Shisha free Mbarara: A success story of tobacco control

HEALTH|TOBACCO

MBARARA - Western Uganda's biggest town is among the fastest growing areas in Uganda. As any urban centre grows, so does the entertainment industry in that area.

Mbarara has had a long history entertainment with places like Odds Club, Club Souls, Lords bar, Club Vision  Empire and  Another life Club dominating the hangout industry for most of the early 2000's. These were the places to be.

Fast forward, a new wave of development hit the area and new, more creative, youth appealing hangout spots emerged from around 2011- giving the area a new breath of life. No wonder, names like The Boss, The Posh, Vegas, Ice, Desert, The Heat Bar, Vintage Bar, Gabiro Bar, Signature Bar, 211, Cave and others have dominated the entertainment industry in the last seven years.

One development related to the entertainment industry that coincided with this period, is the introduction of flavoured tobacco consumption (Shisha) in hangout spots.

"This trend was a big thing in Kampala from around 2011," recalls Albert Muhimbura, one of the residents of Kakoba in Mbarara town but who stayed in Bunga a Kampala suburb between 2008 and 2012.

His passion for soccer meant that he had to go to hangout places in Kampala city mainly around Kabalagala and Kansanga often but he never liked the fact that most of these places were always full of people smoking shisha and cigarettes.

Shisha smoking, also called hookah, narghile, waterpipe, or hubble bubble smoking is a way of smoking flavoured tobacco usually mixed with other substances through a bowl and a hose or tube.

In August 2012, Muhimbura was transferred to another work station in Mbarara town where he studied all his secondary level and to him, this was like going back to the place he knew best.

Alas, Mbarara had changed in as far as hangout places were concerned. "The old traditional clubs were losing market due to the emergence of new trendy places," he explains.

Some things in all this new wave of development however were not ideal for him like smoking in these places. He says the people; just like in Kampala were smoking from these new and trendy places.

Baguma Richard(in a Black T shirt) and the Mayor of Mbarara Municipality Robert Mugabe Kakyebezi conducting a public sensitization. Photos by Cliff Abenaitwe

 
He recalls that some places had designated corners and smoking rooms for smokers. He, however, recalls that one thing that was the talk of town at the time in Mbarara hangouts was Shisha.

"Shisha was the trend in these places. From around 2012 to around 2016, it was the trend with mostly rich young men and the elite ladies taking it in groups in public," Muhimbura explains.

Agaba Eddy, a supervisor at one of the popular hangout spots in Mbarara town  and has worked in other different hangout spots in the area in last five, says that Shisha and smoking in bars and nightclubs in Mbarara town took centre stage around 2012.

"Around 2012 and 2013, Shisha consumption started and became popular," he narrates adding: "But the trend changed about three years ago and now Shisha is a thing of the past."

No single hangout place sells Shisha in Mbarara town today.

Agaba noted that people fell in for Shisha and at the time,  it was making money for business owners but that people never knew what was in Shisha.

"Even some of us dealing in it never knew what it was exactly," he recalls adding that with more public awareness, people understood that it was tobacco and it had negative health impact. That's when the Shisha love ended.

He notes that today, people would more likely refuse anyone to smoke Shisha from near them in any hangout place in Mbarara.

"You are most likely to lose the many that dislike it for a few who would be interested in it. It is the same thing as cigarette smoking now," he observes.   

According to Agaba most managers of public places like him in Mbarara town also know that Shisha is illegal in Uganda now.

Shisha, the more dangerous way to consume tobacco

According to the British Heart Foundation, traditionally, shisha tobacco contains cigarette tobacco, so like cigarettes it contains nicotine, tar, carbon monoxide and heavy metals, such as arsenic and lead.

As a result, shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy.

According to the Foundation, it's difficult to say exactly how much smoke or toxic substances you're exposed to in a typical shisha session. People smoke shisha for much longer periods of time than they smoke a cigarette, and in one puff of shisha, you inhale the same amount of smoke as you would get from a smoking a whole cigarette.

The average shisha-smoking session lasts an hour and research has shown that in this time you can inhale the same amount of smoke as from more than 100 cigarettes.

Uganda's law on tobacco

On July 25, 2015, Parliament passed the Tobacco Control Act (TCA) and it was assented to by the President on the September 19, 2015.

This Act makes Uganda one of the few countries that have gone through the process of enacting  a comprehensive legislation compliant with the World Health Organisation Framework Convention on Tobacco Control.

The object of the Act is to protect the present and future generations from the devastating health, social, economic and environmental consequences of tobacco use and exposure.

"It is the best Public Health Legislation that our country needed in the fight against Tobacco use," says Baguma Richard Tinkasimire- the Coordinator Uganda Health Communication Alliance (UHCA), one of the Organisations at the forefront of Tobacco Control in Uganda.

In the TCA, the sale of electronic cigarettes, water pipe tobacco (shisha), smokeless tobacco like Kuber as well as flavored tobacco of any kind is banned with a fine of between sh480,000 to sh20m or imprisonment for one year or both placed on offenders upon conviction.

A manager of any public place who fails to stop the consumption of the banned tobacco products or who fails to stop smoking from his place also faces a monetary fine or a jail sentence or both under the Tobacco Control Law.  

Despite the ban on Shisha and other tobacco products like Kubar by the Law, these items are still being imported into the country.

"People are still breaking the law but there is much more to celebrate as far as tobacco control is concerned. We are working with Police and Uganda Revenue Authority(URA) to implement the Tobacco Control Law and protect Ugandans," Baguma explains.

He also says that health activists have intensified the sensitisation of Ugandans on their health rights and the provisions of the law as one way of enforcement.

The tobacco burden today

According to World Health Organization (WHO), the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than seven million people a year.

More than six million of those deaths are the result of direct tobacco use while around 890,000 deaths are the result of non-smokers being exposed to second-hand smoke. In fact, tobacco, is the single most cause of preventable death in the world today.

According to WHO, around 80% of the 1.1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

According to a February 2017 report by the Centre for Tobacco Control in Africa, Makerere University College of Public Health (School of Public Health), American Cancer Society and Ministry of Health, about 36 people die every day from tobacco related diseases in Uganda. This translates into almost three commuter taxes full of people perishing as a result of a single substance.

The same report reveals that the annual average medical cost of a current or former smoker suffering from a tobacco-attributable disease is sh3.7m compared to sh1.6m, the annual average medical cost of a never smoker.

The report further notes that in 2013, the cost of tobacco use constituted 0.5% of the Gross Domestic Product, while expenditure on treating tobacco induced illness was 2% of the national health expenditure. This means for every sh1government earns from tobacco, sh4 is spent on treating tobacco related illness.