For decades, khat, or miraa as it is popularly known across East Africa, has been the lifeline for farmers in eastern Kenya, but pressure to convince them to abandon the trade is now mounting.

The growing numbers of young adults chewing the mild stimulant has become a major concern among anti-drugs campaigners who fear dependency could ruin a generation.

Some 30 tonnes of khat are harvested each day by both small- and large-scale khat farmers who cultivate the crop in Meru District. Most of the crop is consumed in Kenya, but some is exported to Somalia and United Kingdom.

Somalia

Traders say some 3,000kg of khat are flown to Somalia’s capital everyday where its chewing has become the norm at social gatherings across Mogadishu.

PHOTO GALLERY In pictures: Growing khat Widow turns to khat

Some blame it for Somalia’s misfortunes.

During Islamist rule last year it was banned and the streets were the calmest for decades, but there was resistance.

Most militiamen have a high dependence on the stimulant and it is argued that it causes them to be irrational and easily provoked.

When the Islamist militia seized a consignment worth about $40,000 and set it on fire to mark the beginning of the ban, there was a riot and a curfew had to be imposed to contain the upheaval.

But since the Islamists were defeated at the turn of the year, exports of khat from Kenya have resumed and so has its consumption.

Kenya

Now the pressure to have khat banned is being stepped up in Kenya, where its consumption is on the rise.

FACTS ABOUT KHAT There are two main types of khat - miraa and hereri Miraa is grown mainly in Kenya Hereri comes from Ethiopia A bundle of khat costs about 3 ($6) in Britain Khat is illegal in the US and a bundle there sells for between $50 (28) and $80 (41)

A survey done by the government drug watchdog, National Campaign Against Drugs Abuse, shows a big rise in new users on the coast and in the capital, Nairobi.

“Reports by our officers show that when a khat ban was enforced in Somalia the local dealers become very aggressive and were off loading the surplus products into the local market,” the watchdog’s national co-ordinator Jennifer Kimani told the BBC.

Now her organisation is advising the government to initiate a process where khat farmers are gradually encouraged to switch to other cash crops.

Apart from the negative health effects to the user, which include loss of appetite, lack of sleep, hallucinations, mental health issues and sometimes impotence, khat is also blamed social problems.

For instance in khat-growing areas, cases of boys dropping out of school are rampant.

“Boys choose to work at khat plantations or sell the stimulant instead of going to school because there they make quick money,” Ms Kimani says.

Casual workers at a khat farm can earn up to $20 a shift while small-scale traders in markets across Kenya may earn 10 times that in daily sales.

Problems

In Mombasa, special restaurants, as seen in Yemen, have been designated as khat joints where groups of adults converge daily to chew the shoots and chat or cut business deals.

I have not treated anybody suffering from ailments caused by its use Dr Samuel Murega

But women complain of the long hours their husbands spend in these joints.

Imam Arshad Salim Imam says that numerous cases have been brought before religious leaders by women who report that their husbands have abandoned their family responsibilities.

“We have women who complain that they do not get their conjugal rights because their husbands remain occupied most of the night chewing khat,” says Imam Salim

He further notes that a lot of family income is committed to the habit at the expense of other needs like education, food and health.

For this reason, Imam Salim insists that the government should impose a ban on khat just like neighbouring Tanzania where it illegal to sell or consume the stimulant.

Defence

But Dr Samuel Murega, a medic and khat farmer in Maua, eastern Kenya, believes calls to ban the stimulant are misguided.

Instead of banning the plant, he thinks the government should license and encourage its growth.

He also denies negative health claims.

“I run an active health clinic here… but I have not treated anybody suffering from ailments caused by its use,” says Dr Murega.

“Some people mix khat with other narcotic drugs to get high and they end up in undesirable state. And since they were chewing it openly then the blame goes on the stimulant and not the drugs they have taken which is unfair,” argues Dr Murega.

At present the trade is probably too lucrative for an imminent ban, but the remarkable changes in behaviour seen in Mogadishu when khat was banned has given officials plenty of food for thought.

What do you think? Should khat be banned? Tell us your experiences using the postform below.

The effects of khat chewing are less than those of smoking. Therefore before considering imposing ban on khat chewing, we should ban tobacco smoking first. Secondly, it’s a major cash crop and only income earner in some parts of Kenya. Myself I don’t see any problem in its consumption and I have friends who routinely chew it with no notable side effects.
Peter Karenju, Zanzibar

Banning khat overnight is completely unrealistic - the reality is that many people in eastern Ethiopia rely on khat production for financial support, and would suffer if they did not have this means of income. It is true that for the many men, women and children who chew khat, it can be incredibly destructive to their health (an estimated 80% of ‘psychotic’ patients in Ethiopia’s only mental hospital are the result of khat-induced psychosis), as well as their productivity, and the health of their marriages and relationships. But banning the addictive substance will not solve anything - if khat is eradicated, it will happen with the support of the Ethiopian government, (which incidentally takes in millions in khat taxes each year).

The government must condemn khat use and conduct research and spread public health messages about the negative health ramifications of khat, but must simultaneously support farmers and coffee growers so they do not have to rely on khat to produce a sustainable income, support education so children will have a greater incentive to go to school, rather than sell khat on the street, and support widows who are the sole bread winners of the family, so they do not have to resort to the khat trade to support their families. Only through a viagra vs levitra
approach to this region-wide addiction will there be any progress in the growing fight against khat.
Elizabeth Arend, Jijiga, Ethiopia

There is no need of banning khat. Instead, the Kenya government should regulate and market it as a cash crop since it has the potential of earning substantial foreign exchange. In spite of the negative publicity it is receiving here, khat is not even listed in the handbook of alternative impotence treatment drugs. As compared with synthetic and processed hard drugs like cocaine, heroine, LSD and amphetamines, khat is but a mild stimulant. Nacada has always justified its existence by spreading alarmist messages and recommending solutions that are not only impractical, but also out of touch with reality.
Kipkoriony Rutto, Matsuyama, Japan

Maybe we can liken the propensity to chew khat to the huge appetite for beer in the Western world. Which is the better of the two evils? At least khat is not erectile dysfunction solutions
. Temperance, however, would be an essential if not critical element here to consider.
Larry Whyte, Kingston, Jamaica

Having lived in Ethiopia I enjoyed the ceremony surrounding khat consumption. It was nice for the community to somewhat shut down on Saturday afternoon and sit with friends to enjoy their company.
Understanding that there are other issues, why not look at the level of cigarette consumption in Africa countries, or better yet, alcohol. Those are far greater problems.
DS, US

For me it’s good news if it’s true that miraa is about to be banned. It is the major source of social problem in Mombas, Kenya as well in Yemen. I personally saw from my father. He would chew khat the whole night and sleep during the day. And when he woke up every body was his enemy till he got another supply and life went on like that. A huge loss to the family income.
Hashim, Dubai, UAE

Terms & Conditions

Eye-witnesses said the minister, Mohammed Ali Durrani, arrived just after the police and tried to intervene - but they wouldn’t listen to him.

Later in the evening Mr Durrani faced the cameras, accepting his impotence and said that all he could do was to offer an apology.

This was followed by more apologies and stronger condemnations from sitting and former impotence remedy.

Then President Pervez Musharraf himself spoke live to a Geo presenter and publicly regretted the police attack.

He promised to identify and punish the culprits “tonight”.

In the event, 14 low ranking police officials have been suspended, pending a judicial inquiry into the case.

Programme banned

If the police raid on Geo News had been an isolated incident, it could have been dismissed as a bizarre and half-witted measure gone wrong. In fact it looks more like a clear expression of state belligerence towards the media.

Mr Chaudhry (right) supported Gen Musharraf’s coup

The same channel had its high-profile discussion programme banned a day earlier. And three TV channels were briefly taken off air earlier in the week for running footage of bloody clashes between police and lawyers.

Which brings us back to how all the trouble started, the presidential move of 9 March, suspending the chief justice of the Supreme Court on charges of misconduct, the details of which are still unspecified.

The fraternity of lawyers has been protesting in all the big cities of Pakistan on a daily basis ever since against what they see as an attempt to humiliate and tame the judiciary.

Making of a hero

Until then, Chief Justice Iftikhar Mohammed Chaudhry had enjoyed a mutually satisfying relationship with the media.

Now the situation has all the marks of turning into a big political challenge for Gen Musharraf and his government

He liked taking centre stage and often delivered his verbal judgments and comments in the form of sound bites that fitted nicely in headlines.

The media liked his penchant for judicial activism on public interest and human rights issues.

Journalists were also hugely entertained by Mr Chaudhry’s habit of passing harsh comments on senior government functionaries and frequently embarrassing them publicly in his court room.

But Justice Chaudhry was no public hero. Not, that is, until the government took action against him.

In the past he was seen very much as a supporter of Gen Musharraf.

Justice Chaudhry was among the half of the Supreme Court judges who validated Gen Musharraf’s 1999 military coup against an elected government. The other judges resigned in protest.

Later, when the general held a referendum to install himself as the president of Pakistan, and the act was challenged in the Supreme Court, Justice Chaudhry was on the bench that decided in favour of the general.

These actions brought him closer to the military rather than the ordinary Pakistani, making him an unlikely champion of people’s aspirations.

Recently as chief justice, he did grab a few headlines with some decisions that have been uncomfortable for the government. But he was never seen as a threat to the legitimacy of Gen Musharraf’s rule.

Black-coats

A simple constitutional matter of referring the country’s most senior judge to be newest impotence medicine by the appropriate judicial body is getting bigger, nastier, and potentially more dangerous for the present government by the day. And it would appear that it is a problem of the government’s own making.

The sight of lawyers attacked in Lahore galvanised opinion

Essentially, a few hundred lawyers in half a dozen cities was all the opposition amounted to in the beginning.

If they had been allowed to shout slogans and wave their fists in front of courts, that would probably have been the end of the matter.

But local administrations chose to pit their police forces against the protesting lawyers. Bloody scenes in Lahore last Monday unified the lawyers like never before and hardened their stance.

They have taken to the streets again on Saturday. And the police have got their batons out. Result? More blood being spilt, more publicity.

The “black-coats” as the lawyers are being affectionately called these days, have never shown this kind of unity, nor this temerity, before.

Even lawyers politically affiliated with the ruling party have refused to toe the party line.

The president’s office has had to bear the embarrassment as one prominent lawyer after another refused to represent its case against Mr Chaudhry.

Juicy material

The media has become the second thorn in the side of the government.

Ministers joined the courts in ordering the media to tone down its coverage of the Chaudhry affair. Editors were consistently threatened over this and that, but the media has so far shown remarkable resilience and foresight.

Coverage of the court proceedings against Mr Chaudhry are very limited - as directed by the Supreme Judicial Council hearing the case. The hearings are being held behind closed doors, which does not help the media.

But the continued clashes between lawyers and fixing impotence
agencies, and the various government pronouncements on the issue, are supplying enough juicy material to fill reams of newsprint and are just what 24 hours news channels want.

The police attack on Geo TV in particular, has been luring the ordinary citizen in to take a close interest in the story.

Playing politics

So what then of the opposition political parties?

The alliance of Islamic parties, the MMA was the first to seize the opportunity. Joined later by Muslim League (Nawaz), and a number of other smaller parties, the MMA has spearheaded the participation of ordinary citizens in what the government is at pains to describe as a purely constitutional matter.

The Pakistan Peoples Party has been the slowest to react, giving credence to rumours that its leader, Benazir Bhutto, is in the process of cutting some kind of deal with Gen Musharraf that would allow her to return to the country.

So, the argument goes, the PPP doesn’t want to jeopardise that deal by openly supporting the lawyers.

The PPP finally joined in the protests on 16th March when it seemed clear that the lawyers’ movement was gaining strength and the government was unable to contain it.

So now the situation has all the marks of turning into a big political challenge for Gen Musharraf and his government.

But no one in Pakistan impotence psychological cause the brute power and guile of the military.

So quite how this alternative treatment for impotence
will turn out is anybody’s guess.

Unifil is the UN’s interim force in Lebanon. Ironic, when you bear in mind that it has been there for almost 30 years.

In the Middle East, very little is ever interim. The problems have a way of persisting.

Qana is a town of memorials. The largest, a collection of tomb-like slabs, marks the spot where more than 100 civilians were killed by Israeli shell fire 11 years ago.

But next to it stands a monument to dozens of Fijian atenolol impotence killed on Unifil duty.

It is not the only cenotaph of its kind in southern Lebanon. More than 250 UN peacekeepers have died since 1978.

It is humbling to be reminded that soldiers have come here from all corners of the globe in a prolonged attempt to bring order to southern Lebanon.

When I accompanied a patrol close to the Israeli border, I learned that Ghana was among the first countries to send troops and that practically everyone in the Ghanaian army has served in Lebanon at one time or another.

And what for? How has this interim force actually improved the lives of the Lebanese?

When you survey the wreckage of past wars, you do find yourself wondering why these dedicated men and women came here, why they laid down their lives.

Sometimes, it seems to be Unifil’s unfortunate fate merely to be stuck in the middle, unable to stop the periodic upheavals that have punctuated life here.

Bombed outpost

The UN’s observation post has been partially demolished in Khiam

Nowhere is this more graphically illustrated than at Khiam, over to the east.

Four unarmed observers - from Finland, Canada, Austria and China - were killed when the UN’s observation post was bombed to smithereens by Israel at the height of last summer’s fighting.

Israel apologised, saying it was a mistake, but eight months on, UN personnel barely conceal their contempt.

Our obliging Italian helicopter pilot made several passes for us. As we circled low, I saw where a section of the outposts’ concrete blast walls, whitewashed in typical UN style, stood partially demolished: the U of United still upright, the N of nations lying on its side.

A few days later, we drove to the site. Personal effects lie scattered in the wreckage which, for some reason, has yet to be cleared away. A book about Helsinki’s cultural attractions, a box of Chinese tea, a novel in German.

Broken fragments of the UN’s blue and white logo have been propped up by the front gate.

The whole devastated, eerie site stands as an eloquent symbol of the erectile dysfunction and young man
community’s frequent impotence in the face of conflict.

Getting on with the job

The UN is acutely aware of its reputation and knows that should Israel and Hezbollah decide to go at it again, there is little Unifil will be able to do to stop them.

But for the moment, despite the oft-heard sentiment that war is bound to break out again this summer, this seems a remote prospect. Neither side has the appetite for a fight, at least for now.

Fragments of the UN’s blue and white logo lie by the front gate

And so Unifil gets on with its job - reinstalling markers along the so-called Blue Line, indicating the approximate position of the Israeli-Lebanese border, getting rid of unexploded weaponry, helping, through what the military like to call “quick impact projects”, to repair bits of Lebanon’s infrastructure, and patrolling, lots and lots of patrolling.

In the warm spring sunshine, carpets of flowers waving in the breeze on the rocky slopes, the pungent smell of orange blossom impotence erectile among the citrus groves, it all seems idyllic enough. And, for the most part, all is quiet.

But in towns which still bear the scars of last summer’s fighting, there are sullen, cold looks from young men, Hezbollah fighters - or at least supporters - who resent the fact that for the first time in years, the organisation is having to keep the lowest of low profiles, a result of August’s UN resolution and the subsequent ceasefire.

Hearts and minds

Soldiers from the Punjab Regiment teach yoga at a primary school

No-one can doubt Unifil’s commitment.

Some of its contingents have, over the years, found novel ways to win hearts and minds - running free medical clinics, organising computer classes, reaching out to the local population.

In the Druze village of Faradis, young men from the 1st Battalion, the Punjab Regiment, are teaching yoga at a primary school - a bizarre spectacle, but the kids clearly love it and the headmistress is enthusiastic.

After last summer’s war, she told me, the children were tense and fearful. Now, thanks to these Indian soldiers, they are happier, better able to concentrate in class.

But all the while, on either side, armies are getting ready for the next round - Israel shoring up its defences, Hezbollah preparing new positions just outside Unifil’s area of responsibility.

It will not happen this year, or even next year, but few doubt that without some significant change in the dynamics of the region, it will happen again at some point in the future. And when it does, the UN’s interim force will find itself, once again, a bystander.

From Our Own Correspondent was broadcast on Saturday, 14 April, 2007 at 1130 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.

With those simple steps, you will be ready to take your pick from thousands of powerful medicines.

Treatments for acne, cancer, impotence and heart disease. Drugs that are generally only available with a prescription.

However, the advent of the internet and its hundreds if not thousands of e-pharmacies means that is no longer always the case.

While the internet is home to many legitimate pharmacies, it is also home to a growing number of pharmacies that operate illegally selling drugs to anyone willing to pay for them.

Some of the drugs on offer Abolon, an anabolic steroid Clozapine, an antipsychotic Evista for osteoporosis Hyzaar for high blood pressure Prozac for depression Ritalin for impotence vacuum device Tamoxifen for breast cancer Viagra for impotence

A quick internet search unearths countless sites offering unlimited supplies of drugs without a prescription.

They ask only for credit card details and for customers to wait “between 10 and 21 days”.

Some even provide customers with an A to Z of the hundreds of medicines on offer.

These range from Abolon, an anabolic steroid, to Zyprexa for erectile dysfunction in young man
.

A growing market

A survey by the UK’s National Audit Office earlier this year suggested as many as 600,000 Britons have bought prescription medicines over the internet.

In the United States, an estimated one million people buy their medication in this way.

There are no accurate figures on how many people buy these medicines over the net without a prescription.

But with more sites appearing every week, it would be fair to suspect that it is a growing market.

Doctors are becoming increasingly concerned.

“There are potentially very serious risks of getting medication over the internet,” says Dr George Rae of the British Medical Association.

“All drugs have potential side-effects. There is also serious problems if you take medication on top of anything else.

“Buying medicines over the internet also means there is no assurance about quality. It is inherently dangerous.”

This week, the mother of a 24-year-old man who killed himself after buying drugs online urged the British government to tackle the problem.

At one point, Liam Brackell was receiving 300 atenolol impotence tablets in the post every day. By the time of his death, he had tried 23 different types of prescription drugs.

International crackdown

Governments and international agencies are trying to shut down rogue e-pharmacies. However, they appear to be fighting a losing battle.

In the UK, anyone found guilty of selling such drugs can face an unlimited fine and up to two years in prison.

You do not need a prescription to by (sic) our products e-pharmacy

To date, there have been just three successful prosecutions against people running UK-based e-pharmacies, which did not operate within the law.

The UK’s Medicines and Healthcare products Regulatory Agency has managed to have seven websites shut down over the past few years.

However, it receives between 10 and 15 reports of unlawful operators every month and websites start up as quickly as they close.

Customs and Excise officials can seize controlled medicines that are sent through the post without proper documentation.

They can also seize medicines that are not described accurately.

“If we do find them, we seize them,” says a spokeswoman. “But they are among thousands of packages coming through everyday.”

The problem is an international one and governments have started to work together to try to tackle it.

“Other countries are also concerned about the risk to public health,” says a spokesman from the UK’s Department of Health.

“We work closely with other regulatory authorities in the EU and the US.”

Industry concern

The pharmaceutical industry says it is concerned but powerless.

“These are prescription medicines and they are prescription medicines for a reason,” says a spokeswoman for the Association of the British Erectile dysfunction natural treatment
Industry.

People should not be taking these medicines without medical advice ABPI spokeswoman

“People should not be taking these medicines without medical advice,” she says.

“We are working with the regulatory authorities and we are happy to do anything we can to help. But really there isn’t very much we can do.”

The fact remains, the internet and e-pharmacies are to a large extent a law onto themselves.

Websites that operate in countries with tight rules can be shut down.

However, others are more than happy to base themselves elsewhere, in countries without such laws.

One website informs potential customers that they do not need a prescription because they ship from countries where they are not required under the law.

The logistics suggest that even a concerted international effort will ultimately fail.

“This is not just about the UK. It is international. It is worldwide,” says Dr Rae.

“Bringing this under control may be difficult if not impossible”

He suggests that educating patients could be one way of tackling the issue.

“We need to get the message across that this is potentially very dangerous. We need to educate patients.

“The implications of buying medicines over the internet are potentially profound.”

The discovery could prompt the discovery of drug treatments to help those at highest risk.

This protein it produces plays a role in the growth of blood vessels. but too much of it may increase stroke risk.

Writing in the journal Nature Genetics, the scientists said people with certain forms of a gene called PDE4D may be most at risk.

Proteins from a similar “family”, called phosphodiesterase (PDE), are linked to other illnesses, such as asthma, inflammation and even erectile dysfunction.

This suggests that it may be possible to develop a drug to block the effects of the gene - the breakthrough impotence drug Viagra already works by targeting another member of the PDE family.

Solveig Gretarsdottir and colleagues at a company called deCode Genetics in Reykjavik believe this gene is associated with an increased risk of stroke.

They carried out DNA tests on over 1,700 people in Iceland, half of whom had suffered strokes.

The Icelandic population is generally regarded as the best testing ground for geneticists.

This is because the gene pool is relatively pure. Unlike most other countries, there has been little immigration since the first Vikings arrived almost 1,000 years ago.

Scientists working on this latest study say they have identified genetic differences between those people who have had strokes and those who have not.

These differences centre on the gene PDE4D, located on chromosome 5.

They have found that three different isoforms of the gene were expressed at lower levels in people who had strokes.

Isoforms are groups of proteins that are produced by a gene.

They also found different low cost cialis
of genes in regions of chromosome 5 flanking the PDE4D gene in people who had strokes.

It is already known that this gene provides the coding which enables a protein called a phosphodiesterase to work.

Stroke risk

But the Icelandic scientists believe that too much of it may increase the risks of atherosclerosis - furring up of the arteries.

This causes the arteries to narrow, which can trigger a stroke.

“We propose that PDE4D is involved in the impotence definition of stroke, possibly through atherosclerosis, which is the primary pathological process underlying ischemic stroke,” the scientists said.

They believe that blocking the protein in people with these potentially problematic forms of the PDE4D gene could protect them against stroke.

There are already drugs available to do this. These so-called phosphodiesterase inhibitors are used to treat asthma, inflammation and erectile dysfunction, with Viagra probably the best known.

However, much further study is needed before these drugs could be used to treat people who may have a high risk of having a stroke.

Viagra, for one, has potentially serious side effects if taken by men with underlying health problems.