10 Successful Minutes in the Chairman’s Office

Armed with the collection of our community’s stories about the impact of alcohol, we sat outside the office of Gulu’s District Chairperson. We waited amongst a mixed assortment of people: three Ugandan men in fancy suits, an Indian man clutching some business cards, a woman in a frayed skirt and bare feet.

How would he respond? Would say, “oh that’s a nice idea,” then do nothing? Would he say “we need to be careful to protect commercial interests”? When after a lengthy wait, we finally entered. I’d come with Josephine and Opiyo from our group. They looked nervous.

Community stories about alcohol harm

We collected these stories from our neighborhood. This is how alcohol is impacting our community.”

He started flicking through the stories.

We believe there needs to be a complete ban on sachet alcohol. And restriction on alcohol drinking hours,” we added, quickly.

Josephine shared her own story about the son she had lost to liver disease.

To our surprise, the chairperson looked right at us and said:

We would love to do this…but,” he paused…

It will need a lot of work. It’s a big process, developing an ordinance. We need to start with a report.”

He made a call. A few minutes later, his technical advisor appeared. Mike, it turned out, already had a fat folder on his laptop desktop entitled ‘alcohol policy international lessons.’ Talk about low hanging fruit. We’d turned up when Gulu District was already thinking about introducing alcohol regulations.

Our research report

Over the following month, I got to know Mike well. We shared our research and discussed our approach to the report. We needed three major sections:

  1. The impact of alcohol (particularly) in Northern Uganda,
  2. The national policy context, and
  3. International policy lessons for Gulu.

For the following month, I hibernated to work on the report with Mike. Here are just a few things from our research I found surprising, devastating or fascinating:

  • Check your facts, WHO.
    In 2004 World Health Organization (WHO) shocked the world by reporting that Uganda has the highest consumption rate in the world at 19.47 liters per capita. However, this figure turned out to be completely wrong – in 2014, the WHO revised the estimate to 9.9 liters per capita in 2003-2005. How could they be so wrong? Short answer, it’s actually remarkably difficult to estimate alcohol consumption, especially in nations like Uganda where so much alcohol is brewed locally and goes under the radar.
    Make no mistake, 9.9 liters per capita consumption of pure alcohol per year is still very high, especially considering that Uganda is a country with a big population of abstainers.
  • The North tops alcohol consumption in Uganda.
    A 2005 study (yes, another WHO study) found that Northern Ugandans are twice as likely to be “heavy drinkers” than Ugandans living in central regions. Northern Uganda suffered 20 years of war and displacement of people into Internally Displaced People (IDP) camps during conflict between the Lord’s Resistance Army and Museveni’s government forces. Insecurity, loss and social pain are ripe conditions for excessive alcohol use.
  • Compounding factors create conditions for high rates of liver cirrhosis in Northern Uganda.
    Studies have revealed very high death rates in Uganda caused by liver cirrhosis primarily due to drinking alcohol (see report). Heartbreakingly, there are two confounding factors that are likely to make rates of liver cirrhosis in northern Uganda even worse.

    • Hepatitis B.
      In northern Uganda there is a 20% prevalence of hepatitis B virus, which is actually the highest prevalence rate in the world. When heavy alcohol use is combined with hepatitis B, the likelihood of liver disease greatly increases.
    • High aflatoxin intake from moldy peanuts.
      Aflatoxins are a toxic compound produced by certain molds in food like cassava, peanuts, and maize. In northern Uganda, such foods are often not stored properly, which can result in aflatoxins. While there is only little research available, aflatoxins have been associated with increased risk of liver cirrhosis. One study showed that people with a high alcohol intake AND a high aflatoxin intake are 9 times more likely to develop liver cancer than those with only a high alcohol intake.
  • The economic costs to wider society are staggering.
    Because no quantitative research on the economic impact of alcohol on society as a whole had been conducted in Uganda, I looked at the evidence from around the world. I was blown away. Again and again, the research showed that the costs of alcohol outweigh the economic gains from the alcohol trade.
    One Government study in the State of Minnesota in the United States, for example, showed that the cost of alcohol consumption was 17 times greater than the US$296 million of tax revenue gained from alcohol sales. There are the ‘direct costs’ like alcohol-related health care, alcohol-related crime and law enforcement, and the ‘indirect costs’ like loss of productivity of citizens due to absenteeism from work or incarceration.

In Gulu, I did a small audit on a large hospital (‘St Mary’s Lacor’) to try reveal just a little of the financial burden of alcohol harm on Gulu’s over-stretched health care system. I found that in just the two wards I surveyed patient records, it costs the hospital about US$5000 per month.

That’s actually a lot of money for a hospital in a struggling developing country. Due to poor record keeping, I couldn’t look at other wards like casualty where you would expect even higher burden due to alcohol (I’m thinking road traffic accidents involving alcohol.)

I think the results of a full-blown study of the economic costs of alcohol to society in Northern Uganda would be staggering, and devastating.

For further reading

The full final report: “Towards an Alcohol Ordinance”, Report of Gulu District Council April 2015, Key Authors: Tessa Laing and Dr. Nicolas Laing With Support and research assistance from: Gulu District Wakonye Kenwa Community Group, The Diocese of Northern Uganda

 

 

Blog Series by Tessa Laing on the trials and tribulations of alcohol control efforts in Gulu District in Northern Uganda : 

First blog post: “He Sells His Land To Drink”

Uganda. Gulu Town. One community. Many, many stories of alcohol harm – and an initiative to bring transformative change. This blog is the beginning of a series exploring how community resolves to tackle alcohol problems and the challenges they face in doing so…

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