Cancer care: So costly, so elusive

By Olukorede Yishau

Margaret Shogunro-Pitan, a nutritionist and mother of four, saw, experienced and conquered pain. She really is a lucky woman. Not just because she is a cancer survivor, but hers is one of those few cases of people who had cancer in Nigeria and money did not stand in between them and the treatment of the dreaded disease.Shogunro-Pitan had in 2003 removed her uterus and tubes known in medical parlance as Hysterectomy. She did this because she had multiple fibroids. Not long after she did the Hysterectomy, she started feeling that her body was not functioning properly. She was feeling a lot of discomfort lying face down, especially with her right breast. But as a Christian and minister of God, she was quick to say 'God forbid' each time the reality of it being breast cancer crossed her mind. With time, she decided to take the plunge. She headed for a private diagnostic laboratory for mammogram, a cancer screening test. But she never returned to the laboratory to ask for the outcome of the examination until two months later, when her doctor insisted on it. The test was positive, but it was decided that a second opinion should be sought. And in February 2006, it was confirmed that she had malignant lump. Now, it was time to act fast and deal with the situation at hand.The so-called January pangs are not strange to salary earners most of whom must have received their December salaries as early as the middle of the month. In fact, most companies pay on or before the 20th of the last month in the year. To the management of those companies, they did their workers a great deal of favour. At least, the beneficiary workers would have money to shop for the Christmas and New Year celebrations without having to borrow.
Lucky Shogunro-Pitan is married to a man whose pension plan has a health insurance policy that came to her rescue. Pronto, she went to the Eko Hospital, where only those with fat purse could seek medical assistance for a money-guzzling ailment like cancer. The hospital boasts of referred surgeons and oncologists whose bills are not for every Tom, Dick and Harry to pick.
For 29 days, she was on admission at the A-rate hospital, where she had mastectomy with equipment she said were fully automated. She had to undergo six courses of chemotherapy, 22 sessions of radiotherapy and CT scan. All thanks to her husband’s pension plan!
But what really does it cost to treat cancer? The Nation’s findings show that the prices vary depending on the type of cancer. But one ring cuts across all of them: they don’t come cheap. Before a patient can undergo chemotherapy and radiotherapy, a CT scan may be required. This costs between N30,000 and N40,000. And to ensure all the areas of threat are detected, the CT scan ought to be done for the brain, the chest, the abdomen and the bone marrow. To do all these, no less than N100,000 is required. But since most patients cannot afford this, x-ray, which is less comprehensive is adopted. The MRI scan, which is an higher form of CT scan, goes for at least N60,000. But it is not commonly used.
In the case of breast cancer chemotherapy, a patient may have to take Adriamycin, which, from checks at pharmaceutical stores, cost no less than N2,000 per bottle. But if the patient has heart problem, he or she has to use another variant of the drug known as Eprirubicin, which is said to cost about N10,000 per bottle. A patient is expected to use six courses of this every three weeks. By the time a patient is through with this, he or she must have spent between N80,000 and N100,000 on drugs alone. There is however a cheaper drug, which cost N400 per tablet known as Cyclophosphamaide, which is not commonly prescribed.
In the event that the patient needs surgery, the cheapest known as Lumpectomy, shows our findings, costs not less than N15,000. Mastectomy, which is the removal of affected breast, goes for about N50,000. As for radiotherapy done through linear accelerator machine for breast cancer, 20 sessions are said to cost not less than N100,000 anywhere in the country. The radiotherapy for cervical cancer costs about N50,000 more. If the breast cancer radiotherapy is done with Cobalt 60 machine, it costs less, especially in government-owned cancer clinics. The rate in private cancer clinics is more.
And in case the patient is hormone positive, she has to use anti-hormone drug known as Tamoxifen. A pack equals N600, which lasts one month. But the patient who tests positive to this is expected to use this drug for five years non stop for efficient result. This drug can only be used by women who have not reached menopause. For the five-year period, a patient needs N36,000. Those who are over menopausal age have to use Tamoxifen for between two and three years before combining it with another higher treatment, which comes at more cost.
But the financial implications of all these drugs and treatments pale into insignificance when compared to what it costs to use the new wonder targeted therapy for women with HER 2+ breast cancer. The drug known as Herceptin costs N400,000 to acquire enough dosages for one month and a patient is expected to use it for one year. That means to enjoy the enormous benefit of this wonder drug, which can be an effective treatment both before and after surgery for people with HER2-positive breast, a patient needs N4.8 million!
No wonder Prof. Muheez Durosinmi of the Department of Haematology and Immunology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, in a paper published by the International Network for Cancer Treatment and Research, identified high cost of hospital care as the major factor against cancer treatment in the country.
In his word: "The major limiting factors to successful treatment of cancer in Nigeria are the high cost of hospital care and the inability of a majority of the patients to obtain chemotherapy, poor supportive facilities and a high default rate. The unhealthy state of cancer therapy in this country is best illustrated with reference to our experience with the management of 213 patients with Burkitt’s lymphoma over a period of 13 years. Over 75% of patients presented in advanced stages C or D; 132 (62%) of the patients received less than the recommended number of cycles of chemotherapy before voluntary discharge from the hospital and, 41 (31%) of these did not complete a single chemotherapy cycle.
"The default rate was unacceptably high, with 166 patients (77.9%) failing to return for outpatient visits after a median follow-up period of 2.3 months (range = 0,67 months). A five year survival rate of only 1.9% was obtained, compared to almost 50% reported in E. Africa, using a similar combination therapy - cyclophosphamide, oncovin and methotrexate (COM). Our experience with Burkitt’s lymphoma is similar to that of most other cancers, in that a large majority of patients present very late and are unable to purchase anti-cancer drugs."
Investigations reveal that the rate of default by patients in taking their medications is very high. A cancer specialist said this is due to the inability of most patients to afford the cost of the treatment. So, the doctors have no choice than to keep recording in their cards that they have not taken the medications due to financial constraints.
Little relief came when representatives of pharmaceutical giants used to be regular faces at the cancer clinics around the country, where they were selling drugs to cancer patients. This reduced the problem of access to the drugs, even though many could still not afford the prices and had to miss their dosages. But this practice has since stopped in some cancer centres, as the management of the centres decided to take over the responsibility of selling these drugs through its pharmaceutical departments. The Nation learnt that this decision was taken after it was realised that some doctors in the cancer clinics saw in the burden of the people an avenue to make money.
"They were getting cuts, I mean percentages from the representatives of the pharmaceutical companies," said a patient. But has the new system curb the problem? "No," said a source, "it is now more expensive to get the drugs at the pharmacy. A drug, which, for instance, patients used to buy for N40, 000 is now N60,000 at the pharmacy." So, it is like jumping from frying pan to fire.
Another barrier, which the reporter found out in the course of the investigation, centres around the fear of chemotherapy. This has made some resort to alternative medicine products. But what really is chemotherapy? It is the treatment of cancer with drugs that can destroy cancer cells. In current usage, the term "chemotherapy" usually refers to cytotoxic drugs which affect rapidly dividing cells in general, in contrast with targeted therapy. Chemotherapy drugs interfere with cell division in various possible ways, such as the duplication of DNA or the separation of newly formed chromosomes. Most forms of chemotherapy target all rapidly dividing cells and are not specific to cancer cells. Experts say it has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (such as hair, bone marrow and intestinal lining). These cells usually repair themselves after the therapy.
A survivor told The Nation that she lost her hair, was generally weak, felt nauseated and lost appetite as a result of chemotherapy. Another said she was almost unconscious and had to take the last two doses with blood transfusion. Then another one claimed: "My skin darkened, my face was puffed up and swollen and my eye lashes disappeared."
But they all agreed that it is better to experience withered hair and all and stay alive than run away and die a harrowing death. After treatment, they all got their hair back, and puffed up face and disappeared eye lashes returned to normal and they live normal lives.
There is also the problem of denial. When cancer is first diagnosed, not a few first engage in self-denial, looking for reasons why it could not be. Rahama Sani, a cancer survivor and social worker, said she faced this challenge and even latched on to a typographical error in her name to back her position that it could not be her. It was also this that perhaps made Shogunro-Pitan not to go for the result of her test two months after, even though she had premonition that she had cancer.
Sani identified access to diagnostic facilities as major barrier to cancer detection and treatment, a development, which she believes is capable of promoting wrong diagnosis. Sani told The Nation that the first three investigations she did failed to show she had cancer. "I did three investigations. I did mammogram, there was nothing. Three investigations, there was nothing, until when the pathologist said they should remove it and he examined it and he confirmed there was cancer. When I got the result, I was like this was not my own because there was a typographical error in my name. But when I went to see the pathologist, he confirmed it was mine. I said we should have a second opinion. This was done by a renowned pathologist in ABU Teaching Hospital, Dr. Rafindadi. I went to see him in Zaria and they did the test again and he confirmed the same result. I was so confused. But he counselled me," said Sani.
All these barriers are compounded by the fact that Nigeria is a developing country with less than 10 percent of the resources for global cancer control and care. In the World Health Organisation (WHO) Technical Report No. 804 of 1990, it was reported that over 50 per cent of cancer victims live in poor nations like Nigeria, where a projection done some years back feared that this year, the figure of new cases could become as high as 500,000 as against the 100,000 cases annually previously. Of this figure, the Nigerian Cancer Society (NCS) says about 32,000 die annually. In 2005, cancer killed 89,000 people in Nigeria with 54,000 of this figure below the age of 70. It is feared further that by 2020, cancer incidence for Nigerian males and females may rise to 90.7/100,000 and 100.9/100,000 respectively. It is also anticipated that by 2020, death rates from cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively.
Yet, a WHO statement of July 3, 2002, said that"of the 10 million cancer cases occurring annually, 1/3 can be prevented, another 1/3 can be effectively treated with early diagnosis, and palliative care can improve the quality of life of the last third",
But with a pharmaceutical industry that is at best crawling, it has to depend on the developed world for drugs for cancer treatment. WHO findings show that the third world countries consume only five percent of cytotoxic drugs, while the rest is sold in the richer nations which account for only 39 percent of cancer cases.
Also disturbing is the fact that Nigeria, with a population of over 140 million people, has less than 100 practicing oncologists. The country also has no medical facility which specializes exclusively in cancer treatment and research. The implication of the shortage of cancer specialists, The Nation learnt, is that oncologists take on more patients than they can handle.
Now, more of the grim facts: The country has less than five active radiotherapy centres, representing a ratio of one machine to about 20 million people. This is against the recommended one machine for 400,000 people.
Durosinmi brought the reality of it further home when he revealed: "The available spectrum of anti-cancer drugs is very limited and such drugs are not readily available. Imaging facilities for staging patients with cancer, such as computerized tomography (CT) and magnetic resonance imaging (MRI), are difficult to come by, and when available, the cost of such studies puts them out of the reach of the average citizen. The inability to properly classify the various types of hematological cancers owing to lack of Immunophenotypic, immunocytochemical and cytogenetic diagnostic facilities is of great concern to hemato-oncologists practicing in this part of the world."
These sentiments were shared by the Chief Executive of a breast cancer awareness network, Care Organisation. Public Enlightenment (COPE), Mrs. Ebunola Anozie, at training for health reporters in Lagos last month. Anozie lamented that the country lags behind in terms of having adequate facilities for the treatment of cancer.
Durosinmi and Anozie find good company in the Chairman of the National Consultative Committee on Cancer in Nigeria (NCCN), Prof. Abayomi Durosinmi-Etti, who also said the country lacks qualified personnel and equipment to manage the treatment of cancer and bemoaned the state of cancer treatment in the country.
The sorry state of cancer care facilities in the country has made the rich resort to running abroad for treatment. The late human rights activist and Senior Advocate of Nigeria (SAN), Chief Gani Fawehinmi, who alleged that he was wrongly diagnosed by a doctor in the country, former First Lady, Maryam Babangida and others who late last year died of cancer, sought help abroad. But this is only the exclusive preserve of the rich and those supported by the rich to seek treatment abroad. However, Health Minister, Prof. Babatunde Osotimehin, believes "there is no point travelling abroad for treatment again because there is Tele-medicine in place now."
Sadly, the country’s National Health Insurance Scheme (NHIS) offers no hope for cancer patients. Even for less costly ailments, it is, shows findings, having passable effects.
Significantly, in the face of these bumps on the way of cancer treatment, not a few will ask: What is government doing?
As of now, the Federal Ministry of Health has developed a five-year National Cancer Control Plan, which is yet to start working. The Federal Government also recently released $2 million to the International Atomic Energy Agency (IAEA) to help in the comprehensive detection, treatment, control and management of cancer cases in the country. The money is the counterpart fund from the country to expand Nuclear Medicine Services, upgrade and strengthen radiotherapy services in 10 tertiary hospitals. This was revealed by Osotimehin when the Director General of the IAEA, Yukiya Amano, paid him a visit.
The foundation for this was laid when First Lady Turai Yar’Adua led the Nigerian delegation to the 53rd General Conference of the IAEA in Vienna and canvassed among others for Technical Cooperation between the IAEA and her pet project, the International Cancer Centre.
If executed according to plan, the first phase of the Nuclear Medicine projects will be available in the University of Maiduguri Teaching Hospital, University of Nigeria Teaching Hospital, Enugu, University of Port-Harcourt Teaching Hospital, National Hospital, Abuja and the Federal Medical Centre, Gombe. The upgrading of radiotherapy facilities will be carried out in the National Hospital, Abuja, University of Calabar, Ahmadu Bello University, Zaria among others.
Mrs. Yar’Adua last year organised a fundraising event for an International Cancer Centre (ICC), which its promoters say would likely be the best of its kind on the African continent. Over N10 billion was realised at the event, which was attended by prominent personalities in government and business circles. She is credited with donating cancer drugs to the National Hospital, Abuja, UCH, Ibadan and three others to be given free to indigent patients.
The Coordinator of the Cancer Control Programme of the Federal Ministry of Health, Dr. Patience Osinubi, also revealed that as from the first quarter of this year, cancer screening will begin in all the 55 teaching hospitals in the country. She also said that a nationwide cancer registry will be established through the National Cancer Control Programme.
Osinubi said this year a pilot scheme for free cervical cancer vaccination will begin. This, she said, will begin in six states. It is hoped that the concerns of Durosinmi are taken into cognisance in implementing all these programmes. He observed that "lack of human and material resources account, in large part, for the dismal results of cancer therapy in Nigeria, but poor planning and lack of positive political will are also major factors militating against effective cancer care in Nigeria."
It is because of Durosinmi’s concerns that many seem to agree that the nation has a not too solid National Cancer Control Programme.
So, what is the way out? Durosinmi is of the view that "it will be important to adopt preventive measures for many cancers, including education against behaviours associated with an increased, risk and immunization and screening where feasible and cost-effective. For example, cancer of the liver can be effectively prevented through immunization against hepatitis B virus (HBV), as well as through compulsory screening of blood and blood products for HVB and HCV markers and by using disposable needles and syringes. Cervical cancer can be controlled through early detection by a "Pap smear" or by the more sensitive ‘visual inspection technique’ with acetic acid or Lugol’s iodine."
He added: "Vaccines against human papilloma virus (HPV) have already been shown to be effective, and could eventually effectively prevent cervical cancer. Regular self-examination of the breast during monthly periods and regular mammography examination of the breast will facilitate early detection of breast cancer, although mammography is unlikely to be cost-effective as a screening procedure in resource-poor countries such as Nigeria. Prevention could have a major impact on tobacco-related cancers as well as other tobacco related diseases. Lung cancer, a difficult disease to treat, is easily (in theory!) prevented by not smoking, but it is disappointing to note that, following recent aggressive campaigns against the tobacco industry in most western populations, tobacco companies have now shifted their advertisement to poorer parts of the world. Tobacco abuse has reached epidemic proportions in many such countries, including Nigeria, and we can anticipate a major increase in tobacco-related diseases in the coming years."
He also advocated the setting up of a National Cancer Institute, with the objectives of providing clinical and investigative facilities for cancer care and research, monitoring cancer trends in the country, providing postgraduate training in cancer, coordinating cancer control activities in Nigeria and collaborating with cancer centres in other parts of the world.
In the view of Dr. Paul Jubrin, consultant pathologist, head, Department of Histopathology, National Hospital, Abuja, there is also the need to evenly distribute cancer diagnosis and treatment facilities. Jubrin told The Nationthat "the facilities for the treatment of cancer in Nigeria are actually up-to-date. But the problem is that it is not well-distributed. Cancer radiotherapy, one of the latest treatments of cancer, is only in Lagos, Abuja, Ibadan and Zaria. At least, you expect up to two of them in each geo-political zones of the country. If you come to the National Hospital, Abuja, the state-of-the-art equipment are there. We recently introduced nuclear medicine, which you can use to detect cancer in your body and apart from that we have an oncology unit. It is just distribution. National Hospital has started training for oncologists. The screening method for cervical cancer called pap smear is between N2, 000 and N3, 000. It is now available everywhere. Now, we have what we call visual inspection with iodine. You don’t even need a specialist for this."
Sani added: "I hope our government will put in place proper diagnostic facilities so that people won’t be wrongly diagnosed and they can take informed action. We need to improve the diagnostic system. I am sure a lot of people have been wrongly diagnosed."
Executive Director of the African Tobacco Control Regional Initiative (ATCRI), Mr. Akinbode Oluwafemi, told this reporter that effective tobacco control through the passage and implementation of the National Tobacco Control Bill 2009 would go a long way in helping to curb cancer. Akinbode explained that many types of cancer have been linked to cigarette, which contains over 4,000 toxic and carcinogenic agents. The bill, which has passed the second reading at the National Assembly, seeks to domesticate the WHO Framework Convention on Tobacco Control (FCTC), a global treaty that has the potential of checkmating the evil of tobacco use, among which is cancer. Smoking related cancer, he said, accounts for not less than 30 percent of cancer related deaths.
But another interesting angle to the treatment and management of cancer came from a Nigerian cancer investigator at the University of Chicago, Dr. Funmi Olopade, who is of the view that cancer does not just kill because of lack of medical treatment. Olopade said at the last conference of the African Organisation for Research and Training in Cancer (AORTIC) in Dar es Salaam, Tanzania: "In Calabar, Nigeria I met some people and we all decided that we were going to look at what breast cancer was like in Africa. From that meeting in Calabar, we got a revelation that we have to come back to a better understanding of biology in the way we treat breast cancer. When I got back to America, I had to challenge my friend, Otis Brawley, who is now the Chief Medical Officer of American Cancer Society who always said it is because people don’t have access to treatment that they die of cancer and I told him that it is not true, that I just came back from Africa and I have gone to their Pathology Department; that this biology is something else. I advised that they should put money to the study of this biology."
The implication of her findings, she said, is that more researches are crucial to understanding cancer better so as to treat and manage it well. She added: "I hope that this work will be done by members of AORTIC in partnership with all of us who are working in the Diaspora because until we get to the point where we can say we have eradicated cancer from the planet, our job is not done."
For now, in the face of these barriers, beating cancer may appear advisable. Experts say cancer – and by extension the attendant psychological, financial and emotional losses- can be beaten through early detection, avoidance of lifestyles that promote cancer such as smoking, exposure to industrial chemicals, consumption of excess fat and heavy use of alcohol, healthy sexual behaviours, and pursuing a lifestyle or diet that modifies cancer-causing factors.
Along this line, renowned gynaecologist and Medical Director, Medical ART Centre, Lagos, Prof. Oladapo Ashiru, said: "As soon as you attain the age of 40, you should go for a comprehensive medical examination. As from 50 and above, women should be undergoing procedures like a mammogram, ultrasound scan and blood evaluation."
Associate professor and Consultant Obstetrician & Gynecologist at the Oncology & Pathological Studies Unit, College of Medicine (CMUL), Lagos University Teaching Hospital (LUTH), Dr. Rose Anorlu, also advised: "Don’t wait until they have symptoms before going for routine checks yearly for breast cancer, cervical cancer including pap smear and ultrasound scan. Post- menopausal women in particular should go for routine self-breast examination, a mammogram test and a pelvic ultrasound scan to check the ovaries."

SOURCE

Cigarette smoking: Easy path to ill-health, death

EBENEZER EDOHASIM, Features Editor

EVERY one knows that smoking hurts, it causes sickness, disability and death. But the harmful effects of smoking may be worse than you really imagine because smoking damages nearly every organ in the human body. Little wonder Mr. Tunji Buhari of the Environmental Rights Action, (ERA), and Friends of the Earth, lamented that, “Tobacco or cigarette smoking is the only known medication that kills half of its users when used as prescribed by the manufactures. It kills over 10,000 persons per day and 4.5 million people yearly.”

As he further disclosed, “Sadly, 70 per cent of this figure are from developing countries, including our own nation, Nigeria and if this trend continues, this figure is anticipated to rise to 10 million a year by 2030.” The history of tobacco is as old as the world itself because almost all parts of the earth has knowledge of tobacco usage and therefore had smoked one form of cigarette or narcotics even in dark ages.

However, modern attention on the manufacturing of this killer sticks came to light during the slave trade era, when the western world found in Africa, cheap and strong labour which they bought from local greedy African slave merchants, who sold their brethren to the white man, to be used as slaves. These slaves in their millions were wickedly exported to the Americas in special slave ships under very dehumanizing conditions, where most of them worked in tobacco plantations on arrival to the new world, as America was then called, especially in the city of Virginia, United States, to produce raw materials for the production of cigarettes and other dangerous narcotics.

Unfortunately, several years after the abolition of slave trade and slavery, which claimed the lives of many innocent Africans, the tobacco plantations which those slaves nourished for their wicked white masters continued to produce killer narcotics for blacks in developing world as some western nations have banned smoking, having discovered that cigarettes smoking is dangerous to health. In Nigeria, commercial growing of tobacco started in 1934 when British American Tobacco,(BAT), decided to source tobacco leaf locally in preparation for the establishment of a cigarette plant in 1937. BAT has been part owners of the moribund Nigeria Tobacco Company, (NTC).

Tobacco cultivation first started in Ogbomosho, Iseyin and Ago Are, all in the present day Oyo State, before spreading to the northern part of the country. After the collapse of the Nigeria Tobacco Company, there was another spirited attempt by BAT to relaunch cigarette production in Nigeria. Therefore on September 24, 2001 at an event tagged Nigerian Investment Summit held at Park lane Hotel in London, BAT signed a memorandum of understanding with the Federal Government to set up US$150 million ultra modern cigarette manufacturing plant in Ibadan, Oyo State. Since then, BAT and other cigarette plants have been producing cigarettes to millions of Nigerians who savour these deadly sticks on daily basis. It is estimated that 18 billion cigarettes are sold yearly in Nigeria, with one in every five young Nigerian a smoker, while women smokers have raised to10-fold during the 1990s – 2000. In the United States, acknowledged as one of the world’s highest consumer of cigarettes, 400, 000 Americans die every year from smoking and that is 1,200 per day. Also one every five deaths in this God’s own country was the result of smoking.

Despite the fact that cigarettes contains over 4,000 different chemicals that make them deadly, with 60 per cent of these chemical being carcinogens, which means they can cause cancer, people still puff this sticks as if their lives depended on them. Investigation shows that people smoke for different reasons and which some of them are ready to justify, no matter how long you spend to alert them on the inherent dangers associated with cigarettes or narcotics. Generally, people said they smoke to make them look mature, older and respected and this reason was mostly advanced by teenage smokers.

Others smoke to relax their tensed nerves. Still some see it as status conferrer to set them apart or make them higher than their peers, while some claimed they do it to keep their weight down. And for another set, they come from family of smokers and therefore embraced smoking as family business which they must continue. Again, cigarettes makers spend millions of dollars on adverts, making smoking look cool, elegant, and highly successful, as they usually use music, film, television or even sports stars, and very beautiful, sexy and erotic ladies to send their outwardly innocent but inwardly deadly adverts, publicity and promotion campaigns across their target audience all over the world. The dangerous thing about smoking is that once people get hooked, it is very hard to stop and this is called addiction. And addiction on the other hand is caused by the nicotine contained in cigarettes.

According to Dr.Stephen Oladele of Ola Ayoka Memorial Conval (Health) Clinic, Ogudu, Lagos, “Nicotine stimulates the brain, giving it a sense of euphoria. It raises alertness and lifts a person’s mood, but as time goes on, it takes more nicotine to have this effect. When a person is slowing down or trying to quit smoking, nicotine levels in the blood stream drops but withdrawal is never easy.” However, whatever was gained as the result of the decision by a smoker to quit is lost the moment he or she starts smoking again which gets the nicotine level in the blood stream going higher once again, like a diabetic patient who allowed too much carbohydrates into his system, thereby shooting up his or her sugar level.

Dr. Oladele further said that, “Smoking primarily causes cancer, cardiovascular diseases, respiratory ailment, and harms reproduction.” On a broader spectrum, smoking has been linked to cancers of the lungs, mouth, throat, larynx (voice box), esophagus, pancreas, kidney and bladder. Smoking could also lead to cancer of the stomach, cervix and acute myeloid leukemia or cancer of the blood. Smoking it was disclosed causes more cases of lung cancer as smokers are about 20 times more likely to develop lung cancer than non- smokers. Smoking causes 90 per cent of lung cancer deaths in men and 80 per cent in women. Smokers are four times likely to die from coronary heart diseases than non- smokers. It causes atherosclerosis, or hardening and narrowing of your arteries which may lead to strokes. Smokers could suffer from abdominal aortic aneurysms, a dangerous weakening and ballooning of the major arteries near your stomach. If you smoke during childhood and teenage years, it slows your lung growth and causes your lungs to decline at a younger age. Smoking is related to chronic coughing, wheezing and asthma among children, teens and adults. It also causes half of all cases of adult periodontitis, a serious gum infection that can cause pain and tooth loss. Dr Oladele equally stated that, “Smoking seriously harms reproduction as it causes lower fertility in women, induces placenta previa and placenta abruption which are conditions that can make the baby to be born too early and then be sick. The nicotine in cigarettes smoke reduces the amount of oxygen reaching the fetus and could also retard baby’s growth in the womb resulting to low birth weight.”

Further investigation showed that smokers are less healthy than nonsmokers, have increased risk of cataracts, and low sexual drive. They are linked with inability of wounds to heal fast, and respiratory problems, with women smokers’ bones losing density very fast after attaining menopauses. One crazy revelation about smoking is that while smokers risk their lives by inhaling nicotine into their lungs and other vital internal organs, nonsmokers who stay near smokers as they puff their stick are also, unfortunately, at risk of tobacco death. Non smokers who innocently inhale smoke from smokers engage in second-hand smoking equally called environmental tobacco smoke or passive smoking, because some quantity of nicotine also enter their system and could damage some organs and cause sickness to unfortunate non smokers. According to WHO report, “It has been confirmed that for every eight smokers who die, one innocent bystander also dies from second-hand smoke and if one is exposed to second-hand smoke for about 120 minutes, then the person must have smoked the equivalent of four sticks of cigarettes.”

Surprisingly, despite these frightening health hazards associated with smoking, people still smoke as if without it they will die the next moment. This writer had interesting interaction with some smokers to find out why in the first place they decided to smoke cigarettes, what they gain from smoking, the health hazards they experienced and when they hope to finally drop this deadly habit. Mr. Oyetunde Olusoji, a young Interior Decorator disclosed that he started smoking cigarette in 1998 due to peer group influence. “Honestly, I still don’t understand why I joined my friends who smoke to do the same. I just wanted to belong to the big boys group and to be seen as one of the movers and shakers of the school environment in which I found myself. One thing led to another and before I knew it, I got hooked into this deadly act and I don’t know how to remove myself from it.” Mr. Olusoji stated that sometimes, certain conditions stimulate the need to smoke. For instance, “If Iam alone and feel bored, I will have the urge to smoke and also whenever I drink beer, only God could stop me from smoking because once Iam taking beer, the next thing that comes to my mind is to smoke and I must satisfy that urge. Interestingly, Mr. Olusoji is aware of the health hazards linked to smoking and even postulated that 60-70 per cent of chest and lung pains come from smoking. However, he argued that since some people developed cancer of the lungs without even touching a stick of cigarette, he no longer bothers himself on the dangers inherent in smoking as long as his urge is satisfied each time the feeling to smoke envelopes him, fully aware that one day, he will die of one illness or the other. As he further disclosed, “One negative effect of smoking on me which I regret so much is the social stigma it hangs on me as some of my girlfriends refused to kiss me because my mouth always smelled of cigarettes. My girlfriends at a stage, individually, asked me to choose between them and cigarette and when I chose my stick over all of them, I knew that my liberation from smoking was still very far. If you smoke, you can hardly get responsible girlfriends because any girl that accepted to befriend you as a smoker if you investigate well, equally has bad habit which when you discover and want to make noise over it, she will blackmail you with your smoking act and you will have no option than to keep tolerating each other’s vices.”

But in a very interesting swift, Mr. Olusoji dramatically decided to quit smoking in 2006 only to resume in2009. According to him, he returned to smoking when he encountered serious challenges which mounted pressure on him, thereby tensing him up. So till today, he is still helplessly addicted to nicotine, hoping that one day God will grant him the grace to quit what he tagged “this destructive habit that robbed me of all my responsible girlfriends, leaving me with the bad ones as I don’t expect any reasonable girl to date a smoker.”

A former chronic smoker, Pastor James Okoro, founder and general overseer of the Word Foundation Assembly, Lagos, who by what he identified as the special grace of God and his will power, discipline and determination quit smoking in 1997, a habit he acquired in 1983 said that, “There is an evil spirit in cigarettes that induces people to smoke. The day that unclean spirit of nicotine addiction left me, I knew that I have been liberated. The very bad aspect of smoking is that every smoker will advance reasons to justify his action. Some light a stick each time they wanted to go the toilet as thy claim it helps them to empty their bowels. To others, it simply gives them joy and any attempt to stop smoking takes the joy in their lives away which is ploy by the devil to get them permanently hooked to smoking. Others will tell you that whenever they drink beer, they must smoke so that the beer will go down their throat very well.”

Pastor Okoro said that smokers should be pitied because quitting cigarette smoking is not an easy task. But he counseled that because of the health hazards linked to smoking which he experienced while he smoked, people should halt smoking without further delay. Those who want to stop must involve God in the process as no smoker can automatically quit smoking with power of the flesh because of cigarette’s addictive nature. Before he stopped smoking, he first bid farewell to alcohol which stimulates him to smoke, cut off from his friends who smoked to avoid any temptation, and fully declared himself a born again Christian before all his friends and neighbours, preaching fiercely against smoking. He said that after few weeks, when the urge came up, he looked for a very secret place to hide and smoke so that people he had already told that he was now born again will not see him smoking. However, when he found that there was no hiding place for the gold fish, he used will power and prayers to suppress the urge and subsequently became freed from nicotine addiction.

He advised those who want stop smoking to reject suggestion by some people to go for an alternative to smoking like kola nut, bitter kola, and alcohol, sweets among others, disclosing that if one quits smoking to embrace kola nut for instance, he could again be addicted to kola nut which contains caffeine that is equally harmful if taken constantly in large quantity. “Once you have prayed to God to direct the Holy Spirit to help you stop smoking, let your yes be yes and no be no because anybody who said no to something and could not maintain his no, is a fool. And since I don’t want to be classified as a fool, I totally rejected smoking, and the urge disappeared after two weeks. Up till today, I have never gone back to smoking. Smoking is almost like a curse for an addicted smoker can even go and wake up his worst enemy for cigarettes, once the urge sets in.”

For Mr. Rowland Chukwuka, an Immigration expert, he started smoking in 1996 when he was still in secondary school, stopped in1997 only to go back in the year 2000. “I started smoking through the influence of friends in school. I felt that they are high up there and what they were doing by smoking was very good, and I wanted to belong to the big boys club. Again in 2003, I quit smoking only to return to this bad habit in 2007. It is not as if one deliberately went back, but it is only God Almighty that can help me stop smoking by taking care of me whenever Iam under pressure which actually triggers my quest for cigarettes. I assured my wife on several occasions that I was quitting, only to disappoint her by embracing smoking again.”

Mr. Chukwuka admitted like others that he was fully aware of the hazards linked to narcotics but said that addiction is a very dangerous thing for once you are hooked to a habit, it becomes very difficult to pull out. “Before I temporarily stopped smoking, I experienced terrible headache, which was near a migraine, my dress sense nose-dived as I found myself unkempt and could go without bath for days, stinking even to myself of congealed smoke. I was excommunicated in some quarters and I utterly appeared near irresponsible.”

Lamenting further on the plight of addiction, he said, “It is a big shame to even think that as a member of the Red Cross Society, I still indulge in this awful habit. I hope to one day develop the will power to quit smoking, if not for any other reason, for my children’s future, so that I will not die young and make them fatherless at tender ages. Non smokers should never think of embracing it because all those things you see on cigarettes adverts are false life styles, tailored to get you hooked to smoking. They should obey the warning by the Federal Ministry of Health that cigarettes smokers are liable to die young, for once diagnosed of cancer, then, your days are really numbered on this earth.”

A journalist, who simply called himself Jones, said that he has been smoking for the past 20 years. According to him, he left secondary school, came to Lagos to stay with his big uncles and then look for job. It happened that most of his uncles were smokers and he innocently grew up with them to believe that smoking was a good way of life and has been puffing since that regrettable informal initiation into the club of smokers by his uncles, which could be described as a navigational error. As he recounted, “I started smoking due to peer group pressure as I tried to belong. In those days in question, if you don’t smoke, womanize or drink what then makes you a good big boy. I craved to belong and even when I entered higher school in 1986/87, I continued smoking to maintain the big boy status on campus. I smoke whenever Iam tensed up or under pressure, if Iam drinking beer or when Iam lonely, driving alone back home after work. I saw smoking as part of growing up as those I emulated never told me that it was a dangerous habit until I became addicted because I did not realize what I was doing to myself in the first place and when to call it quits.”

Jones said that though he has not been clinically diagnosed of any ailment linked to tobacco smoking, “I knew that some serious pains I do feel at my back were induced by smoking because if I leave smoking for some time, the pains disappear only to return when I resume.” He disclosed that the warning on cigarettes packs meant to serve as deterrent has no effect on him, for if it did, he would have stopped smoking long time ago. “So the best I could do is to stop it before it stops me for if I don’t stop smoking, cigarette will stop me. A situation where hide my mouth from my wife even after using mouhfreshner so that she would not decode that I smoked is certainly not the best.”

Another journalist, who pleaded anonymity, told this writer that he derailed into this dangerous zone of nicotine consumption since 1975, made a failed attempt to stop in 1996 but resumed almost immediately and had not considered making another move to quit since that botched attempt. He stated that his smoking habit has caused him breathing difficulties, lack of energy to do strenuous jobs meant for young men, and has seriously lowered his libido or sex drive. Again, he disclosed that smoking made him cough always as he said that there is what is called smokers cough, which is recurrent whether one has cough or not. He experienced pains in his chest, lungs and had fractured relationships with women because of smoking.

This journalist, who is a prolific writer, condemned attitude of Africans to smokers when he blasted, “I don’t see why Africans claim to be holier than the Pope, as smoking in most parts of Africa is still regarded as sin with serious moral burden. Those who smoke in some parts of Africa are viewed as direct candidates to hell fire, who require no visas to enter that terrible place meant for Satan and his servants. In Europe where I grew up, people were concerned only with the health implications of nicotine to smokers and not whether they will go to hell or heaven. In Italy, ashtrays were placed on tables in classrooms and both students and teachers were free to express themselves by smoking if the urge was instigated.”

He disclosed that he is chain smoker who buys cigarettes in rolls and could smoke up to four packs in a day. Speaking further, this articulate journalist who from the way he puffed as our interaction interview progressed has actually mastered the act of smoking yelled again, “Don’t condemn or sympathize with smokers, feel for them and hope that they change because you may be suffering from other forms of addictions, more dangerous than cigarette. It is very difficult to quit smoking because nicotine is involved which is addictive. In my case, I once commenced fasting all in the struggle to stop smoking. During the fasting, whereas I did not eat food, I couldn’t resist the urge to add more nicotine into my system, and therefore I broke the fasting by smoking some sticks. It is indeed better not to start smoking than to think of the gruesome road that leads to quitting this habit.”

Asked if he is not afraid of Federal Ministry of Health’s warning that smokers are liable to die young, he exploded again, “That is outright hypocrisy. How can the government that granted license to these tobacco firms to operate in Nigeria turn around to discourage people from buying the products of companies that pay huge taxes to them? That is why nobody is taking the warning on cigarettes packs serious. If government is honest, let them revoke those firms’ operating licenses and ban them from producing cigarettes in Nigeria, because government posture only amounts to giving with the right hand, only to retrieve with the left hand, which is day light robbery.”

On how to stop the inherent dangers in smoking, he went philosophical; “Every age has its own poison. There was time when alcohol was in vogue, and then tobacco came on board. At a point in history, people took designers drugs like ecstasy and Chinese pill. Then Indian hemp or Marijuana became status conferral on musicians, actors, dancers among others sometimes ago. Today, they take cocaine, heroine, and tobacco. If only for medical implication, I support the clamor to ban cigarette smoking. But again, people will find other poisons to fill their system with but I believe that one day, cigarette will go out of fashion.”If cigarettes smokers themselves have testified that smoking is dangerous, what is the government doing to ensure that its citizens don’t die young as the result of smoking. Interestingly, the Federal Government instituted a case in court against three tobacco firms some years ago, demanding 22 billion British pounds for glamorizing cigarettes smoking through deceptive adverts targeted to lure youths into smoking. Though the case is yet to be decided, it is a step in the right direction but we had expected the Federal Government to consider the health implications of tobacco in its entirety before granting license to tobacco firms to start producing this dangerous product in our country just because government wanted funds from these companies.

Again, the compulsory inscription by cigarette makers on their packs, warning on the side effects of smoking is also encouraging, only that it is one thing to warn somebody to desist from doing something, but the onus to adhere to the warning lies on the reader. It now becomes a typical case of leading the horse to the river but not forcing it to drink. Worthy of mention and emulation by other states was the decision by the Federal Capital Territory, (FCT), Abuja which banned smoking in public places on June 1, 2008, to ensure safer air and also prevent second-hand smokers from suffering innocently while the real smokers burn their hearts.

However, the silence maintained by the Federal Government on taking long lasting decision on how to control smoking or ban it out rightly is not in the interest of the nation. The Federal Government should take a cue from the governments of South Africa and Kenya who summoned courage to enact laws regulating smoking in their countries. In South Africa, a law banning smoking in public places and cigarette adverts was enacted, making the people to be conscious of their environment and health for there are penalties for offenders. Also in Kenya, there is a standing law which banned smoking in public places, especially in the capital city, Nairobi. Though the law became effective for sometimes before it slacked, it was a step in the right direction and we expect the Nigerian government to come out with a holistic direction that will make smoking in public places a thing of the past. In fact, against the background that tobacco firms target youths who are the leaders of tomorrow, should make the Federal Government react fast and safeguard the teeming population of our youths, before these glamorous tobacco adverts lure them into smoking today, only to render them useless by one tobacco related disease or the order tomorrow, when we shall look up to the youths to take over from the old and aging leaders.

For smokers who want to quit, physicians developed and monitored website, Healthcommunities.com suggested the following five steps towards final disengagement from cigarette smoking. The are, Get Ready, Get Support, Develop Strategies, Ask Doctor about Prescription Medications and Prevent Relapse. In getting ready, the smoker should outline reasons for quitting, keep diary on when he/she smokes and what triggers it on, research on available information in your area about quitting, set date for quitting and on this date, get rid of ashtrays, lighters and all tobacco products.In getting support, ask health provider for advice on quitting, sign up for a smoking cessation programmme, talk to friends and family for support and keep journal of your thoughts and feelings during this challenging process.

Developing strategies should make the person learn yoga, meditation, deep breathing, start physical exercises, talk to counselors and research into nicotine replacement therapy (NRT) options. In asking doctor about medications, consider medication that can help reduce nicotine withdrawal symptoms and improve your chance of success, research your medication and other withdrawal treatment options. Finally according to these distinguished doctors, in preventing relapse, keep busy. When the urge comes, take one deep breath at a time until it passes. If you relapse, don’t give up; remember many people who quit had to try several times before succeeding.

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Reducing Tobacco-Related Deaths

By Ozioma Ubabukoh

African nations seem poised to undergo the highest increase in the rate of tobacco use among developing countries, and nearly 90 per cent of people on the continent, perhaps, remain without meaningful protection from second-hand smoke, according to a new report released at a regional conference recently.
The report, ”Global Voices: Rebutting the Tobacco Industry, Winning Smoke-free Air”, however, tend to point to signs of hope. Several African countries are fighting against the tobacco industry‘s aggressive campaigns to stop public health interventions by putting smoke-free laws into place, probably protecting more than 100 million more people since 2007. This report was published by the Global Smoke-free Partnership.
Recent data suggest that, with current trends, more than half of the region of Africa may double its tobacco consumption within 12 years. And to check this, ”Smoke-free public places are one example of a low-cost and extremely effective intervention that must be implemented now to protect health”, said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society.
In about less than two years, Kenya and Niger Republic have enacted national smoke-free policies, and South Africa, which has been smoke-free since 2007, according to reports by environment reporters, has been termed to play an important role in the region, demonstrating that smoke-free laws could work in Africa. In what seemed as a first for the region, Mauritius recently passed a law that is close to meeting the Framework Convention on Tobacco Control standards, ranking among the most robust anti-smoking measures in the world.
According to the American Cancer Society monitoring team report, implementation remains a challenge in many places, including the Democratic Republic of Congo, Ghana and Uganda. Even with the ban placed on smoking in public places in Abuja, the nation‘s federal capital, in 2008, by its former minister, Alhaji Aliyu Umar Modibbo, the city is seen as most vulnerable to the campaign of ensuring a smoke-free society.
”In Abuja, Nigeria, for example, 55 per cent of school students are not aware that second-hand smoke is harmful to health, and only 1 per cent of Nigeria‘s population is protected by strong smoke-free laws”, the report said.
It also exposes the tobacco industry‘s tactics to hold back legislation and convince African governments that tobacco is important to economic activity; that raising taxes on cigarettes and implementing smoke-free laws will result in revenue and job losses. In Kenya, for instance, it was reported that the tobacco industry issued a legal challenge to a smoke-free law passed by the Parliament. In Zambia equally, the British American Tobacco company has been accused of aiming to dilute proposals for a smoke-free law.
Some people have alleged that the campaign against tobacco smoking, especially in Nigeria, seems to be hindered by some journalists who would rather comment on any other health issue, no matter how agonising, than report or write on the dangers of smoking cigarettes.
According to them, some journalists are of the belief that the best writers are those who smoke and drink. And they have passed this notion to the younger ones planning to take up a career in journalism.
The National Coordinator, Nigeria Tobacco Control Alliance, Mr. Akinbode Oluwafemi, said this might be responsible for deaths of more journalists from tobacco-related ailments.
Oluwafemi, who is also the Programme Manager, Environmental Rights Action and Friends of the Earth, Nigeria, said, ”For how long are we going to be silent? Several Nigerian journalists and activists are aware that they are dying from cancer of the lungs and tobacco-related ailments, yet they have kept the stick burning. On most occasions, they lead the campaign against smoking, and immediately after that you find them lighting the stick. We have lost the likes of Steve the sleek Kadiri, Momoh Kubanji, Yinka Craig and Beko Ransome Kuti to tobacco smoking.
”Cancer control programme should be linked to tobacco control. Journalists should lead on awareness creation. It is time to be open about our friends, brothers and sisters dieing of tobacco- related cancers. Let‘s support the passage of the national tobacco control Bill.”
It is estimated that in 2010 smoking will claim the lives of six million people worldwide, 72 per cent of whom reside in low and middle-income countries, Nigeria inclusive. If current trends continue, tobacco will kill seven million people annually by 2020 and more than 8 million people annually by 2030.

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Reducing Cancer begins with supporting Tobacco Control Bill

When news that former First Lady, Mrs. Maryam Babangida had died from ovarian cancer in far away United States (US) filtered through the airwaves on December 27, 2009, many Nigerians realised that if the latest cancer victim was wife the former military President, Ibrahim Babangida, it is indeed time to check the killer disease. One way to fight cancer, a non communicable disease involving abnormal growth of cells, is keeping away from tobacco smoking.

According to data issued by the World Health Organisation (WHO), cancer affects people of all ages with the risk for most types increasing with age. With the increase of cancers recorded globally since 2008, the link between cigarette smoking and cancer has been brought to the fore.

Researchers have clarified that tobacco use is associated with many forms of cancer and that cancer caused about 13 per cent of all human deaths in 2007. Also, research has shown that cancer causes 90 per cent of lung cancer. These are some of the issues raised at a training on Cancer Reporting for Health Reporters organised by Journalists Advocacy on Tobacco & Health (JATH) in Lagos recently. Among resource persons at the workshop were Mrs. Ebun Anozie, Chief Executive Officer, Care Organisation Public Enlightenment, also known as C.O.P.E., Akinbode Oluwafemi, Programme Officer, Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN), Tosin Orogun of JATH, among others.

Tobacco’s role in increasing the chance of lung cancer is one of the most widely known of tobacco’s harmful effects on human health. Decades of research has demonstrated the link between tobacco use and cancer in many sites in the body in addition to the lungs. Other parts of the body that cancer can affect are the head and neck, (coveringof the esophagus, larynx, tongue, salivary glands, lip, mouth, and pharynx), urinary bladder and kidneys, uterine cervix, breast, pancreas, and colon.

According to the Programme Officer, Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN), Akinbode Oluwafemi, there are about 599 approved additives in a stick of cigarette. He said, “Cigarette smoke is proven to contain over 4,000 toxic and cancer causing chemicals. The list is long: carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia to name a few.”

He noted that smoking is a major risk factor for different cancers and apart from the high cost of cancer treatment and the infrastructural challenges, smoking related cancers account for 30 per cent of cancer related deaths.

Therefore, taking prompt action to check cancer related deaths becomes more compelling now considering the large number of smokers in the nation. Data issued by the WHO states that 17 per cent of Nigerian adults smoke, resulting in 17 million Nigerians. “And because research has shown that half of smokers are going to die of tobacco-related illnesses, that means 6.5 million Nigerians are going to die as a result of that smoking habit,” he said.

Consequently, Akinbode said that is why it is very urgent for government to begin to take actions in order to reduce tobacco use in Nigeria.

While he noted that tobacco related deaths are preventable, Programme Officer of ERA/FoEN urged the government to put in place policies that will discourage people from putting up the habit of tobacco smoking and for people who are already smoking to quit.

A speedy passage of the National Tobacco Control Bill 2009, sponsored by Senator, Olorunnimbe Mamora will help, Akinbode said.

The bill, which has passed through the First Reading at the National Assembly seeks to domesticate the Framework Convention on Tobacco Control that was negotiated under the WHO. Nigeria became a party to that convention in 2005.

Since Nigeria is now a part of that Convention, he said, “We should domesticate all the provisions of that international treaty.”

The provisions talks about Tobacco Demand Reduction, the mechanisms of which include ban on advert, sponsorship and promotion of tobacco products, raising taxes on them, creating smoke-free environment for the citizens and making the public places smoke-free.

Similarly, it includes awareness creation and obligations on cessation of tobacco smoking.The other side of it that has to do with manufacturing talks about packaging and labeling of tobacco products.

How do manufacturers package tobacco products? Programme Officer of ERA/FoEN said they have to put in place appropriate warnings on cigarette parks.

“For instance, Akinbode said the Framework Convention on Tobacco Control recommends 50 per cent pictorial warnings, meaning that manufacturers have to put on the cigarette park pictorials on what is cancer, that cigarettes cause impotence, that cigarettes smoke is dangerous for unborn babies and pregnant women, among others.”

According to him, these pictorial warnings are already being put on cigarette packages in some African countries. He said, “For instance, Mauritius has even moved a step further to say that those warnings will occupy 75 per cent of the display area on the cigarette park Besides, it is the same companies that are here that are manufacturing cigarettes in Mauritius. So, they don’t have any excuse for not complying with those laws in Nigeria.”

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WHO On Passive Smoking

EDITORIAL

The warning by the World Health Organisation (WHO) that passive smoking constitutes a global threat, is revealing and must be checked.
The UN agency had in its second major report on the "tobacco epidemic" released last week, said second-hand or passive smoking killed nearly 600,000 people each year. WHO, which also warned that tobacco is still the leading preventable cause of death, killing five million people every year, said more and more people were likely to suffer from the harmful effects of passive smoking.
According to the agency, only 5 per cent of people in the world are protected from second-hand smoke in public areas. Insisting that unless more stringent measures were taken to minimize smoking's impact, WHO said that of the world's 100 most populous cities, just over a fifth, or 22 are smoke free.
Last year, WHO unveiled six strategies that countries could implement to protect their people from the harm of cigarettes. These include smoking bans, higher tobacco taxes and bans on tobacco advertising. The 2005 WHO Framework on Convention on Tobacco Control (WHO FCTC) made it clear that banning of smoking in public places is essential to not only protect nonsmokers, but to make it easier for those who want to quit to stay smoke-free.
WHO, which lamented that just a mere 17 nations had passed comprehensive smoke- free laws, raised the alarm that the annual death toll from tobacco related diseases could rise to eight million by 2030.
It is sad that despite the well documented effects of smoking on humans, countries have more or less, continued to pay lip-service to fighting what from all indications, constitutes one of the major health challenges of the 21st century. No less a body than the International Labour Organisation (ILO) has said that 200,000 workers die every year due to exposure to second-hand tobacco smoke at work. WHO estimates that around 700 million children, or almost half of the world's children, breathe air polluted by tobacco smoke which is generally carcigenous.
Given the insalubrious effects of tobacco smoking, governments the world over must rise to the challenge of not only protecting passive smokers, but ensuring that smokers alike are regularly reminded of the risks they face. There is no safe level of exposure to second-hand smoke. Action is, therefore, needed by governments to protect their people from the dangers posed by this type of smoking.
Besides, the fact that more than 94 per cent of people remain unprotected by smoke-free laws three years after international tobacco control measures introduced the requirement, shows that much work needs to be done. Governments must implement the 2005 WHO Framework which 170 nations have signed. As it is said, passive smoking kills people and being passive about it will also kill.
For Nigeria, which is a signatory to the WHO FCTC, the challenge posed by passive smoking is by no means less daunting. Although there are no available data on passive smoking, a report by an Expert Committee on Non-communicable diseases in 1988 certified that 4.5 million Nigerians were smokers. The committee set up by the federal health authorities, also said Nigerians smoked close to seven million sticks of cigarettes daily, which according to then Health Minister, Prof. Olikoye Ransome-Kuti, added up to 49 million sticks a week, or 196 million sticks a month.
It is pertinent to add that it was during Olikoye's tenure as Health Minister under the Ibrahim Babangida regime, that a law against smoking in public places was enacted. Unfortunately, the law all but exists in name as a report by the News Agency of Nigeria (NAN) had it that over 60 per cent of Nigerian undergraduates smoked. Given the very lax nature of the law on smoking and the general lack of awareness about passive smoking in the country and its consequences, it is not unlikely that the general population are at risk.
While it must be stated that Nigerians are also exposed to other equally deleterious forms of fumes such as acid rain and fumes from automobiles, no effort should be spared to save lives that are exposed to this danger. Indeed, every single life is important and as much as possible, life should be safeguarded.
There is no gainsaying that smoking places a huge burden on health care provisions all around the world. Governments should, therefore, embark on aggressive public enlightenment campaigns to sensitise Nigerians on the effects of passive smoking, and indeed, smoking in general. No effort should be spared to ensure that Nigerians stay healthy.

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State government takes tobacco companies to court

-Odunayo Abiodun

A joint suit filed by the Lagos State Government and the Environmental Rights Action/ Friends of the Earth Nigeria (ERA/FOEN) against five tobacco companies was brought before a Lagos High Court on Monday.
The claimants jointly instituted the action against the tobacco companies - British American Tobacco (Nigeria) Limited, International Tobacco Limited, British American Tobacco Plc and British American Tobacco Investment Limited - on the ground that tobacco smoking has severe health implications including but not limited to cancer, cardiovascular and pulmonary complications, noting that the defendants have recently admitted these facts.
At the resumed hearing of the suit before Bukola Adebiyi, the counsel to the claimants, O. Akinosun moved his application asking for extension of time to file his reply to the request for stay of proceeding in the matter by the defendants.
The defendants did not oppose the application; but they noted that the reason given for the delay was not contained in the affidavit attached to the application.
Mr. Adebiyi, however granted that application and she further adjourned the hearing in the matter until February 9, 2010.

Allegations
The claimants had alleged that, in spite of the obvious knowledge of the adverse effect of their product, the defendants have fraudulently targeted young and underage people in their advertising and marketing.
They claimed that, through the use of market surveys and sophisticated advertising, the tobacco companies have utilised such means as music, cinema and fashion, to attract young and underage persons to smoking.
They submitted further that the mandatory health warnings inscribed on their packs are ineffective as the defendants promote a retail strategy of sale by the stick whereas the individual sticks that most consumers purchase have no such warning.
The claimants' causes of action are based on negligence, public nuisance, restitution, strict liability, and conspiracy to commit actionable wrongs, among others. It was contended that the overall effect of the defendants' course of conduct is that the state government is called upon to expend its resources in treating tobacco related ailments caused by the use of defendants' products, maintaining that the state government spends at least N316, 000 per month on each of these ailments.

Claims
Consequently, the claimants wants an order of mandatory injunction compelling the defendants, their successors-in-title, privies and or agents to cease the marketing, promotion, distribution and sale of tobacco-related products to minors or under aged persons.
An order of mandatory injunction restraining the defendants from representing or portraying to minors or persons under the age of eighteen, any alluring and or misleading image regarding tobacco related products whether by direct depictions, pictorials, advertorials, images, words, messages, sponsorships, branding and or through overt or covert and or subliminal means.
Furthermore, the claimants asked for an order of mandatory injunction restraining the defendants from marketing, distributing, selling, or putting into the stream of commerce either by themselves or through their distributors, agents, resellers, trade partners, marketers, and or any other person, any tobacco related products of whatever make or brand within a one thousand (1000) metre radius of any schools, hospitals, cinemas, playhouses or locations, children's shopping areas, childcare facilities or such other public places in Lagos State, which are predominantly a location for minors and young persons under eighteen (18) years old to "hang out", play, assemble, congregate for any purpose whatsoever including but not limited to educational, recreational, social, religious, sports or any other purposes.
In addition, they urged the court to grant an order of mandatory injunction compelling the tobacco companies to fund a tobacco control programme to be administered and controlled by an independent third party who is to be appointed by the Lagos State government, targeted at minors and young persons under eighteen (18) years old.
They also want a declaration of the court that the tobacco related products as manufactured, marketed, promoted, distributed and sold by the defendants are addictive and a declaration of the court that the tobacco related products as manufactured, marketed, promoted, distributed and sold by the defendants are hazardous and injurious to the public health.

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Childhood passive smoking increases miscarriage risk later in life

If you’re a woman who was exposed to second-hand smoke during your childhood you are more at risk of fertility problems or miscarriage, according to new research.
Toxins breathed in from passive smoking when young could have caused permanent damage that will harm your chances of falling pregnant or miscarrying the baby during pregnancy.
A team from the University of Rochester in New York studied nearly 5,000 women who gave details about their attempts to fall pregnant, miscarriages and history of being exposed to second-hand smoke.
A third of the women questioned lost one or more babies while 11% had difficulty falling pregnant. In total, 40% of women reported problems with prenatal pregnancy such as miscarriages and struggling to become pregnant.
Four out of five women reported being exposed to passive smoke during their life and 50% grew up in a home where a parent smoked. Of those who during their childhood had parents who smoked, 26% were found to be more likely to have difficulty conceiving and 39% were more likely to have suffered a miscarriage.
An estimated 17% of mothers smoke during their pregnancy despite the many warnings about how it affects their health and that of their unborn baby. Passive smoking is also likely to interfere with hormones which will affect fertility.

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