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obacco farming in Indonesia is mostly a family endeavor. Most farmers cultivate small plots of land; either they own their own land, rent it or are tenants of a large land owner. There are only a few large-scale tobacco plantations and most are owned by the state. Those small farmers cannot afford to hire help, so they involve family members in everything from land tilling, planting, leave picking and drying, to packaging. This explains why child labor is quite common in tobacco farming in Indonesia. The children work before going to school, often very early in the morning when tobacco leaves are still wet with dew, and in late afternoon after school.

Tobacco farming usually involves chemical fertilizer or “de-fertilizer” like MH30, as well as a lot of pesticides as tobacco plants are very vulnerable to many kinds of plant pests. MH30 is used to stop tobacco plants from producing flowers, encouraging it to produce more leaves instead.

But in Indonesia farmers do not often use this fertilizer, choosing to manually check and pluck any budding flowers very early in the morning.

By doing it manually, the laborers have direct contact with the nicotine on the wet tobacco leaves, as well as fertilizer and pesticide residue. Absorption of these toxins into the skin can occur through this activity, especially if the workers do not wear gloves. This can further cause ailments, which have been dubbed “green tobacco sickness”. The symptoms include nausea, vomiting, headache, dizziness, breathing difficulty and other signs of intoxication. The workers’ fingers will look greenish in color, hence the name.

Children are more susceptible to those toxins since the outer layer of their skin is still thin and will easily absorb the toxins, including nicotine. Nicotine intoxication in children will not only affect physical health, but mental or psychological health as well.

A study reported in the Archives of Pediatrics and Adolescent Medicine in December 2010 showed that a higher level of salivary cotinine, a biomarker used to measure secondhand smoke (SHS) exposure, is associated with poorer mental health — particularly hyperactivity and conduct disorder — in children.

In another study reported in Journal of Molecular Psychiatry, chronic nicotine intoxication will cause thinning of the cerebral cortex. The cortex is where important thought processes such as memory, language and perception occur. The damage on this cortex will impair the childrens’ ability to learn, or have learning disability.

A study by the University of Jember in East Java last year revealed that cotinine (metabolite of nicotine in the body) level in tobacco farming workers in Jember is much too high at 16.7 ng/ml — compared to the normal level of below 2ng/ml.

With so many child workers in tobacco farming, added with growing numbers of child smokers — an annual increase of 19 percent as reported in the 2012 Global Youth Tobacco Survey — means that we will have many low quality future human resources, intellectually and physically. There are many indicators that the government just does not care about this.

The first indicator is the Industry Ministry’s 2015 Road Map on cigarette production.

It shows the ministry’s plans to increase cigarette production from 365 billion sticks in 2015 to 525 billion sticks in 2020 to increase excise revenue.

We know very well that those billions of stick of cigarette will not automatically increase the excise revenue if they are not consumed.

As the prevalence of adult smokers in Indonesia is already saturated — as 63 percent of Indonesian adults — the possible increase of smokers can only be recruited from youth and young children.

The second indicator is the reluctance of the government, particularly the Finance Ministry, to increase cigarette excise in its protection of the tobacco industry.

This shows the government prefers to have more smokers to get more excise revenue than curb consumption by increasing prices and tax. And to support those intentions, the government is not willing to stop cigarette advertisements and sponsorship, so our younger generation can be lured into the smoking trap by the tobacco industry. That is the third indicator.

The fourth indicator is the lack of green tobacco sickness knowledge among health professionals, with no awareness of the problem, there is no initiative to carry out epidemiological studies and no proactive action to stop it.

So far the Health Ministry is yet to provide information about green tobacco sickness to their health workers on the ground.

The fifth indicator is the eagerness of parliamentarians to pass a bill that will protect the interests of the tobacco industry in the pretext of protecting tobacco farmers, even if there is already a law that protects all farmers.

So even if the recent study of Human Rights Watch shows a large number of unprotected child workers in tobacco farming and the ever growing number of child smokers, the government shows no interest. So who will help them?

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The writer is a former chairman of the Indonesian Doctors Association (IDI).