given below is a summary of findings generated through the questionnaire given to attendees at camps regarding their tobacco habits. It provides an interesting insight on tobacco addiction in a wide spectrum of people from different backgrounds.

This year 20 camps were held between 15^th May and 7^th June at sites all over Mumbai. As in the previous five years, CPAA undertook an extensive screening exercise, offering free head and neck check up facilities to people all over the city of Mumbai and its suburbs. CPAA has concluded that the only effective means of fighting against the increasing incidence of tobacco related cancer are

• Prevention by raising awareness through lectures
• Early Detection by screening at clinics and on-site camps.

CPAA tries to reach out to high risk, asymptomatic individuals with these facilities. On the occasion of World No-Tobacco Day, this programme takes the form of a month-long project, specifically targeting tobacco habitues and offering these checkups free of cost. High-risk groups are identified and a panel of doctors and counselors spread the message of tobacco cessation and early detection. 843 people attended the free public camp held at Hutatma Chowk. Sanjeev Chowdhury, Vice Consul, Canadian Consulate and Honorary Secretary, CPAA, Ms. Siloo Jasdanwalla inaugurated the camp. The presence of celebrities, Tanaaz Currim, Meghna and Sushma Reddy, Marc Robinson, Chhaya Momaya and Vikas Bhalla went a long way in attracting a large number of people who benefited from the camp.

Twenty camps were organised this year for diverse groups (see following list) and 4059 individuals were screened for early warning signs of tobacco related cancers. Campsites were chosen with two primary objectives. Working establishments or community centres where tobacco consumption was high were chosen so that they could benefit from these camps. These sites were also those where future periodic screening programmes could be promoted resulting in long term, sustained and result oriented services being provided to those groups who needed it most.

1. DOORDARSHAN KENDRA
2. C. RAILWAY WELFARE CENTRE
3. PRS PERMACEL PVT. LTD.
4. LIFE INSURANCE CORPORATION
5. NAIGAON S.N MANDAL
6. REGIONAL PASSPORT OFFICE
7. MANTRALAYA
8. ARMED POLICE H. Q., NAIGAON
9. MAZGAON DOCK LTD.
10. BYCULLA DISTRICT PRISON
11. ORCHID HOTEL
12. MAHINDRA & MAHINDRA
13. BOMBAY UNIVERSITY
14. HUTATMA CHOWK
15. MUKTI
16. AIRPORT AUTHORITY OF INDIA
17. RAMU CONSTRUCTIONS
18. BMC
19. ALL INDIA RADIO
20. FAMOUS STUDIO

The credit for reaching out to these hitherto unapproached groups and convincing the management to let us organise these camps goes to Neeta More – General Manager, Diagnostic Service. Her persistence resulted in all the establishments contacted agreeing to allow us to organise these camps.

CPAA’s team of Head & Neck specialists consisting of Dr. Asit Gore, Dr. Sanjay Bhatia, Dr. Manohar Shaan, Dr. R. Alimchandani, Dr. J. Narayan, Dr. Panna, Dr. S. Ghildiyal, Dr. P. Sud, Dr. Jaideep Mankani and Dr. Kamlakar Dandekar rose to the occasion by attending every camp in full strength and by offering much more than their medical expertise. Many a compulsive chewer or smoker was persuaded to surrender his packet then and there at the doctor’s table. Kirti Dustkar ably managed the schedule. Mr. Deepak Tirlotkar, Ram Dhadwe, Raju Kamble, Nandu Raut, Tulsi Bhoir, Rakesh Talpade, Abhay Patil, Vishal Amaysar and Owen Walter all played a very important part in ensuring that camps ran smoothly.

Minal Parab and Jennifer Quadros ensured that the findings were immediately tabulated so that the report could be presented immediately and follow up lists drawn up. The entire CPAA staff contributed to the efficiency of each camp by attending all the camps and helping out with filling of the forms. Ms. Viji Venkatesh, Anita Peter, Neeta More, Kirti Dustkar and Minal Parab provided counseling to individuals after the screening.

A total number of 4059 individuals were screened, 3475 men and 584 women. As many as 1796 or 44% were tobacco habitués and 572 or 14% were in the high-risk category. A shocking fact was that 462 persons were found to have precancerous lesions such as leukoplakia, melanoplakia, erythroplakia and submucousal fibrosis (SMF).

It was observed that chewing tobacco is still the most popular form of tobacco consumed in the middle-income group and in the age group of 40-55 years-695 individuals chewed tobacco.

Cigarettes are popular with the higher income group and younger age group who choose this form of tobacco-613 individuals smoked.

Gutkha and Pan Masala follow with no income or age group consideration at all-410 individuals. Out of the 410 Gutkha habitues, 79 users or 19% were detected with SMF. Some of the individuals presenting with SMF had been eating gutkha for only 7 or 8 months. The youngest individual with severe SMF was only 9 years old.

Pan with tobacco comes next with 342 individuals consuming this very popular mixture.

The lower middle and lower income group was heavily addicted to masheri-279 individuals.

Over the past 5 years that we have been conducting the programme, we have seen a decline in the consumption rates of snuff (10 individuals) and tobacco paste (18 individuals) but the increase in gutka consumption more than makes up for it.

Leukoplakic, melanoplakic and erythroplakic changes were seen in large numbers (318 individuals) corresponding to the habit of chewing tobacco. Buccal mucosa and gingivo buccal sulcus changes and erosion were observed in 175 individuals, even in those who were only chewing tobacco or gutka occasionally. Biopsies were advised for as many as 79 individuals. All these high-risk cases, especially the biopsies, will be followed up till malignancy is completely ruled out.

Some Observations:

• The only work place that was relatively free of tobacco habitués was the Passport Office at Worli.
• Almost 50 % of individuals seen in each camp were addicted to tobacco in one form or the other.
• Cigarettes are very common in the younger age groups; all those employees in Hotel Orchid who were under 22 years were smokers.
• 90 % of workers seen at the Airport Authority Camp were tobacco habitués.
• Very high percentages of employees in the BMC, Byculla Jail and Naigaon Police

Station were compulsive tobacco users.

• Younger people are predominantly eating Gutkha.
• Tobacco chewers are taking to eating gutkha besides sookha.
• All the young street boys who came for the camp at Hutatma Chowk were eating Gutkha.
• The Hutatma Chowk camp attracted young college students. This is the first time students have voluntarily come for a screening and acknowledged their compulsive addiction to smoking.

Department Reports

Cancer Awareness Programme

During the month of June awareness lectures were conducted in Bhabha Atomic Research Centre (BARC) Tarapur, at BMC T-ward in Mulund, at the May and Baker factory at Kanjur Marg and at Bayer India. 3000 persons attended the programme. The BMC lecture was organised by Ward Officer Mr. Bindashar, Mr. Badekar and Mrs. Ganashar. Mrs. Zainab Allana and her group raised over Rs. 1.5 lakh through individual donations, money boxes in Mumbai and Thane and salary deductions at the factories covered.

Ms. Viji Venkatesh delivered an awareness lecture at the Jindal Iron and Steel Company’s Head Office at G. Deshmukh Road. The auditorium was packed during the talk and a lively discussion followed. The company intends to follow this up with a detection camp at each of their locations, including factories.

Prevention and Early Detection

19 camps and OPDs were held during the month of June. 2 camps each were organised at Aga Khan Jamatkhana, Thane and for Rotary Club of Mumbai Sea Land and one camp was arranged for SICOM.

A total of 149 people, 77 males and 72 females were screened in the camps. 21 were advised follow up. 14 OPDs were held. 72 males and 147 females were screened. 72 people were advised follow up. 25 women were screened under the Well Woman Clinic programme and follow up was indicated for 6.

Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre

The Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre was kept extremely busy, seeing a total of 287 patients during June. A record 1275 tests were performed, out of which 1123 were pathological tests. 4 free tests were performed. 28 sonography, 77 x-ray and 47 mammography investigations were carried out. 26 free mammographies were done under the two Well Woman Clinic OPDs held during the month. The centre earned over Rs. 1.25 lakhs during the month. Congratulations to Ms. Valsa Peter and her team, Lizzie, Rajshari, Ijaz and Sanjay!

Insurance

41 new policies were registered in June, bringing the total to 6448. 89 people were examined of whom 19 had come for the first check-up and 70 for renewal check up. 2 claims were settled during the month, bringing the total number of claims settled to 63. A sum of Rs. 53,219 was disbursed. One new case was detected during the month, increasing the number of people the policy has helped to 20, out of which 14 are surviving.

Patient Care

At Smt. Panadevi Dalmia Cancer Management Centre

57 new patients were registered during the month of June, 33 under the Aid category, 20 under the Adoption category and 4 under the Special Adoption category. 367 patients were aided, counseled and given guidance. 200 patients availed of ambulance facilities. 100 sets of clothes and 100 packets of biscuits were distributed. 23 home and institutional visits were made. Donations amounting to Rs. 20,750 were collected and Rs. 2.15 lakhs were disbursed. Eight of our patients expired during the month.

At Tata Memorial Hospital

901 patients were aided, guided and counseled at CPAA’s room No.189 in the Golden Jubilee Block at Tata Memorial Hospital during June. 27 ward visits were made. 150 packets of biscuits were distributed. 8 patients were given clothes. 2 kgs of sweets were distributed. 10 referred cases were helped. 4 children were given toys and 3 patients were given medicines.

At Bai Jerbai Wadia Hospital for Children

17 new patients were registered during the month. 399 patients attended follow up of whom 100 patients are undergoing chemotherapy. 20 patients were counseled and guided and 6 patients were visited in their wards. 3 group meetings were held about cleanliness and diet during the month. 10 packets of biscuits were distributed.

Mrs. Priti Choksi visited the ward along with Ms. Zakia Topiwalla on 20^th June. She distributed sweets and toys to the 20 children there. Mrs. Choksi took the time to talk to each of them. Such visits go a long way in showing both patients and their parents that they are not alone in their struggle against the disease. Too often patients give up the fight mid way, feeling disheartened by the long drawn out treatment. The show of solidarity always raises their morale and motivates them to fight on.

Mr. Murgan of Ramu Constructions visited the ward on 30^th June and distributed biscuits, colouring books and pencils to the children attending the clinic. Mr. Murgan appreciated the efforts being made to bring joy into the lives of the children and promised to make similar visits every month.

Rehabilitation

The Rehabilitation Centre adopted 5 new patients and relatives this month. A total of 69 patients were helped. 9 cases of mastectomy were attended and breast prostheses were provided. 143 patients were given rations worth Rs. 19,440. Rs. 24,890 was spent on teachers’ salaries, for patient education and vocational training. Rs. 93,394 was spent on patient wages and Rs. 23,976 was spent on welfare activities, conveyance and diet supplements. A total of Rs 1.4 lakh was spent on patients during the month. The Rehabilitation Centre’s total income for the month, exclusive of CPAA transfer, was Rs. 3.73 lakh.

New Projects

In a novel collaboration between Pepsi, the website contests2win.com and CPAA, an interactive game was devised. The game is intended to promote awareness about the harms caused by tobacco, the many kinds of cancers it can cause and the chemicals that are introduced into the body through cigarette smoke. A donation of Rs. 5 is made to CPAA very time a particpant plays the game. A mark of the popularity of the game is that as many as 5000 people had already taken part by month end.

A set of three anti-gutkha stickers in Hindi and English, designed by Network Advertising and produced by PRS Permacel were featured in the Indian Express Junior Express. A number of enquiries have resulted, including one from interior Maharashtra, which will go a long way in disseminating information.

As a part of CPAA’s proposed plan to set up a Communication Centre, a computer with internet connection was donated to Breach Candy Hospital. Dr. K. G. Nair, Director Medical and Dr. Ashok Bhatkande, Director Administration have both supported this idea whole-heartedly.

As a part of the initiative to promote World No Tobacco Day, three readers of the website were given coupons entitling them to a free lunch at Three Flights Up generously provided courtesy of Mars Food. Ms. Camlin Ltd’s donation of pens was very much appreciated by prizewinners.

Cancer Patients Aid Association is bidding farewell this month to Ms. Viji Venkatesh, Executive Director, Diagnostics who after a long stint of 13 years is leaving us to join Crosswords. All of us at CPAA wish Viji the very best in her new career.

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