ATITUDE UJA TABAKU ESTRATEGIA PREVENSAUN IHA TIMOR LESTE Many Hands International, 10 July 2015

Ezbosa/Outline Aprezentasaun Profile Organizasaun MHI Projetu Advokasia Kontrolu Tabaku Konkluzaun Peskija Prevene Uja Tabaku Prevalensia Uja Tabaku Iha Timor Leste Dalan ba prevensaun

Profile Organizasaun MHI Many Hands International (MHI) (www.manyhands.org.au) Organizasaun husi Australia nebe registradu ona nuudar Organizasaun Non-Govermantais MHI promove Kultura liu husi projetu komunidade, trainamento profisional, nomos advokasaun publiku Parseria ho komunidade hodi promove dezemvolvimentu kultura. Projetu dahuluk liu mak harii sentru kultura no arte kontemporeneu iha Lospalos -Timor Leste.

2. Projetu Advokasia Kontrolu Tabaku Parseria Iha inisiu tinan 2014 Many Hands International parseria ho Universidade Deakin Australia hodi dezemvolve Projetu Peskija Prevene Uja Tabaku Objetivu Projetu ne’e prepara data-base no konsulta organizasaun relevante no pesoal sira kona ba dalan prevene uja tabaku. Bolu atensaun ba prevalensia uja tabaku iha Timor Leste Implementasaun projetu ida ne’e halo parseria ho matenek na’in husi parseiru lokal sira, nasional, nomos parseiru internasional

Many Hands Organigram Directors 1. Dr Kim Dunphy 2. Holy Schauble Country Manager & Project Supervisor Lucia Pichler Mentor Early Child Education program Officer Cultural Heritage Preservation & Development Youth Creative Art Development Health Promotion & Tobacco Control Advocacy Woman Empowerment & Physical wellness development Finance & Adminstration Advisors & Members

3. Konkluzaun Peskija Prevene Uja Tabaku INTRODUSAUN Globalmente Epidemia tabacco hamate ema besik miliaun 6 kada tinan Mortalidade >600 000/tinan husi ema fumador pasivu. Bainhira la foti asaun ruma, epidemia bele hamate ema liu husi miliaun 8 iha tinan 2030. >80% husi menus halo prevensaun ba mortalidade mak ema ne’ebe moris iha nasaun sira nebe rendementu kiik inklui mos Timor Leste Industria tabaku iha maneira oi-oin hodi dada konsumedor foun sira hodi nune’e bele mantein no hasa’e faan tabaku no hetan lukru.

Expozisaun ba fuma passivu iha uma entre labarik foin sa’e sira ho idade 13-15

Fator Risku ba Moras La Hadaet Condition Cardiovascular diseases Diabetes Cancer Respiratory Conditions Uja Tabaku/Fuma √ Alkohol Menus han ai fuan & modo tahan Konsume masin barak Menus aktividase fizika Obesity Tensaun ran sae Masmidar barak iha ran Lipido ran la normal

Kauza mate tamba Moras Hadaet no Moras La Hadaet iha Timor Leste GBD PROFILE: TIMOR-LESTE

* La inklui mate fetal intrauterina Mortalidade no Morbilidade tanba MLH iha Hospital Timor Leste (Jan-Dez 2012) Fonte: Relatóriu Anual Estatistika Saúde Kategoria Moras   Admisaun/Baixa Mate Númeru % Moras La hada’et 17193 49.9 272 22.2 Moras Kardiovaskular inklui Stroke 1307 3.8 147 12.0 Diabetes Melitus 115 0.3 16 1.3 Moras Respiratória Krónika 531 1.5 29 2.4 Moras Hepátika no Renál 608 1.8 73 6.0 Moras Nutrisionál 563 1.6 21 1.7 Moras Mental no neurolójiku 183 0.5 0.0 Kanek 1416 4.1 39 3.2 Kauza moras la-definidu ka La-espesífiku 12504 36.3 626 51.2 TOTAL 34420 100.0 1223* * La inklui mate fetal intrauterina

B. Dalan ba Prevene Uja Tabaku

Resultadu Survey MHI Metode Delphi Study Technique Treinu iha Deakin University Australia hodi devemvolve abilidade peskija. Dezemvolve no Analiza Questionariu iha lian Tetum no Inglesh no aprejenta ba supervisor iha Deakin University Identifika Lista Sample Liu husi Belun org. data base no Departementu Administrasaun Distritu Lautem Revizaun Literatura Sistematika Intervista Pessoal no Grupu Diskusaun Analiza Data

Survey iha Municipiu Lautem Lista ema nain 50 nebe nuudar opiniaun lider no kaer papel lideransa iha Distritu Lautem no iha nivel Nasional hodi kompleta questionariu, liu husi intervista ho Offisial Promosaun Saude MHI. Data halao survey husi 8 July 2014 too 29 Agusto 2005

Sampel Baboot I. Karakteristika Organizasaun Opsaun Respondente N % Lideransa Komunidade Suco 12 24% NGO 7 14% Departmento Edukasaun Governo Distritu 5 10% Ofisial Saude Lokal Organizasaun Sosiedade Civil 4 8% Governo Nasional 3 6% Universidade 1 2% Seluk* 6 12% Total 50 100% * Refere ba profesores da escolas, estudantes, no Lider Relijaun

II. Nivel Edukasaun Response Options N % Masters, PhD or Equivalent 2 4% Bachelor, Diploma or Equivalent 23 46% Secondary School Completion 17 34% Up to 11 Years Secondary School Below 10 Years Secondary School 6 12% Total 50 100%

III. Status servisu partisipantes Opsaun Respondentes N % Servisu Full Time 42 84% Servisu Part Time 5 10% Servisu iha Kapasidae Voluntariu 3 6% Total 50 100%

Prevene uja tabaku sai isu proridade

Importansia halao Program prevensaun utiliza tabaku

Aksaun nebe bele foti hodi hatan ba prioridade nee

Opsaun no Potensia nebe iha hodi halao prevensaun

Kapasidade nebe persija hodi kontrola Tabaku

Konklusaun Problema tabaku sai ona isu global nebe seriu no dezafiu ba dezemvolvimentu iha Timor Leste Prevalensia uja tabaku iha Timor Leste fo alarma 70% tuir dadus GYTS 2013 Tabaku kontribui ba risku MLH nebe oho ema Timor Leste Fasil atu prevene, maibe difisil atu kura Governu iha komitmentu maibe falta iha instrumentu legal (Legislasaun)

ATITUDE UJA TABAKU ESTRATEGIA PREVENSAUN IHA TIMOR LESTE Many Hands International, 10 July 2015

Obrigado

Objetivos Atu Komprende baze legal no prevalensia Global no Nasional ba Tabaku Atu komprende Efeitus husi Tabaku ba Saude Atu Koñese Bareiras no Dezafius atu kontrolu Tabaku iha Timor Leste Atu Kompriende Estrategia kombate Tabaku iha Timor Leste

Baze Legal Decreto Lei No 9 / 2006: Avisos de Saúde e Controlo Fiscal do Tabaco Manufacturados Timor Leste asina ona Plataforma Konvensaun ba Kontrolu Tabaku iha loron 25 Maio 2004 (FCTC) no ratifika ona iha loron 22 Dezembru 2004 Lejislasaun Tabaco Komprensivo Draf ona no sei submete ba konsellu ministro iha tempo badak . Rejime publisidade ba Tabaku no alkohol 2011 Planu estrategiku ba kontrolu Moras la Hada’et 2014-2018

DNSP DSCD D. CDNC U.Idosos, Moras Cronica no Disabilidade U.Saude Matan U. Saude Mental U.Saude Oral U. Prevensaun Injuria, Controlo Tabaco no Alcohol DPHO NCDC 13 DISTRITOS

INTRODUSAUN Globalmente Epidemia tabacco hamate ema besik miliaun 6 kada tinan Mortalidade >600 000/tinan husi ema fumador pasivu. Bainhira ita la foti asaun ruma, epidemia bele hamate ema liu husi miliaun 8 kada tinan iha 2030. >80% husi menus halo prevensaun ba mortalidade mak ema ne’ebe moris iha nasaun sira nebe rendementu kiik inklui mos Timor leste Industria tabaku iha maneira oi-oin hodi dada konsumedor foun sira hodi nune’e bele mantein no hasa’e fan tabaku no hetan lukru.

Non-Communicable Diseases (NCDs): 36 million deaths (63% of global mortality) 10 M 20 M 30 M 40 M; 50 M 60 M 28% 16% 47% 9% Globally, 58 million people died in 2005. 35 million of these deaths were a result of chronic diseases. This means that 60% of all deaths in 2005 were due to chronic diseases. 2008 estimates Communicable, maternal, perinatal and nutritional conditions NCDs < 60 NCDs > 60 Injuries

Low and middle income countries are the most affected Low-income Countries Lower- Middle-income Countries Upper- Middle-income Countries High-income Countries Communicable, conditions NCDs < 60 NCDs > 60 Injuries

The problem has a serious impact! NCDs Have major adverse effects on the quality of life of affected individuals; Cause premature deaths: 44% of NCD deaths occur at age <70 years Create large adverse economic effects on families, communities and societies in general. It is a misunderstanding that chronic diseases would mainly affect high income countries The reality is that four out of five chronic disease deaths are in low and middle income countries Looking at the graph you can see that only for the lowest income countries, communicable diseases are a bigger problem than chronic diseases. And even there almost 40% of people die from chronic diseases For all the other countries, chronic diseases is the main cause of death.

Prevention is possible Largest part of main NCDs can be prevented if risk factors are eliminated 20% 20% 20% 60% 40% 80% 80% 80% The largest part of the main chronic diseases can be prevented! 80% of type 2 diabetes for example, can be prevented. (source WHO Chronic disease report from 2005) Heart disease Stroke Type 2 diabetes Cancer preventable not preventable

Substansia hirak ne’ebé maka perigu

Social determinants of health Causal links NCDs Raised blood glucose Overweight/obesity Raised lipids Raised BP Harmful use of alcohol Physical inactivity Unhealthy diet Tobacco use Social determinants of health Population ageing Urbanization Globalization Metabolic Risk Behavioral risk factors

Mekanismu oinsa tabaku aumenta risku ? Radical livre—kauza oxidasaun ba plasma LDL Aumenta LDL Adesaun ba monosytos ba arteria/veias aumenta ateroesklerosis

Risk Factors Common to Major NCD Conditions Cardiovascular diseases Diabetes Cancer Respiratory Conditions Tobacco use √ Alcohol Low fruit & vegetable High dietary salt Physical Inactivity Obesity Raised blood pressure Raised blood glucose Abnormal blood lipids

Expozisaun ba fuma passivu iha uma maka entre labarik foin sa’e sira ho idade 13-15

Prevalencia konsumo Tabaco no fator risku seluk iha Timor-Leste Timor Leste seidauk iha Informasaun seluk kona ba Tabaku iha tinan ida ne’e

* La inklui mate fetal intrauterina Mortalidade no Morbilidade tanba MLH iha ospital Timor Leste (Jan-Dez 2012) Fonte: Relatóriu Anual Estatistika Saúde Kategoria Moras   Admisaun/Baixa Mate Númeru % Moras La hada’et 17193 49.9 272 22.2 Moras Kardiovaskular inklui Stroke 1307 3.8 147 12.0 Diabetes Melitus 115 0.3 16 1.3 Moras Respiratória Krónika 531 1.5 29 2.4 Moras Hepátika no Renál 608 1.8 73 6.0 Moras Nutrisionál 563 1.6 21 1.7 Moras Mental no neurolójiku 183 0.5 0.0 Kanek 1416 4.1 39 3.2 Kauza moras la-definidu ka La-espesífiku 12504 36.3 626 51.2 TOTAL 34420 100.0 1223* * La inklui mate fetal intrauterina

The UN High-level Meeting Konaba Moras Lahadaet NCDs (New York, 19-20 September 2011) Badala rua isu saude diskuti husi Estadus Unidus Asembleia Geral (UN GA) Atende husi Ulun Boot nasaun 113 Chefe Nasaun ka representativu Hamosu: Declarasaun Politika As many of you are aware, last year in September, there was a high-level meeting of the UN General Assembly to discuss NCDs. It was only the second time in history that UN GA discussed a health issue, the first time being a decade earlier to discuss HIV/AIDS. The UN HLM on NCDs was a landmark event attended by heads of states and other high level delegates from113 Member States The outcome of the UNHLM was the Political declaration which lists many follow-up actions for MS, WHO and partners 43

Moras La Hadaet iha Timor-Leste Moras oin rua mak mosu– Moras Hadaet komesa tun neneik no Moras La Hadaet komesa sae neneik 30% husi pasient moras baixa iha hospital no mate tamba moras sira Lahadaet Numeru arkivu Hospital hatudu katak moras lahadaet aumenta no pasiente nia tinan menus ba bebeik. Afeita ba profuktividade ekonomia durante periodu moris. Pasiente nebe refere ba nasun seluk hatudu gastu makas iha orsamentu Saude.

Prevensaun & controla Moras Lahadaet (NCD): Framework Simples Hahalok sira nebe bele muda: Tobacco La halo actividade Physico Dieta nebe la saudavel (masin, bokur & midar, afuan/modo) Patho-physiological Fator Risku Tensaun As Kolesterol As Diabetes Bokur liu Atakasaun moras Fuan Stroke Diabetes Cancers Moras Kroniku Respiratoria Strategia ba Populasaun: Envairomentu Regulamentu/Lei Edukasaun Strategia ba Risk-As: Screening no tratamentu ba ema risku Kustu efektivu tx ba kasu mora la hadaet akut + Surveillance Matadalan & halao evaluasaun ba intervensaun Prevensaun Primaria (Hamenus incidensia kasu-kasu foun)

Concentración media por pitillo Komponentes husi Sigaru suar Componente Concentración media por pitillo Alquitrán 1-40 mg Nicotina 1-2.5 mg Fenol 20-150 mg Catecol 130-280 mg Pireno 50-200 mg Benzo (a) pireno 20-40 mg 2.4 Dimetilfenol 49 mg m- y p-Cresol 20 mg p-Etilfenol 18 mg Sigmasterol 53 mg Fitosteroles (toal) 130 mg Seluk tan

Relasaun Tabaco ho Saúde Sigaru suar nia kontenidu iha sustancia >4000 substancias quimicas :Nicotina, no > 60 Cansirigenos (Provoca Kankru) Substancia hanesan monóxido de carbono, alquitrán, arsénico no plomo toxiku ba ita nia isin . Nicotina hanesan Droga Psikoativa ne’ebe provoka Toleransia no Dependensia (Ketagihan) Hanesan substancia Hidrosoluble ne’ebe absorbe direitamente husi ita nia ibun no vias respiratorias, ran, Aten, Bazo no kakutak Sigaru nia suar iha Monoxido de Carbono provoca disfunsaun endotelial Generalizada no provoca ateroesclerosis (Sulan uat) Efeitus Cigarus aumenta Estimulos Nervoso simpatiku, Libera Adrenalina halo oat sai klot no Aumenta Tensaun Arterial

Efeitus husi Tabacco ba Saúde Fuma no Hasae Risku ba Saude Moras coronaria (fuan) dala 2 to’o dala 4 Stroke dala 2 to’o dala 4, Mane dezenvolve kankru aten bo’ok to’o dala 23 Desenvolvementu kankru ba Feto to’o dala 13 Hamosu moras respirasaun Kroniku(hanesan Bronquitis Kronika, Enfisema, Asma) dala 12 to’o dala 13.

Moras Kankru Kanker iha ibun “Cancer of the oral cavity (mouth)” Kanker iha Aten Book (Lung cancer) Kankru iha ran (Acute myeloid leukemia) Kanker Mamik (Bladder cancer) Kanker iha Servikal (Cancer of the cervix) Kanker iha Esofagus (Cancer of the esophagus) Kanker iha Rins (Kidney cancer) Kanker iha Laringe “Cancer of the larynx (voice box)” Kanker iha Pharinx “Cancer of the pharynx (throat)” Kanker iha Pankreas (Pancreatic cancer) Kaker iha kabun (Stomach cancer)

Types of Cancers Cancer is known by many different names. Carcinomas (cells that cover internal and external body surfaces) Leukemia (Blood Cells) Lung Lymphomas (Lymph nodes &tissues) Breast Colon Bladder Sarcomas Cells in supportive tissues – bones & muscles Prostate (Men)

Efeitu Seluk husi Tabaku La iha fertilidade (Laiha oan) Partus antes (preterm delivery), Moris mate (stillbirth), Bebe moris ho todan menus (low birth weight), no Sinais mate derepente ba bebe depois partus “sudden infant death syndrome (SIDS)”. Malformasaun konjenita

Moras vaskular no moras seluk Fuma provoka gangrena Fuma taka arteria no kauza ataka kardiaku no estrok. Avizu: fuma kauza moras hirak ba ibun Fuma kauza matan delek Kankru Avizu: Fuma kauza 92% husi kankru oral hirak.

Risku maka’as ba ataka kurasaun BA DALA RUA BELE MATE

Feto sira Fuma bele aumenta liútan oportunidade ba abortu

Maski horon fuma uitoan ida mos perigu Laíha nível seguru ba expozisaun ba Fumu Pasivu Fumu Passivu maka kauza boot ida ba moras fuan, estrok, moras respirasaun, kankru pulmaun, no selu- seluk tan. Maski so expozisaun 30 minutu de’it ba fuma passivu, produz reasaun fiziku hirak ne’ebé hanesan ne’ebé sei mosu husi fuma ba longu prazu, no aumenta risku ba moras fuan ba ema sira ne’ebé la fuma. Aumentu ida iha risku ba kankru pulmaun ba ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba fumu passivu iha 20% iha feto no 30% iha mane sira. Ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba Fumu Passivu iha serbisu fatin iha aumentu husi 16 to’o 19% iha risku husi dezenvolve kankru. Rizku husi hetan kankru pulmaun aumenta depende ba nível expozisaun.

Lakuna Manufacturas manan profit husi konsumu produtos halo straga ba saúde Media mos halao publisidade ba productos ne’ebe halo straga ba saúde Governo generaliza reseita husi faan produtos ne’ebe halo straga saude Konsumedores gosta uza productos ne’ebe halo straga saúde Tradisaun/ Situasaun Sociocultural iha Timor Leste fo dalan ba ema atu kontinua konsumo Tabaco Behaviour modification approaches require changes in social policies, which pose several difficulties. Government generates revenue from industrial production and sale of health damaging products such as alcohol, tobacco, and processed food; media benefits from advertisements of these products; producers of these products profit from their consumption; and consumers enjoy using them. Therefore, any attempt to restrict the production, distribution, and advertisement of these products is foiled by these companies by lobbying. Their argument is that government should educate people for not consuming these products, and let market be regulated by the consumers rather by the government. In reality, government budgets for education never matches with budgets which companies employ for advertisements. However, innovative approaches of public health advocacy keeping in mind the local socio-economic and cultural context can overcome these barriers.

Dezafios ba Saúde Pública Merkado livre/Globalizasaun Moris Moderna ( Stilos Moris la saúdavel ) Sosiokultura ( Tradisaun moris rai nian ) Asesu Tabaco ne’ebe libre tebes ba populasaun ho idade hotu-hotu. There are three key public health challenges that the governments have to face to effectively to cope with rising burden of NCDs: Firstly, Macro-economic policies in agriculture, industry, energy and housing can affect living conditions leading to chronic diseases which need long-term and often expensive care. Secondly, globalization and trade liberalization process will influence the development policies of nations, some of which will affect health. Thirdly, inequity is likely to increase as the care of NCDs is long-term and expensive. The poor are less likely to get early screening even when effective preventive treatments are available. They are more likely to seek care at late stage only when symptoms occur mainly from organ involvement or organ failure. The poorer population who need more care would not be able to access it due to high costs, thereby continuing the inequity. Fourthly, as a result of modern living, chronic diseases will kill and disable both the rich and the poor. Obesity a consequence of physical inactivity results from mechanization which can pervade all sections of the society. Addictions to nicotine, alcohol and other drugs are common lifestyles among both poor and rich.

Estratejia Nasional ba Kontrolu no Prevensaun ba Moras la Hada’et 2014-2018 D:\PLANU ESTRATEGIKU NCDC TRADUZIDU\PLANU ESTRATEJIKU NCDC PREPARA BA TRADUSAUN_Revisaun\Planu Estratejiku NCDC Final\Final NCD Strategy cum Action Plan 2014-18 - Copy.pdf

Vision “Ema Timor oan hotu bele Goja moris saudavel no moris produktivu no livre husi moras, disabilidade no mate sedu relasiona ho Moras La Hadaet (NCDs).”

Estrategia Nacional ba kontrolu Tabaku Advokasia no Lideransa ba resposta husi multi-setoral Promosaun Saude no Prevensaun Primaria Haforsa sistema saude Surveilencia, Monitorizasaun, Evaluasaun no Pesquija

Estrategia ba no prevensaun no kontrolu Tabaku Introdusaun komprensivu ba lejizlasaun ne'ebé relasiona ho tabaku hodi tau iha kompromisu tuir Konvensaun Enkuadramentu kona-ba Kontrola Tabaku (FCTC) no obriga ninia implementasaun. Hasa’e impostu kona-ba produtu tabaku inklui taxa importasaun. Deklara fatin públiku hotu hotu livre tabaku Halo obrigatoriedade avizu saúde ho imajen iha produtu tabaku Implementa bandu ka proibisaun komprensivu ba iha publisidade tabaku iha mídia no liu husi Orgaun legal, patrosíniu no promosaun. Bandu fa’an tabaku ba no husi otas sei ki’ik.

Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. Hala’o kampaña mídia hodi responde hasoru influensia husi industria tabaku no dezenkoraja uza tabaku. Backup of PROPOSTA DE LEI DO TABACO, Versao Ultimada 15-09-14.docx Proposta RCT 14-11-2014.pptx

Advokasia Política saudável Edukasaun Saúde An understanding of the decision-making process among policy makers, politicians and bureaucrats is required for success of health promotion. Political action to change the public policy is of major importance. Therefore, advocacy and lobbying strategies have to be utilized which are backed fully by evidence in favour of change. Without the policy support creating supportive or enabling environment it will be difficult to change behaviours by health education alone. Conversely, taking a somewhat ‘tough’ policy decision is immensely difficult unless there are sufficient public (ballot box) pressures for it which can only be built up by an effective health education campaign also called ‘agenda setting’. The relation between health education and healthy public policy is synergistic. Muda hahalok Hili Hahalok saudável hanesan ‘ fasil’ atu hili

Asaun Multisetoral no Interministerial Advokasia / Akonsellamentu Mudanca hahalok ema lubun ida Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. Politica no Regulamentu Limitasaun ba Manufaktura Hasa’e Taxa Limitasaun husi publisidade Regulamento ba faan sigaru Avizu saúde iha label sigaru Fatin publiku livre husi sigaru Bandu fa’an tabaku ba no husi otas sei ki’ik. Komprimentu: kompriende no halo mundansa livre husi fuma

Kolaborasaun Interministerial no multisektoral hodi kontrola Tabaku iha Timor Leste Instituisaun Privadu Sociendade Sivil NGO Igreja Ministerio Saude Ministerio Edukasaun Ministerio Justisa Ministerio Agrikultura MTCI SEJD Sec.Estado Com. Social Sec Est.Seguransa Media etc

Haforsa Sistema Saúde Haforsa kapasidade rekursu humano iha nivel hotu sistema saude Fo kontinuasaun servisu liu husi sistema referal inklui tratamentu tersiaria Establese servisu tratamentu tersiaria iha Hospital Nasional ba moras Fuan, moras rins, stroke no kankru. Desenvolve solusaun inovativa atu kobre kustu inklui realokasaun husi taxa ba atividade promosaun saude Estabelese Akonselamentu hapara tabaku (Tobacco Sesasion services)

Survelencia, Monitoriza, Evaluasaun & Pesquiza Halao Survey ba Fator Risku NCDs kada tinan 5 Identifika area sira iha Estudu Demografia Saude (DHS) atu involve dadus Peskiza ba Tabaco. Haforsa Sistema Informasaun Saude hodi fo suporta ba foti desijaun Atu haforsa peskisa relasiona ho Fator risku ba Moras la hadaet (NCDs)

Kankru iha Ibun

PREVENE ESTILO DE VIDA LA SAUDAVEL

PREVENE ESTILO DE VIDA LA SAUDAVEL

PROMOVE ESTILO DE VIDA SAUDAVEL

OBRIGADO WAIN