For our Global Societies project, reporters around the world will be writing about societal problems, sustainability and development in Asia, Africa, Latin America and Europe. The series will include features, analyses, photo essays, videos and podcasts looking behind the curtain of globalization. The project is generously funded by the Bill & Melinda Gates Foundation.
Isabel de Santiago is widely disliked. The bishop, the pediatrician, the tourist guide, the head of the orphanage, the moonshiner, the women's rights activist: None of them have kind words for her. Even mothers, fathers and teenagers. Whoever hears her name makes a face and looks over their shoulder to see if anyone is listening. Or they simply spit on the ground.
The name Isabel de Santiago is seen as a threat, the embodiment of an issue that people on the island would prefer not to talk about. But it is one that the scientist and health expert from Lisbon highlighted several weeks ago: a vast, nationwide alcohol problem that even affects minors. "On São Tomé, children drink more alcohol than milk," says de Santiago. They have no access to milk, she adds, or even drinking water in some instances.
For many people living in São Tomé and Príncipe, alcohol is a daily crutch. Some drink because they can't afford the medicine they need, others because they are hungry and still others simply because they have become addicted to drinking. It's a problem born of ignorance, but also of poverty -- and children and adolescents are not excluded. But instead of discussing ways to help or support those suffering from the problem, a conflict has erupted in the country.
The timing isn't auspicious. The island nation has only just managed to work its way into the discussion of the best hidden travel destinations, as one of the world's last, undiscovered paradises. The travel guide company Lonely Planet even included the 1,000-square-kilometer (386-square-mile) country as one of the world's top 10 places to visit in 2019.
Turtles, Tropical Birds and Beaches
The two islands are separated by a 35-minute flight, with Príncipe, where a well-known rum ad was filmed in the 1990s on famed Banana Beach, being the smaller of the two. They are located a few hundred kilometers off the west coast of Africa in the Gulf of Guinea.
It is a beautiful place. Some of the last sea turtles of their kind swim in the ocean, while humpback whales glide past from July to October. There is hardly any traffic, a surfeit of coconuts, tropical birds, sun, white beaches and blue lagoons while the rain forest hides enchanting waterfalls.
And now this. Charter flights to São Tomé and Príncipe have been suspended and cruise ships are no longer welcome in the country's harbors. The coronavirus has brought tourism to a stop, thus temporarily eliminating the economy's primary source of revenue. As of the end of April, there are 11 confirmed cases of COVID-19 on the islands. On top of that, this tropical paradise is apparently facing an alcohol problem.
According to a study published in early April in the scientific journal Acta Médica Portuguesa, based on research conducted by Isabel de Santiago between September 2013 and May 2014 with 2,064 participants on São Tomé and Príncipe, 52 percent of men and 48 percent of women between the ages of 12 and 30 regularly drink alcohol. Furthermore, the alcohol they drink is frequently contaminated with heavy metals, the scientist says, which poses serious health risks, particularly for young children -- including birth defects and premature death.
"I Will Fight"
The research team released their first numbers back in January, before COVID-19 had emerged as a significant threat, and they were received in the country as a serious threat to the nation's image.
The government reacted immediately, accusing de Santiago of seeking to destroy the country's reputation and threatened to sue her. Furthermore, they demanded that she issue a public apology to all of the country's residents and particularly the children. She refused.
Newspapers and television stations in Portugal, which used to hold the two islands as a colony for the slave trade and cocoa plantations, reported on the preliminary statistics and discussed the study, only a few sentences of which had been made public by that point. One of those, however, was the line about alcohol being more widely available than milk -- and it fueled the uprising of hatred against Isabel de Santiago.
"I'm not afraid," she says over the phone. She was born in São Tomé herself in 1971. She says she has even received death threats as a consequence of her study. "I will fight. The lives of many people depend on what is now done to address the problem. There is a life-threatening alcohol problem on the islands that affects everybody. Not just the children, but they have to be protected."
"It's Like a War"
In the capital, also called São Tomé, legions of children dressed in blue-and-green uniforms pour into the streets at the end of the school day -- joking and singing. Some of them throw off their backpacks, undress and jump into the ocean for a swim. They don't look drunk.
"The abuse of alcohol looks different," says de Santiago. "Many mothers, for example, drink during pregnancy and give birth to babies who exhibit withdrawal symptoms. Others give their 6-year-old children strong alcoholic drinks to kill worms in their stomachs. Alcohol is a part of their lives from a very young age and in many instances, it remains so." Potent alcoholic beverages, she says, are omnipresent.
Bishop Manuel dos Santos is well aware of the problem. Still, he insists that "there aren't any children on the streets here with a beer in their hand." Dos Santos, 60, has been responsible for several churches on the main island of São Tomé for 13 years. Around 80 percent of the population is Catholic. The bishop is closely connected to the various parishes and he also supported de Santiago in her work. "I have advised her to avoid coming here for a while," he says. "It's like a war."
Manuel dos Santos lives in a house in the city center and he is one of the few who still has the courage to speak publicly about alcohol consumption in São Tomé. "I only do so because there really is an alcohol problem," he says, adding that he has long discussed the negative effects of alcohol in his sermons. He says he visits many people in their homes and tells them that excessive alcohol consumption is harmful. But he thinks the study should have left out the children. "How does that make us look?" dos Santos asks.
In contrast to the bishop, most residents prefer to completely deny that there is any problem with alcohol at all. And their concerns about the country's image threaten to completely overshadow a public health risk that has thus far been largely ignored.
A Leading Risk Factor
Indeed, there are very few studies about alcohol consumption in Africa. The continent has so many difficult problems to address -- diseases like HIV, tuberculosis and malaria, not to mention hunger and countless armed conflicts -- that deaths caused by alcohol abuse can be forgotten.
Each year, around 3.3 million people die around the world due to excessive alcohol consumption, with many more losing their lives from the indirect consequences. In South Africa, for example, 60 percent of automobile accidents are the result of drunk driving. Alcohol is the ninth leading risk factor in the world for death and such serious health problems as liver cirrhosis. In Africa, it is number five on the list.
The World Health Organization (WHO) believes that "the African region is faced with a growing burden of harmful alcohol consumption and its disastrous effects." The WHO writes that "there is no other consumer product as widely available as alcohol that accounts for as much premature death and disability." And the problems are only getting worse, according to the WHO.
Wine consumption alone has increased in recent years at a pace five times faster than the global average. That is partly because the alcohol industry has identified the continent as an exploitable new market. The more economies in certain countries improve, the more people can afford to regularly buy beer, wine and other alcoholic beverages.
But at least a third of the alcohol consumed in Africa cannot be documented through import and sales numbers. Many people don't have enough money to buy a can of beer in the supermarket. Homemade concoctions, by contrast, tend to be far cheaper and they are widely available.
Anne Backhaus/ DER SPIEGEL
Palm Wine and Cacharamba
For visitors, the alcohol problem in São Tomé and Príncipe isn't apparent at first glance. There are, in fact, no children wandering around with a beer in their hand. But take a closer look and you will see alcohol available on almost every corner -- of the kind that likely would not be approved for sale in Europe.
On hot days, palm wine is the drink of choice, an alcoholic juice made from different palm varieties. It isn't as strong as cacharamba, a brownish, potent sugarcane spirit that shouldn't be consumed in the sun and is widespread in all corners of society.
Grandmothers, with grandchildren strapped to their backs, sell the stuff out of plastic containers on the side of the road. A glass costs just a few cents. In the large market halls in the city center, cacharamba is on offer next to fresh fish, bananas and avocados, with the saleswomen holding it up in old plastic water bottles. It is often enhanced with papaya flowers or ginger "for the stomach." It is also frequently said to "help against hunger," and a piece of kola nut is sometimes served along with it, indeed enough to alleviate hunger for a couple of hours.
Just a few streets away in front of a small grocery, mothers drink cacharamba and locally brewed beer at 10 a.m., their children parked on the bed of a delivery truck. They are joined by fishermen who have been up since 4 a.m. to bring their wares into the city in a timely manner. "We've earned it," they say as they raise their glasses.
The tourist guide would rather not head out on a tour of the countryside on Sunday. "That's when people drink the most and the mood isn't good," he says. In the villages, where simple wooden houses line the only road through town, young men often stumble in front of the car in the afternoons. A hotel owner in one village has been trying for three days to find someone to paint his garage, but he has had to send eight candidates away so far because they were too drunk.
Drinking Against Poverty
Everyone has different reasons for turning to drink, but they have one of them in common: poverty.
"Everyone drinks because everyone wants to be strong," says a 46-year-old man who has been brewing cacharamba every day for the last five years and selling it in the surrounding villages. His distillery consists of two basic wooden structures hidden between sugarcane fields on a hill in the north of the island. "People want to feel good," says Pereira, whose name has been changed for this story. "Those who have money don't drink."
He then laughs and dunks a glass into the bucket at his feet. "Let's drink to that, but be careful!" he says. "Everyone starts with just one. The next day, they want another one, and then another one. And then they just keep drinking." Pereira drinks his sugarcane schnapps quickly, his head thrown back.
Cacharamba is a blessing for him, a reliable source of income that never dries up. Before turning to distilling the spirit, Pereira had never had a job for longer than five years. Indeed, there isn't much work on the islands and the economy is fragile, with two-thirds of the 200,000 residents considered to be suffering from poverty. Half of them live on less than 2 euros ($2.17) per day. People say that cacharamba helps them get through the day, with the spirit replacing at least one meal a day for many.
Those with stomach pains or other maladies drink cacharamba with medicinal herbs, the drink being far more affordable than real medications. Hardly anyone here can afford aspirin, with individual tablets sold for 2 euros each in the pharmacies.
Many mothers who give their children medicinal schnapps are unaware that it can be harmful to their health. On the contrary, it is seen as beneficial. "And children here don't drink milk anyway," says Maria de Cristo, the 60-year-old director of the local Caritas and of a children's home called Casa dos Pequeninos. Because it is imported, she says, it is far too expensive and isn't part of the traditional diet anyway. "The children all drink tea."
But they also drink alcohol -- and apparently more than is good for them. But even if that is the case, people across the country seem to agree, you shouldn't come out and say it. "Isabel de Santiago's claims are an attack on the pride of all mothers and have damaged the country's reputation," says Maria de Cristo.
The island nation is big enough that not everyone knows each other by name. But it's so small that nearly all of its inhabitants feel personally offended by negative media reports. Especially when it comes to the children.
"Pride is unimportant," says de Santiago. She intends to return soon to São Tomé and Príncipe to conduct another study and hopes to be able to cooperate with international aid organizations. "People are dying," she says. "Children and youth will have long-term health problems. How can you simply look the other way?"
This piece is part of the Global Societies series. The project runs for three years and is funded by the Bill & Melinda Gates Foundation.
The Global Societies series involves journalists reporting from Asia, Africa, Latin America and Europe about injustices in a globalized world, societal challenges and sustainable development. The features, analyses, photo essays, videos and podcasts, which originally appeared in DER SPIEGEL’s Foreign Desk section, will also appear in the Global Societies section of SPIEGEL International. The project is initially planned to run for three years and receives financial support from the Bill & Melinda Gates Foundation.
The Bill & Melinda Gates Foundation (BMGF) is funding the project for a period of three years at a total cost of around €2.3 million.
No. The foundation exerts no influence whatsoever on the stories and other elements that appear in the series.
Yes. Large European media outlets like the Guardian and El País have similar sections on their websites -- called "Global Development" and "Planeta Futuro," respectively -- that are likewise funded by the Bill & Melinda Gates Foundation.
In recent years, DER SPIEGEL has complete two projects with the support of the Bill & Melinda Gates Foundation and the European Journalism Centre (EJC): "Expedition BeyondTomorrow," about global sustainability goals, and the journalist refugee project "The New Arrivals," which resulted in several award-winning multimedia features on the issues of migrants and refugees.