South Sudan: Shisha comes under cloud over health concerns
By Atem Yaak Atem, Sydney, Australia
Sunday, January 13, 2019 (PW) — Smoking shisha, * the pastime that is common in some middle Eastern and African countries, is known by several names. In its weekend edition the Australian daily newspaper, Sydney Morning Herald reported two bodies working for local communities, the Australian Lebanese Muslim Association and South East Sydney Local Health District, had come together in their concern over the effect of shisha on the users within the community. In their campaign to enlighten the public on the dangers smoking shisha posed to people, the state government of New South Wales (NSW) has contributed Australian $ 386, 000 (US $274, 368.80 at the time the article was being written) to support the campaign that aims at advising smokers to quit the habit.
Well-founded fear
The concern expressed over harm inherent in smoking shisha may appear to be the work of fear mongers. It is not alarmist; the campaigners have reputable source of information on which they base concerns. Claims that smoking shisha could be harmful to people’s health the way smoking tobacco has been identified as a culprit, is slowly but surely gaining grounds among scientists and health workers in the developed world. Australia is one of these countries. The Herald’s report has quoted NSW health minister, Brad Hazzard: “Smoking shisha for an hour is equivalent to inhaling the volume of smoke from 100 to 200 cigarettes”. Such frightening statements, similar to this one, do not come from a politician’s guesswork or imagination. The minister has a credible authority to back his claim. World Health Organisation (WHO), the United Nations’ body responsible for global governance of health and disease is the source. According to the 2005 advisory note from WHO’s research arm, TobReg or tobacco study group, the smoke that comes from water in the shisha “contains toxicants known to cause lung cancer, heart disease and other disease”.
The report adds that the campaigners aim at educating members of their community as well as the general public to rethink about the perception of shisha smoking as a pastime. In their drive to educate the public, the organisers are not alone. The head of NSW Cancer Institute, Professor David Currow, backs the campaign against smoking, when he told the paper that “shisha smokers were unknowingly putting themselves at risk of the same deadly diseases that kill cigarette and second-hand smokers”.
Health and education as a basic human right
Virtually all the countries in the developed world take public health, which an integral part of preventive healthcare, more seriously than is the case in their emerging counterparts. Being the case, when governments fund public awareness about common factors that contribute to illness and other preventable conditions, costs of maintaining public health ultimately become considerably cheaper, confirming the truth of the old saying: “Prevention is better than cure”.
In such countries creation of awareness on health matters alone is not enough. Side by side with health education, legislation on health comes in to provide compliance in area where individuals or businesses might endanger or expose members of the public to risks that undermine public health.
Towards that end, pieces of legislation have been passed, for example, to ban advertising tobacco products in news media or any other public platform; make it a criminal offence for anyone to smoke in enclosed spaces such as restaurants, pubs (bars), bus stations or taxi ranks; criminalise sale of cigarettes or alcohol to underage persons, and so forth. Such laws do not just lie idle on the statute books; they are enforced and offenders punished accordingly. Several years ago, a barmaid in one of Australian states successful sued her employer, after she was diagnosed with a cancer she got as a passive smoker while working in a club bar for years.
The club had to pay her damages, which although would not save her life was an admission of responsibility. Payment of compensation was also a warning to individuals, businesses or organisations that there is a price to be paid when an agent, wilfully or otherwise, exposes other people’s lives to hazardous situations or dangers that could be avoided or prevented from happening. In fact, due to availability to the general public of information on health and safety, it is rare in developed world for people to be ignorant of items, conditions, processes or substances that are known to be harmful to human health and wellbeing of people.
It may come as a surprise to some South Sudanese readers of this article that in Australia, public education on health matters is conducted in all the languages spoken by migrant communities. Of course this is besides English, spoken by the majority of the population (not designated as “official language”). This includes provision of translation of information on health issues such as diabetes, pregnancy, mental illness, obesity, anorexia nervosa and so forth. This type of education is provided through translation (written form while the spoken version is “interpreting”) in some of the languages, among them Nuer, Collo, Acholi, Bari, Dinka or Juba Arabic.
Public health situation in South Sudan
We South Sudanese as a country lag behind a great deal in health education, environmental matters and bureaucratic management to name just three aspects of our public life. This is hardly surprisingly since we the elites have chosen to reject meritocracy in favour of incompetence and amateurism when selecting for public office.
People smoke everyone even in public offices as if they are intoning a soothing tune; while nobody cares to check whether cigarettes that are sold to the public carry warning that smoking kills; people as young as 12 years old go about pupping as if it is a practice one should be proud of; patients suffering from mental illnesses not only suffer being stigmatised for their misfortunes, just like people with Aids, but are also likely to be found chained to walls of prisons instead of being cared for in psychiatric wards.
Examples of bad behaviour by us (the elites) could fill pages, if not a complete book profiling shameful things we allow to happen to fellow humans such as people with disabilities of all kinds. (One can guess the reason for lack of ramps and other facilities for disabled persons is that we have never envisaged a day when we would have an undersecretary or a minister with severe physical disability. According to our warped thinking, public buildings and facilities are for the high and mighty only).
Shisha smoking widespread in Juba
When I returned to Juba at the end of 2009, a friend invited me for a meal in one of restaurants downtown Juba. The facility was full of clients. For the first time I noted young people, girls and men, eating together at a table. To me this was a new but welcomed phenomenon for Juba, which I left for the last time in September 1982. In those day except for schools and government offices including newsrooms, unofficial gender apartheid was part of life. Ironically, nobody complained about that social import.
The surroundings inside the restaurant were apparently clean and food, varied and a lot of options were available. By the standards of the city and time, the meals served were tolerably decent. The building had a toilet which was too close to the kitchen, nevertheless. But that was not the only thing that was out of the ordinary; there were three hajjat (hajjat is a plural of haja, literally a Muslim woman who has gone pilgrimage to Mecca. In the parlance used in the two Sudans, the word is used to refer politely to a woman of middle age and older and regardless of her faith, in the manner of “lady”), relaxing in the narrow space between the kitchen and washroom. Customers had to visit the toilet contained a basin and clients had to wash their hands before and after the meals.
The three of them, one who I was later told was the proprietor of the restaurant, were enjoying their long pipes of shisha. They were as happy as a pig in muck, chatting and laughing, likely trading gossips doing the round in town. Each of them was from time to time drawing a heavy pull from the pipe after which she would release a huge amount of thick cloud of grey smoke. At time, the three were covered by the smoke they produced to the extent that they were partially invisible for a while.
On my return to my friend at the table I began to ask questions after questions on what I had seen. I was almost beside myself over the hygiene of the restaurant. My friend was philosophical. “I thought you journalists are a species that have done away with emotions”, he joked.
“Well, not always. It depends the issue at hand. Don’t forget that we, like other professionals lead two lives, one private and the other public”, I corrected him.
“You have just arrived. Take it easy and take time to educate yourself. You will see more that will upset you”. He took leave from me to pay our bill.
He was right. Shisha smoking was the norm in Juba, particularly in restaurants, in hotels, hair salons, most of the smokers being women, especially those who had returned from Khartoum at the end of the war. And as I realised later, nobody saw anything wrong with the habit. The proliferation and use of the hookah in Juba was a culture export from Khartoum. That idea hit my memory to recall my nine years as a student in Omdurman and later in Khartoum. Were people smoking shisha then?
Yes, shisha smoking was a pastime but at a very minute scale as I could remember. The hobby was mainly confined to men, mostly among the older folks of the Levant and people of Greek and Turkish ancestry. Those men in their twilight years would be found on reclining chairs within some of retail shops or cafés or bookshops, where they spent much of their time reliving old, blessed times.
Most of them were jolly fellows, ready to entertain customers- who showed interest to listen or chat while shopping or browsing- with tales from their past, which according their various accounts had few problems, while one was shopping. Now in South Sudan, shisha smoking is a leisure in which women outnumber men by a ratio of 4:1.
Indifference as the norm
As if our attitude towards such cases were not bad and hurting enough to be stopped, we go about as if everything is well in our society. No. We are now a country where the abnormal has become the new normal, and this has firmly taken hold. Did not someone, one of prominent leaders, recently say publicly that some people and their actions (and omissions) make us a laughing stock. Indeed, that is a fact that does not need anyone to quarrel with its accuracy.
What might be missing in the statement is that, by association and collective responsibility as ruling elites, we morally share the blame even if one were an unacknowledged saint. What we need to do then is for all of us to admit that we have failed in many areas without any justification and that we should rise and act to correct matters that are within our reach and ability. We are told that when one embraces honesty and humility, one has just embarked on the path to wisdom.
Modest proposals
Media studies in the 1960s and 1970s emphasised that preliterate societies such as South Sudan where more than half of the citizens do not read or write, were best served by radio (to some extent television). Even in the digital era, that finding largely remains valid.
Kenya is one of the few African countries which broadcast in vernacular languages. It works this way: programmes and news items are made to measure and centralised in the capital, Nairobi, so that local broadcasters in the regions do not come out with messages of their choice that may have a regional bias. Such programmes carry civic education of which health matters enjoy a sizeable segment.
South Sudan stands to gain a lot by borrowing from success stories of the use of media for public education in some African countries. It is true that the major role of our electronic media outlets, the radio and television, is dissemination of government message to the people. That message, more often than not, tends to be the continual praise of the establishment and its managers on the one hand and demonisation of rivals or those who are not known to sing praise of the status quo.
One is not suggesting here that the government should stop its media agenda and its contents in its favour but rather, there would be no harm when public education on important matters such as health and environment and its protection are added in the list. The state will be killing two birds with one stone, so to speak.
Knowing that the current Minister of Health, Dr Riek Gai Kok, as one of few South Sudanese politicians who believe that action speaks louder words, I am sure his directives and personal supervision to introduce and take public education on health to the millions of ordinary South Sudanese in their diverse mother tongues and Juba Arabic can take off. Experience from the former Sudan Council of Church’s civic education carried by its programmes over Radio Juba in the 1970s is an example that can be replicated. There is no doubt that within a few years such efforts will pay off hefty and healthy dividends.
Why can we not give a try?
*Other names of shisha are nargila, argileh, hubbly bubbly, hookah and goza (Kate Aubusson, health reporter for the Sydney Morning Herald).
Atem Yaak Atem is a South Sudanese journalist and translator currently living in Australia where he is a full time writer. He is the author of Jungle Chronicles and Other Stories: Recollections of a South Sudanese.
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