By Sahan Lungu
In most Malawian cultures, smokeless tobacco is traditionally used for different factors such as pain relief for toothache, headache, Blood pressure, colds, stress, anxiety and depression. With some cultures using it for religious cleansing of evil spirits. In Mchinji, there has been an emergence of the popularization of the usage of a snuff tobacco product commonly known as Pembe among women tobacco users in the past few years. According to local sources, Pembe originates from Zambia and was at some point made from the carvings of the Pembe tree which is believed to have healing properties. The tree has since been replaced by dried Burley tobacco leaves.
Women from Madzimayera and Cheyadi in the district expressed that a lot of them started using Pembe because they believe it helps with High Blood Pressure and pain relief from the symptoms of arthritis. The common tale is that, not more than three to five years ago, traditional healers from the Zambia region came to Mchinji and sold people on the healing power of snorting Pembe. Through word of mouth and peer pressure, a lot of women are getting initiated into using Pembe and just like with other forms of tobacco use, most of them are becoming addicted to it.
“Some years back I was having problems with symptoms of arthritis and the medicine I got from the hospital did not help much, that is when I heard of Pembe and how it helps relieve pain. When I started using Pembe, I started to feel better and I haven’t been able to stop, it has been four years now. Most of the women around our community here snort Pembe, we know that it is made from burley tobacco and that it could be harmful but for now it helps us feel good and as you know quitting tobacco is not easy,” expresses Mrs. Kaseya from Madzimayera.
Pembe is sold in small 55 ml recycled glycerin bottles that go for 100 Malawi Kwacha (USD 0.12) which, dependent on individual usage behavior, can last one a day or two. Being a communal culture, some of the women share the Pembe with oner another out of camaraderie and as a recreational activity at social gatherings, such as village bank meetings. Whether Pembe really does help with blood pressure and symptoms of arthritis or it is just a placebo effect from existing beliefs, remains unknown. What is known is that, this remains to be one of the harmful ways of consuming tobacco and it is associated with various health complications. This includes heightened risk of cancer, heart disease and stroke.
The misinformation surrounding the functional use of snuff tobacco that is spreading around these parts of Mchinji is setting a very wrong precedent which will lead to serious adverse effects on our public health in the long run.
The problem is further compounded by the limited access to tobacco harm reduction information and interventions in the country. Most of the women who use Pembe stated that they have never heard of any of the safer nicotine alternatives that are out there despite having knowledge of tobacco associated harms. At the same time, due to price constraints, the modern harm reduction products such nicotine vaping devises are out of reach for a lot of tobacco users. For a group of tobacco users who pinch pennies to afford the Malawi Kwacha 500 (USD 0.61) they use to buy Pembe weekly, they would not manage to afford the running costs of a vaping device which can run up to USD 50-150 for purchasing alone. While safer smokeless tobacco products such as snus are yet to be available on the local market.
Despite these challenges, tobacco users still express a willingness to quit or switch to safer nicotine alternatives if made available.
“You will have saved our lives if you bring the Snus. I have the urge to quit but can’t fight off withdraw symptoms within days of stoppage” highlighted a concerned Kaseya.
This is a positive point to start from for those working in the field of tobacco harm reduction in Malawi. From there, deliberate efforts that aim at countering misinformation surrounding the functional use of smokeless tobacco have to be made and supported. Accurate information that clearly distinguish safer forms of smokeless tobacco from unsafe ones should be strongly highlighted through media channels that are accessible to tobacco users in rural communities like Mchinji, these include national and community radio. It is also imperative to harness the power of word-of-mouth communication to spread correct information on tobacco associated harms and safer forms of smokeless tobacco usage, instead of the misinformation being spread. Tobacco users belong to social groups in their communities which have opinion leaders, who if equipped with the right information, can influence their fellow tobacco users to either quit or switch to safer forms of tobacco use.