Stubbing it out: Ethiopia implements smoking ban

(Pic: Flickr / Tom Magliery)

The bars and cafes are full and lively in the northern Ethiopian town of Mekelle – but they are no longer smoke-filled, with the strict implementation of a smoking ban in public places.

“It’s a good thing,” said Hiriti, the owner of a small bar in a busy street. “Of course, some customers are not happy, but it also depends on the way you tell them not to smoke.

“I tell them it is not only about the law. It is also about your health,” he said. “They react better if you tell them that way.”

The town of Mekelle is bucking the trend in Africa where tobacco use is increasing driven by companies that see a growing market on the continent amid a tightening of smoking laws elsewhere.

Tobacco consumption in Africa – excluding South Africa – increased by almost 70 percent between 1990 and 2010, according to a study by the American Cancer Society. The number of African smokers could grow by 40 percent by 2030, the study predicted.

Ethiopia is not the first country to impose a ban, but is one of the few to act on the law. Kenya’s capital Nairobi has designated smoking cabins, with smoking on the street illegal, although the rule is widely flouted.

Several African countries have a complete ban on smoking in public – most recently, Uganda passed a law banning smoking within 50 metres of any public place – according to the World Health Organisation (WHO), but such laws are rarely implemented.

Nearly 80 percent of the more than one billion smokers worldwide live in low and middle-income countries, “where the burden of tobacco-related illness and death is heaviest”, according to the WHO, which estimates that 600 000 people die worldwide each year from the effects of second-hand smoke.

‘People really stopped’

In Ethiopia, parliament passed a law banning smoking in public places in 2014 and Mekelle is the first city to implement it.

The town of some 200 000 people is the state capital of the far northern Tigray region. Since January smoking has been banned in cafes, restaurants, schools and hospitals, as well as cultural, sports and religious centres.

Those who break the ban face a fine of 1 000 Ethiopian birr ($50) fine, a small fortune in Ethiopia where salaries rarely exceed $100 a month.

“We hardly see more smokers. People really stopped,” said Teklay Weldemariam, the head of the city’s health department and one of the architects of this law.

“The speed of non-communicable diseases is increasing. Cancer is one of them. So it is high time to ban cigarettes in public areas.”

He hopes Mekelle will be an example to others.

“I know other Ethiopian towns are interested in the experience of Mekelle. This can also inspire other East African cities,” said Teklay.

Some grumble at the ban, frustrated at the restrictions, but others say the law is necessary.

“If you enter a cafe with smokers, you could not say anything because it was part of social life, it was fully accepted. This prohibition is a very good idea,” said John Haile Selassie.

After targeting tobacco, the authorities are also aiming to stamp out khat, a leafy green herb that is mildly narcotic when chewed.

“Consumption is rising and the government wants to do something,” said Teklay. But he recognised the subject is “sensitive” as chewing khat plays a role in some customs and traditions in parts of Ethiopia.

9 years ago

Ebola’s victims of the future: pregnant women

A volunteer in protective suit in the capital Freetown. (Pic: AFP)

For the last 13 years, Sierra Leone has seen a dramatic decrease in its maternal mortality rate, due in large part to the introduction of free health care for pregnant women. One of the most devastating and yet rarely acknowledged impacts of the Ebola epidemic is that it threatens to undo all this good work.

It’s not just the loss of more than 220 health workers, including many midwives, to the virus, with little training or wiggle-room in the fragile health system to replace those skills. It’s also the lingering fear of hospitals and doctors among the local population, which remains traumatised by an outbreak that has claimed almost 4 000 lives and still sees new infections each week, albeit small numbers.

A World Bank report in July – Healthcare Worker Mortality and the Legacy of the Ebola Epidemic – estimated that Sierra Leone’s maternity mortality rate could increase because of the current crisis by 74 percent, to levels not seen since the end of the civil war in 2002.

“During the Ebola outbreak, there were many challenges that we encountered that led to many pregnant women not coming to the hospital and this may have led to the [recent] increase in death rates [among pregnant women],” A.P. Koroma, medical superintendent at the PCMH (Cottage) Hospital in Freetown, told IRIN.

The hospital has lost 85 mothers since the outbreak was first reported in May 2014, which Koroma said is “definitely a sharp increase compared to previous years.”

“People were, and are [still], afraid,” he added.

Before Ebola came, an average of 10 700 women each year gave birth at Cottage Hospital. Since the outbreak, this number has dropped to 6 723.

The most recent maternal mortality rate is not yet available at the national level, but given the hospital attendance records and the risks of at-home childbirth in Sierra Leone, it is expected to rise.

“During the Ebola outbreak, people had the impression that when they come to the hospital, they may be infected,” Koroma explained. “For those coming to the hospital, we did our best… but some of them came to the hospital late because they were told that if you have bleeding, which is one of the symptoms of Ebola, no nurse or doctor will want to touch a patient until an Ebola test is done, which can take up to three days.”

Others, who did come, died while waiting for the Ebola test results.

The hospital now has access to a rapid diagnostic test, which can give results in less than three hours.

Despite this, and better safety measures generally, many hospital staff are still afraid to tend to pregnant women, given the fact that childbirth puts them in direct contact with bodily fluids.

“When we started hearing of our colleagues dying, everybody was afraid and nobody wanted to even touch a patient,” Koroma explained.

But not all women are staying away.

“Some of my friends said that if I came to the hospital I would get Ebola… so I became afraid,” said 22-year-old Mary Conteh, from Freetown, who gave birth earlier this month. “But later I decided to come to Cottage Hospital…. I thank God I had a safe delivery.”

Shortage of health workers

Sierra Leone lost an estimated seven percent of its nurses and midwives to Ebola, according to the World Bank report – a devastating loss for a country that had just over 1 000 to begin with.

“This is just a terrible shock to an already weak healthcare system,” said David Evans, Senior Economist at the World Bank Group. “And if one were to put this [loss of health care workers] into actual numbers, that’s an additional 1,850 women dying per year [in Sierra Leone] just as a result that we’ve lost health care workers due to the Ebola epidemic.”

If Sierra Leone is to prevent its maternal mortality rate rising further, experts say more investment is drastically needed to plug the gap in maternal healthcare.

“In terms of response, it’s not rocket science,” Evans said. “These countries and the international communities supporting them need to hire more health workers and provide resources so they are well paid and want to be in Sierra Leone working there. And, as the Ebola epidemic wanes, as it continues, making sure they have protective equipment.”

In the short-term, to avoid a further increase in maternal mortality, Evans suggested a “stop-gap measure” of employing foreign healthcare workers and birth attendants, allowing local capacity to be built up over the longer term.

Women in Sierra Leone say they are praying for just that.

“All I want is to have a healthy baby,” said 25-year-old Frances Tucker, who is five months pregnant. “I don’t want to have problems like other pregnant women have had by staying at home, afraid of coming to the hospital… putting you and your baby’s life at risk.”

Jennifer Lazuta and John Sahr Sahid for IRIN

9 years ago

Pilgrims cast prayers to the skies from Algeria mountain peak

Pilgrims climb the Azro Nethor peak in the Djurdjura Mountain rangeto reach “el-Jammaa Oufella” (the upstairs mosque). (Pic: AFP)

Determined to rise high enough for their prayers to be heard, climbers defy the stifling summer heat to conquer a summit in Algeria’s northern Kabylie region.

They are women desperate for children, youth seeking jobs, and the sick hoping for a cure.

At the heart of this restive Berber-speaking region, Azro Nethor – the zenith prayer rock – towers at 1 884 metres above sea level, at the end of a steep path in the Atlas Mountains, an exhausting, giddy climb up the rocky mountain side.

Thousands of people climb the peak every year to perform prayers hoping “the saints” will answer their pleas. (Pic: AFP)

On the rock’s summit sits El-Jammaa Oufella (The Mosque at the Top), a small, stark place of worship. Inside, slim candles light the alcoves in its white walls.

For three successive Fridays each August, thousands of people from across Kabylie, and even from the capital Algiers, flock to the mountain peak, wheezing in the suffocating heat, for a pilgrimage rooted in a belief in the powers of holy men.

Islam does not recognise any intermediaries between God and men, but the cult of holy figures remains deeply rooted in Algeria, despite orthodox Muslims fighting to curb the practice.

Before the Bamiyan Buddhas were blown up in Afghanistan in 2001 and the Timbuktu mausoleums destroyed in Mali a decade later, armed Islamist groups in the 1990s destroyed many of the holy sanctuaries that dot the Algerian landscape.

Miracle men

Across the North African country, there is hardly a town or village that does not have at least one mausoleum, like that of Sidi Abderrahman, Algiers’ patron saint.

A pilgrim lights a candle inside the mosque. (Pic: AFP)

Azro Nethor is named after a legend passed down over the centuries. It says that an elderly wise man topped the mountain peak just as the sun reached its zenith and died there as he finished his midday prayer.

The wise man, said to have received God’s blessing, has since made endless apparitions in the villages dotted along these mountain crests.

His blessing has saved numerous local residents from grief, according to the legend, and once even a plate of couscous that hurtled all the way down the mountain without losing a single grain.

Since, a giant plate of couscous has been offered up to visitors at each pilgrimage, with dozens of sheep slaughtered for the occasion. Pilgrims quench their thirst at a spring said to have purifying properties.

At the foot of the mountain, in the shade of a tent, faith healers offer hope to those who have come to consult them.

Couples, young women and children place their head under a piece of fabric to hear a prayer.

“Next year, you will come back here with a husband on your arm and in two years’ time you will return with a child,” one healer promises a young woman, whose face bursts into a smile.

“I have been coming here since I was 20,” says a woman in her 70s who has made the journey from Larbaa Nath Irahen, some 50 kilometres from the sanctuary.

“The first time, I prayed for a husband, then to have children – and then for peace,” she says, referring to a civil war between the state and Islamist insurgents that abated in the late 1990s.

“The saints heard my prayers and they were all granted, which is why I always come back,” she says, her face beaming.

Prayers cast across the sea

Women make up the majority of those who come to climb the mountain, some launching calls to children snatched up by lives abroad, convinced that their voice will travel across the mountains and the nearby Mediterranean Sea.

A pilgrim lights a candle inside the mosque. (Pic: AFP)

Three years ago, 62-year-old doctor Mohamed came with his ailing mother, who was desperate for news from a child living in Italy. Her plea rose up to the skies and her son came home within days.

But it was the doctor who had begged his younger brother to make the journey, he says.

“My mother died relieved, convinced that her cry had reached Italy,” he recounts on his latest visit to the mountain, choking with emotion.

Like the doctor, youth huddling in groups nearby do not believe in these tall tales either. Many here say the annual pilgrimages were actually established as a pretext for match-making.

“The legend was made up by a feminist before his time, in revolt at the fate of young women in these mountains,” one explains.

“They were prisoners inside their fathers’ homes and had little chance of marrying outside their tribe’s circle. With the start of the legend, they could finally come to Azro Nethor where they could be seen by men from other villages and increase their chances of marrying,” he says.

“Today, we also come hoping to meet someone nice.”

9 years ago

Ivorians ignore ban on skin-lightening creams

Skin whitening products for sale at a boutique at the Marche de Marcory in Abidjan. (Pic: AFP)

At just 26, Fatou’s skin is marbled from layer on layer of whitening cream. Some even call her a “salamander” woman after the little reptile with light spots and translucent skin.

But nothing can stop the hairdresser in Côte d’Ivoire’s commercial capital Abidjan from using the skin-lightening cream in her quest for a paler complexion.

“I love light skin,” Fatou said. “I can’t stop.”

Many Ivorian women – as well as more and more men – are using creams with dangerous chemicals for depigmentation, despite government attempts to stop the practice.

In late April, Côte d’Ivoire banned whitening creams because of the negative health effects associated with them, ranging from white spots and acne to cancer.

If applied liberally, the cosmetics can also cause high blood pressure and diabetes, according to Professor Elidje Ekra, a dermatologist at Abidjan’s Treichville university hospital.

The banned products include creams containing mercury, certain steroids, vitamin A, or with hydroquinone levels above two percent.

Hydroquinone is often used in black and white photography and is banned as a skin-lightening ingredient in Europe as it is considered a potential carcinogen.

The dangers don’t seem to deter consumers, though.

Pressure from men

While no official statistics are available, “tchatchos” – or those with lightened skin, often recognisable by their darker knuckles and elbows — are omnipresent in Abidjan.

Businesses continue to sell the whitening products, because they know people will continue to buy them despite the risks.

“We know that our lightening products are dangerous,” an executive for an Ivorian cosmetic company said, adding that a ban would be counterproductive.

“It would push consumers to make their own products, which would be even worse.

“At least we know the composition.”

Some women say that it’s societal pressure – particularly from men – that forces them to lighten their skin.

“It’s men that push women to become lighter,” said Marie-Grace Amani, who has been whitening her skin for the past four years.

Côte d’Ivoire’s Health Minister Raymonde Goudou Coffie agrees.

Ivorian men “love women who shine in the night”, she told AFP. “They bring light and glow in the bedroom.”

Measure still an ’empty shell’

Three months after the new law was introduced – which could entail a fine of 50 000 to 350 000 CFA francs (US$83 to $585) for violators – salons are still advertising their lightening products.

Whitening soaps with names like “Glow and White” and “Body White” leave little doubt as to their intended use.

“After raising awareness, we will move to the next phase of removing products from the market,” Coffie said.

A national evaluation and marketing authorisation committee has been set up to ensure implementation of the measures, but one of the biggest fights could be against cultural beauty standards.

Lightened faces continue to proliferate on billboards in Abidjan, with the featured models flaunting fair skin.

Ekra says that while it’s a great initiative, the text is still an “empty shell”.

“We see women on national television who use the corrosive products,” said Ekra.

“Do those that enforce the measure even respect it?”

If people want to lighten their skin, experts say they’ll always find a way to do it.

“We tell people it’s not good for their health, but if they find something good there… we cannot forbid someone to do what they wish,” said Paul Aristide Kadia, who sells the products.

The practice is not only present in Côte d’Ivoire but widespread elsewhere in Africa, as well as in large parts of Asia.

In nearby Senegal, people mobilised against skin lightening in 2013, but failed to get a ban on products.

9 years ago

Uganda bans repayment of ‘bride price’ after divorce

Uganda’s Supreme Court ruled on Thursday that refunding of goods paid to a bride’s family after divorce was illegal, sparking celebration by rights groups who said women would no longer be “chained in violent relationships”.

In Uganda, as in many nations, the custom of the groom or his family paying a sum of money or property – known as a “bride price” – to the parents of the bride upon a marriage has a long tradition.

Bride prices are payments made from the groom’s family to the bride’s – the opposite of dowries paid in some countries, where the bride hands goods over to the man.

The Supreme Court ruled that refunding it upon dissolution of a customary marriage was unconstitutional, after local women’s rights group Mifumi launched an appeal following an earlier court decision, arguing the practice contributed to domestic violence.

“Refunding compromises the dignity of the woman,” Chief Justice Bart Katureebe said, according to the Daily Monitor newspaper, adding that paying a dowry back implied a woman was in a marriage as though on “loan”.

Mifumi said the judge’s decision was a “landmark in the history of Uganda” that meant women were “now free to walk out of an abusive relationship without fear” of how their family would pay back the bride price.

Mifumi said the payment of a bride price “reduces the status of women to cattle, to property that can be earned and paid for and exchanged for goods.”

The charity, along with 12 other individuals, first launched a 2007 petition at the Constitutional Court, arguing that the refunding of bride price portrayed women “as an article in a market for sale” amounting to “degrading treatment”.

The court however dismissed the petition in 2010, with the group then taking the case to the Supreme Court.