Tobacco-related illnesses will cost you Shs 5m every 3weeks

Born and raised in tobacco-growing district of Arua, Emmanuel Ojapi learnt how to smoke at 17.

Now 38, Ojapi smokes between 26 and 30 sticks of locally woven tobacco daily – which is probably why his teeth are steadily changing colour from white to deep yellow.

When he smiles, the change is evident with the teeth of his lower jaw. Ojapi has easy access to tobacco because he works on tobacco farms for a living.

“I have worked on these farms since I was a child. It took me less than a month to learn how to chew the leaf and my friends taught me how to smoke,” he confidently says as he goes about his daily routines on a tobacco farm in Maracha district.

He is, however, oblivious of the health – and cost – implications of smoking and chewing tobacco.

Dr Fred Okuku, a medical oncologist at the Uganda Cancer Institute (UCI), says there are various types of cancer and other diseases associated with smoking that are costly to treat.

For example, cigarette smoking is a major risk factor for developing small cell lung cancer (SCLC), the commonest lung cancer associated with smoking.

This is treated using chemotherapy, with anti-cancer drugs injected into the vein or taken orally.

“We administer chemotherapy in cycles and these generally last about 3 to 4 weeks. Initial treatment is in four to six cycles, which costs about Shs 5m to Shs 6m,” Dr Okuku says.

Each cycle costs Shs 700,000 to 800,000. And all the six cycles are a prerequisite because SCLC spreads fast to the brain and liver.

Before undergoing chemotherapy, other money-drenching tests are conducted such as a CT scan of the chest, which costs about Shs 200,000, blood, Hepatitis B, urine and abdomen tests which cost a minimum of Shs1m.

Meanwhile, lobectomy, where a section (lobe) of the lung is removed is another treatment option although it is rarely used as the main form of treatment. This costs Shs 25m. Other operations cost Shs 10m to Shs 15m.

Dr Okuku says of the 50 patients admitted to the institute with SCLC, only five benefit from the treatment options because majority come when the cancer is in its advanced stages.

According to an article titled “Do you know tobacco?” by the Centre for Addiction and Mental Health, when tobacco is burned, a dark sticky “tar” is formed from a combination of hundreds of chemicals, including poisons that cause cancers and bronchial disorders. 

Tar is released in tobacco smoke in tiny particles that damage the lungs and airways and stain teeth and fingers. Tar is the main cause of lung and throat cancers.

Globally, the World Health Organisation estimates that tobacco causes about 71% of lung cancer, 42% of chronic respiratory diseases, 20% of global tuberculosis incidence and nearly 10% of cardiovascular diseases.

Smoking is also associated with Chronic Obstructive Pulmonary Disease (COPD) where lungs lose their elasticity, making it difficult to breathe. Coughing up mucus is often the first sign of COPD.

“When one is diagnosed with COPD, you spend a minimum of shs 300,000 a week for treatment and when it becomes severe, one needs oxygen for life,” Dr Okuku says.

TOBACCO BURDEN

Currently, Uganda loses an estimated 13,000 people to tobacco-related illnesses annually. Statistics also indicate that 75% of the cancer patients at Mulago hospital have had a history of smoking (actively or passively) between two and 33 years. Currently, UCI needs Shs102bn annually to treat patients.

Last year the anti-smoking lobby made some progress, moving the Tobacco Control Bill that seeks to increase taxes on tobacco products, bans tobacco advertising and prohibits the sale and importation of duty free tobacco products among others.