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.



A Day at the Races

I must be lucky in love because I have neither skill nor good fortune when it comes to picking winners at the racecourse. The Kenyan St Leger took place on Sunday, June 24th at the Ngong Road Racetrack. We had nothing better to do, so we picked up the ingredients for a picnic at Junction Mall and called a cab.


In 1980 I was evacuated to Nairobi for root canal treatment from Southern Sudan. The local British community rallied round and tucked me under their wing until I could arrange my journey back to Sudan in a Landrover. My dentist drove me around Nairobi Game Park and a medical secretary I had met in Oxford took me to the races.

None of it looked familiar, although the grandstand was probably built before my first visit. There is now a nine-hole golf course inside the track. We paid the 200/- admission fee, bought a programme, bagged a seat on the bleachers with a good view and settled down to study the form. There were seven races, each with between 5-10 runners. Before long, I was completely bamboozled by all the names, jockeys, trainers, handicaps and past performances. The going was good, but I wasn’t.


The programme went into great detail about the different types of bet one could place. I knew about betting to win or for a place, but there were many others. You could place bets for two horses, both coming first or second in a race, intriguingly called a swinger. Plus a trifecta and a quartet, when you had to place all three or four horses past the post in order. Then there were accumulator bets, where the winnings (fat chance) from one race would be staked on the next race, and so on. The example clearly showed how 40/- could win hundreds of thousands of shillings if all the bets came good and you hit the jackpot.


I decided not to bet physically but placed imaginary bets on my chosen horses. Only one of my picks won, at 3 – 1, so I would have been out of pocket if I had staked real money. Selfie came in 4th, forget about Unforgettable which came in 3rd, and tough luck for Tough Cookie, which limped past the post in 4th place. Forewarned was what I should have been, as the Irish horse came in 4th.

My colleague is a more experienced gambler, but even he only bet the minimum amount (40/- which is equivalent to about 30 pence or 40 cents) on a few races.


In front of us, there was a hen party of white women, dressed in hats and finery, sipping something potent from a thermos flask. One lady wore a sash identifying her as a bride to be. To our right, there was a phalanx of teenagers wearing red tracksuits. At first, I thought it was the local Arsenal supporters group, but I think they were students on a school trip.



Four Kenyan singers kept us entertained with catchy tunes and slick dance moves, in between races. A disk jockey managed the backing music and sound system. As the alcohol in the thermos flask began to take effect, the bride-to-be joined the singers for some line dancing. Unfortunately, the booze had affected her co-ordination and she couldn’t match the moves of the other four singers. She got a hearty round of applause at the end of the song and tottered unsteadily on high heels back to her hen party.

We watched the horses being led around the ring, and how they reacted when the jockeys mounted. The races were all on the flat, varying from 1200m to 2600m. The starting gate was moved around the course. A team of lads helped to get the horses into the gate and after the start, the lads would pile into a van and come back to the grandstand. There must have been about 15 of them in the van, so when the door slid back and they dismounted it reminded my colleague of a clown car, where a never-ending line of passengers would exit. He even downloaded some appropriate circus music to play for their next exodus.


We drank orange juice, scoffed our ham and chicken sandwiches, followed by a slice of gateau. My colleague managed to pick up a signal on his smartphone and kept me updated with the score in the England vs Panama football match. The score sounded like the odds of a poorly fancied horse, 6 to 1.


After a few virtual losses, my colleague started to get more confident in his ability to pick a winner. We both chose the same previously unraced horse, Fast Five, for the final event. He backed it to win a place. Unfortunately, another horse withdrew, so his bet was invalid. When the horse won, he waited patiently for his meagre winnings (actually, it was mainly to get his stake back), only to be told his bet was void because there weren’t enough runners to pay out on a place. Storm clouds were gathering to the south, but they didn’t look as angry as my colleague. So 80/- worse off (about 60 pence), we trudged away from the racecourse to our taxi pickup on Ngong Road.



Road trip

“What goodies shall I bring to the project?” I asked Dr E. She said, “The staff like sweets.” I thought that this was not such good advice because my new mission deals with chronic diseases, such as diabetes and hypertension. Sugar is the enemy! But I found I was wrong when I had my briefing in the office.

“What we want is Quality Street! Not Celebrations. As children we found out where my father hid the Quality Street and we ate them,” she said.

“Even the green ones?” I asked.

“No, they were our least favourite. We liked the red and yellow ones.”

“What about the purple ones with the soft toffee and the brazil nut?”

“We liked them too. When he discovered what we had done and he asked us if he was the father of thieves!”

My departure to the field was delayed by an enormous traffic jam caused by a lorry and trailer jack-knifing on the Mombasa Road. It had been loaded with cement, which was tipped over two carriageways of the highway. It had been raining since midnight, so the cement must have been setting. In my mind’s eye, I could envision workers chipping away at the hardening cement of the road surface, trying to clear the way.

We set off and joined the traffic jam. Some roads were raging torrents of orange water. Our twin cab Toyota Pickup truck ploughed through the flood, creating a bow wave. A truck passed us on the inside lane and drenched my side of the vehicle with a tsunami of muddy water. Unfortunately, I had left a crack of window open to prevent the glass from steaming up with condensation…

As we left the city en route to Embu, the rain stopped and we were able to make good progress. I sat back in the passenger seat and drank in the atmosphere. I made some notes:

Most locals use minibuses called matatus. Some matatus were named after Manchester United. Another was called, “Addicted to Jesus”. The message on a truck’s mudflap was “Almighty Leader”.

The side of a bus was painted with the Nike swoosh and the slogan, “Jesus did it.”

Motorbike taxi riders wore yellow tabards, advertising their sponsors. Some bore the name of the President. To shield passengers from the rain, a few motorbikes sported elongated umbrellas which must have limited their speed. But not as much as one man with a two-seater sofa balanced across the pillion seat.

About halfway to Embu, there is a village which is famous for its catfish. I spotted saloon cars with fish hanging from their wing mirrors, presumably to keep cool.

The countryside was verdant and sparkling after the rain. Villagers were slashing the vegetation at the side of the road, to keep the verges clear. Some workers had tucked their trousers into their long socks, which gave them a “plus four” appearance. The privet hedging around some of the petrol stations’ forecourts had been clipped in a more careful manner, with topiary which would not be out of place in the Home Counties.

Some of the roadside hotels had great names. “Beach Hotel” and “Red Soil Hotel” were two that stayed in my memory. We arrived in Embu just before lunch. Across the road from the office is the “Kryptonite Hotel”. The sign above the entrance glows green. It’s fortunate that I am not “Superdoc”.