Picture this: A dimly lit room, the sound of bubbling water, and friends gathered around a hookah, enjoying the flavours of shisha.
But amidst the allure and companionship, there's a hidden story.
Shisha is a glass-bottomed water pipe in which fruit-flavoured tobacco is covered with foil and roasted with charcoal.
The tobacco smoke passes through a water chamber and is inhaled deeply and slowly.
In 2017, Kenya implemented a comprehensive ban on shisha, including the use, import, manufacture, sale, offer of sale, advertising, promotion, distribution and encouraging or facilitating its use.
Kenya became the fourth country in East Africa to prohibit shisha after Uganda, Tanzania and Rwanda.
But even after the ban, shisha is still widely sold in the country, especially at upmarket nightclubs, and is popular among socialites and sportspersons.
Carol (*not her real name) started smoking shisha four years ago back in university after being introduced by her friends.
She saw her female friends smoking and she was curious to try and get to know how it felt.
“It’s not something that was in my mind. A female friend of mine was smoking and I was like, let me try,” Carol said.
“I tried but it was so uncomfortable at first because I didn’t know how it was done. I didn’t know if I was supposed to swallow the smoke, or even how it comes out.”
She added that it was a challenge mastering the art of smoking shisha since she didn’t know how to play with the smoke like her friends, but with time, she mastered and could comfortably smoke in and exhale the smoke through the nose.
“With time, I could remove the smoke with both my mouth and nose. And it was fun,” she said.
“You get that head rush that makes you feel good for some minutes.”
THE FLIPSIDE
Fun as it was, Carol noticed that there was a problem.
She could not deal with the aftereffects of the substance as they come with a severe headache.
“The problem was that the next morning, it was always hell because of the headache. It was some sort of hangover,” she said.
“The headaches were terrible to the point that even lifting my head felt impossible and I had to take painkillers. ”
Despite her experience with the tobacco product, Carol still smokes but on rare occasions, adding that she is not much of a fan.
“With time you get to know what works for you and what doesn’t. Just like with alcohol, one can decide, for example, that Gin works for me and Vodka doesn’t. Or Vodka works and Whiskey doesn’t.”
Women in Nairobi are said to love smoking shisha. You will find a bigger number of them smoking in nightclubs or selling joints compared to men.
Carol said this is because the act makes them look and feel like cool kids or, rather, classic babes.
Apart from the aftereffects of shisha, Carol wants to stop using the substance because of its health effects.
In 2014, before the ban was effected, the Ministry of Health, in conjunction with the National Authority for the Campaign against Alcohol and Drug Abuse (Nacada), barred 19 shisha flavours found to contain bhang, heroin and cocaine.
In the activities preceding the ban, 79.2 per cent of the shisha samples collected tested positive for heroin.
I have friends who are so much addicted to shisha to the point they cannot go to a club if it doesn’t sell shisha. Others have the shisha bong at home, they smoke anytime they want or feel like it
PARTY ESSENTIAL
Jack* said he doesn’t mind trying new things, especially if they are not that much addictive.
He has been smoking shisha, but mostly with his friends and only at social gatherings.
“I loved it. My friends also love it, although they don’t use it that often. It only happens when we are in a social event. And also because it’s not addictive like other substances,” Jack said.
This is contrary to Carol, who said most of her friends are so hooked to shisha, they can’t have fun without it.
“I have friends who are so much addicted to shisha to the point they cannot go to a club if it doesn’t sell shisha,” Carol said.
“Others have the shisha bong at home, they smoke anytime they want or feel like it.”
On the reason shisha is loved, Jack said it is because most people want the ‘highness’ that comes with it.
He said alcohol does not give someone a consistent high unless they keep drinking more and more.
“When you add shisha to alcohol, you get a spike high. So if your high was at 30 and you take shisha, it will spike to 50,” Jack said.
“Then after maybe five to 10 minutes, it comes down. That spike is fun, really fun. Shisha introduces an element of enjoyment that alcohol cannot give you.”
Jack said shisha goes for around Sh1,500 to Sh2,000, depending on the night club, and can be smoked for 30 minutes to one hour.
To end the sale and distribution of shisha, Jack urged Nacada to work with police agencies in a collaborative fight against the tobacco product.
He said nightclubs are comfortably selling it without hiding because they have the protection of some police, who take bribes to allow them to sell.
“If they are selling it so openly despite being illegal, it tells you that they know even if they are arrested, mostly, it will not get anywhere.”
TOXIC FUN
WHO’s advisory note on waterpipe tobacco smoking links shisha to oral, oesophageal and lung cancers and possibly with gastric and bladder cancers as well.
There is also evidence of associations with respiratory disease, cardiovascular disease, periodontal disease, low birth weight, male infertility, gastroesophageal reflux disease and impairment of mental health.
Both Carol and Jack know the dangers of smoking tobacco-laced shisha too well, but they just can’t resist the substance.
“A puff or a session of shisha is like smoking between 100 and 200 cigarettes,” Jack said.
Indeed, WHO estimates that the volume of smoke inhaled in an hour-long shisha session is equivalent to smoking between 100 and 200 cigarettes.
The belief that shisha allows the smoker to inhale purified smoke is a misconception that remains prevalent in society today.
Nacada South Rift regional coordinator Robert Olweny said shisha usually contains tobacco, which is sometimes mixed with fruit or molasses sugar.
Popular flavours include apple, strawberry, mint and cola.
Olweny' added that shisha smoke contains high levels of chemicals and poisons, including carbon monoxide and tar.
“When burnt, tobacco produces more than 7,000 chemical substances, of which about 250 cause different types of cancer,” he said.
“They can cause diseases like lung cancer, heart disease and respiratory diseases. Shisha smoking is very dangerous.
He cautioned that even though shisha comes in different flavours, young people should know that it is hazardous and not cool as they think.
Olweny said a study done by Nacada in 2022 showed that there is a prevalence of shisha use among 18- to 24-year-olds of 1.2 per cent and among 25 to 35 years of about 1.6 per cent.
In terms of the population, that is quite high, he said.
“It’s quite popular and people have stocked it as much as it’s illegal, and now Nacada together with security agencies are trying reinvigorate the fight. With joint efforts with different multi-agency teams, we will increase the fight.”
He added that despite the attack on Nacada officials, journalists and security officers during a recent crackdown at a nightclub in Nairobi, they will not be deterred from the fight against shisha.
He added that the authority plans to roll out a programme targeting university, college and technical institution students.
He said this will discourage young people from smoking in their houses, where Nacada or security agencies might not be able to reach.
“There is a need to have sufficient awareness created about shisha smoking's harmful effects,” Olweny said.
Sensitisation of youth has to be undertaken at every educational institution, he said.
He called on the public and all stakeholders to support them because people might think that only 1.2 or 1.6 per cent of the population is using the drug.
“If let go, you will find that every young person is smoking shisha, and it might or will actually get out of hand, with the fact that it has negative health effects.”
CALL FOR ACTION
In an interview with the Star, Kenya Tobacco Control Alliance head Joel Gitali called for concerted efforts to eliminate shisha joints.
He said it is unfortunate that the number of shisha smokers is growing and little is being done.
“There should be a proper plan of enforcing the law to see that all shisha selling joints are closed and owners prosecuted,” Gitali said.
“But our porous borders, corruption, impunity and laxity of those in authority are to blame. Some of these goods enter through our ports and other legal routes manned by our own officers. We need action.”
He said it has become hard to fight illegal substances in the country because some senior politicians own the nightclubs that distribute, offer and encourage or facilitate the use of shisha.
He added that shisha is a banned business and product and it should not be tolerated.
“If we do not deal with shisha, our fight against drug abuse and illegal trafficking will remain rhetorical,” Gitali said.
“We can’t be talking of problems of mental health and a yet we are promoting a behaviour that is destroying our young people. These substances will increase cases of Non Communicable Diseases.”
Olweny also cautioned that the sharing of shisha tips poses health risks as a smokers can easily transmit contagious diseases.
He said even though everybody gets their own tip, they are bound to forget to change the tip every time the shisha pot goes round, especially if they are taking alcohol and shisha.
Cardiologist Dr Duncan Killingo said the harmful health effects of shisha smoking are mainly due to the presence of carbon monoxide, nicotine and tar, among other hazardous chemicals.
He said the carbon monoxide in the smoke competes with oxygen in the blood to form carboxyhemoglobin, leading to cell hypoxia and impaired cell respiration.
“The nicotine in shisha smoke has acute and chronic cardiovascular effects and increased heart rate,” he said.
“While tar is known to cause carcinogenesis, which is known to cause the formation of cancer, whereby normal cells are transformed into cancer cells.”
He warned that tobacco smoke generated from shisha has more than a thousand different chemicals, some of which are human carcinogens and tumor promoters.
Killingo said the amount of chemical compounds found in one shisha smoking session is a lot more than in a single session of cigarette smoking.
For women who are shisha lovers, he cautioned that smoking shisha while pregnant is associated with low-birth-weight babies and increased pulmonary problems for the newborn baby.
“There are also harmful impacts of second-hand smoke on the mother and the foetus,” Killingo said.
“Pregnant women should refrain from smoking shisha and exposure to second-hand smoke or passive smoke. It could also lead to infertility.”
He also said the sharing of the shisha tips could increase the risks of transmitting communicable diseases, such as tuberculosis and hepatitis.
He warned that if not properly regulated, the country could see an increase of people suffering from cardiovascular diseases, lung problems and cancer.
“The risk of cancer is something that might be seen increasing in future among young people who are exposed to shisha smoking if nothing is done about it.”
