When it was confirmed last year that two women who seemingly died from cancer acquired the disease as a direct result of sustained skin bleaching the authorities knew the time had come to do something about the practice, which has reached epidemic proportions.

At the Korle-Bu Teaching Hospital in the Ghanaian capital of Accra doctors proved what had been feared for a long time, that skin bleaching causes skin cancer. What is now known is that continuous stripping away of the melanin in the skin over a number of years leaves it more open to cancers. Whereas traditionally, black people have never been prone to skin cancer, Albinos, whose lack of melanin is responsible for their pale colouring, have been more vulnerable. When the melanin is removed from naturally black skin it becomes similar to that of an Albino and is thus more susceptible to disease.

“The most serious thing we know, which I predicted 26 years ago, is that bleaching can cause death,” says Dr Edmund Delle, a dermatologist and founder of the Rabito Skin Clinics in Ghana. “I was the first dermatologist in the world to associate it and now, after all these years, we’ve discovered cases of cancer due to bleaching because we know that melanin has a protective role in the skin and we’ve realised that black people, because of this protection, hardly have skin cancers.”

Bleaching in some parts of Africa is nothing less than a way of life. Women are known to have strict bleaching regimes where they take anything up to half an hour in the morning and evening smearing powerful soaps and creams from head to toe in an effort to attain their ideal of black beauty.

A quick walk around the Makola Market in Accra and the Central Market in Kumasi reveals that at least eighty per cent of women who trade there bleach. The symptom which most betrays an indulgence in bleaching is that while some women are fair-skinned on their faces, their legs and the rest of their body is black, what’s known as “Fanta Faces, Coca Cola Bodies” because of their kaleidoscopic colour. Some also have rough black and blue patches scarring their faces while most reek of a nauseating smell.

A listen-in to the conversations of women around town reveals just how deep-rooted the colour-complex is. Young women speak with envy of other women being “good-looking” because of their fair colour while a new mother tells a friend that she thanks God that she’s given birth to a light-skinned child. Mothers have even started bleach their young children. The signs of the practice are painfully visible.

Skin bleaching has become a lucrative business. Advertising of bleaching products is extensive. The propaganda campaign to encourage women to part with their hard earned cash is waged effectively through the print media. There are approximately 27 billboards dotted around Accra alone promoting products like “Fair & White” with by-lines boasting, “For the colour you’ve always wanted.”

And Africa has become the dumping ground for the world’s banned products; goods that were prohibited in Europe years ago but are still manufactured in the EU and elsewhere solely for export to Africa. Some companies manufacturing exclusively for the continent produce creams with dangerously high levels of the bleaching agent hydroquinone. It’s even doubted that the regulation 2% hydroquinone limit is 100% safe.

“It’s not safe. I’m against it,” Dr Delle asserts, who’s also a senior member of the African Association for Dermatology. “In fact, we went to conference and there was a lot of disagreement but in my opinion, it’s the length of time of exposure to the sun so it doesn’t matter how tiny the percentage is.”

In the past the tendency to bleach was known mainly to be a routine of prostitutes and women who worked in the sex industry. It’s thought to have originated in the 1960’s when a number of products first became widely available.

Nowadays, however, all kinds of people, including men and children, are engaging in the activity which can prove both time consuming and costly. Professionals – teachers, police officers, doctors, nurses and even politicians, are all doing it.

“I went to an African country and the Head of State bleaches from head to toe and the wife does the same thing. So when I was going to give a lecture on bleaching I was told that I had to change the topic,” Dr Delle recalls.

What’s more disturbing is the fact that people living in rural communities struggling to exist below the poverty line are also bleaching in earnest and are innovating new and dangerous ways to take part in the trend. Because they can’t afford sophisticated creams and soaps they create their own homemade preparations mixing everything from toothpaste, shampoo and milk to household bleach, cement and brake fluid, anything that has a corrosive effect on the skin.

A survey carried out last year revealed that some women in Kumasi have developed a new procedure involving the smearing of hair relaxers all over their bodies and wearing up to three layers of clothing including socks, gloves and long sleeved tops to protect themselves from the sun’s penetrating rays.

The reason for this potentially life-endangering practice is purely aesthetic. The women who bleach do so because they believe men prefer their lighter skinned counterparts. It’s also known that in some African societies lighter skinned people are perceived to be more intelligent than those with a darker hue. In the Ashanti region in the South of Ghana, which recorded the highest number of bleachers, 462 out of 500 people between the ages of 16 and 76 admitted to bleaching with 102 of those being men.

Dr Delle says that he’s had women come to his clinic in Accra from all over the country offering large sums of money to turn their naturally black skins brown. Whereas before, many people were bleaching just their faces and necks, the most visible parts of the body, they’ve now resorted to trying to lighten the whole body. He admits that he’s had patients come to him faking an illness just so that they could be given steroid creams or injections that have the side effect of lightening the skin.

“They accidentally come to you for a disease. They see this [that they’re getting fairer] and then the message goes around and everybody does it. And some of these things I’ve discovered by accident,” Delle insists. “If I give them an injection or I was giving some of them creams and in a week or two they find they’re looking fair they come back for it every time only for you to find, “Oh, when I use the cream I’m fine.” So they continue to use it and they go to the extent of doing this. They inject themselves and they take penicillin tablets, anything.”

The skin bleaching industry is big money. Companies manufacturing soaps, creams and lotions export hundreds of tonnes of the suspect goods to Africa and make thousands of dollars a year despite the fact that both Nigeria and Tanzania have long since banned their importation, Uganda and Kenya are soon to follow and Britain and France prohibit the export of bleaching products to Africa. However, local government agencies whose job it is to regulate the influx of such substances, Customs, The Standards Board and The Food and Drugs Boards, are grossly lacking.

Someone wanting to buy an ordinary body cream or lotion would be hard pressed to find one that doesn’t contain a bleaching agent among the hundreds that do. And those believed to be non-bleaching are not always so. Dr Delle’s research shows that of the 66 beauty products he’s analysed, only 11 have adequate labelling specifying that they contain 2% hydroquinone. The remainder, 4 of which are soaps, have no labelling or content specification at all.

However, some local individuals have begun manufacturing their own brand of skin creams for the home market creating a new “backyard industry.”

Tom Dorkenoo, Editor of The Ghanaian Times, claims those who work at beauticians and have discovered the formula for bleaching products are responsible for the rise in unsophisticated domestic manufacture. He says the reason why many people aren’t deterred from bleaching is because they mistakenly think the advantages outweigh the disadvantages.

“They put the blame on the so-called quality of the bleaching creams because there’s some people who bleach everyday and their skin has become very rough but you still see the lightness there.”

But the health implications are numerous. Kidney disorders, potential miscarriage and increased susceptibility to common skin diseases and allergies are among the many consequences. Tough, rough, scarred skin, the most serious side effect, makes it difficult for operations to be performed should surgery be required since the skin is too damaged to be stitched up once cut.

“I did a study in 1995 with a pharmacologist at the University of Ghana Medical School and he saw that these creams are destroying the internal organs of women and children,” Dorkenoo says. “Last year alone there were about 140 women who died because they went for operations and they could not be sewn up because the melanin on the skin had been destroyed.”

Dorkenoo began his campaigning journalism when a friend of his who had been bleaching died from this very condition. “It was the shock that made me follow up this thing. And I keep on doing it. Every year I write about three editorial comments on skin bleaching.”

However, not everyone appreciates the outing of the bleaching phenomenon. Dorkenoo says he’s received little thanks especially from those who are guilty of engaging in the practice. He says he’s suffered both physical and verbal abuse as a result of his work.

“It’s not a very comfortable thing because when you write these articles some of the ladies when they see you they abuse you. A woman spat on me because she bleached and I told people about this. So it’s not easy because a lot of people in society are doing this.”

Dorkenoo, who’s currently doing a study of the chemical constituents of a range of bleaching products with a friend in Germany, blames Ghana’s older generation for being negative role models for the country’s youth.

“If a child of 11 goes to hospital and sees a nurse sitting before a doctor with skin bleached that tells the child that it’s healthy to do it. If a child leaves the hospital and goes to the classroom and sees the teacher doing it that too tells the child that it’s healthy to do it.”