Seated outside his house, Dr. Cornelius Balandya, 65, watches admiringly as his neighbour who is his age-mate walks briskly past his house before he starts trotting down the muddy road near his home. He wishes he could do the same but he is too weak to do so.
A resident of Kimara Kilungule on the city outskirts, Dr. Balandya, can no longer walk without support. He normally depends on his wife for support.
The ailing scientist, a graduate in Bachelor of Medicine and Bachelor of Surgery (MB,ChB) from Uganda’s respected Makerere University started developing symptoms of physical weakness after twenty years of smoking cigarettes.
After it was confirmed that this was related to smoking, Dr. Balandya gave up smoking for a while. However, he started smoking again a few years later. His condition worsened and he ended up being bedridden for six months.
“I regret for having succumbed to peer pressure when I was in form two at Kibaha Secondary School. This is the source of all the health problems I am facing today,” he says regrettably.
Dr. Balandya’s first brand was Sweet Menthol (SM), but as time went on, he wanted something stronger. He therefore decided to switch to Sportsman, now known as Portsman and he could smoke a whole packet a day. What he did not know that time was the fact that he was putting his health at risk.
“I am a qualified medical doctor, but let me tell you that it doesn’t mater who you are, smoking is a very bad thing. It is like committing sin. The moment you steal for example, the next day, you think of stealing again and by so doing you develop a habit of stealing,” he says.
The doctor says he developed a bad cough after 20 years of smoking but didn’t mind. He went on smoking until when he started coughing blood. This is when he realized that he was actually seriously sick.
“I was completely shocked that day. I could not sleep. I went to Muhimbili National Hospital (MNH) the following day and consulted one Dr. Sabuka. After diagnosis, the Doctors said I was suffering from TB. I asked myself how can smoking cause TB? The Doctors said tobacco does not cause TB but it accelerates it as it limits the supply of oxygen to the lungs and body,” says Dr. Balandya.
Smoking limits the supply of oxygen to the lungs and so when you contract TB, it gets worse and may ruin your life in a very short time.
Lutgard Kokulinda Kagaruki, the Executive Director of the Tanzania Tobacco Control Forum (TCF), says the government collects 68bn/- each year from tobacco but at the same time, the health department spends 30m/- per year to treat tobacco-related cancers alone.
The 340bn/- for five years (68bn/- per year) figure was quoted from the speech of the Deputy Minister for Agriculture and Food Security Mathayo David Mathayo (now Minister for Livestock Development & Fisheries).
This is tax that goes into government coffers. A 2010/11 study indicates that in 2008 Excise & Value Added Tax (VAT) taxes from tobacco was 67,781bn/-, which tallies quite well with the average of Tsh 68bn.
Dr. Crispin Kahesa, a medical specialist in the cancer screening section at the Ocean Road Cancer Institute (ORCI) says tobacco smoking is a risk factor in the four top non- communicable diseases which include cardiovascular cancer, diabetes cancer and respiratory cancer.
He says the prevalence of tobacco smoking is increasing especially among young people. This is also reflected in the number of tobacco smoking related cancers over the past twenty years.
“There are 4,000 new cancer cases per year. Five to six years back the number was 1,600,” says Dr. Kahesa.
The 4,000 cancer cases are only 10 percent of all cancer patients who managed to access care at the ocean road cancer institute. Dr. Kahesa believes there are many other patients out there especially in rural areas who cannot access the services due to poverty and poor referral systems.
“Ocean Road Cancer Institute (ORCI) is the only specialized government cancer care centre in Tanzania. Just imagine a country of more than 40 million people with one cancer treatment centre. So, some victims fail to reach the ORCI and access services because of transport, financial resources and a poor referral system,” he says.
Dr. Kahesa explains that cancer can take a long time to develop and therefore someone who smoked 20 years ago may only develop cancer in later life.
For example, he says, because Tabora, the major tobacco growing region, increased production over the past fifteen years, there is a possibility that new cancer cases caused by smoking might double in 2015. He says the government contributed to the increase by encouraging more farmers to grow tobacco without assessing its impact to their health and the economy.
“Smoking tobacco affects people in two different ways. While it affects active smokers directly, the passive smokers suffer both psychologically and physically,” Says Dr. Kahesa
He says government should see this as a big burden because the few resources that could be used for development issues such as improving social services are now channeled towards cancer treatment.
Dr. Kahesa suggests that the government should ban adverts that promote smoking, hike taxes on tobacco, increase the price of cigarettes and increase awareness about the effects of smoking in public.
He says tobacco growing should be completely banned and that farmers should be encouraged to grow other crops or provide them with alternative sources of income such as cassava, maize or cotton farming.
While Dr. Ayoub Magimba, Acting Assistant Director of non-communicable diseases (NCD) in the Ministry of Health and Social Welfare says the government plans to develop and strengthen legislations for the prevention and control of non-communicable diseases, activists are concerned about the implementation of the plan.
“There is nothing like that. The non-communicable diseases strategy has been there for years. It should have been out now but the government simply puts it under the drawers,” says Lutgard Kagaruki of the tobacco control forum.
Tanzania has the Tobacco Products Regulation Act, 2003 (TPRA, 2003); which has loopholes. One of the reasons being the interference from the tobacco industry during its formation- the industry was accepted as one of the stakeholders.
Among others, the Act prohibits smoking in public and work places; tobacco advertising, promotion & sponsorship; selling to or having minors sell tobacco and others. Due to lack of enforcement, TPRA regulations continue to be broken without the defaulters being taken to task.
If drastic measures are not taken now, we shall continue witnessing people dying from tobacco related cancers. This will include the innocent passive smokers who get the disease without even touching a cigarette. These are even said to suffer the most.
Tax payer’s hard earned money that could otherwise be spent on important development issues will instead be used to treat tobacco related cancers.
Although those engaged in tobacco business insist on the fact that smoking is a choice and that the industry will continue to thrive as more people choose to smoke, it’s high time the government thought seriously about the implication of tobacco on the health of its people.
It should ensure that those who willingly choose to smoke do so knowing well what to expect after so doing. It should also make sure they don’t make the choice at the expense of those who choose not to smoke. There should be strict regulations for not smoking in public.
There should also be massive awareness campaigns from time to time to educate people on the side effects of smoking rather than just hinting on cigarette adverts that smoking is dangerous to health while at the same time promoting the products!