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Saturday, May 25, 2024

Why are many Gambians dying young? (A wave of chronic diseases and systemic flaws in a health sector paint a sorry picture)

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Just across the Gambian borders, in Senegal, both sexes of their citizens live two years longer than Gambians. Ninety-three of their children per 1,000 live births will not live to see their fifth birthday. In comparison, citizen of a developed nation such as the United States which is not considered the best in health care accessibility in the world, are expected to live 18 years longer for men and 20 years longer for women than Gambians according to the same 2009 WHO statistics. I won’t be surprised if revised figures covering recent years failed to reveal any improvement for The Gambia.

There are systemic flaws in the Gambian health care system that need to be corrected. One cannot refute the fact that the current government is trying to improve the health of its citizens. Laws and policies against public smoking and tobacco selling to minors, the seatbelt law, and the most recent call for banning smoking in government buildings are all efforts, if implemented, that will contribute towards improving the lives of Gambians. It is prudent for our law enforcement officers to enforce the laws as stipulated. But it is always a challenge, for a society where corruption and nepotism are the norms, failure in implementing and enforcing public health laws, becomes all too familiar.

This failure can be partly blamed on the lack of efforts to educate law enforcement officers and other stakeholders about what these policies and laws entail. What is a public place? To me, public places include but are not limited to, restaurants, night clubs, government buildings or any purposeful public gathering. It is not about harassing smoking pedestrians with a puff or two, who are merely minding their own business. This should be explained to law enforcers.

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To me, the effect of rusty exhaust fumes in our crowded Gambian cities is more troubling than people puffing smoke in the air. Don’t get it twisted: I am not in anyway condoning cigarette smoking in the open, but rather trying to pinpoint where our fundamental problems emanate from.

To abate the smoking problem in The Gambia will require concerted efforts from politicians, law enforcement officers and the business community. One will put more emphasis in educating the public about the adverse effects of smoking tobacco, and just as important, our law enforcement officers, in order to curb the problem.

The executive branch and the politicians should come up with laws that will levy heavy taxes on the cigarette industry. The other thing that can be done is to ban cigarette advertising in the country. Businessmen and women who profits from selling cigarettes should be asked to compensate the public by contributing to the country’s health care cost. Levying heavy taxes on cigarettes have contributed to the dramatic reduction of cigarette consumption in New York State. One year after cigarette tax increased from $1.25 to $2.75 per pack of cigarette, smoking was at its lowest rate ever recorded in the state. The state survey revealed a 12% (310,000 fewer adults) decrease in smoking1.

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It is the responsibility of those in law enforcement to ensure adherence to the laws enacted. They have to weed out corruption in order to enforce the laws effectively. It is essential to have an impartial judicial and law enforcement body in a civil society. One cannot run a society through impartiality. Everyone should be equal in terms of the law but it is rather sad to say, in The Gambia, “Some people are more equal to the law than others.” There should be no way around it: those who smoke in public places, sell cigarettes to minors, litter our streets or those who do not wear seatbelts, should be prosecuted and fined according to the law.

The business community should work hand in hand with policy makers and law enforcement officers to assist in minimising the damage cigarette smoking is doing to our society. They should be part of the policing body by simply refusing to sell cigarettes to minors. The country needs responsible retailers who will request identification before selling tobacco products. The idea of law enforcement officers using undercover agents in making sure retailers are checking IDs before selling tobacco products should be highly encouraged.

Tobacco products are not the only detrimental factors explaining our country’s low-life expectancy. What about the foods we eat? The “Maggie”or “Jumbo” seasonings are among the many products sold and highly consumed in The Gambia that need to be regulated, but aren’t unfortunately. These products have hidden ingredients that should be made public. The salt content of these products should be made known to the public. Salt is known for causing hypertension which is one of the leading chronic diseases in The Gambia. With the increasing indulgence of ordinary Gambians in canned and processed foods, food labeling policies have to be installed so that consumers are not misled on what they are eating.

It seems a luxury to live beyond 54 years in The Gambia today. Gambians hardly live through their elderly ages. The emerging chronic disease epidemic in the country caused me to be pessimistic about the health future of our fellow citizens. Hypertension, diabetes, kidney disease and many more, are ravaging our communities. Environmental and personal behaviors will cost The Gambia an entire generation sooner or later. Modifiable factors such as unhealthy eating, smoking, sedentary lifestyles, just to name a few, together with our genes which are not modifiable, have made Gambians more prone to chronic diseases.

One wonders whatever happened to the Gambian society of the recent past that once depended on locally-grown fresh vegetables and fruits. What happened to a society that was once on the “go”? Back then it was the norm for children to play games after school, students growing the vegetables consumed in school lunches and helping their parents in the farms during the rainy season. Nowadays the “attaya vous” is the new normal. It is not unusual to see folks spend four to six hours consecutively brewing and drinking “attaya”. How much sugar is being consumed during these “attaya” sessions? What are folks doing to offset these high consumptions of sugar?

If Gambians want to live longer, they have to shift from the status quo. They have to eat healthy nutritious diets, avoid high dense foods, exercise regularly, and move away from the sedentary lifestyles and bad habits such as smoking.

All governments are charged with the responsibility of taking care of the health of their citizens, but citizens of any country ought to be responsible for their own health. The government can only do so much. The leaders of the country have to take the lead, though, if they want to lead a healthy nation. A country without a healthy population is bound to perish. We have to start grooming the future work force of The Gambia now by taking care of our health needs.

No one can be forced to eat healthy or exercise but they can be motivated to do so. Critics will argue that poor people in The Gambia cannot afford to choose between foods. I somehow disagree. If one goes back to basics, there used to be a time when people grew fruits and vegetables for family consumption. All these efforts towards healthy-eating can be enhanced with the support of elected and government officials. Smoking-cessation, for example, can be attained through educational programs targeting young people. 

We all have to be in this together to effect a change.


Bakary M Jallow, RN, BSN, MPH, is an Infection Preventionist Clinician with the John C Lincoln Hospitals Network, and also an editorial board member of ‘My Basse’ online blog. He lives in Phoenix, Arizona, USA.

By Bakary M Jallow


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