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URUGUAY Eduardo Bianco I am a cardiologist and work in Montevideo (Uruguay, South America). Since I began my medical practice, first as a physician and after as a cardiologist, I have been worried about patients' tobacco consumption. Very soon I realized that quitting was not easy for many smokers, but ,as a non smoker, I didn´t understand why it was so difficult. In 1990 I started to look for ways to help smokers quit. In 1994, I organized a smoking Cessation Program in my private practice. At the beginning, I worked with a psychologist. From June to November 1997, I participated in an international course on "Addictives Substances Consumption- Related Troubles," organized by the Uruguayan University and National Drug Committee. In this course there weren´t any uruguayan people who mentioned smoking as a drug addiction, but invited foreign lecturers did. On that occasion I convinced myself that smoking was an addictive behavior and that Uruguayan health care proffesionals weren´t aware of it. It led me to consider smoking cessation as a drug addiction treatment, and to look for a way of modifying the Uruguayan people's understanding of smoking addiction. In 1997, the Asociación Española Primera de Socorros Mutuos (Spanish Association), a non profit prepaid health care institution that covers 200.000 people in Montevideo, asked me to organize a Smoking Cessation Program. I proposed that they run not only a Cessation Clinic but also an Education Program directed to public and health care workers. In November 1997 I started Smoking Cessation Clinic activities in this Institution, but this time working alone (without any kind of support). We worked in group. At this moment I wasn´t involved in tobacco control activities, and the tobacco control movement was very weak in the country. In February 1998 I was invited by Uruguayan Honorary Cardiovascular Committee to partipate as organizer member of the first Quit and Win perfomed in my country. In April 1998, I was sent by the Spanish Association, to Ottawa, to participate in a "Train the Trainers" course for latinoamerican people organized by Interamerican Heart Foundation, based on the "Guide your patients to a smoke free future" Program, run by Heart and Stroke (Canada). There I met Dr. Beatriz Champagne and Dr. Elinor Wilson who provided me tools and knowledge to apply in my country. At this time I begin my training in Tobacco Control activities. In May 1998 we run Quit and Win, and I consolidated contacts with Uruguayan people interested on tobacco control. In June 1998 we organized, with Dr. Ricardo Bachman, a meeting at Uruguayan Honorary Cardiovascular Committee, where Dr. Beatriz Champagne (Executive Director, Interamerican Heart Foundation) presented "Guide your patients to a smoke free future" and in October 1998, with Dr. B. Champagne (USA), Dr. Andreas Wielgosz (Canada) perfomed a "Train the Trainers" course for first time in Uruguay. In November 1998, we run a Training Course based on "Guide your patients" for health care workers at Spanish Association. In December 1998, I was invited to speak at the Uruguayan Cardiology Congress about "How to manage smoking habit in clinical practice." In February 1999, I participated at 2nd European Conference on Tobacco or Health. This event made me feel that we would need to work harder in Uruguay if we wanted to stop the tobacco epidemic. In June 1999, I participated as speaker at the first worshop on Smoking Cessation organized by Uruguayan Honorary Committee to struggle against Cancer, oriented to health care workers. In October 1999 we perfomed the 2nd. Training Course on Smoking Cessation at Spanish Association. As in Uruguay we haven´t posibilities to receive training as Smoking Cessation Specialist, I decided to complement my knowlegde attending and completing a Training Course on Cognitive-Behaviour Therapy (March 1999 to December 2000) and a course on-line entitled "Nicotine -The Forgotten Addiction" sponsored by The Distance Learning Center for Addiction Studies (Hazelden Organization, USA). In November 1999 a letter I had sent, entitled "A burning issue: Physicians and Smoking" ( claiming on our responsability in this issue as health care professionals) was published, in the Uruguayan Medical Association Bulletin. In March 2000 I personally collected colleagues' signatures to support a letter asking our National Medical Association to create a Tobacco Control Committee. It was approved, I was nominated as chairman, and took over the role in June 2000. In April 2000 I applied to and was awarded with a scholarship for the 11th World Conference on Tobacco or Health. In May 2000 I participated as lecturer in the 2nd workshop on Smoking Cessation perfomed by Uruguayan Honorary Committee to struggle against cancer and as organizer in the 2nd Quit and Win promoted by Uruguayan Honorary Cardiovascular Committee. In August 2000 I have the opportunity to enjoy the Global Scholarship Program Pre-Conference Training in Lisle and the 11th World Conference on Tobacco or Health in Chicago, USA. Both of them were a great experience because I have never been in a World Activist Meeting as I felt the Conference was . It gave me a lot of scientific knowlegde and also a feeling that "I was in the right side" and that there was a lot of people all around the world that was ready to struggle with the tobaccco epidemic and the tobacco transnationals, and that if we work togheter and support WHO activities we can stop them! There I got in touch with Essential Action and I started to participate in the Program "Global Partnership for Tobacco Control", and also I got in touch, for first time, with CLACCTA (Latinoamerican Coordinator Committee for Tobacco Control). After returning home , I was told that my monography: " The Tobacco Epidemic in Uruguay" has been awarded with the Prize: "Ministry of Public Health", one of the Prizes given annually by the National Medical Academic. In December 2000 at the Official Ceremony , in a room plenty of physicians, with Academic Authorities, Uruguayan´s Health Services Director (a smoker) and the Minister of Education (related to tobacco companies), I felt very happy when they had to listen to my speech on Uruguayan´s tobacco epidemic and the social responsibility that physicians, Ministry of Health and Politicians have in this issue. Since December 2000, uruguayan tobacco control advocacies (supported by PAHO/Montevideo) have been working to built a Coalition for Tobacco Control in Uruguay. We have met with Ministry of Health authorities to discuss uruguayan participation in the next Framework Convention Meeting in Geneve. They asked us to elaborate a document to discuss with Dr. Batlle (president of Uruguay). Extraoficcially we were told that the president thought that Uruguayan people weren´t prepared to a publicity prohibition. Next months, there are going to be three events that will define the tobacco control evolution in our country: 1) Framework Convention in Geneve, 2) Mercosur (trade market integrated by Argentine, Brazil, Paraguay and Uruguay) Ministry of Health Meeting , where tobacco consumption is a discussion topic and 3) a National Meeting on Regional Health Priorities In Tobacco Control Committee of National Medical Association we have planned, as strategies to influence on Policy Makers, to perfom the First National Report on Tobacco Consumption Related Diseases (is being prepared) and a National Forum of Discussion on Tobacco Consumption (June 2001) . These strategies were presented to the National Coalition to Tobacco Control ( in development) and they are going to be supported by this coalition and PAHO/Montevideo. Sindicato Medico del Uruguay is partnered with Cancer Prevention Education at Boston University School of Medicine |