Recently I had the privilege of accompanying two of my Masters (MSc) students to different parts of rural Ethiopia to help supervise and assist them in their final-year MSc research projects. Both projects involved assessing smoking habits and passive smoking among people in small rural Ethiopian towns. One town was Chena, in Southern Nations, Nationalities and Peoples Region (SNNPR), and the other town was Ogolcho, a small town in Oromia. SNNPR and Oromia are two of the nine geographical/ ethnic divisions of Ethiopia.
Not only did we find that smoking is common in the men, but rare among women, in these towns, but also we saw that passive smoking is particular common, especially in families where there is a family member who smokes in the home, and among social groups of males where non-smoking males are frequently exposed to the smoke of cigarettes smokers among the group.
Another striking feature of these rural smokers was a frequent, often frustrating, desire to quit. Many of these smokers are, like many smokers around the world, inexorably addicted to cigarettes. Try as they must, they just can’t quit! Speaking to these rural, often impoverished, Ethiopians, brought home to me more emphatically than ever, the message that tobacco is one of the most highly addictive, vile substances known to Man.
One Oromian man told us that he and several of his friends dip their cigarettes in petrol (gasoline) then smoke them, to try and quit. When they do this, he says, it makes them feel nauseous and causes them to vomit. For a day or two it keeps them off cigarettes, they say, but soon the urge to smoke returns. They have tried other means to quit and this is the best they can do. Medications for helping people to quit smoking are difficult to obtain, and are generally not available, in Ethiopia.
Another man told us that one of his friends once took his cows to the hills and realized he had no cigarettes with him. He was desperate for a cigarette to smoke, so he left his cows and walked 14 kilometres to find a store that sold cigarettes. When he returned to his cows later that day, they had been killed and eaten by hyenas.
Yet another man told us how he was once craving a cigarette, and eventually found a woman who was chewing tobacco. He bought some of the tobacco from her, but could find no paper to roll it in. After searching for some time, he decided the only way to solve his desperate desire was to roll the tobacco in a 100 birr ($5 US) banknote- 5 days’ salary for this man- and smoke the resulting “cigarette.”
Some Ethiopians spend a substantial proportion of their often meagre income on cigarettes (some also use shisha- tobacco smoked from a waterpipe). What is particularly striking is the difficulty these men have in quitting and the fact that tobacco has reached even these relatively isolated areas of Ethiopia. Indeed, tobacco has permeated every corner, every human niche of our planet!
Of great concern is that we found passive (second-hand) smoking to be particularly problematic in these rural areas of Ethiopia. Homes there are often small, with poorly ventilated rooms, and families frequently consist of many children and extended family members living under one roof. Men who smoke in their homes commonly expose their children and wives to high levels of tobacco smoke. Many of the men vowed to quit smoking when they learned how dangerous passive smoking can be to their wives, children and other family members.
Tobacco use clearly is an insidious pandemic. It is at least as significant a human threat and plague as are some of the great infectious diseases- tuberculosis, HIV, malaria, diarrheal diseases and pneumonia- of our time. It is not just a disease of wealthy nations, but is a pestilence of developing countries and their precious inhabitants, whom tobacco companies exploit for their financial profits.