The effect of chewing tobacco in women in West Bengal an observational study.
It’s seen that the habit of Gul chewing is common in districts of Malda and Murshidabad.The effect includes foreign body sensation , persistent ear discharge in those with COM,earache, reflux,headache,myalgia,low energy and overall malaise.
On examination pallor,submucosal fibrosis,post nasal drip
There’s also an association with concurrent betel leaf,Areca nut chewing with or without bidi making habits.

The Gul habit appears either at a young age in presence of elder women in the family,or past middle ages when the women is a mother-in-law.

The most common symptoms is usually that of persistent something stuck in throat syndrome which often causes distress at night especially after a heavy meal of meat and rice.

While this sounds like an easy enough diagnosis, what I found interesting is in the big cities and Medical Colleges there lacks an awareness about this form of addiction  .

Since our Medical Text books are often reflecting the Western viewpoint,this local habit is missed and rarely asked while taking history.
Let me correct that .I wasn’t trained to ask that since we were not aware women took tobacco in that form.

Plus when I ask “do you have any addictions?”Many times for both men and women it’s no.While I dig deeper I get to know .

For Men
They use Gul for their rotting teeth
They take betel nut abd Supari for reflux.

For Women
They smoke cigarette few times  a day if someone offers (depends on socioeconomic status)
Bidi A pack a day .
Alcohol :Only on weekends and special occasion or when feeling low.
Pan occasional
Khaini/Gutkha :If a user They will say things like I drive,I do heavy work so that helps.
I understand .

But I also try to sensitize them about –
yhe problem of increasing addictions including the current problem nit getting better unless they stop the addictions and invest wholehearted in their own health.
Higher morbidity.
Lower ability of medicines to work even in higher doses.Plus the real risk of other diseases.