K M Venkat Narayan: Smoking Jordanian doctors

venkat narayan During a recent trip to Jordan a waiter at the international chain hotel I was staying at seated me at a table in the midst of several smokers. When I asked for a “no smoking” table he took me to another, still surrounded by smokers, and replaced the ashtray with a no smoking sign.  I could barely breathe and eat my sandwich to my room. 

The next morning I chaired a session on public health aspects of cardio-metabolic diseases at a conference held at the University of Jordan.  There were some excellent presentations on the huge and growing burden of cardiovascular disease, type 2 diabetes, and obesity in Jordan, and in the region.

But what was most striking was a piece of data that Feras Hawari, Director, Cancer Control Office at the King Hussein Cancer Center, shared. In Jordan, 84% of male nurses and 95% of male physicians smoke. (Shishani et al, In Press).

Apparently, the mean life expectancy for male physicians in Jordan is several years lower that the average for the population. (Personal communication, Dr Hawari). The tobacco smoking culture was evident all over the place: male medical students smoking anywhere on campus, female medical students smoking in toilets – despite the presence of “no smoking” signs.

Yet they all knew about the risks associated with smoking, and about the major causes of cardiovascular disease.  What was especially ironic was that a very large number of bright young medical students wanted to pursue careers in cardiology or cardiothoracic surgery, and had great dreams of treating and “curing” heart diseases.

During a trip to the Dead Sea that afternoon I asked the three male medical students (Bilal, Khaleel, and Saied), who so kindly accompanied me, why so many physicians and medical students smoked. Their was simple – “it is fashion and style!”

It is time for Jordan to change that “fashion and style” and to take tobacco control seriously.  Dr Hawari spoke passionately about the need to implement anti-tobacco policies, and the senior leadership at the university was also very supportive.  A public commitment was made at the conference to fight tobacco as a leading priority.

On the way back from the Dead Sea, the three medical students decided to do a small epidemiological survey, and to start focusing on research and public health. They added that they need help and wanted a collaboration between University of Jordan and Emory University.

That gave me hope for the future. Even more positive was the fact that Omar Lattouf, a Jordanian-American cardiothoracic surgeon, openly expressed his feeling that it was far more important for physicians to be preventing disease than trying to do heroic deeds after allowing the disease to advance.

Dr Lattouf was one of the driving forces behind the public health focus at the conference, and he was also the reason why I was invited to the meeting.

K M Venkat Narayan is Ruth and O.C. Hubert Professor of Global Health and professor of epidemiology and medicine at Emory University, Atlanta. He is a product of three continents, having lived and worked in India, United Arab Emirates, the United Kingdom, and the United States of America.