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Kenya Medical

Khat

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.

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“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.

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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.

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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.