Hameed Jokhio first experienced pain in his mouth seven years ago. He ignored it in the beginning but it became so intolerable and excruciating in the following days that he was left with no choice but to visit a doctor. 

He then went to a private hospital in Karachi where he was told that he had developed ulcers in his mouth which were growing rapidly. He was also informed that it was his habit of chewing gutka that had caused these ulcers which could become incurable if he did not give it up. 

Jokhio, 48, lives in Makhdoom Mohallah in Sindh’s southern city of Thatta. He has two sons and two daughters whose ages range between two and eight years. He became addicted to gutka in his youth, he says, but when the doctor told him in 2015 that it could potentially be fatal, he stopped using it and began getting treatment earnestly. 

The treatment improved his ulcers and the pain in his mouth began to subside. Soon, however, he felt the urge to use gutka once again. “I resisted it in the beginning but after one week I reached the limits of my resistance and started chewing it again. This caused the pain to return in 2018,” he says. 

He then went back to the same private hospital for treatment where the doctors told him that his disease has become severe so he needed to visit a better-equipped hospital to have it treated. Acting upon this advice, his wife took him to the Jinnah Postgraduate Medical Centre, a large government hospital in Karachi. The doctors there carried out his detailed examination and told him that he has oral cancer which can only be treated through surgery. 

He could not get the required treatment immediately despite being diagnosed because there was a long queue of other patients of oral cancer who were all waiting for the same treatment at the Jinnah Postgraduate Medical Center. When he did not get a date for the surgery even after waiting for four months, he consulted a private hospital where he was told the surgery will cost him 1.6 million rupees.

Jokhios’s wife says it is impossible for her family to arrange such a large amount because it does not have a stable source of income. Explaining her family’s financial situation, she says: “Even before his illness, my husband worked as a manual labourer and earned barely enough to put two square meals on the table but he has been unable to do any sort of work for several years, I have been working as a maid in order to feed my children”.

The only asset her family owns is a small house in which all its members live. She says she is conflicted about whether she should sell the house for Jokhio’s treatment or not. She fears her children will lose their sole shelter if her husband does not survive even after the treatment. 

A crisis in the making

Dr Shyam Kumar (a dental surgeon by training) is the provincial health department’s focal person in Thata. He says a large number of men in the area under his supervision use drugs such as gutka, mawa and mainpuri. These drugs contain tobacco and some other intoxicating chemical substances, he says. These men, according to him, at one point in their life or other suffer from some dangerous illness –cancer being the most notable among them. 

Referring to the relevant data collected by his department, he says that the number of people receiving treatment for oral cancer from the government hospitals in the twin districts of Thatta and Sajwal was more than 1,000 between January 2021 and the end of May 2022. Similarly, in the last three to four months, four to six people on average have been visiting these hospitals with the same illness every day. Cancer, according to him, is spreading so rapidly in this area that the facilities available for its treatment in the government hospitals are falling short. "So, such patients have to wait for several weeks for diagnosis and treatment," he says. 

Most oral cancer patients are also reluctant to go to a doctor out of fear or shame which causes their illness to worsen gradually, he says. "Eventually, when they come to a hospital for treatment, their mouths are swollen shut. At that stage, even if they get treated with radiation or surgery, the chances of their survival remain limited, " he adds.

Cancer in Thatta, is spreading at such an alarming rate that Kumar has written a letter to the director general of Sindh’s health department about it. In this letter, he warned: "If the government does not take immediate steps to overcome this problem, a major health crisis could erupt in the area". 

Many local residents believe that the main reason for this situation is the uninhibited sale in Thatta of a number of harmful concoctions such as gutka, mawa and paan laced with tobacco. Sindh has no effective laws to prevent this business, they say, which consequently prevents the local police from taking any concrete steps in this regard. 

Adeel Hussain Chandiyo, Senior Superintendent of Police (SSP) in Thatta, contradicts this. He says the police have prepared lists of people associated with this business and all possible legal actions are being taken against them. According to him, 184 cases were registered in 2021 in this regard and 222 persons were arrested under those cases. Similarly, he says, 88 cases have been registered and 123 of the accused have been arrested so far in 2022 for their involvement in the purchase and sale of such narcotics. "Legal action is also being taken against all those arrested," he claims.