06-06-2022

MonDay, June 6, 2022
5
Protesters in Kathmandu call for reform of the rape laws.
SaRah JohnSon
A young woman's account on
TikTok of being drugged, raped and
then blackmailed by a beauty
pageant organiser when she was 16
years old has provoked outrage in
Nepal and prompted calls to reform
the country's "grossly inadequate"
rape laws.
In one of a series of videos, which
together have been viewed millions of
times, the former model and child
actor broke down in tears as she talked
about Nepal's statute of limitations
that dictates survivors must report
cases of rape within one year of the
offence being committed.
Days after the videos were posted on
the social media site on 18 May,
hundreds of protesters took to the
streets calling for change to the
country's rape laws, and on 24 May six
lawyers filed a petition at the supreme
court demanding the repeal of the
statute. As a result of public pressure,
a man has been arrested in connection
with the case but under a section of
the law related to human trafficking.
Dechen Lama, a human rights
lawyer who also works for the Forum
for Women, Law and Development, a
Nepali rights organisation, said: "The
law is not comprehensive …… It leads
to so much unfairness and injustice. It
has to be changed. There are so many
loopholes in the rape law, most
particularly the statute of limitation
and the definition of rape."
Nepal's 2017 penal code extended
the statute of limitations on reporting
rape allegations from 35 days to a
year. A report by the international
women's rights organisation Equality
Now found that in comparison with
five other south Asian countries,
Nepal has the shortest statute of
limitations on sexual violence cases.
Activists and lawyers say the law
stands as a barrier to justice for rape
survivors and that it helps
perpetrators to evade punishment.
Smriti Singh, Amnesty International's
south Asia deputy regional director,
said the stigma, shame, intimidation
and trauma associated with rape
stopped many people from coming
forward.
"This case has brought attention to
Photo: Prabin Ranabhat
Protesters call for age old
Nepali laws on rape
how grossly inadequate and
ineffective the provision [for rape
survivors] is at this point," she said.
"The one-year limitation is really
outdated and harmful. It does not
factor in the stigma that survivors face
when reporting cases of sexual and
gender-based violence."
It is not just the statute of limitations
that needs to change, according to
campaigners. The definition of rape in
Nepal's penal code only recognises a
crime committed by a male against a
female, and not against people of
other genders. Nonconsensual sexual
acts are not included within the
definition of rape, and marital rape
receives a lesser punishment.
"This can be a watershed moment
for Nepal," said Singh. "From a
human rights perspective, this
incident has triggered a conversation
around how inadequate provisions
are. "I think it's a good opportunity for
the authorities to take a moment and
go back and see whether rape laws are
in line with international human
rights standards, and if not, to bring
them in line."
RaCheL Kitonyo
For decades, smoking has
been on the rise, driving more
than 100m deaths in the 20th
century alone and creating
health and other costs of
about $1,500bn a year that
have hampering global
growth. According to a report
from the global health policy
organisation Vital Strategies
and the University of Illinois
Chicago in the latest edition of
the Tobacco Atlas, the era of
big tobacco is coming to an
end: there is an unequivocal
drop in global smoking rates,
to 19.6% in 2019 from 22.6%
in 2007.
Concealed in the figures,
however, is a plan to turn
tobacco back into a growth
industry by focusing on
Africa. Global progress
against the "tobacco
epidemic" is driven by large
declines mostly in nations
that have raised taxes on
tobacco, limited marketing,
mounted hard-hitting public
information campaigns, and
banned smoking in many
public places. Our research
shows that the decline in
smoking in Africa has been
small, and adult prevalence
increased in 10 of the
continent's countries between
1990 and 2019.
As outlined in research from
the University of Bath, a
partner in the tobacco
industry watchdog, Stopping
Tobacco Organisations and
Products (Stop): "To protect
their profits, transnational
tobacco companies (TTCs)
began shifting their business
to relatively untapped
markets in parts of the world
where the opportunity for
growth is largely unrestricted
… Nowhere is this
underexploited prospect as
ripe for the picking as Africa.
TTCs are expanding into
African countries, where,
excluding South Africa, the
tobacco market grew by
almost 70% through the
1990s and the first decade of
the 21st century."
Taxation is the most
effective way to control
tobacco use but Africa has a
poor record in this area.
Tobacconomics' cigarette tax
scorecard rates nations on a
scale of 0 to 5, with 5
indicating the best
performance. Compared with
leaders such as New Zealand
or Ecuador (4.63), which are
making rapid progress,
Africa on its way to the
world's ashtray
countries such as Kenya
(0.88), Zimbabwe (1.38),
Chad and Central African
Republic (both at 0.75) show
that tobacco is lightly taxed
across most of the continent.
Cheap cigarettes suit
international tobacco
multinationals. As profits are
choked off in the west, big
tobacco has homed in on
African communities, and
especially their young people,
as incubators for deadly new
initiatives. The Africa Centre
for Tobacco reported in 2016
how shops and pushcarts
peddling cigarettes alongside
sweets were operating near
schools in Cameroon and
Burkina Faso. The Tobacco
Atlas lays out stark data on the
industry's global youth focus,
finding smoking rates among
13- to 15-year-olds increasing
in 63 countries.
Ironically, keeping
cigarettes affordable for poor
people has been used by
industry lobbyists as an
argument against taxation.
However, it ignores the fact
that those groups are more
sensitive to price, and the
health, social and economic
benefits of higher taxes - fewer
people starting to smoke and
more quitting - accrue much
more to these groups. The
positive impact can also be
amplified by governments
that use tobacco tax revenues
for the benefit of those same
groups, such as supporting
programmes to help people
stop smoking.
Another industry argument
is that tobacco cultivation in
many east and southern
African countries is an
important part of the
economy. The tobacco
industry lobbies governments
to stall action for fear of
hurting farmers, but the
Tobacco Atlas identifies
recent research that
demonstrates that most
tobacco growers are
impoverished and
governments would serve
them better by helping them
transition to more profitable
crops.
We cannot let Africa be the
world's ashtray. Governments
should act now to raise
tobacco taxes to at least World
Health Organizationrecommended
levels, restrict
marketing to young people,
create policies that control
access to tobacco products,
and protect policymaking
from interference by the
tobacco industry. Smoking
rates on the continent are still
relatively low, and the tobacco
epidemic that has already
scarred the US and Europe
will not inevitably take off in
Africa if we act now to protect
the next generation.
African economies remain
vulnerable; the vestiges of
colonialism are still at play.
We can work together to
ensure that global
corporations based in highincome
countries don't siphon
profits out of lower-income
countries at the cost of their
people's health. Less than 2%
of all development aid is
dedicated to noncommunicable
disease
prevention and the figure is
even more dismal for Africa -
an oversight leading to
preventable premature deaths
and increased costs, as well as
leaving populations more
vulnerable to health shocks
such as Covid. Financial and
technical aid for tobacco
control should be readily
available to protect Africa's
one billion people from being
the next growth market.
It is heartening to see
tobacco's influence on the
wane anywhere in the world,
but this edition of the Tobacco
Atlas exposes an industry
hard at work to make Africa
the new frontier for smoking.
It will take a concerted effort
to implement established
tobacco control measures to
resist the powerful
multinationals looking to
profit at the expense of
people's health. As highincome
countries act to
ensure tobacco-free futures,
we need to use those same
policy measures to prevent
tomorrow's health crises
across Africa.
a woman selling tobacco in nairobi. Cigarettes are often sold singly in many
developing countries.
Photo: David Levene
Lizzy DavieS
The children of Bees Haven kindergarten
are about 15 minutes into their weekly
taekwondo class when their instructor has
some stern words for them. "You guys are
not panting," says Lizzanne Adhiambo,
with a grin. "I want to see the power! Let's
punch!"
Aside from a certain amount of
confusion over left and right hands,
Adhiambo's pupils obey. With alternating
arms they punch out in front of them, 15
four- to six-year-olds, wearing white
training uniforms , shouting "Yeah!" as
the instructor counts from 1 to 10.
"They love it so much," says Beryl Itindi,
director of the pre-primary school in
Syokimau, on the south-western outskirts
of Nairobi. After class, the children sit
down for lunch of beef stew, leafy greens,
ugali - maize flour porridge - and fresh
fruit. "Thank you for our food and our
many blessings," they chorus. "Amen."
These children are at the forefront of
new efforts to foster lifelong habits of
exercise and healthy eating - and stave off
a foe increasingly visible in Kenya's towns
and cities: obesity. As in much of Africa,
the number of people classed as obese in
Kenya is on the rise: by 2030, the World
Obesity Atlas says 1.4 million five to 19-
year-olds will be obese. The WHO
considers a person with a body mass
index (BMI) over 25 to be overweight,
while a BMI over 30 is obese.
A 2015 survey - the most recent
undertaken - found 20% of Kenyan men
and more than 50% of women were either
overweight or obese. In a report last year,
Kenya's government recognised obesity as
a major risk factor for non-communicable
diseases (NCDs) such as diabetes and
cancer, which are responsible for 39% of
deaths in Kenya - up from 27% in 2014.
"The statistics show that obesity is
growing at a very alarming rate, not just in
Kenya but in the region and world," says
Stephen Kimutai Tanui, strategy manager
for Wellness for Greatness, the
organisation behind the taekwondo
classes.
The education the group is giving
children was sorely lacking when Tanui,
32, was a child: "We were not told that
physical activity has very many benefits …
not just to enjoyment and performance in
school but to our health."
In a country stalked by hunger and
where more than three million people are
Kenya’s hidden food crisis
Francis njuguna, a community health worker, advises local people on growing vegetables.
Photo: Brian otieno
classed as acutely food insecure, the
priority was getting enough food,
irrespective of its nutritional value, he
says. "When we were young, that link
between good nutrition and good health
was missing," says Tanui. "In Kenya and
in most African countries we have a
problem with malnutrition, and that's
what everyone focuses on. People should
have food, but we should also focus on
getting good and healthy foods, because
the rates at which obesity is growing, they
are going hand in hand: malnutrition and
obesity. It's a terrible burden."
In parts of the rural north and east, the
worst drought for 40 years is driving
thousands of Kenyans from their homes.
According to the International Federation
of the Red Cross, approximately 755,000
children under five will be acutely
malnourished throughout 2022.
In Nairobi, where fast food chains such
as KFC, Burger King and Domino's stand
on every other street corner, and
billboards push "vitamin-enriched"
chocolate drinks to motorists on the
heaving roads, the problem is "completely
different" says Dr Davis Ombui, a
diabetologist. "People get to jobs in the
morning, get into office, get back into their
cars, go home. They don't walk to work as
much, and fast food is now a big thing in
Nairobi."
The result is clear at his private clinic
surgeries. "We are seeing younger and
younger people diagnosed at a younger
age. Today I had someone who was 21 .
Type 2 diabetes. It's all because of obesity;
all because of the lifestyle."
Last year the ministry of health
published a strategic plan to respond to its
"epidemiological transition" in disease
burden from communicable diseases,
such as malaria and tuberculosis, to the
rising burden of NCDs. It recognised
obesity as a major risk factor, but doctors
fear there is little concrete action.
"You might find these policies are there
on paper," says Ombui. "But no one is
translating that into action on the ground.
I'm sure if you go to the cabinet you'll find
really nice policy papers that were
sponsored by WHO and [other]
organisations - just gathering dust."
The health ministry was approached for
comment. The government's target is to
reduce obesity prevalence from 28% in
2020 to 26% in 2025, and the clock is
ticking. By 2030, NCD deaths are
expected to increase by 55%.
And there remains a lingering
association in society between excess fat
and material success. "You find young
people at university want to add weight
and grow a belly as a status symbol. It's
that bad," says Stephen Ogweno, CEO of
Stowelink, a youth-led enterprise aimed at
combating NCDs. "There is still this
perception that needs to change."
For well-off Kenyans, Dr Wyckliffe
Kaisha has the answer. One of the few
surgeons in the country to perform
bariatric - or weight loss - surgery such as
gastric bypasses, he has seen a significant
increase in patients, partly due to Covid-
19, which alerted more people to the
ramifications of obesity, diabetes and
hypertension.
One of his patients, a 29-year-old who
last year had a sleeve gastrectomy -
involving removing part of her stomach -
has no regrets. "It requires somebody to
be psychologically and emotionally
prepared because it is not easy, especially
if you're used to taking a lot of junk [food].
I really loved chips. Nowadays I can't even
stand the smell of fries," she says.
The woman, who does not want her
name published, says she has lost 40kg:
"At least now I can walk up stairs. I don't
have to depend on lifts."Bariatric surgery
has its critics, but Kaisha insists it is
beneficial for the vast majority. His
bugbear is with insurers, who refuse to
cover the procedure, meaning only the
wealthy can afford his $5,000 charges.
He has told insurers that bariatric
surgery is cost-effective as it prevents
conditions developing. "They still reject it
and say it is cosmetic surgery. But it is not
at all," he says. The village of Njathaini, on
the northern outskirts of Nairobi, is a
world away from Kaisha's clientele. With
high unemployment and little disposable
income, it is in places like this that
intervention is urgent, says Ogweno.
Thanks to genetics, diet and lack of
exercise, Ogweno, 26, once weighed
almost 20st. Driven by wanting to "look
like Dwayne 'The Rock' Johnson" he lost
weight at university and competed in Mr
Fitness contests.
He wants to prove that obesity, diabetes
and cancer don't just affect "the old and
the rich." What he and his colleagues
found in Njathaini shocked them: "[This
is] a very low-income community, and
almost 70% of the homes here live with
diabetes or hypertension," says Ogweno,
sitting in the village chief's office.
Traditional diets in poor
neighbourhoods rely heavily on
carbohydrates and cooking fat with
vertiginously high levels of transfats,
known to increase the risk of heart
disease. At one Njathaini shop, you can
buy a cabbage for 70 shillings (50p). At
another, a few doors down, there are bags
of crisps for 20 shillings, and fried bread
rolls are 10 shillings.
Then there's the sugar. "Soft drinks are
more available than clean water," says
Ogweno. The shops are fully stocked with
fizzy drinks, and bunting advertising
Sprite, Coca Cola and Fanta, as well as
water, greets every customer.
Francis Njuguna, a community health
worker, was born and bred in Njathaini.
"Before, it [obesity] was a non-issue.
There were very few cases. But nowadays
there's a lot of people," he says. Working
with Stowelink, Njuguna advises local
people on growing vegetables as well as
other cash crops. "Kale, tomatoes, onions,
spinach" are all possible, he says.
The worst aspect, says Ogweno, is that
once people are diagnosed with
conditions associated with obesity, they
struggle to get treatment. "If you're not
formally employed … you are almost
always not covered [by national health
insurance] and if you are sick you have to
pay out of pocket," he says. This applies,
for instance, to insulin for diabetics.
"People literally have to rally the whole
village to contribute cash to then go and
do that because otherwise it's a death
sentence."
Ogweno, whose aunt died from diabetes
after seeking help from a traditional
healer, feels the government is moving,
slowly and belatedly, to take NCDs
seriously. For the moment, then, it is the
Bees Haven children forging the way.
Exuberant after their training, the
kindergarten's martial artists eat their
lunch enthusiastically - even the managu
greens. Often the children arrive rather
shy, says Itindi, the director, and the
exercise "really opens them up both
mentally and physically."