Last week we discussed on the non-psychotic effects of smoking, which included the increase in the risk of occurrence of cancer, lung diseases, cardiac and vascular diseases. We also noted that cigarette smoke mainly contains carbon monoxide, tar and nicotine. This time we are going to look at how smoking affects our mental faculties, and how we can be free from its chains.
Of the triad of cigarette smoke constituents, nicotine has both psychological and non-psychotic effects and it is highly addictive. Soon after exposure to it, the body`s first reaction is the “kick” which is caused by the drug`s stimulation of the adrenal glands resulting in the release of adrenaline. In turn, adrenaline increases blood glucose, blood pressure, heart rate and respiration.  Nicotine also supresses the release of insulin – a hormone that facilitates the uptake of sugar from the bloodstream, by the pancreas leading to diabetes-like effects, that is increased blood glucose. This increases the risk of smokers, who are in constant exposure to the drug, to develop diabetes.
The psychotic effects of nicotine occur when the drug stimulates the release of some brain chemicals, dopamine, in the pleasure and motivation areas of the brain. Dopamine affects emotions, movements and sensation of pleasure and pain. An increase in dopamine levels, triggered by the nicotine from cigarette smoke, brings a sense of pleasure and the feeling of contentment. Nicotine can also act as a sedative, which brings a calming and soothing effect. It is also linked to increased alertness, improved memory and concentration; and it reduces anxiety. These are the euphoric effects that excite smokers, what they term as “being high”.  
With the constant exposure to smoke, the body becomes “used” to the presence of nicotine; and would require a higher dose in order to enjoy the same euphoric effects. This is called nicotine tolerance. The desire to “get high” will prompt smokers to increase the number of cigarettes they smoke per day to the extent that they feel like they cannot live without a “pull”. Nicotine is highly addictive and a sudden stop to a regular consumer will result in withdrawal symptoms which may include cravings, a sense of emptiness, anxiety, depression, moodiness, irritability and difficulties in focusing or paying attention.
So, how do you quit? … Quitting smoking is not a single event that happens on one day; rather it is a journey that requires behavioural changes. It comes with a number of positive advantages which include improvement of health, quality and duration of your life and of those around you. Quitting smoking requires you to alter your behaviour so that you cope up with the withdrawal symptoms that come with cutting off nicotine, and also to manage your moods.
1.    Set up a quit date. The decision to quit is the first step of the journey. Setting up a date makes the mission more important and adds the weight of seriousness to the decision. Pick a date that is not too far in the future, but which gives you enough time to prepare. Decide whether you are going to:
•    Quit abruptly, that is you continue smoking right up until your quit date and then stop.
•    Quit gradually, that is you reduce your cigarette intake slowly until your quit date and then stop.
On the quit day, do not smoke at all; stay busy; drink more water and juice; avoid alcohol, avoid individuals who are smoking and avoid situations that urge you to smoke.
2.    Tell your friends, family and co-workers about your decision to quit, and about your quit date. Sharing this with people who care about you is a source of encouragement that will keep you disciplined and focused on your goal. Family and friends will help your on this quest.  If possible, join a stop smoking support group where you will find comrades like you fighting the same enemy. Listen to the stories of people who have successfully quit smoking and draw inspiration from them.
3.    Stopping smoking comes with various withdrawal symptoms that have been mentioned earlier. When the craving comes, use oral substitutes like gum, toothpicks or candy, instead of taking a cigarette. 
4.    Get rid of all the items that are related to your smoking. Throw away your ashtrays, destroy the cigarettes and get rid of the lighters. All these things may trigger the desire to take a pull. Break routines that included smoking as part of your day. At smoke breaks, rather than lighting a cancer stick, drink a glass of juice. This will help your brain to associate the time with juice rather than smoking
To win the rigorous battle of the urge to smoke, make use of the four D`s:
•    Delay until the craving passes. This may seem hard to overcome, but try your best.
•    Deep breathe. Breathing in slowly through your nose and exhaling through your mouth helps you to calm down, giving you an upper hand in fighting the urge.
•    Drink water. Do it slowly, taking small sips at a moment. This will help you beat the craving
•    Do something else. This will distract you and helps your mind to focus at the task at hand, rather than smoking. Make sure that whatever thing you decide as your distraction does not trigger you into smoking.
So, make that bold step and improve your health, and of those close to you. Until next time, remember to make healthy choices.
Zimbabwe Medical Students Association (ZiMSA) is an association of medical students that mainly deals with reducing the incidence of diseases and their control by information dissemination. It encompasses students from the three medical schools in the country that is Midlands State University (MSU), University of Zimbabwe (UZ) and National University of Science and Technology (NUST). 
Taona Tivafire is a Third Year medical student at MSU. You can check out ZiMSA Health Page for more health related topics.health

FGM/C (female gender mutilation/cutting) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It compromises all procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.
The procedure has no health benefits to women or girls, on the contrary it has many consequences. It is a direct violation of human rights- both sexual and reproductive rights. It can be traced back to the pharaonic era in ancient Egypt and also in certain ethnic groups in sub-Saharan Africa.
There are 4 types of FGM/C.
•    Type 1- excision of the clitoris or the prepuce with or without excision of part or all of the clitoris (in Sudan and Arabian countries it represents religious backgrounds and beliefs)
•    Type 2- excision of the clitoris with partial or total excision of the labia minora
•    Type 3- excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation; the colloquial name is pharaonic type)
•    Type 4- includes pricking, piercing or incision of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissues; scraping of the vaginal orifice (anguyrya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding, into the vagina or for the purposes of tightening or narrowing it; and any other procedure that falls under the definition of FGM given above.
The practice is mostly carried out by traditional circumcisers who often play other central roles in communities, such as attending child births. In many settings health care providers perform FGM due to erroneous belief that the procedure is safer when medicalised. Midwives and the elderly in the family may also perform the FGM.
The age FGM is performed depends on the ethnic and geographical distribution. The age is flexible within the communities, either because it is not tied to any particular ceremony, or because people’s belief in its ceremonial significance has died away. The procedure may be carried out on infant girls, during childhood or adolescence, at the time of marriage (preparing for the marriage), at a woman’s first pregnancy, or even whilst in labour (this is a form of fixing the woman and making the vaginal opening as small as it used to be).
Such an extensive procedure involves many complications and risks that are not only medical but psychological too. Severe pain is inflicted due to the operation being performed with crude instruments and without anaesthetic and many women writhe in pain and this can bring injury to the adjacent parts such as the vagina, tissue of urethra, perineum, rectum and some obtain broken limbs from being held down. These complications can also be due to the operator being ignorant in anatomy and physiology of the female external genitalia, has poor eyesight or a careless technique (no prior education in surgery) or just because the operation was done in poor light. Infection is also very common because of an unhygienic non-sterile operating environment which can cause it to fail to heal. Rupture of urethra can result in incontinence. Acute urine retention is another complication and so are keloids scars (shown in picture below), obstructed labour, infertility, shock due to haemorrhage (because of sudden loss of blood) and neurogenic shock due to severe pain and trauma. The women may also experience apareunia (impossibility of sexual intercourse), superficial dyspareunia (pain during intercourse), sexual dysfunction, anorgasmia (lack or orgasms), post-traumatic stress disorder (PTSD), obstructed mensuration, insecurity and trust violation by closest family, relatives and peers.
FGM is such a horrendous act that you are probably asking yourself, why? Why would anyone do that to themselves or to another human being? There are many reasons for this vile act. Some cultures do so as a means of controlling women’s sexuality and to ensure virginity until marriage and fidelity in marriage (women who have had FGM don’t enjoy sex so they won’t have multiple sexual partners). But is this not counter intuitive? Sex is described as one of the basic needs together with water, shelter and food and in essence they are associating it with something not pleasurable. So in short they have turned water into gasoline and are now depriving women of their needs. Some men say that the FGM increases sexual pleasure for them and hence they request for their brides to undergo FGM before they are married. FGM also makes girls more acceptable in certain communities and increases their eligibility for marriage and can also be used as a traditional rite of passage into adulthood (this rite is often surrounded by various myths). FGM is associated with notions of being “feminine,” “modest,” “clean” and/or “beautiful” and these are things many females strive to be as the tradition brings honour to the family. Some types of FGM are done when one is sick to cure them e.g. if one has mass on the vaginal opening such as a cancer or any chronic disease which they have never come across or don’t know how to treat FGM is performed to remove the mass and the women is “cured” from the unknown disease. There is also FGM for the afterlife- it is done on the dead body of the female so that they are considered new again and ready for their next life. It is also believed that an unmodified clitoris leads to masturbation and lesbianism which is unacceptable behaviour.
The real reason is power and control over women and this instils fear. This is why it is mostly concentrated in patriarchal societies where fear is confused for respect. In such patriarchal societies women have little or no say and do not voice their opinions which is a demoralisation of integrity and a robbing of personality. Although it is illegal it is a social norm, a tradition, a culture that’s deeply rooted in the communities and the pressure keeps this mal-practice on going. Women are not at liberty to speak about their sex life and hence whether it is enjoyable or even durable is not a concern. Lack of sexual pleasure is a norm- even the wise elderly women who the women consult have never had such experiences hence the women do not know what they are losing or that they are they are losing anything at all. Women in such communities are also afraid of being alone and divorced if they do not consent to the procedure. There is a stigma of being unclean if the procedure is not done and this serves as a platform for bullying for girls at school hence they would rather have the procedure than endure the bullying. Some women go as far as asking for the procedure again after traumatic child births that may “undo” the procedure.
Hence empowering women and educating them is paramount. The elimination of FGM cannot be done overnight but is instead a painstakingly long process that requires long term commitment and the laying of a strong foundation that will support successful behaviour change. A hands-on approach of working in the community and also embracing the emotional aspects of it is needed- FGM is dressed to be the key to beauty and honour (things which women strive for) and hence by this virtue make the harmful procedure “appealing” to women. Fighting against FGM will require strong and capable anti-FGM programmes at national, regional and local levels. FGM prevention should be integrated into all relevant government programmes and health care workers should be trained to manage the complications of it whilst advocating for the practice to be stopped.  Continuous campaigns are in order because they are convinced the procedure is right and has many benefits. Playing on the physical and traumatic harm towards women and girls is a starting block in eliminating such practices. Education shouldn’t only be targeted at the women but at the men too- maybe if they don’t find it attractive women may not feel pressured into it. The practice is very embedded in the culture and social norms and sadly women do not know their rights.
Remember that FGM is stealing the sexual rights of a woman (women’s genitals are cut off unnecessarily like rags), while male circumcision is for medical reasons. This is why we all need to advocate and raise awareness, to empower women and change the society’s mentality!
Chipo a medical student at the University of Zimbabwe. She is a member of the Zimbabwe Medical Students’ Association (ZiMSA).health