issue 198 - August 1989
A smouldering problem
Tobacco companies are pouring millions into Third World advertising
and the World Health Organization predicts an epidemic of lung cancer in
developing nations over the next 40 years. Elizabeth Obadina looks
at Nigeria's plans to fight the tobacco menace.
I stopped smoking because I didn't want to set a bad example to others, says Professor Olikoye Ransome-Kuti, a paediatrician and Nigeria's Health Minister.
His brother, Fela Anikulapo-Kuti, Afrobeat king beloved by rebellious youth, smokes 40 cigarettes a day - and Indian hemp (marijuana) besides. He says: 'In these hard times when many people are going through a lot of economic hardship, people need to smoke to reduce stress and cool the nerves. If you stop smoking the problems of this country are going to get some people mad.'
Despite having a wide selection of cigarettes made from locally-grown tobacco, Nigerian consumers seem to prefer imported brands - even though they cost five times as much. Bensons, Rothmans or Marlboro cost 50 kobo (six cents) each while local brands sell for ten kobo each.
Until early 1989 all foreign brands were smuggled into the country. Now they can be imported legally, but stiff customs charges still encourage smuggling. Malcom Fry, the British managing director of the Nigerian Tobacco Company (NTC), estimates half of all cigarettes in Nigeria are smuggled. This makes it difficult to enforce health warnings on all packs.
Most smokers in Nigeria's cities believe smoking is bad for them, but they do it because, 'It fit make me warm' (on a cold rainy day) or just because, 'I like am.' Some prefer to buy imported cigarettes even at the cost of going without food. Mohammed Umar, a 22-year-old house guard began selling cigarettes to supplement his 200 naira a month salary (about $30). However, with a wife and young baby to support and the habit turning 'heavy' - up to ten sticks (cigarettes) a day - he had to give it up. He also gave up selling, to put temptation out of his way.
Clement Opara, who runs a corner store in Ikeja, reports that most of his regular customers still come to him for cigarettes despite financial hardship - and buy their sticks five or ten at a time.
Alhaji Halimu is a roadside cigarette vendor in Lagos. He doesn't smoke and reacts indignantly to the suggestion that his two wives, left behind in the northern State of Katsina, smoke. However, northern men and women inhabit quite different worlds. What the men don't see, they don't find out about. One Nigerian health researcher recalls her amazement on entering a traditional Muslim household in Katsina State. She saw women naked to the waist, pounding millet, with cigarettes dangling from their mouths. 'Suddenly,' she says, 'I saw a whole new reason for the low birthweights of so many babies in the area.'
But an anti-smoking backlash is building. In mid-May the country's leading airline, Okada Air, decided to ban smoking on all its flights. The anti-smoking lobby received a further boost when all smoking in public places was banned a few months later. The ban includes Government offices, cinemas, theatres, public buses, trains, lifts, hospitals and clinics, schools and nurseries. Both individual offenders and companies are liable to fines and prison sentences.
The regulations may also be extended to promotion. Tobacco advertising could be banned in newspapers and magazines, on radio and television, and on billboards and advertising circulars. Warnings on cigarette packages are also on the cards.
The new laws come after a decade of pressure from leading Nigerian physicians convinced of the link between cigarette smoking and ill health.
Nigerians are starting to live longer - average life expectancy has climbed from 40 to 50 years since 1970. As a result, more cases of lung cancer are appearing. Dr Lanre Bandele, Secretary of the Nigerian Committee on Smoking and Health, says that ten years ago a case of lung cancer in Lagos University Teaching Hospital was a cause of great medical interest. Today, he says, it's gone from two patients a year to a couple a month.
According to Professor Ransome-Kuti: 'Data from hospitals and clinics indicates that cancer in all its forms is on the increase in Nigeria.' He hopes the establishment last year of a Cancer Registry in University College Hospital, Ibadan, will give a better sense of the problem.
The tobacco industry is sceptical. The NTC's Malcom Fry, a non-smoker and a statistician by training, says evidence linking smoking and cancer is thin. 'I could not work for something I believed was harmful. NTC is doing nothing illegal, nothing immoral.'
NTC says the Government's proposed new anti-smoking laws owe more to foreign anti-smoking lobbies than Nigerian circumstances. WHO spokesman, Dr Samuel Brew-Graves, dismisses the charge. 'Must we re-invent the wheel?', he asks. 'If we wait for African data to mount an anti-smoking campaign then we'd never start.'
Nigerian cancer treatment facilities are more advanced than elsewhere in Africa. But there are problems: high-tech machinery frequently breaks down and treatment is expensive. Most hospitals charge for drugs and dressings and the cost of chemotherapy is out of reach for all but the wealthiest.
Nigerians are also reluctant to seek early treatment for cancer. According to hospital social worker, Mrs Olufunke Akikunmi, more than 90 per cent of cancer patients are in the final stages of the disease before they seek medical help. Many need assurance the illness is not a punishment for their sins or that they have not become the victims of some evil spell.
Most cancers in Nigeria are preventable. According to Professor Ransome-Kuti, 95 per cent of cancers are connected to age and environmental factors. The leading killer, liver cancer, can be traced to polluted water supplies, birth damage, and the consumption of mouldy, stored foods.
Nigeria's three-year-old Primary Health Care system is trying to tackle the problem. The Ministry of Health has produced posters which illustrate the degenerative and pauperising aspects of the habit. And Dr Bandele hopes health warnings will be printed on cigarette packets in the three main Nigerian languages: Hausa, Yoruba and Igho.
'Reaching the Unreached' is a favourite slogan of Nigeria's embryonic Primary Health Care System. It's the 'unreached' that Dr Brew-Graves would like to sway with the Government's anti-smoking message - especially the young. Half of Nigeria's population is now under 15. If there is a future epidemic of lung cancer, it will be today's schoolchildren who suffer.
Elizabeth Obadina is a journalist based in Ikeja in Lagos State, Nigeria.