Blinded by the smoke: The price Ghana's fish smokers are paying

In the doorway of her small roadside shop in James Town, Accra, Naomi Dowuo rests her chin in her hand, the blue sea sparkling in the sun behind her. The 70-year-old wears a purple tie-dye kaba, a colourful headwrap and thick-lensed eyeglasses, the kind a doctor prescribes.

Only one of her eyes still sees.

“I am still grateful to have my other eye functioning, and I will do everything possible to protect it,” she told me in Ga.

Naomi has not smoked fish in years, but the smoke found a way to stay with her anyway.

For more than two decades, Naomi stood over open kilns, turning fish through fire and haze for up to six hours a day. She never wore protection. When her eyes burned, she blinked, finished her work, and kept going. Eventually, the pain got so bad she couldn’t sleep. She finally went to hospital.

“They said I had dirt on my eyes so they had to go and wash it,” she says. They took me to wash it, but it didn’t bring me any relief, so they admitted me for over a month.”

At the end of that month, doctors had bad news. Vision in her right eye was gone for good. 

Surgery could help return some vision, but she cannot afford it. Her glasses help with what is left of her sight. 

Ghana loses more than thirty-two thousand people prematurely each year to air pollution according to the 2025 State of Global Air report. And while air pollution’s role in hypertension, cancer and respiratory diseases is increasingly well known, few know that the same toxic smoke is quietly destroying the eyesight of 30,000 women who make their living smoking the fish that many Ghanaians eat. 

Daughters typically replace their mothers in the fish processing business, bringing more young women into the dangerous work every year. Across Ghana’s 340 coastal communities, women who have spent decades smoking fish are developing eye complications they rarely associate with their work. Some blame bad luck, others witchcraft, unaware of the dangers of prolonged smoke exposure.

The damage it causes

Dr Samuel Sessah, an optometrist and occupational health expert, says the exposure is more complex, and more damaging, than most people realise.

“Somebody who is a fish smoker is exposed to basically three things,” he explains. “One, the person is exposed to air pollutants, the smoke. Two, the person is exposed to heat. And three, the person is exposed to some sort of chemicals used in treating the fish. All these three things, when exposed to over a period of time, have tendencies in causing irreparable damage to one’s vision.”

Over years, women can get dry eye disease, cataracts, and in the worst cases, glaucoma. Pollutants don’t stop at the lungs. They enter the bloodstream and from there they enter every organ in the body. In the eyes, that means reduced blood flow.

“When blood flow is reduced to the optic nerve, it can cause severe conditions like glaucoma,” Dr Sessah says. “And once there is a pathological damage to one’s vision, it will lead to diminishing results. It will lead to one’s vision being reduced.”

What the hospital sees

At Ussher Hospital in James Town, less than a kilometre from where Naomi Dowuo lives, the Outpatient Department’s optometrist has seen cases like hers before. Catherine Manu declined an interview but in a written statement she said the two conditions she sees most are pterygium - a fleshy growth that forms on the white of the eye after years of exposure to smoke, dust and sunlight - and cataracts.

For pterygium, she tells patients to wear sunglasses to protect their eyes. For the smoke itself, she tells patients they must switch from using charcoal and wood to cleaner options.

Manu said the Outpatient Department uses regular health talks to raise awareness of the dangers. Whether that information is reaching women at the kilns, in the communities where the smoking actually happens, is a different question.

A government aware, but underfunded

None of this is news to government. The Fisheries Commission has spent years developing and promoting cleaner technologies designed to reduce the smoke. Cleaner ovens like the Ahotor or FTT are safer, but Professor Benjamin Betey Campion, Chief of the Commission says obstacles have limited uptake.

“Our major challenge is not the unavailability of technologies. It is more about the adoption of the technology. The cost also hinders adoption. The Ahotor oven, the FTT, these are quite expensive. And so their cost hinders adoption of the technology.”

The Ahotor oven sells for around GHC10,000. Most of these women cannot afford it. International donors including the UN’s Food and Agriculture Organization have bought hundreds of ovens over the last decade, but they are now looking to Ghanaian solutions to overcome the barriers. 

One spark of hope came from last month’s announcement by the Food Research Institute at the Council for Scientific and Industrial Research, Ghana’s main state research agency, that it is piloting modified versions of those ovens that will be cheaper. 

For now, Yaa Amoah Tiwaa, the Fisheries Commission’s Deputy Director of Post-Harvest Management, is frank about the challenges.

“Currently, we do not have dedicated funding for our women to construct new ovens. There are over thirty thousand fish processors in the country. We cannot say that we are coming to give everybody an oven. When a project comes, and there is that commitment, we do support them. But we have to teach them how to fish, rather than providing them with the fish every time.”

The Commission runs workshops alongside the Environmental Protection Agency and other partners, teaching women how to reduce exposure: stepping away from the smoke whenever they can and keeping children away. UV-protective sunglasses, worn every time a woman stands near a lit kiln, stop the smoke and heat from reaching the surface of the eye.

But EPA officials have conceded in the past that the Agency lacks funding for the scale of awareness creation the problem demands.

Tiwaa says the Fisheries Commission has had some success taking training to communities.

“Instead of calling one, two, three women from communities and bringing them to workshops, when they go, they don’t really relay the information. But when you rather take the training to the communities, we are able to get a lot of them to participate.”

The problem, though, is growing. More women enter the fish smoking trade each year, and are being exposed to its dangers. Researchers and health experts say government efforts are simply not keeping up with the scale of what is unfold