Hotib is practicing his speech. Repeating the letters from his therapist "A-E-I-O-U."
Hotib, 64, smoked cigarettes for almost 40 years and a cancer diagnosis led to his larynx being removed. He now breathes through a hole in his neck. His voice is raspy as he relies on his esophagus to produce the sounds for his speech and his pauses between sentences are noticeably long.
"Back in my day, smoking was considered a tradition and a casual thing to do by kids at that time," said Hotib, who like many Indonesians uses only one name.
"People said if you're not smoking, you're not manly enough," he added.
May 31 is World No Tobacco Day, when many health advocacy groups try to raise awareness about the dangers of using tobacco. The World Health Organization says about 70% of Indonesian males ages 15 and up smoke tobacco, one of the highest rates in the world for men. About 2% of Indonesian females ages 15 and up smoke.
Indonesia is one of only six countries with rising rates of tobacco use, according to WHO research.
"I think it's being portrayed as being part of our culture, that smoking is part of masculinity, and it's also being portrayed by the tobacco industry that it's cool for guys to smoke."Olivia Herlinda, policy director for the Center for Indonesia's Strategic Development Initiatives, a nongovernmental organization focusing on health issues.
"Because of the high rates of [male] smokers in Indonesia we also have high rates of lung cancer and other heart- and lung-related diseases such as stroke, ischemic heart diseases," Herlinda said, adding that nonsmokers can be harmed by secondhand smoke.
On a recent weekend, Mukhsin, 20, relaxed on a bench in a park in Jakarta, Indonesia's biggest city. He was smoking a cigarette. It's a habit he started two years ago.
"I knew about the harmful effects of smoking when I started," he said. "I smoke to relax, calm myself down. Smoking is so common here."
The tobacco industry promotes itself in Indonesia with advertisements on television as well as billboards and by sponsoring popular events such as music festivals. These types of promotions by the tobacco industry face tighter restrictions in most countries, according to Vital Strategies, a global public health organization that has been actively supporting efforts to reduce tobacco use in Indonesia.
Some local and provincial governments, including Jakarta's, have taken their own steps to ban cigarette billboards.
Indonesia is one of only 13 countries, and the only country in Asia, that is not party to the WHO's Framework Convention on Tobacco Control, which requires strict limits on tobacco sponsorships and advertising.
Labels that warn of the risks of smoking cover 40% of the front and back sides of cigarette packs in Indonesia, but the WHO recommends at least 50%.
"The warning labels need to be bigger, and the taxes on cigarettes need to be higher to help discourage tobacco use," Herlinda said.
Indonesia, the only Asian country not part of the WHO's Framework Convention on Tobacco Control, has labels warning of smoking risks covering 40% of cigarette packs, though the WHO recommends at least 50%.
Indonesia has a complicated tax system for tobacco with multiple categories. For many of Indonesia's popular cigarette brands, about half of the price paid by a consumer is for taxes, including a sales tax as well as an excise tax that tobacco companies pay before the cigarette packs reach store shelves, according to Abdillah Ahsan, an assistant professor in the Faculty of Economics and Business at the University of Indonesia and the coordinator for the Indonesia Tobacco Control Research Network. The World Health Organization advocates for total taxes to be at least 75% of the final cost of a pack of cigarettes.
Local health advocates blame the country's high male smoking rates not only on the tobacco industry, but also on the government, particularly the Ministry of Industry.
"The tobacco industry has very high influence in our policymaking, and that leads to very weak regulations in our country regulating tobacco," Herlinda said.
Public health advocates are pushing for tight restrictions on the tobacco industry's access to lawmakers and regulators.
"The government is currently required to consult with the tobacco industry if they create regulations that might impact the industry," Herlinda said. "There are a lot of behind-the-door negotiations happening between the tobacco industry and government too. We need to change things."
VOA sent questions to the Ministry of Industry as well as to the Association of Indonesian Cigarette Manufacturers and Gudang Garam, one of Indonesia's largest tobacco companies, but did not receive answers.
Taxes from tobacco made up about 7.5% of the Indonesian federal government's revenue in 2023, according to economist Abdillah Ahsan. But he was also quick to point to a 2017 report from Indonesia's Ministry of Health that says the health costs from smoking were three times the amount generated by tobacco taxes.
Hotib, who had his larynx removed, says he's living proof of the harms of using tobacco.
He speaks at schools and to youth groups, explaining the hardships he now faces after decades of smoking.
"I need to breathe through this hole in my neck. My nose doesn't work, and my physical fitness has declined," he told VOA. "I am the proof of the cruel effects of cigarettes."
(VOA/AP)