With World No Tobacco Day on May 31, local doctors offer advice for those who want to quit smoking
By Dominika Maslikowski
There are ashtrays in the corridors of the five-star hotels on the Nile Corniche, and cigarette packs as cheap as LE 2.50 in the markets near Cairo’s Ramses Station. University students meet over shisha after classes, while cigarette smokers light up anywhere from the hallways of the Mogamma to the dining rooms of family restaurants. Egypt is a paradise for the tobacco industry, with some 60% of males using some form of tobacco products according to the World Health Organization (WHO). But for those trying to quit, it’s often a struggle to find support or aids in a country where smoking is considered a social norm.
As the international community gets set to mark the World No Tobacco Day on May 31, an event created by the WHO in 1987, local doctors and activists say that Egypt needs to launch an anti-smoking campaign, adopt stricter regulations and offer more support for those trying to kick the habit.
Dr. Hany Ragy, a cardiologist who runs smoking cessation services and who’s passionate about combating tobacco, is a former smoker himself who knows what it’s like to quit when cigarettes are easily available and smokers are everywhere. He spoke with Egypt Today at the sidelines of the Philips-sponsored roadshow Cairo to Cape Town, which focused on sustainable healthcare in Africa.
“We’re both sitting now in a 5-star hotel that is holding a cardiology meeting, and yet people around us are smoking in the corridors. Yet this same chain of world-famous hotels has a no smoking policy in other countries. This in itself should tell you the challenge Egyptian smokers are facing. It’s the total availability without restriction of the substance they’re addicted to — nicotine,” Ragy says. “The problem in Egypt is that there’s no organized anti-smoking campaign or effort, so the smoking industry has a free run. They have been literally chased out of many countries in the West, or at least out of the public space that they enjoy in Egypt without restriction.”
There are no restrictions on the amount of nicotine and tar in cigarettes, Ragy says, while shisha is now being promoted to young, educated and affluent youth. The WHO recently released findings that one hour, or one session, of shisha smoking is equivalent to smoking 100 cigarettes, Ragy says. Shisha cafes, with their hip decor or live music, appeal to teens who then become quickly addicted to nicotine, and who at some point will likely start smoking cigarettes. Both have staggering health risks, but shisha is even more harmful despite misconceptions that it’s safer.
Despite the peer pressures they face, young children are receptive when they’re told about the dangers of smoking. Ragy speaks at primary and secondary schools to warn children about the health risks and uses sports personalities that young boys look up to as examples. Lionel Messi of Spanish football club FC Barcelona, for example, doesn’t go around smoking at pubs, and Ragy says it’s easy to get his message across.
At a national level, Egypt has the 16805 hotline that offers guidance on quitting, a dedicated department at the Ministry of Health and various NGOs involved in spreading the anti-tobacco message. But a lot of those programs are formalities because there’s no continuous source of budgeting and Egypt spends less than 5% of its budget on healthcare in general, Ragy says.
“The government has not yet started to invest in combating tobacco. On the contrary, the government enjoys the tobacco tax like many other governments,” Ragy says. “Just before the revolution, we managed to make a law just for the city of Alexandria for cafes and restaurants to be smoke-free like European cities. But after the revolution this crumbled, and now people are smoking in places which are in fact smoke-free.”
Dr. Wael Safwat Abd Elmeguid, the program coordinator of the tobacco treatment unit at the Wadi El-Nil Hospital in Heliopolis,has been on the front lines for many of the battles against tobacco. He is the founder and co-member of three Egyptian NGOs working on tobacco control and health awareness, and played a key role in establishing the Egyptian National Coalition for Tobacco Control in 2008.
Abd Elmeguid says Egypt must rigorously implement the MPOWER measures, part of The WHO Framework Convention on Tobacco Control, which Egypt signed in 2003. The measures include protecting people from tobacco smoke, offering help to those who want to quit smoking, enforcing bans on tobacco sponsorship and raising tobacco taxes. Designating smoke-free places is an effective policy that helps smokers to quit, but in Egypt there is not enough enforcement of the smoking ban in public places like hospitals, universities and other educational facilities, Abd Elmeguid says.
If the political decision is taken to combat tobacco, then it has to start with an education campaign that should use the media, Ragy says. This will save the country’s youth in future generations from becoming smokers, and it will save the government billions of pounds in the coming years in health costs.
“In my hospital, we have many women who are very vulnerable because they’re diabetics and they’re having heart attacks because their husbands are chain-smoking at home. We have many children with asthma because their parents smoke at home,” Ragy says. “If the Egyptian government buys in (to an anti-tobacco campaign,) a lot of us would volunteer our work, including the media and sports personalities. Because I can’t help but think that the tobacco industry — if they don’t have any direct involvement in what’s going on — must be laughing their heads off.”
DECIDING TO QUIT
When a smoker in Egypt does decide to quit, they can do it cold-turkey or use nicotine replacements like gum, lozenges or patches to gradually wean themselves off. Counseling and the 16805 hotline can help, but medications can often be hard to find. Health insurance doesn’t cover aids like gums and patches, which makes quitting very costly for most smokers.
“Aids are available in Egypt in a very sporadic way, and there are major shortages because the prescription rate is low. The pharmacists and government are not promoting it. It’s not a conspiracy theory if I tell you that the tobacco industry is extremely powerful politically in Egypt, like in many other countries,” Ragy says. “You can find chewing gum and possibly patches in some of the large pharmacy chains, but the companies have almost stopped importing them because they expire on the shelf since nobody buys them. There are also medicines that help smokers to quit, like Champix, which blocks the nicotine receptor in the brain, and that’s supposedly legally available in Egypt. One of my patients had so much difficulty in getting it that I had to buy it for her from abroad.”
Many smokers find empowerment by joining a community of people who are also quitting. Websites like quitnet.com offer free registration and a network of ex-smokers who share advice on battling urges, frustrations and success stories. Members take daily pledges not to smoke that day. Some write on the website in frustration when they are having urges to smoke, and are given immediate pep talks from other users.Allen Carr’s Easy Way to Stop Smoking has sold 13 million copies worldwide with its no-nonsense approach to quitting. The book dispels popular myths smokers have, like that cigarettes help you relax when in reality they raise blood pressure and make you constantly irritable.
Plenty of smokers know about the dangers of tobacco, yet they excuse their habit by telling themselves half-lies and believing in an array of misconceptions. Others quit smoking and limit themselves to the more harmful shisha or they get addicted to electronic cigarettes, also known as e-cigarettes, personal vaporizers or electronic nicotine delivery systems. Abd Elmeguid points out, however, that there are not enough studies about the safety and harmful effects of e-cigarettes and they can’t be considered a way of quitting smoking as they still deliver nicotine and keep the smoker attached to all the psychological aspects of smoking.
Ragy says he’s spent his entire career studying smokers’ misconceptions. Smokers tell themselves they can stop whenever they want, but don’t realize they’re addicts who can’t stop unless they make a decision. They tell themselves that people smoke and nothing happens to them, but they ignore statistics that say half of smokers will die because of their addiction. Or they’ll say that non-smokers still get lung cancer or have heart attacks, but don’t realize the amount of smokers who get those diseases are much higher percentage wise.
“My advice is to look at the world around you, look at the intelligent people in other countries and they are quitting. And why are they quitting? Because the information has been provided for them,” Ragy says. “If you go to the supermarket and buy yogurt and the label says it may contain radioactive milk from Chernobyl and it will probably give you cancer, is there any chance that you would buy the yogurt and eat it? I think not.
“Why do you look at a pack of cigarettes and you still buy it? Because you’re an addict. The tobacco industry knows you’re an addict to the extent that they’ve washed their hands from the crime by putting the warnings on the box. And now it’s up to you,” the cardiologist continues. “Nobody will help you in your fight. If you don’t stop now, you’ll probably going to stop — if you’re lucky — during an illness sometime in the future. It doesn’t have to be that way. Because you’re an addict, you won’t stop automatically. You won’t wake up one morning and stop. You have to make a very conscious decision to stop and focus on quitting tobacco.” et
Say No to E-cigarettes
While some feel electronic cigarettes, like gum or patches, deliver nicotine without the tar, Dr. Abd Elmeguid notes that e-cigarettes don’t actually help you beat your addiciton. Some studies also suggest the liquid nicotine they contain is dangerously toxic.
Need Help Quitting?
Dr. Wael Safwat Abd Elmeguid rounds up some of the aids locally available to help you kick the habit
Nicotine gum and patches are sold over the counter and usually available at larger, better-stocked pharmacy chains like El-Ezaby (pharmacyincairo.com, tel: 19600,) Ali & Ali Pharmacy (tel: 19905) and Seif Pharmacies (seifgroup.com/pharmacies, tel: 19199). Packs of 105 pieces of gums from brand Nicorette range in price from LE 195 to LE 245. Patches are sold individually at about LE 35, or in packs of 7 (or a one-week supply) from LE 285 to LE 320. Small pharmacies sometimes carry gum or patches at lower prices, but you have to shop around.
Champix is a pill that blocks the nicotine receptor in the brain. It is sold over the counter at major pharmacy chains like El-Ezaby, Ali & Ali Pharmacy and Seif Pharmacies.
Wellbutrin, an anti-depressant sold over the counter, can also be used by smokers to quit tobacco. It is usually available at major chains including El-Ezaby, Ali & Ali Pharmacy and Seif Pharmacies.
Hotline 16805: Egypt’s national hotline offering advice for those trying to quit smoking.
Wadi El-Neel Hospital offers smoking cessation services. (Wadi El-Neel St., behind the Presidential Palace, Hadaaq El-Kobba. Tel: 20-2-24562700, or email Dr. Abd Elmeguid for more information at firstname.lastname@example.org)
Sehaty is a network of clinics that offer smoking cessation therapy at locations including Heliopolis, Mohandiseen, Zamalek and Maadi. Call (011) 0082-0024 for more information, or check out their Facebook page Se7aty.
WEBSITES AND BOOKS
Quitnet.com offers free registration and a network of ex-smokers who share advice and give support for others trying to quit. The English-only website claims members from 160 countries.
Allen Carr’s Easy Way to Stop Smoking is available at AUC Press bookstores and sold widely in Souq Ezbakeya, the book market near Attaba metro station.