Kenya Medical


There was an external fixator holding his fractured tibia together. Pus was oozing from where the stabilising rods entered the skin. On standing, he was clearly in pain.

“What happened?” I asked.

“I was hit by a car two months ago,” he replied. He went on to talk about not being able to work and the financial effects of his injury.

“Will you get compensation? Was the driver insured?” I asked.

He became evasive and didn’t answer my question. When I pressed him further, he said that the driver was a powerful man, who could make life difficult for him.

“Is he a witch doctor?” I asked.

“He is in the mirror business,” he replied.

This set me thinking. Mirror business? Something to do with magic based on your reflection in the mirror? Or something about selling mirrors, surely a niche market?

It was only a month later, when our vehicle was passed by a reckless speeding driver, that I had an epiphany. Our driver said, “That crazy boy is transporting miraa to Nairobi for the morning market.” Miraa (not mirror!) is the Swahili term for khat (or chat, qat, kat, qaad – choose your own spelling), the leaves of a shrub. Chewing the fresh leaves produces a stimulant effect somewhere between a strong cup of coffee and amphetamines. Latin America has coca leaves; India and South East Asia have betel nut; East Africa and Yemen have khat.

Low bushes of khat seen from the road in Embu County

Khat has been used for thousands of years in the Horn of Africa. Men get together and chew the leaves (sometimes the soft branches, too), keeping a wad inside their cheeks. The leaves contain an alkaloid called cathinone which causes feelings of well-being, excitement and friendliness, stimulating conversation. These effects are quite rapid, kicking in after just 15 minutes.

Khat also suppresses the appetite and dries out the mouth, so users often drink coca cola to mitigate these effects. Other sympathomimetic effects are dilated pupils, increased pulse rate, high blood pressure and diminished sex drive. Like cannabis, a small proportion of people have a genetic predisposition to develop psychosis, which may be temporary or permanent.

The leaves are gathered in the early morning and laid out for sale on plastic sheets at the roadside. Buyers pack up the leaves carefully to avoid bruising and arrange for their rapid transport to Nairobi for the morning markets. At the end of the day, more leaves are collected and brought to market at Embu. There they are packed and loaded onto trucks for overnight transportation to Mombasa at the coast.

I rarely go into the centre of town after dark, but driving back from a late clinic last week I saw a thriving night market, with clothes, electronics, shoes, food, hardware on sale. Enterprising stallholders had seized an opportunity to relieve the farmers of their earnings from the sale of khat.

Last month I was talking to a county health official who asked me what I knew about khat. I told him that I knew very little about it other than it had been classified as a drug of abuse in UK.[1]

He said that the Kenyan Government has a different view; it is an important cash crop. Indeed Meru and Embu Counties provide ideal climatic conditions for the cultivation of khat. He then asked me if I knew what pests attacked khat shrubs, and whether chemical spraying could deter or treat the infestation.

At first I thought he was asking for horticultural advice, but then I realised that people don’t wash the leaves before chewing them. Users could be at risk of organophosphate poisoning if the bushes had been sprayed. According to Wikipedia, organophosphates kill over 200,000 farmers in developing countries every year.[2] Perhaps we need to add treatment for inadvertent organophosphate toxicity (atropine and pralidoxime) to the cache of drugs we keep for use in emergency situations.


[1] Five years ago, after lots of discussion in Parliament, the then Home Secretary, Theresa May, decided to ban khat as a class C drug.

[2] Recently, a California court ordered the agrichemicals company, Bayer/Monsanto, to pay cancer-sufferer Dewayne Johnson damages of $289 million. “Roundup”, an organophosphate weedkiller, had been labelled as safe, despite the WHO warning it could cause cancer. The court ruled that the carcinogenic properties of Roundup had been suppressed by the company.



The Kiss

This photo has nothing to do with the accompanying text. Two sisters wanted their picture taken in front of the pirated DVD stall in the market.

On Saturday, I made an early start to do my weekly shop in the market. I had just turned the corner when I saw a couple fifty metres ahead. The young man turned to the young woman, her face came up to look into his eyes and they kissed. They were obviously oblivious to onlookers. You do not see this sort of behaviour in public in Kenya.

I kept walking towards them and to afford them some privacy, I ostentatiously covered my eyes with the palm of my hand. The lovers disengaged, holding hands for a second and then he turned towards town and she walked back to where they had come from.

Another young woman walking towards me saw what I had done and giggled.

I followed the young man up the hill, along the muddy track by the HIV Children’s Orphanage, past the coffin makers and behind the District Hospital. I was just about to catch up with him when he turned around and addressed me, saying  “Is kissing against the law? Is it a crime?”

I said, “Hello, good morning (always important to start with a greeting). Of course it isn’t. It was refreshing to see two people demonstrating their love for each other. It just doesn’t happen that often in public here.”

“By covering my eyes I was trying to give you some privacy, but I admit it was done in a cheeky, humorous way. I hope you were not offended.”

He smiled and said he wasn’t offended. “What are you doing in our country?” he asked.

“Mimi ni Daktari,” I said. “What about you?”

He told me he was training to be a teacher and he had classes on Saturdays.

We came to a fork in the road. I went right, he went left. I called to him, “Make sure you concentrate on your studies, not your girlfriend!”

He laughed and said, “I will, don’t worry.”




Hopeland Hotel isn’t the most lavish or opulent place to eat in Embu. Its narrow entrance leads from an unmetalled road. If it wasn’t for the sign, you could easily miss it. The first time I ate there I wasn’t sure of the quality of the food. “We now serve chips!” said a poster on the wall. So to play safe, I had chips with a couple of samosas.


I haven’t had chips there since. My favourite meal is minji, which is peas in a thin beef broth with a lump or two of potatoes and some freshly grated white cabbage. I like madondo, which is a simple dish of stewed red beans, served with ugali (a bit like a dollop of polenta), pilau rice or chapatis. Sometimes I have a mixed plate of green grams (a type of lentil) with mashed potatoes and beans. It’s heavy on the carbohydrates, but we probably eat too much protein. An average meal costs about 50pence.


Occasionally, I lash out and have half an avocado. The last one I bought was so large, creamy and perfect that three people shared it with me. I don’t drink the water and I stay clear of any pre-prepared fried pastries in the glass cabinet separating the diners from the chapati production area. Oddly, the main kitchen is at the other end of the restaurant.

From 1-2pm, it is extremely busy. People get their heads down and eat fast. There is a high turnover. The tables and chairs are packed in, but people don’t mind moving to accommodate new customers.

After 2pm, the lunch crowd has vanished

After seven weeks the waitresses are getting used to me now. They know that I like a small bowl of spicy consomme to accompany my food and if avocados are available, they let me know. I lost a bit of weight in the first few weeks I was here and I noticed that I seemed to get bigger portions than my fellow diners. Now my weight is stable, I get the same sized meals as everyone else.

Sometimes there are troublesome flies, but when it is busy, they are shared out among lots of diners. The seats are uncomfortable, but service is brisk and we don’t linger. The worst thing is the massive amount of flatus the food creates.


Suits you, sir

Thanks to CNN, Kenya National Television screened the wedding of HRH Prince Harry and Meghan Markle. I was familiar with Ms Markle from her appearance in the television serial “Suits”, about a law firm in New York City.

Strangely enough, the very morning of the wedding, I had been attracted to a street where there were several tailoring shops. I stopped to chat at “Ngai’s Quick Fashionable Tailors & Outfitters”. Hanging on the folding door of the shop, there was a natty faux-Burberry checked jacket, with black lapels and facings, which caught my eye.

There was no front window, just a display cabinet, holding some zinc buckets and white sheeting. On top of the cabinet, a cutter was chalking out the measurements for a jacket on some pinstriped grey woollen cloth.


The cutter kept working while I asked him questions. He said the jackets were in the “American style”, whatever that meant. There was a row of them hung onto the wall on one side of the shop, with a selection of cloth displayed on the opposite side.

Further back into the shop, his partner sewed the pieces of material into suits using an ancient treadle Singer sewing machine. A lady in the rear of the shop took the money.

The cloth came from Germany. I felt the need to rub it between my fingers and thumb and discovered that there were four layers. The cutter explained that the customer had requested two suits in different materials, each in two layers – right and left sides. As he used sharp, heavy shears to cut around the lapels, the material began to bunch up. I put a hand on the cloth to keep it steady, but he waved it away.

Other shops catered for a more modern style, drainpipe trousers, shorter jackets (“bum freezers”) and narrower lapels. Some of these designs are shown on the billboard for E. Njue’s Tailoring. These images reminded me of the photographs of celebrities sporting fashionable hairstyles stuck onto the walls of barbershops everywhere. Aspirational targets, perhaps. My overseas haircuts never resemble those of David Beckham or Brad Pitt. And you just know that these suits are never going to look like the billboard.


There are other tailors in town, some specialising in school uniforms and wedding attire.


At his wedding, HRH Prince Harry wore a frock coat dress uniform of the Blues and Royals Regiment so he would not have needed the services of the Jaflo Clothing Centre in Embu.

And no, I don’t have a clue what “Hemasod” means.



Not an assembly line

There’s no import tax to pay on motorcycles under 250cc, that’s why there are so many of them. The motorcycles arrive from China in bits. The larger components (frames, fuel tank and wheels) are packed into cheap plywood boxes, edged with metal protective strips. Other smaller pieces arrive in cardboard boxes.

When I pass the shop, there are usually a couple of men putting the bikes together. Although they may share the same bench, they assemble individual machines. Not exactly bespoke, but made by hand. One experienced worker told me that it just takes a couple of hours. He doesn’t need to refer to the instructions anymore.


The bikes are not that complicated. The electrical connections just snap together. I looked at the accompanying plastic package of nuts, bolts, washers and bits, and asked him if he ever finished a bike and there were some bits left over. He just smiled at me.


The finished article




Many people in Embu like eating pork. There is a side street in town where half the shops are pork butchers or restaurants specialising in pork dishes, mainly barbecued or roasted pork. You can even get pork and mash. I can satisfy my yearning for a bacon sandwich any time I want.


Sunday Walk in Embu (part 1)

The clear, bright, blue sky was a welcome change to the ominous, dark, cloud-filled skies of the past few weeks. The rainy season has been unusually prolonged. Some say el nino, some say la nina. I was just glad to be able to go on a long walk without being drenched.

I packed my rucksack with apples, a litre plastic bottle of boiled and filtered water, my sunglasses and the brilliant Canon EF 100-400mm f/4.5-5.6L IS II USM lens fitted to my 6D camera body. This would be ideal for capturing photographs of birds. For close up and “street photography” I would rely on my OnePlus3 smartphone.

The first church services of the day were ending when I tramped up the muddy road from our house to the main highway. Families dressed in their Sunday best and clutching their Bibles were walking home. I crossed the highway by the Anglican Cathedral and headed north down into the valley.


Boda-boda motorcycle taxis swished past me when their riders had cut the engine and were freewheeling down the slope. Those with empty pillions beckoned me to come aboard. Those already loaded with passengers would wave and shout greetings, lost on the slipstream. I discovered recently that there was no import tax on motorcycles of less than 250cc, so they were popular and more affordable.

Motorbikes coming towards me would have coasted down the opposing slope of the valley. As they bled off speed, their drivers would press the electric starter, but sometimes this didn’t work, and they would stop and have to kick start the motor. Going over speed bumps can be tricky while you are messing about with the starter.

Everyone at the side of the road, gardeners, motorcycle washers, people coming and going to church, would all catch my eye and greet me.

“Where are you going?”

“To the forest,” I would reply.

“Oooooh. Why?”

“Because I want to walk.”

Some of them expressed surprise that a muzungu (white man) would be walking at all. They think we are all from the WaBenzi tribe (the people who are driven around in Mercedes Benzes).

Up ahead was the Sunmoon Lodge, a local hotel. There was a half moon in the sky, but I couldn’t frame a photograph to show both. I walked up the hill and past a few dilapidated dukas (shops). The Njukiri Forest was to my left, but there were no clearly marked paths in that direction according to Google Maps. (I have a love/hate relationship with this app. It can be lifesaving at times and infuriatingly wrong at others.)

There was a sign pointing to the County Show Grounds, laid out on the fringes of the forest. I can just imagine the scene 70 years ago, with the white farmers proudly displaying their produce, their wives entering bakery and flower arranging competitions, with prize beasts being judged by men in white lab coats. It looked sad and dejected now.

At Njukiri Shopping Centre, a vivacious middle-aged lady wanted to walk with me. She hooked her arm through my elbow but I declined. I didn’t want to spend the next mile explaining to her why I didn’t want an African wife. She laughed and went back to her crowd of friends. I wondered what on earth had been in the priest’s sermon.

The prolonged rainy season had painted the countryside bright green. It is very fertile, with people planting stands of maize, interlaced with beans, sugar cane, potatoes (English and sweet) and arrowroot everywhere. The lakes and dams were full. I took a long look at one stretch of water to see if there was any birdlife. Two lads in fashionable Western clothes and American baseball caps asked me if I wanted to swim. I told them that I’d left my swimming trunks behind, unfortunately, and they laughed.


On the other side of the road, there was a ruckus. A man was trying to control a massive bull as it rumbled through the undergrowth onto the tarmac road. The bull continued to be rather frisky on the road, and motorbikes had to swerve to avoid it. I greeted the man and asked him what he was doing. Surely they would not be slaughtering on the Sabbath? No, he was taking the bull to cover some cows. “He knows, that’s why he’s impatient,” said the cowherd.


From one of the many churches at the side of the road, I saw a man with a massive box on a wheelbarrow. We chatted and he told me he had to move the loudspeaker from one church to another for the next service.

A boda-boda driver stalled his engine going over a speed bump and couldn’t get it restarted. I offered to help but he didn’t think much of my expertise. He pushed the bike up the hill, where there was a shack offering boda-boda repairs.


I’d been walking for two hours now and the sun was beating down. I stopped to rest and look down at a garden in a flooded valley. It looked charming, so I got out my camera. Out of nowhere, two men came to ask me what I was doing. “I am photographing this attractive scene. Your country is very beautiful.” They seemed unconvinced. “Why is this beautiful?” I rambled on about the verdant pasture, the different crops, the flooded stream, the people working in the distance. They were still suspicious. “What are you doing here?” I told them I just wanted a pleasant walk to see the countryside. “Why are you in Kenya?” When I said I was Daktari, their manner completely changed. From being a suspected spy, I had become a most welcome guest.