Tara Singh Bam: Dedicated to stopping the disease of “tobaccosis”

Tara Singh Bam:  Dedicated to stopping the disease of “tobaccosis”

In the remote Nepali village where Tara Singh Bam was raised, people grew their own tobacco. They claimed smoking helped overcome the stress of struggling to survive, but his father died from asthma and the results of heavy smoking, and other relatives died too.  

“Even though I didn’t know the full effects, I saw tobacco was a problem,” he says, and he became determined to work in public health.

Tara went to high school in his village then worked his way through the Tribhuban  University in Kathmandu. After graduating in 1995, he became a technical officer for the National TB Programme. “DOTS was just starting, so it was an exciting time to be in TB control”, he recalls.

One of the people he met was Prof Don Enarson from The Union, who became his mentor.  “Don really inspired me”, says Tara.  “He taught me to be accountable and that, if you value your work, other people will value it too.”

In 2004, Tara went to Bangkok for graduate study, completing his PhD in 2007. His dissertation was on gender delay in accessing TB treatment – a critical issue in Nepal and elsewhere. What he discovered, though, was a surprise. Gender was not the biggest factor causing people to delay asking for help. It was smoking.

“I found delay in accessing TB treatment was unacceptably longer in smokers – 133 days.  Smoking could mask a TB-related cough and therefore contribute to longer delays Since they were contagious during this whole period, the consequences for TB control are very serious”, says Tara.

This realization completely changed his perspective on smoking. “I saw that tobacco use is not pleasurable.  It’s not a risk factor. It is itself a disease – tobaccosis – and, if you want to cure a TB patient, you have to cure tobaccosis first”. 

Furthermore, the problem is not only smoking, but also the smoke. “Our goal should be to help patients quit smoking and also eliminate passive smoking, second-hand smoke.”

In 2007, Tara applied to work for The Union on the Bloomberg Initiative to Reduce Tobacco Use (BI).  For two years, he was based at The Union South-East Asia Office in New Delhi before moving to Indonesia, home to 61.4 million smokers.

In Indonesia, Tara Singh Bam began as a “Union office of one” (now up to three), but when he counts the members of “his team” they include the Ministry of Health and the Indonesian Public Health Association, to say nothing of the 30 million members of the civil society organisation Muhammidayah – all of whom have joined the fight for tobacco control.

“It was not easy to start a tobacco control campaign there,” says Tara. The stakes were high on both sides with the public health goal to prevent disease and death, and the tobacco industry goal to retain its fifth largest tobacco market.  From the beginning, the industry tried to block the tobacco control advocates at every level from policy to implementation.

In 2008, a BI partners meeting in Indonesia concluded that the focus should be on sub-national efforts.  The cities of Bogor and Palembang were interested in piloting this approach and, by November 2009, they had passed Indonesia’s very first smokefree legislation.

Despite the tobacco industry’s ongoing campaign to defame the project, a Mayors’ Alliance was established and has grown steadily from 12 mayors in January 2011 to more than 90 today. Fifteen cities with a total population of 33 million people are now protected by 100% smokefree legislation; and 75 others are at different stages in developing their own laws. Governors have become interested too.

“This is not an easy decision for them. The tobacco industry has both political and financial power, because they fund campaigns,” says Tara. “Still we fight to maintain the integrity of the protocol, and 19 cities now have no direct relationship with the industry”.

Tara attributes the Indonesia team’s success not only to their commitment, but also to the training provided by The Union’s International Management Development Programme (IMDP). Some 300 government, non-governmental and university staff have been trained since 2007 to develop and manage what he calls “evidence-based” advocacy. 

A critical point came In 2009, when the Parliament revised the country’s Health Law and included a smokefree provision. The tobacco industry lobbied against it and overnight it disappeared, but the Indonesian Tobacco Control Network worked tirelessly to have it reinstated. Lawsuits followed, and the bill was finally signed in 2012. Thus, in the  past five years, Indonesia has achieved significant progress on tobacco control with a national law mandating pictorial health warnings covering 40% of tobacco packages, a smokefree law and  a national civil society movement.

A recent public opinion poll showed strong support for tobacco control, with 91% now in favor of Indonesia ratifying the WHO Framework Convention on Tobacco Control.

“We hope this will happen before the end of the 2013,” says Tara. “It won’t stop the opposition, but they know we are going to win. We are not killing; we are saving lives”.

Tara’s achievements were recognised by New York City Mayor Michael R Bloomberg in 2011, and he is undaunted by the challenges ahead. He is dedicated to preventing tobaccosis from taking more lives not only in Indonesia – but also around the world. 

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