Passion with a vision for a tobacco-free world
You transitioned from surgical oncology to public health. Why did you move into the public health arena?
The move has been multi-factorial. It can be dated back to late 1987 following a return to my alma mater after two years training in surgical oncology. This was a transition following a return from an apex tertiary cancer center (Tata Memorial Center) to a medical college setting.
More than the lack of an administrative support as a result of an undue competitive barrier from colleagues in general surgery department, these were: (1) welcoming responses of the local community to know about comprehensive cancer care; and (2) my introduction to palliative care through a nurse-teacher from the United Kingdom. The latter made me stand in the shoes of my patients and their cancers to drift slowly but steadily, first toward to palliative care in the 1990’s but in the last decade and a half to the public health (cancer- and tobacco- control; the latter as a major focus) as a result of empowerment by the American Cancer Society (ACS).
Sustained societal mentoring and encouragement through the faculty of its university (American Cancer Society University- ACSU) made me capable to do what could be effective for the masses or larger community groups in a shorter period through a proper work plan, suitable budgeting, optimal media advocacy and grassroots working. Since prevention then became a logical choice, initially of cancers and now tobacco-related diseases and non-communicable diseases as such, I could move to public health due to support of some mentors in India and abroad.
Surely, it is tougher many times on my immediate family — and me too, than the safer confines of the operating room and a steady income from limited working hours. Nonetheless, at heart I am satisfied that at least I am able to work for the cause, not only due to support of my immediate as well as extended family of friends and colleagues globally (in particular, Advocacy Forum for Tobacco Control [AFTC] members in India and the ACS mentors, supervisors and colleagues in USA and other countries), but many unknown and unrelated too in several communities and work-groups countrywide who endorse that it is the way forward.
Yes, I am seen as a hugely motivated, passionate person working in tobacco control with a vision and creativity, but I think it is due to my constant realization that one lifetime is too short to achieve the goal of tobacco-free world!
What is the main focus of your work now?
Holistically, the focus has been to accomplish an effective and comprehensive tobacco control in my State of domicile- Rajasthan as well as countrywide. To accomplish this, I am working with the State Nodal Office for Tobacco Control, District Tobacco Control Committee and District Administration, the State NGOs working in tobacco control (as members of Rajasthan Coalition for Tobacco Control- RCTC) and state- and local media agencies.
I have recently concluded a collaboration with State Television (Doordarshan, Jaipur) of a 10-episode series titled “Tobacco-free Society” on its weekly prime time evening program SamajikSarokar (Concern for the Community) with two objectives:
- to establish the norm that “Tobacco Use is A Disease and A Tobacco User is A Patient”;
- to motivate masses statewide (especially in rural Rajasthan) to call the State Medical Helpline (Pehal; its toll-free # 104) to quit through its quitline service. Its impact is being measured. through the assistance of the India-based team of World Lung Foundation through adoption of its survey proforma.
I also have an engagement with the Public Health Foundation of India as its resource partner in Rajasthan to train doctors in tobacco treatment as part of a Bloomberg Global Initiative grant I recently received.
What do you hope to accomplish with your work?
I am impatient, more than ever before, with a growing realization that the answer lies in an endgame of tobacco, especially in low-and middle-income countries like India. But, until then, with my experience through the creation of models of best practices in tobacco control, I believe that, besides continued advocacy to have a tobacco tax raised further (to match with international norms) and uniformly countrywide, the way forward lies in:
- Becoming tobacco-free within the workplaces through a workplace-specific policy (as it addresses the issue of control of smokeless tobacco besides reinforcing the enforcement of notified rules of the tobacco control act of the country)
- Providing quitlines to help people quit (through an improves access at no-cost, in their convenience and with confidentiality).
I hope that these steps could add to reduce the humungous tobacco burden India has.
What are some of the challenges you have faced in your work?
The challenges have been:
- An absence of a public health agency locally that will establish a full-time position in tobacco-, cancer or NCD- control to stay assured of a sustainable financial security.
- The large multi-specialty hospitals and the Cancer Center locally have no intent and a resultant provision for preventive care, a Tobacco Treatment and Research Unit to deliver tobacco treatment optimally.
- The lack of sustainable collaborative working with the AFTC and RCTC members and indifference of the State Nodal Agency in Tobacco Control to support optimally in the working for community tobacco control initiatives.
- Inability to collaborate nationally and internationally largely due to financial limitation but also due to lack of a formal position in public health set-up.
- Insufficiently published for the work done at the grassroots level in tobacco control.
What are some success stories as a result of your work?
These are following, in order of chronology:
- Conducted over 300 awareness campaigns in 13 districts of the State of Rajasthan (2002- 2005) after establishing a NGO- Rajasthan Cancer Foundation (RCF) in 2002 through a seed grant from ACS.
- Established Smoke-free Jhunjhunu City in 2007(the first city in India to become smoke-free) working in collaboration with the district administration, local NGOs and media.
- Established tobacco-free State Police Academyin 2008; and tobacco-free Police Training Centers (PTCs) statewide in January 2010.
- Implemented Tobacco Treatment Protocol in a multi-specialty hospital (SK Soni Hospital; now Soni Manipal Hospital) in 2013 that also became tobacco-free in October 2013.
- Association with all quitlines in NGO sector in India till date towards their establishment and operations- the ACS quitline for Indian workplaces (2008-09), The PSI India quitline (Wish2Quit) in Chennai (2011-12) and Quitline within Rajasthan State Medical Helpline (2013-ongoing as a volunteer to HMRI- the NGO in public-private partnership with the State Government); all have achieved a quit rate over 30%. Further, as a short-term board member in 2011, I assisted National Tobacco Cessation Quitline in private sector (Johnson & Johnson, Mumbai, India) in development of some of its materials. Also, I am member of Asia Pacific Quitline Network (APQN) since 2012.
- Initiated rise in tobacco tax through its advocacy with the State Chief Minister in 2009, resulting in an increase in taxation of retail tobacco products from 20% to 40%. Thereafter, through the collective efforts of RCTC colleagues, the next two years of his regimen saw the rise to a whopping 65%, the highest amongst the Indian states.
- Assisted Rajasthan State to become the fifth state in country to ban the sale of Gutka (the most popular chewable tobacco mixture) in collaboration with the Ministry of Health and Family Welfare, the government of India, the office in India of the Union (International Union Against Tuberculosis and Chest Diseases) and RCTC members in the State.
- Partnered with Hriday-Shan at New Delhi around WNTD 2013 toadvocate and collaborate with the District Tobacco Control Committee and District Administration to have almost 80% point-of-sale advertisements removed in the capital city.
- Awarded by WHO with Director General’s WNTD 2013 for SEARO region in recognition of working in tobacco control in category of an Individual. Earlier, I had been awarded at the District- and State-levels for working in tobacco control at Jhunjhunu and through Medical & Health Department, Government of Rajasthan in 2007 and 2011 respectively.
All of these short-to-mid-term goals could be achieved through sustained capacity building and support from ACS plus collaborations at many levels within the collaborating agencies to get optimum financial and personnel support.
Please add anything we have not asked about but you believe is important for the audience to know about.
India has new governance that is supportive of tobacco control covertly and has taken some significant steps in the past several months. Now is the time that it decides on a timeline for the endgame of tobacco.
Personally, my hope is that public health resources like me get utilized optimally by the State- and Country- Governance in collaboration with the international agencies. Full-time positions should be created through unbiased easily-procurable matching grants in Tobacco Control and Treatment. Not only will it assure a financial security but it will also enable working suitability through a proper utilization of capability at all levels of tobacco control nationally and internationally.