The state of tobacco dependence treatment in Tanzania
What is your professional background?
I am a psychiatrist who has specialized in addiction psychiatry, currently working at the Department of Psychiatry and Mental Health, Muhimbili National Hospital, Tanzania.
You have been very active and passionate about tobacco control/tobacco dependence treatment. What led to your involvement?
I first became passionate about tobacco control activities in 2003 after I conducted a grey literature on Tobacco and Tanzania; that’s when I learned about the tobacco status in Tanzania. I have also worked for the Department of Psychiatry since 2003 , and witnessed a lot of my patients struggling with tobacco dependence among other forms of addiction where nothing was done to address the situation. I was curious to learn how to help smokers quit including patients who suffer from co-morbid mental health and addiction problems.
What are some of the things you have been able to accomplish, specifically in the tobacco control arena?
- Carried out pioneer research on prevalence of smokeless tobacco use among the youth in Tanzania (2007/08) that led to banning of imported smokeless tobacco products in the country
- Served as a national team member for the drafting of the Tanzania National Tobacco Control Strategic Plan (2009-2015)
- Served as a member of the Tobacco Working Group of the Tanzania Public Health Association
- Engaged as a WHO consultant for Tanzania data search for the Global Tobacco Control Report II (Dec 2008)
- Worked as a clinical fellow in a smoking cessation clinic in Canada’s largest mental health and addiction hospital, CAMH, Toronto, Canada (2009 – 2012)
- Served as a faculty of Training Enhancement in Applied Cessation Counseling and Health (TEACH) Program, training a number of health care providers (HCP) on smoking cessation in Toronto, Canada (2010 – 2012)
What do HCPs currently do in your country – and what do you think they could do?
Regarding tobacco dependence treatment, it is anticipated that HCPs offer brief cessation advice but there are no studies that ascertain the extent of such coverage/practice in the country. There are no approved pharmacotherapies for smoking cessation available yet in Tanzania. Few HCPs have been trained in tobacco dependence treatment, and we hope that they will train others so that HCPs can be active in applying the five A’s for tobacco dependence treatment. The HCPs could be trained to offer brief cessation counseling and apply motivational interventions to the unmotivated smokers. HCPs should also be able to identify those smokers who may need more intensive counseling and smoking cessation pharmacotherapy when available in the future for referral and further management.
Describe some of the biggest challenges you face in your work?
The challenges I face at work is the fact that I work with complex tobacco dependent patients — a significant proportion of them are heavy smokers and these are the patients who can benefit from both intensive counseling and use of pharmacotherapy. The lack of available pharmacotherapies in the country impacts on cessation rates resulting in increased morbidity and mortality from tobacco-related problems.
Please tell us about some of the things you are working on now.
We have recently integrated smoking cessation services in a methadone clinic. We are a multidisciplinary team of four clinicians — one nurse, one social worker, and two psychiatrists who offer tobacco cessation services to patients who are on methadone treatment. We hope to integrate these services into the wider hospital community. We are closely working with the government to persuade them to provide the essential medications such as Nicotine Replacement Therapies be included in the national formulary including pharmacies to register and bring in other pharmacotherapies such as bupropion in the country. I teach undergraduate and postgraduate students registered with MUHAS on the fundamentals of tobacco cessation including conducting trainings for HCPs.
What else would you like to accomplish in your work with tobacco control?
Generally, I wish to advance tobacco control in Tanzania through intensified IEC, policy advocacy (establish a national tobacco control policy and legislation, guided by FCTC) so that no-smoking policies go hand in hand with the cessation work. As a clinician, I would like to introduce and scale up smoking cessation services and tobacco dependence treatment programs in Tanzania.
Is there anything else that you want people to know?
Tanzania is the third largest tobacco producing country in Africa (avg. 70,000 tons of leaf per year in 2010) and the production trend is growing. Given the existence of a tobacco policy in the country, since colonial times, the country finds itself in a dilemma to advance tobacco control, much as Tanzania is a Party to the FCTC, since 2007. There is a striking lack of human capacity to sufficiently understand the global tobacco industry, in general, and its influence in Tanzania, particularly. The Civil Society needs strengthening (human and financial resources) to advocate for policy change in favour of tobacco control vs. the Tobacco Industry which is has been growing stronger every year since 2001. Equally important is the need to create tobacco control pioneers, among the policy makers in the cabinet and in parliament to support tobacco control at the decision-making level.
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