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Whether it is drought or it is raining, miraa never lets us down. Khat, also known as miraa, is an amphetamine-like plant native to the Horn of Africa and Arabian Peninsula. The industry is so central to the regional economy that when Somalia briefly banned khat imports for a single week in , Kenyan farmers lost millions of dollars. Khat is most popular with men: in Somalia, an estimated 75 percent of men chew the leaf for its mild stimulant effect.

In Kenya, they say khat makes men stoned, docile, and impotent. But it makes women rich.

Dabar, who has been chairwoman since , says it has become one of the most successful khat distributors in Garissa. But Dabar is an exception. Most of the women who run the khat business are unmarried: widows, divorcees, and single mothers. The economic reliability of khat in this semi-arid region rests on a critical foundation: it is a drought-resistant crop.

In Garissa, the ability to resist climate change means survival. Khadija Dabar understands the threat first-hand.

Gaining respectability in Kenya

For decades, Dabar was one of them. She grew tomatoes, bananas, and papayas on her acre farm alongside the River Tana, and for a while, times were good. One morning, Dabar woke up to discover that a flood had washed away 2, banana trees in a single morning. It had taken her nine months of work to grow them. Desperate to support her family, Dabar traveled to Nairobi to sell honey. Curious to see how much she could increase the profits from her honey sales, Dabar traveled to Meru in The trip to Meru was the decision that transformed Dabar, a devout Muslim and middle-aged mother of ten, from farmer to reluctant drug lord.

Women have a long history of dominance in the East African khat trade.

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey

According to David Anderson, author of The Khat Controversy , a businesswoman named Yasmin who moved from Somalia to Kenya in the s was one of the first people to export khat to the United Kingdom. Her wealth and success in the industry inspired others: in Somaliland, a disputed breakaway state in the Horn of Africa, an estimated 72 percent of khat vendors are female. Rose Mugambi Karanja remembers the morning over 20 years ago when she first got into the khat business.

For six months, Karanja woke up very early in the morning to go to work as an apprentice for a trader. There, she saw how the green twigs were cultivated and picked, learned to distinguish the quality of the leaves, and became familiar with how the khat was wrapped and shipped to all corners of the world. For hundreds of years, khat—also known as miraa in Kenya and chat in Ethiopia—has thrived as a socio-cultural commodity. In the Horn of Africa and the Arabian Peninsula, where khat is grown and traded, it has had the distinct quality of promoting interaction among people from different religions, ethnicities, and race.

It has also been associated mostly with the male gender, many of who control the businesses, and who devote hours chewing it pdf in both public and private spaces. But what is mostly overlooked is the role of women in the production and sale of khat. But women, Goldsmith says, have thrived on the fringes of the retail trade. In Maua town, women work in picking the leaves from the farms; collect and sell the banana leaves used to wrap khat in bundles to keep its moisture; knit and prepare the sacks used to transport khat; and act as brokers between farmers and traders who export it worldwide.

Participants held a variety of views on whether khat was addictive. Some, predominantly users, reported that they did not believe khat is addictive, and that they could limit their khat use to once or twice a week. Others reported it to be addictive and that some people have difficulty controlling khat use. One cannot easily say only sit for khat on Sunday or on Saturday. Whenever you get a chance, you want to grab it, because one is really addicted to it. Somali man, Perth. Some participants stated that they used alcohol to relieve the insomnia and restlessness they experienced after a khat chewing session and were concerned that this practice of combining khat and alcohol contributed to mental health problems.

Others reported that khat users sometimes sought medical treatment for sleep and mood problems. The sad part is they go to their [general practitioner] here and the GP gives them happy pills. Conversely, commonly identified psychological health problems such as disrupted sleep patterns, low mood and irritability were reported to occur after the effects of khat had worn off. A minority of participants identified a link between heavy khat use and more severe mental health problems:. People are alright if they stop it, they can come back alright. The general view of participants was that people do not become more violent upon using khat, although some participants reported domestic violence linked to khat use.

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Many participants suggested that such conflict arises out of disagreements about the amount of time and money spent on khat, rather than as a direct effect of the drug:. Some people when they eat the khat they come to you very angry. The first thing they do is hitting the kids and the mother and all those things. The husband will become abusive in defending his actions [khat chewing].

The partner is not happy with that, the children are not getting a fair share of his life, all those kinds of things, then it may constitute domestic violence because of defending his habit. Somali man, Sydney.

Some participants reported that khat users often neglected dental hygiene after a long night of chewing. Most reported that khat chewing caused constipation, although some reported a laxative effect. Many claimed they used khat as a treatment for diabetes mellitus.

Use is linked to community networks and cultural traditions, and may also be associated with existing high levels of mental health disorders anxiety, depression and post-traumatic stress disorder among displaced refugee communities. The fresh leaves preferred by khat users contain a higher ratio of cathinone to the less psychoactive cathine, 22 and are usually sourced from local trees.

Dried khat is usually imported into Australia from Kenya or Ethiopia. Some participants also identified a negative impact on psychosocial functioning and relationships, although more severe drug-induced psychosis or violence were reported to be uncommon. Participants suggested that when it occurs it is not a direct effect of the drug; we suggest that such behaviour may be due to the effects or discontinuation effects of khat. The concurrent consumption of large volumes of sugary drinks and sweets to counteract the bitter taste of khat, coupled with reduced appetite and poor nutrition, is likely to contribute to poor oral health.

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Overwhelmingly, participants in this study incorrectly believed that khat was harmless or possibly beneficial for a range of medical complaints. There were a number of instances where perceived effects contradicted the evidence — for example, reports that khat was useful in treating diabetes.

Further, the belief that khat use increases libido and fertility contradicts the limited evidence that long-term use of khat may reduce sperm count, volume and motility. Difficulties in detecting and responding to health problems associated with khat use may be compounded by poor health literacy and poor utilisation of health services by people who use khat, different cultural understandings of the role of khat as a drug, stigma regarding disclosure of khat use to health care providers, and low awareness among health practitioners of khat use, its effects, and the health issues affecting refugees.

Those experiencing adverse effects are most likely to access general health services complaining of specific symptoms eg, sleep or mood problems, constipation and may not report their khat use because of concerns regarding stigma, illegality or genuine belief that khat use is not linked to any health problems. Khat users may also present or be referred to drug and alcohol treatment services with dependence issues, although there are no specific services available for khat users in Australia.

Khat in the Western Indian Ocean

Multicultural drug and alcohol health services are available in some states and may be able to offer more culturally specific assistance to patients. Health professionals have a role to play in educating users about potential harms arising from khat use, promoting responsible use of the drug in order to minimise the negative health effects for the individual and for the community, and informing community members who experience problems about the services available to them.

Importantly, many users reported not disclosing their khat use to health professionals, and we therefore recommend that health professionals should routinely enquire about khat use and related health problems with patients of Somalian or other East African background, incorporated into enquiries regarding lifestyle factors such as use of tobacco, alcohol and other substances. Dizziness, impaired concentration, insomnia, headaches, mydriasis, conjunctival congestion.

Agitation, labile affect, fatigue and disrupted sleep often occur after cessation of use. Transient psychosis is uncommon and generally associated with heavy daily use or other risk factors 8,9. Discontinuation features mild withdrawal, including agitation, labile affect, fatigue and disrupted sleep are common after regular use. Dependence has been reported, usually associated with daily khat use Ischaemia, infarction, pulmonary oedema, cerebral haemorrhage all uncommon Dry mouth, polydipsia, periodontal disease and dental caries 12, Reproductive and obstetric effects.

Metabolic and endocrine effects. Received 17 February , accepted 6 October Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.

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Khat - is it more coffee or cocaine?

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