Smoke and dumplings
After the fall of the Soviet Union, state-owned tobacco companies in the former Eastern block fell by the wayside as multinational tobacco companies took over and instituted Marlboro-style marketing campaigns. Many of these countries have some of the highest smoking rates in the world. One counter-influence is the Framework Convention on Tobacco Control, a legally-binding international treaty designed to limit smoking by regulating marketing, increasing taxes and other measures (see our editorial ). Georgia was the 124th country to ratify the treaty. Suzaynn Schick, a friend of mine and a postdoctoral fellow at the University of California, San Francisco, traveled to Georgia this February and got a first hand look at the country’s efforts to enforce the new regulations. I asked Suzaynn to tell us about her trip. She paints a picture of a country with bad air but great food.
One quiet afternoon in late January I answered the phone, heard the raspy, nasal voice of my ex-boss Stan Glantz and tensed up. Working with Stan, a high-profile tobacco researcher at the University of California, San Francisco, had been exciting and very good for my career—but it had also featured some experiences common to demonic possession.
11 months after leaving his group I was almost done with our last paper and enjoying my autonomy in a new job. Stan, who was on the phone with Tom Novotny, fellow UCSF researcher and former US Assistant Surgeon General, said " We have a project you might be interested in." Tom asked me if I'd like to go to Tbilisi, Georgia to assist local public-health scientists in monitoring Georgia’s compliance with their new ban on smoking in health care facilities. I immediately said yes.
My task was to deliver 50 passive nicotine monitors to scientists at the Institute for Public Health, a Georgian Nongovernmental Organization. The monitors are small cassettes of filter paper, impregnated with a compound that binds nicotine present in the air. We spent Tuesday chatting up directors and doctors and being stared at by patients as we climbed on top of chairs, desks, gurneys and ladders, hanging the monitors in nine hospitals and clinics in Tiblisi and the vicinity.
Ultimately, I visited seven of the nine facilities—all gray, concrete block Soviet style. Two had been upgraded but five were broken down—-with cold dark corridors, shattered light fixtures, and water damage.
Despite the grim surroundings, the doctors and nurses seemed engaged, caring and confident—and they worked in a haze of smoke. People smoked cigarettes everywhere and no one seemed to think anything about it.
We visited a cardiology facility where people smoked in the stairwells just across from critical care wards. Patients and visitors smoked in the hallways as they waited in the clinics. The doctors smoked. In terms of prevalence, Georgia is probably worse off than United States was in the 1950s: more than 40% of men smoke and the percentage of women who smoke is rising rapidly.
However, there is hope. For instance, the director of one the new facilities I visited actually enforced the federal smoking ban. My Georgian colleagues will use the data we collected to pressure the federal and local governments to start enforcing the ban on smoking in health care facilities.
By Wednesday I had time to relax. The monitors were in place, my luggage finally arrived, my jet lag was beginning to relent and I started to enjoy the visit. Georgia was beautiful when I saw it in cold, gray February. I can only imagine how it looks in spring when the fruit trees blossom and the grapevines leaf out.
My hosts were incredibly kind and solicitous: I never ate lunch or dinner alone and suspect that I was taken to the very best restaurants in Tbilisi. I had some truly amazing food. Georgian food reminded me of Yugoslavian food, Persian food, Indian food and even Chinese food. Traditional Georgian bread is baked in an oven like an Indian tandoor, but it’s heftier, with a stout European crust. The stews were like Persian stews: tart with sour plums or pomegranate and full of green herbs. Kinkhali dumplings reminded me of succulent Shanghai soup dumplings, but the seasoning was herbal, an ineffable combination of celery, coriander, dill, garlic and pepper.
On the last two days I carried my aerosol particle monitor with me everywhere. The outdoor air pollution level in downtown Tbilisi was about four times higher than in downtown San Francisco. Indoors it was much worse. The man who owned my hotel was a chain smoker, so at breakfast I imbibed more than 600 ug/m3 particulates (40 times the EPA limit for continuous exposure) along with my coffee, yoghurt and wildflower honey.
One night we went to a restaurant/nightclub. The later it got, the smokier the air became. We lingered until the monitor showed over 3,000 ug/m3. To be honest, I'm not sure it was any worse in that nightclub than in the smoky bars I used to frequent in San Francisco. It's been almost 10 years since Californian bars went smoke-free though, and I've become accustomed to it. I loved visiting Georgia, but I was glad to get home to clean air.
