For over 25 years, Paulo Bagara, 64, was smoking tobacco, mainly in the form of cigarettes—a habit he repeatedly thought of quitting but in vain.
“Each time I visited a clinic due to some chest problems; medics were quick to tell me to stop smoking. I was warned. I was really warned,’’ he recalls, with regrets.
“Sometimes I promised doctors that I would quit, but upon stepping out of their offices, my mind couldn’t really resist it. The cigarette was everything to me,’’ he says.
“In the year 2015, I remember to have been at loggerheads with a certain doctor who lives in our neighbourhood…he always asked me to quit, I could just appease him that I had stopped smoking…’’ Bagara recalls further.
Today, as he recounts his story, Mr Bagara, the resident of Karatu District in Arusha Region, is fighting for his health at the Ocean Road Cancer Institute (ORCI).
“I wish all the public hears me out, that cigarette smoking is bad for their health and their life.”
He is among the 6,338 Tanzanians who sought treatment for cancer at the facility by the year 2016, according to recent data obtained from ORCI.
But Bagara is also among several people in the country who may have always been exposed to the product—tobacco—known to contain more than 50 substances that can cause cancer.
“Cigarette smoking is one of the key things we enquire from suspected cancer patients whenever we are taking their medical history,” says Dr Crispin Kahesa, the ORCI’s Director of Cancer Preventive Services.
In Tanzania, cigarette smoking has continued to flourish, fueled by the growing tobacco industry, says Ms Lutgard Kagaruki, the Executive Director of Tanzania Tobacco Control Forum (TTCF).
“Tobacco business is also booming. This is because of the belief that the crop is an economically important. It is believed that putting tough control policies would lead to loss of revenue by the government,’’ she says.
Across the country, shops continue to sell cigarettes and for people such as Mr Bagara, the number of cigarettes smoked depends on where one lives and financial capacity.
About 14.1 per cent of all Tanzanians smoke tobacco daily while the product remains a major risk factor for Non-Communicable Diseases (NCDs), data from the Ministry of Health, Community Development, Gender, Elderly and Children show.
Ups and downs in my journey of smoking
“When I was in the village, I could smoke raw tobacco, but when in town, I could buy cigarettes…’’ recalls Bagara as he goes ahead to tell his story.
“I used to smoke about two packets on a day. At times three...later on, doctors advised me to scale down the number…I tried to reduce them to one packet a day…’’ he says.
In the market in Tanzania, a packet contains 20 cigarettes. In this case, it means Bagara could smoke up to 40 cigarettes day.
“As far as I can remember, there was a time I reduced to 5 cigarettes a day, I felt so relieved…it was a moment of great success for me…but still, I couldn’t stop completely,’’ he narrates.
“When I started getting sick, I tried to stop completely…but it was only too late, I was already too weak...”
Success in quitting alcohol, not cigarettes
“I used to drink a lot of alcohol too. But I was able to quit. Not with smoking though. Before I knew what my life would turn into, doctors were already telling me I have a cancer. That’s when I got back to my senses,” he tells Your Health.
“When I look back, I realise that my family and I have spent a lot of money to secure my health. I have been admitted here for about three months now,’’ he says.
His son, Mr Chrisent Paulo, who is a shopkeeper in Karatu District, tells Your Health he had to leave his shop closed in order to stay at the hospital to take care of his ailing father, Mr Bagara.
“Until today [as he spoke], I have spent over two million shillings from my pocket. At one moment, we had to mobilise funds from the family because drugs are expensive,’’ he says.
“It’s now a year since my dad started getting on and off sickness. All that time, I have never settled. Being the first born, I have a big responsibility.”
“My dad can’t feed on his favourite food normally anymore. He has to use a special tube. But also, he has to eat special food, I have to spend over Sh100, 000 on three days to secure his food. Imagine now, if he will continue to be admitted for more months,’’ says Bagara’s son.
New turn in my life
Mr Bagara’s illness began from simply failure to swallow.
“At first, I could not swallow ugali. Then later; porridge couldn’t go past my throat. That’s when I realised things were turning from bad to worse. I began starving.”
“I was referred to Karatu District Hospital,’’ he says as he recalls his early struggles in finding healthcare for a problem he had initially treated with contempt.
“My family began getting worried when they heard that I have to go to a District Hospital. But we had to go anyway. On arrival, the doctor asked that I should be referred to a Regional Hospital in Arusha. That was, about one year ago,’’ says Mr Bagara.
“At the regional hospital, a doctor looked at me in the eyes and told me frankly that I could have cancer. So a decision was made to refer me to Muhimbili National Hospital and later at the Ocean Road Cancer Institute. That’s when it became clear to me that my oesophagus had been affected by cancer.”
“Being diagnosed with cancer has come as a big set back to my family. I used to work as a technician…now I can’t do it anymore…”
“I became weaker. I later went for lighter activities in the shamba…I did that only for some time before my illness became worse. As we speak now, most of my crops haven’t been harvested…may be they are rotting in the shamba…”
He continues, “…most of the time I’m at the hospital. I pray that my children are doing all they can to save my crops,’’ says a father of 10 children.
“Now I see no meaning of smoking…I think tobacco farmers should be given alternative crops to grow….the companies that sell cigarettes should re-think about what they are trading in…they are harming society,” he sighs with regret.
And he says, “I know cigarette factories make a lot of money…and it’s difficult to stop doing business, but they should know what they are doing is harmful to us. Now, I know, I can’t advise anyone to take up smoking cigarettes…”
About 16 percent of male cancer patients who report to the ORCI are suffering from Cancer of the Oesophagus, Dr Kahesa tells Your Health.
“You see, cigarette smoking is a risk factor for many cancer cases. How that directly or indirectly leads to cancer of the oesophagus, it’s a question for research,’’ he says.
In 2010, a study published in the Journal of National Cancer Institute found that cigarette smoking was associated with increased risk of cancer of the esophagus in white men and women.
“Smoking cessation was associated with reduced risks,’’ says the study titled: Cigarette Smoking and Adenocarcinomas of the Esophagus and Esophagogastric Junction.
“We may need to conduct similar studies here on cancer of the oesophagus. But what we already know is that most cigarette smokers in Tanzania end up with lung cancer,’’ he explains.
Challenges in advising smokers
Dr Kahesa says, “The most difficult part is usually on convincing the smoker to stop the habit when he/she hasn’t started getting problems. Most of them come to realise that they should quit smoking when it’s too late.”
He adds, “But also, I do believe healthcare practitioners have a moral responsibility to stop smoking so that they set an example,’’ he says as he challenges health workers.
“Imagine a scenario where a healthcare provider who preaches the health hazards of smoking but he/she goes ahead to smoke…this has a huge impact on how the smokers respond to calls by health experts on stopping the habit,’’ he says.
Over a decade ago, Tanzania ratified the Framework Convention on Tobacco Control, under the World Health organisation (WHO FCTC 2007), which was touted as a tool that would effectively control harmful use of tobacco.
However, until to date, the country has not yet enacted a legislation that would control tobacco use. Anti-tobacco campaigners have been pushing for the inaction of the law to control tobacco use and production.
Dr Sarah Maongezi from the department of Non-Communicable Diseases at the Ministry of Health, Community Development, Gender, Elderly and Children, says plans are on by the government to set the agenda on the Tobacco Control Bill in Tanzania.
“I can assure you that there is the political will as for our part and the Ministry of Health is working on taking this Tobacco Control Bill forward,’’ she said.