Shisha, the silent killer


It is a chilly Friday night at the famous Casablanca II nightclub in Mukono town. Files of youths make their way to the little, black, ramshackle gate that we will later realise is the entrance to club. We are ushered in by a mean-looking man, who barely makes an effort to check us, into a crowded compound of what looks like a poorly lit residential house. The Music is blaring and deafening, drowning out random screams and loud conversation.

We squeeze our way to the back of the building, through familiar faces holding beer bottles, to a group of three young men sharing a pot of the famous shisha. They indulgently inhale long puffs from the pipe and blow out clouds of smoke with little regard for the people near them that were not smoking.

Asked why they chose to smoke this particular substance during their pastime, over all the others on the menu, Jonathan (not real name), a visiting student from another university, concedes that he has been smoking it for two years, and according to him, it is safe compared to cigarettes.

“I started smoking shisha about two years ago on a dare and it has been part of me since then. It helps me chillax (read chill and relax) for an hour or two, and it comes in all flavors,” he says prompting us to try it too. When we ignore his invitation he adds, “But I cannot do cigarettes, those things are dangerous!”

As the conversation goes on, it is apparent that he and his colleagues are oblivious to the danger beyond the myth of flavoured tobacco that is sold to them as a way for them to ‘safely’ socialize and ‘get high’.

Shisha myths unveiled

Shisha, also known as hookah, goza, narghile or the waterpipe, is a popular practice among the youth today of smoking tobacco from a pot-like bowl through a tube attached to it. This tobacco is mixed with flavours like apple, strawberry, mint, cola, kiwi among others using water to give it an aromatic taste. Hot charcoal is then burnt on the head of the pot to heat the flavored tobacco syrup in the bowl, creating smoke that is inhaled through the pipe. At times, other additives like marijuana are added to the composition for a quicker intoxication effect.

It can be purchased in most night clubs and bars in Uganda. There are no standing statistics available to show what demographics enjoy this dreadful substance most. However, anecdotal evidence shows that its captive audience includes the youth, the rich and the corporate class.

In Casablanca II, one pot costs between Shs8,000 to Sh10,000 only. And in The Hive, another commonly frequented bar and restaurant that is located less than a kilometer away from Casablanca II, Stella a waitress there told The Standard that it costs as low as Shs5,000 sometimes to encourage customers to buy more.

“But at times when the customers are many, like towards the end of the year, we sell over 100 pots a night. At such times a pot goes for Shs10,000. A pot can be shared by up to ten smokers depending on the size of the group and what they can afford,” Stella said.

Putting in context the affordability and the enticing quantities, the targeted demographic have made shisha a preferable alternative to cigarettes, with an additional misconception that it is not as dangerous to their health as the latter.

This misconception is partly based on the unsubstantiated belief that marketers are using to promote it, that since the tobacco is flavored and is being passed through a small receptacle of water for purification then it is cleansed of all the toxic substances like carcinogens and nicotine.

Dr Sheila Ndyanabangi, the Programme Manager for Mental Health and Substance Abuse in the Ministry of Health, during an interview with CCTV (an international television station) however debunked this myth.

“You see, cigarettes prescribe warnings on the packets, but shisha pots have no warnings whatsoever, so people take it with no label to show them that this is tobacco. And they take much more than one would take in one pack of cigarettes,” she said.

She also decried the poor sterilizing system of the pots and the mouthpieces shared by different customers in the bar.

According to a study by the World Health Organization, the smoke that emerges from a shisha pot contains several toxics known to cause lung cancer and heart disease, among others, as is the case with all tobacco products.

The study’s findings further show further that, “Cigarette smokers typically take eight to 12 puffs over about five to seven minutes and inhales 0.5 to 0.6 liters of smoke. However, water pipe smoking sessions last 20 to 80 minutes, taking 50 to 200 puffs which range from about 0.15 to 1 liters of smoke.”

This simply means, one session of smoking a pot of shisha is equivalent to smoking 100 or more cigarettes.

In an interview with The Standard, Dr Isaac Gabriel Otuk a consultant at Mulago National Referral Hospital and Uganda Christian University’s sports department, and also the CEO of Fitness Health Nutrition Sports (FHNS) Limited, the disadvantages of shisha smoking are innumerable.

He explained that the form in which shisha is consumed is far more dangerous than that of cigarettes therefore the damage it causes to the body is a hundred times more.

“First of all, it is served with burning charcoal on top of the pot. Charcoal has carbon monoxide in its composition. This odorless gas comes down and mixes with the already harmful ingredients in the syrup, which the consumer inhales at once in large quantities. And unlike cigarette smoke, the shisha smoke is in moisture/vapor form meaning when it gets to the lungs, it first settles on to the walls of the lungs affecting the tissue directly,” he explained.

He added that people, especially youth, smoke because they want to fit in socially and look ‘cool’, yet the syrup contains Nicotine, an addictive drug.

“Therefore, as they inhale these harmful substances, they are slowly killing the cells which make up the tissues that make organs in the body. When the cells realize they are dying rapidly, they are triggered to form more cells to replace the ones dying, a process called metaplasia. At the end of the day, the body gets excess cells, which are cancerous. This is how some cancers some cases of oral cancer, trachea cancer, and lung cancer start,” Dr Otuk said.

On the means of consumption, Dr Otuk said that people who enjoy smoking this substance tend to share the pipe amongst themselves with no knowledge of the medical history of each other. Therefore, they are prone to contracting infectious diseases like Tuberculosis.

He concluded that passive smokers of Shisha are also in great danger.

“The bars that sell shisha do not provide isolated areas for the smokers, meaning that everyone in the bar is as equally affected as the direct smoker. Ten people smoke and fifty get affected.”

The ban on smoking

The Parliament of Uganda passed a law that bans the importation, manufacture, distribution, possession and sale of water pipe tobacco (shisha) in the country, the Tobacco Control Act of 2015. According to this law a person found guilty will face imprisonment of up to a year, or a fine of between Shs480,000 and Shs20,000,000 according to the individual’s participation.

The Uganda Police, in partnership with the Uganda National Health Consumers’ Organisation (UNHCO), carried out civic education for the awareness of bar owners and tobacco consumers. A total ban was put on tobacco advertising, promotion and sponsorship. Posters were published explaining the law. They asked bar owners to display them in English, Luganda, Swahili and a commonly used language in the area, all over their bars as provided for by the Act, in section 13.

However the law, just like many others in Uganda is not adhered to. In December 2016, a group of environment police led by Mr Robert Wowuya the CID officer, Mukono and Moses Tibita the legal officer of UNHCO, raided Casablanca II and confiscated several shisha pots. In January 2017, environment police once again raided the same bar and confiscated more shisha pots. But here we are in March 2017, and the bar’s shisha shop is still operating normally!

Mr Wowuya told The Standard that the enforcement of the Act is still in its early stages.

“Several raids have already taken place and we now have over 20 pots in our custody. In some of the raids in Mukono and Kampala, bar owners and customers were arrested. Some were released on court bail and others are still in confinement. However, just like any other behavioral criminal, some bar owners and customers do not fear the law.”

“There is a law that says murder is illegal, but people still kill. Some people break the law deliberately. We actually understand that some bars have gone ahead to increase the price of shisha in order to cover the cost of bail. But we also know that a vice cannot just stop overnight; we believe that discipline will take shape over time as we continue enforcing the law,” Wowuya said.

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