Living Well in Myanmar
Do Not Smoke!
Seriously, do not smoke.
If you’re 20, smoking will slow your recovery from injury. If you’re 30, it increases your chance of breast cancer. If you’re 40, smoking compromises the longevity of you heart, lungs, brain, kidney, bladder, etc. And it gets worse as you get older.
Living in Myanmar is not good for a smoking habit. Cigarettes are cheap, the ingredients are low quality, smoking is allowed most places, social stigma is rare, and public health campaigns are minimal. As a doctor I find that everyone knows that smoking is bad. Therefore my conversations with patients are usually about if, when, and how to stop smoking.
The timing of quitting is dependent on both the willingness and the confidence of the smoker. For example, I ask patients to tell me “On a scale 1 to 10, what is your desire to stop smoking?” and “On a scale of 1 to 10 what is your confidence in being able to stop?” This helps us start the discussion. An unwilling and non-confident person needs a reminder of the dangers of smoking. Someone who wants to stop but has low confidence may need help creating a quit plan.
Doctors think about planning to stop smoking in two ways – physiologically and behaviorally. First, the smoker is biochemically addicted to nicotine. Each cigarette prevents the onset of physical and mental agitation. We treat this addiction by adding up daily tobacco consumption and then offering a matching dose of replacement gum or patches.
At the same time the smoker is addicted to the process of smoking a cigarette. Certain places and certain times trigger the desire for a cigarette. We treat this addiction by changing daily behaviors. The physical environment associated with smoking has to be altered. This means moving the chair you smoke in, putting a photo of your kid in the car, visiting a different tea shop, or avoiding the shop that sells you cigarettes. Ashtrays and lighters are thrown out. Also we need to have alternative small pleasurable activities at the ready for the times when we usually smoke – cough drops, a game on the phone, a friend to call, a healthy snack.
I ask my patients to pick a quit date, which we circle on the calendar, and then tell to family, friends, co-workers, etc. The hope is to create a sense of obligation that makes success more likely. On the quit date everyone calls the patient to congratulate them on stopping smoking.
My patients have quit smoking for many reasons – knowing it’s bad, a lingering cough, pregnancy, social awkwardness, impotence, finances, putting kids at risk for asthma, failing organs, etc. Usually it’s one of the hardest things they’ve ever done.
If you have tried and failed to quit smoking in the past, don't be discouraged. Having stopped for any period of time in the past improves you chances for succeeding in the future. Become a part of the effort to get more people in Myanmar to quit than start.