The hazards of the mild narcotic
The growing use of khat among teenagers could create a future mental health crisis, experts have warned.
Students as young as 14 are chewing the stimulant plant unaware of the effect it is having on their health.
Professionals are now calling for tighter controls amid fears Ethiopia’s hospitals will be unable to cope with the rise in mental illness.
Tamirat Abdisa, Assistant Medical Coordinator at Gefersa Mental Health Rehabilitation Centre, said most of the psychiatric patients they treat were khat chewers.
The Ethiopian authorities are said to be worried about the situation.
About half of Ethiopia’s youth are thought to chew the plant-based drug, which has been linked to a variety of health problems, including depression, paranoia and psychosis.
Speaking about all age groups, Tamirat said: “If it continues like this – the chewing and other substance abuse – it will cause many mental health problems in Ethiopia. We will need a lot more health professionals and a bigger budget to get ready for this.”
An estimated 100,000 mentally ill people are living on the streets in Addis Ababa and are in need of help. Their families have often abandoned them while many in the community think they are possessed by the devil.
Gefersa, just outside Addis Ababa, is the only government rehabilitation center in the country, serving a population of over 100 million people. They have room for fewer than 200 patients, some of whom were just dumped in the forests by their families.
Numerous studies have shown that chewing khat is harmful to health but it remains legal for cultural and economic reasons.
Experts at Gefersa have called for a legal age limit of 18 to be put on its consumption and they want better controls of khat cafes.
They also want people to be educated about its dangers and more studies into its effects on young people.
Jaleta Bulti, Medical Department Co-ordinator at Gefersa said: “There is a link between khat chewing and mental health problems. If someone has mental health problems, it can exaggerate those problems.
“I don’t think people are aware of the problems it can cause. With students we know they are under a lot of pressure to pass exams and read a lot of material. There is also the peer pressure to chew. They assume it gives them happiness and helps them study, even though there is no scientific evidence to support that.
“There is an awareness of the so-called “positives” of khat but not the negative or the mental health consequences. Once people develop a habit they become dependent on it and can’t function without it. It’s a big issue and if it continues like this there will be big problems.”
Khat, the evergreen shrub that produces euphoric effects, is believed to have its origins in Ethiopia. Chewing used to be limited to mainly Muslim areas where devotees used the mild narcotic to help them stay awake during Ramadan prayers.
However, it is now a social custom and every section of society – old, young, rich and poor chew the leaf.
Countries in Europe and the US have banned it but it remains legal in the Horn of Africa and is a big revenue earner for the Ethiopian government.
Growing khat is thought to sustain over two million farmers who can make substantially bigger profits than using their land to grow crops.
A bundle can fetch anywhere between 50 and 500 birr, depending on the quality.
Official figures are unavailable but it is thought to be one of Ethiopia’s biggest export earners.
The stimulation effects of khat are similar to those of amphetamines and users report feelings of well-being, mental alertness, excitement and euphoria.
The World Health Organization (WHO) has classified it as a drug and long-term use has been linked to insomnia, anorexia, gastric problems, depression and liver damage.
It can also lead to mild to moderate psychological disorders and exacerbate existing conditions. A 2009 study from the Austrian medical journal Wiener klinische Wochenschrift noted that “manic and delusional behavior, violence, suicidal depression, hallucinations, paranoia and khat-induced psychosis have also been reported.”
Nevertheless an increasing number of high school and university students have been turning to the drug to keep them alert during their studies. The long-term unemployed are also using as a way to pass the hours during the day.
There are fears that because the number of users is increasing then so too will the number of people with mental illnesses.
Gefersa Mental Health Rehabilitation Centre offers professional psychiatric treatment, boarding and rehabilitation occupational therapy. The aim is for the patients to return to their homes after treatment.
It is government-funded with an annual budget of 27 million birr and for the last seven years has been managed by the Ethiopian-branch of the Brothers of Charity.
It is the only public health facility in the country that is focusing on rehabilitation and it works closely with Amanuel Hospital in the city.
There are other private rehabilitation clinics around but these are prohibitively expensive for the majority of the population.
People are referred to Gefersa from all over the country and there are currently 161 in patients and a further 20 in the community. The hope is for the center to grow and be able to help address Ethiopia’s growing mental health needs.
Brother Eric Jeje, General Manager of Gefersa, said: “Our aim is to help the country. There is so much to be done. There is a stigma for mental health and a belief in curses so people with problems haven’t always been treated well.
“You have to respect them and give them love. Of course now there is the growing worry about the use of khat. We will see more people needing our help over the coming years.”
Ed.’s Note: Jane Wharton is a volunteer at The Reporter.
Contributed by Jane Wharton