Khat chewing in Yemen: turning over a new leaf.

Among the many products found in the bustling markets of the Yemeni capital Sana’a are bundles of stripped branches covered by scraps of cloth or plastic, put there to preserve the freshness of the tender oval leaves, known locally as khat. Grown in the surrounding highland towns, khat is picked at dawn from groves of the tall-growing Catha edulis plant and by midday has found a buyer who that same afternoon will devote three to four hours to its mastication. Khat chewing is a practice that dates back thousands of years in the Horn of Africa and the Arabian Peninsula where the khat plant is widely cultivated and known by a variety of names, including qaat and jaad in Somalia, and chat in Ethiopia. The chewing of khat leaves releases chemicals structurally related to amphetamines, which give the chewer a mild high that some say is comparable to drinking strong coffee. There is some debate about where the plant originated, but wherever it came from it has certainly been a part of Yemeni culture for a very long time. In the words of Qahtan AlAsbahi, implementation officer for the National Programme for Integrating Water Resources in Yemen: “There is no social event [in Yemen] without khat.” Sitting in animated groups, men and, increasingly, women (though never men and women together – that being the tradition in this Islamic country) talk and laugh while plucking the tender leaves from the branches and tucking them into the cheek, eventually forming a wad that can bulge almost to the size of a tennis ball. It is estimated that up to 90% of adult males chew khat three to four hours daily in Yemen. The number for females may be as high as 50% or even higher as young women take up the habit; a recent study for the World Bank estimated that 73% of women in Yemen chew the khat leaf more or less frequently. Meanwhile, a staggering 15–20% of children under the age of 12 are also daily consumers. The fact that khat is not considered by the World Health Organization (WHO) to be a “seriously addictive drug”, does not mean that its consumption is without physiological repercussions. “Khat chewers experience euphoria followed by depression, while people who are genetically predisposed are extremely vulnerable to psychosis,” says Dr A A Gunaid, Faculty of Medicine and Health Sciences, University of Sana’a. Gunaid also notes that there have been many cases of khat chewers experiencing persistent hallucinations. Khat can also affect sleep, leading to rebound effects such as late awakening, decreased productivity and day-time sleepiness. The effect of khat on the cardiovascular system is rather less dramatic, but increased heart rate and blood pressure are common side-effects, making khat very harmful for hypertensive patients. Meanwhile, according to a recent study, khat chewing during pregnancy results in lower birth-weights. Khat is also known to be excreted in breast milk, but no studies have been done so far on how this affects nursing babies. For Jamal Al-Shammi, head of a Yemeni nongovernmental organization known as the Democratic School, W HO /F F le ck