Friday, June 5

Holy smoke! Kick the fags

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Cigarette smoke contains more than 4,000 types of chemicals of which 63 are potentially carcinogenic.

IT took Jamadan Rosli 20 years to quit smoking and he has never had another puff since.

The 47-year-old assistant environmental health officer in Sibu recalled he picked up the habit when he was in Form Three.

He is among the participants of the Ministry of Health’s ‘Quit Smoking Programme’ who have successfully kicked the habit.

Jamadan Rosli

Sharing his ‘quit smoking’ tips and experience from the programme, he said he was only 15 when he lit up a cigarette and it had taken him 20 years to finally stop smoking.

“It was really hard to stop. Over the years, I tried to quit but to no avail. You can ask any smokers – they intended to quit but couldn’t because they didn’t have any help.

“Take me for example. I wanted to stop but it didn’t happen overnight. I prepared and planned when I wanted to quit. That’s why the date to stop smoking is very important.

“I remember the last time I smoked was on Dec 31, 2007. It has been some 13 years since I stopped. Thanks to the ‘Quit Smoking Programme’, I’m leading a healthier life now.”

Jamadan said when he was smoking, he had low self-esteem.

“I was working in the Health Office, yet I was smoking. Not only that, I got tired easily as well.”

He shared that smokers would experience certain withdrawal symptoms such as coughing and feeling down when they quit smoking. These, he noted, were signs the body was recovering to being normal.

Jamadan encouraged those wanting to stop smoking to make preparations and set their minds on quitting.

He said it was important to get help and registering for the Quit Smoking Programme is a step in the right direction. However, he emphasised a strong determination is a must.

“Apart from the counselling and therapy I got in the clinic, my mind was set on quitting. So, I stopped going to the places like coffee shops that I frequented or where I usually smoked to avoid the temptation to light a cigarette. I replaced them with other activities.

“It’s important to change one’s lifestyle,” he stressed.

Jamadan said also it was important to “declare” the efforts to quit smoking.

“When we declare to our friends, colleagues and family that we are going to quit smoking, we feel challenged to see it through. Making a declaration but not honouring it will be embarrassing and shameful. It will make us more determined to stop and our friends will support us.”

 

Clinics in Sibu

Medical officer (non-communicable disease unit) in Sibu Divisional Health Office (DHO) Dr Siti Romahani Rahman said so far, the clinics offering quit-smoking services are Lanang Health Clinic (KK), KK Oya, KK Sibu Jaya, KK Selangau.

Other clinics with medical officers also offering similar services are KK Bawang Assan, KK Machan and KK Tada.

Family medicine specialist in-charge of KK Lanang Dr Norraliza Md Zain (seated centre) and Dr Siti (seated right) showing ‘Quit Smoking’ guidelines together with Dr Law (seated left), Jamadan (standing left) and others.

She noted that the other smaller clinics were not that active as indicated by the low registrations for the Quit Smoking Programme.

“So, we’d like the public to know this service is offered at our clinics and hospitals nationwide and open to Malaysians who wish to stop smoking. They can register at any big clinics like KK Lanang, KK Oya and KK SibuJaya. But if they go to any of the small clinics, we’ll still give them the medication,” she assured.

As for Sibu Hospital, Dr Siti said it’s more established and there is a person assigned to run the programme.

She added that all MOs and assistant MOs had been trained to help the DHO.

As such, she hoped that as many smokers as possible would register for the programme.

 

High cost

KK Lanang MO, Dr Robert Law Chin Seng, who is also part of quit-smoking clinic team, noted the cost of running the Quit Smoking Programme, especially the medication part, is very high.

“So, usually what we do, we screen the patients – we only select those really determined to quit and subject them to the programme. This is because the cost of such a therapy – for example, patch for one patient for a month – can easily come to RM400-RM500.

“Of course, we encourage more people to quit smoking but because of the cost factor, we only select those who are determined and have already prepared to quit.”

According to him, MoH has been actively promoting the programme for the past two to three years – and for a start, patients were given counselling.

Although determined, some patients may still have some withdrawal symptoms after quitting. Since they have been smoking for, say, the past 20 to 30 years, it’s impossible to stop immediately. So some replacement therapy is needed to help them quit slowly.

The standard duration for the replacement therapy is three months. But it takes six months for patients to really stop smoking – three months with therapy and another three months without therapy. If patients still manage to not smoke for six months, then they are considered to have successfully quit smoking.

Dr Law did not rule out the possibility of some patients returning to their old habit due to friends’ influence.

“We call it relapse,” he added.

A close-up of nicotine chewing gum.

Two types of therapy

Other than counselling, two types of replacement therapy – nicotine and non-nicotine – are provided to help smokers quit gradually, according to Dr Siti,

For nicotine replacement – gum and patch which contains a certain level of nicotine with a different dosage – it is based on the dependency of the individual.

If the physical dependency is bad, the dosage will be increased. If it’s controlled and okay, the dosage will be lowered. But eventually, the dosage will be lowered, then, completely stopped.

“Patients must be determined to quit,” she said.

For non-nicotine replacement, pills are prescribed but this must be done by the specialist from the DHO. The dosage differs from patient to patient.

Of the six months duration, three are for therapy. There will be follow-up checks on patients to assess their progress.

Patches and chewing gum replacement therapy to help smokers quit at KK Lanang, Sibu.

Dr Siti said for the first month, the follow-up is every two weeks, then monthly for six months but this could be discussed with patients.

“Since patients come for monthly follow-up checks, it means they’re not entirely on their own. Every visit, we do assessment to see whether or not they have completely quit smoking. Otherwise, the treatment might be prolonged more than three months. Strong determination is needed and support from family and friends is also essential.

“If patients manage to stop smoking completely after six months, they’re regarded as successful. If not, we’ll continue to help them if they’re still determined to quit.”

She said her unit was even willing to provide such service on Saturdays if there were enough patients.

“We’ve already discussed with the DHO if many of smokers in Sibu really need this service on Saturdays, we will try to provide it. But not all clinics, maybe selected clinics.”

Jamadan, meanwhile, remembers taking chewing gum (prescribed) as nicotine replacement at the start of the programme but after few weeks, he felt it was no longer necessary.

“I relied on will power and it worked for me. Determination is, indeed, very important.

“Smokers need help to quit. Come to the clinic to get advice, counselling and so on,” he said.

 

Success rate

Dr Siti said the success rate of the Quit Smoking Programme in Sibu Division is encouraging.

“From the total of 48 smokers last year, 35 or 73 per cent successfully quit in six months. In 2018, 32 out of the 75 registered patients or 42.67 per cent were successful.”

In this connection, Dr Law noted that MoH is targetting30 per cent of patients under the programme to quit smoking – or three out of every 10 patients.

According to The ‘Quit Smoking’ guidelines, the objectives are to provide knowledge and skills for smokers to quit, treat and rehabilitate smokers intending to quit, raise awareness among smokers on the harmful effects of smoking and encourage and motivate them to avoid a relapse and maintain the non-smoking status.

“We welcome all smokers who intend to quit to any clinic or hospital. Some may be afraid to walk in and ask our staff.

“In this case, they can just check out MoH’s portal www.myhealth.gov.my, Info Sihat’s portal www.infosihat.gov.my or call the Quit Smoking Infoline (03-8883 4400). These are the platforms they can go to obtain information first and when they are ready, come to us.

“Smokers who join the programme are only required to pay RM1 for each appointment. So, if they come six times in six months, it’s RM6. We will give them the treatment and medication. Smokers will generate savings if they quit,” Dr Siti said.

She also mentioned a few tests to check whether smokers had really stopped smoking when they came to the clinic.

 

Challenges

Dr Siti pointed out that their main concern is smokers having relapse after six months.

“That’s why we need help from those who have successfully quit to share their experience on maintaining their non-smoking status. We encourage them to give testimony to motivate other smokers to join the Quit Smoking Programme.”

She said they had yet to get adolescents into the programme as those who registered were over 18.

“I’m not saying adolescents don’t smoke – they do. Getting them into the programme is one area we need to improve on. Teen-age smokers can also join the programme. The younger they start, the better for them.”

On Dec 20, 2019, the MoH announced that starting in the new year, smoking and vaping would be strictly prohibited in all food premises across Malaysia.

Its Deputy Minister Dr Lee Boon Chye said offenders would be fined RM250 but the amount would be reduced to RM150 if settled in less than a month.

Dr Lee added that offenders who refused to pay maybe fined up to RM10,000.

With the anti-smoking law in place, Dr Siti opined it was the timely for smokers to quit now.

“Moreover, quit smoking to enjoy a healthier life,” she advised.