Horror of River Road’s deadly cosmetics

My friend and I, a slim girl, just as I am, are walking down the bustling Nairobi’s River Road when we ask for the location of Mombasa Rest House.
“Oh, kule kwa mafuta (oh, the place of cosmetics)?” poses a matatu tout before making a 180-degree turn to point at a multi-storey building yonder. Bystanders throw curious glances from the corners of their eyes, as if to confirm who the culprits seeking the infamous building are. Apparently, ‘mafuta’, once an innocent Swahili noun, now has a weird meaning.

Body enhancers

It refers to body enhancers – the ones that young women in pursuit of a killer body would use to enlarge their hips, buttocks or even breasts to attain the full figure that is considered the hallmark of African beauty. It is also associated with fertility.
In this lower section of the capital city, synonymous with crime and fake products, also thrive unregulated clinics that offer backstreet injections, gels, creams and pills for butt and hip enhancement, as well as skin bleaching. This practice has become increasingly popular with young women and a huge source of worry for medical experts.
We follow the tout’s directions, but hardly have we reached the first corner of the building when we see women, lined up as hairdressers do outside a hair extension shop. They whisper as we pass: “Mami mafuta, mafuta.” They are a bunch of illicit beauticians scrambling for customers.

They all look like they’re up to no good – possibly because they know they are cashing in on illegal trade. They vet potential customers by looking them in the eye. We later learn this is their way of detecting whether you’re a genuine customer or a government official on a crackdown mission. In the 1990s, the Kenya Bureau of Standards (Kebs) banned cosmetic products containing hydroquinone, steroids, mercury, hydrogen peroxide and other elements that are harmful to the human body.

Clueless
What’s puzzling is that Kenyan authorities seem clueless on how these unlicensed products get into the country despite the many regulations associated with the importation of such goods.

When we approach Kebs with the products we eventually purchase, the parastatal, whose job is to test goods for quality, and to license the importers of cosmetics that pass muster, disown the products, saying they are pharmaceuticals and do not, therefore, fall under their mandate.

We cannot test these products because they don’t fall within our mandate (and we) don’t have the capacity to break down the components even if we wanted to,”

Mr Danson Maina, the licensing manager, says. Asked how such uncategorised products end up in the market, he says that is not for him to answer.

The National Quality and Control Laboratory (NQCL), which tests medicines on behalf of the Pharmaceutical and Poisons Board (PPB), also distances itself from our samples. NQCL’s senior deputy director, Dr Pius Wanjala, refers us back to Kebs, saying the samples are not medicines but “goods”, which fall under Kebs docket, not theirs. “Those are categorised as goods. They lack the phamacoepea standards that we use but Kenya Bureau of Standards (Kebs) can do,” he advises us.
Clearly, no one has tested these products for efficacy or danger, neither has anyone attempted to stop the sale of the products whose existence is an open secret.

Infertility
Medical experts have warned that some of the ingredients found in such products have contributed to rising cases of infertility in the country, and may cause cancer.

The women on the street assess us for customer potential; if a woman shows interest in what they are saying, they will reveal more details: “Tako (buttock), boobs, hips, or bleaching, tuko na zote (we have them all).” We follow a group of four, who seem to be business associates, into a cubicle the size of a big-roomed pit latrine. The shelves are filled with all sorts of creams and gels; you can barely see the colour of the wall.

“We are new to all these. Could you tell us which is best to enhance our behinds?” we ask.

The four, who can hardly complete a sentence in English, unanimously tell us pills will do.
“You are well-rounded already and your hormones appear to be high, so an injection wouldn’t be necessary. Just a little increment on the hips, and some bum-tightening and you’re good to go,” explains one of the women who identifies herself as Maggie.
They add that as much as injections have instantaneous results, their side effects are detrimental to fertility. That said, skinny girls who are determined to grow a figure eight overnight have no salvation in pills or creams. They have to get the jab.

Injections

Injections cost Sh20,000 for 10 millimetres of the drugs while pills cost an average of Sh3,000.
At Sh1,000 or less, creams and gels are easier on the pocket but the women say those are a life-time commitment.

“This one, if you stop using, your hips deflate to the size they were at the start,” says one woman, pointing at a gel concoction.

As they speak, their third colleague – who happens to carry a humongous behind that she credits to pills – deliberately shakes it for us to illustrate that the pills work. Maggie reveals that the only reason she is yet to swallow the pills is that she is breastfeeding.

We settle on pills. One of the four ladies dashes out to collect three samples; C-4, Cypomex and Dr James Hip-Up and Stretchmark Capsules. The women tell us most women prefer C-4, although our own research indicates that Cypomex is more popular with online shoppers.

C-4 is actually an anti-histamine. Its active ingredient, cyproheptadine, is used to relieve allergy symptoms. It is unclear what Cypomex is made of.

Herbs
The manufacturers of Dr James capsules indicate theirs is a “supplement” with “natural ingredients” such as Kigelia africana (better known as sausage tree), Pueraria mirifica (a plant primarily found in Thailand), ginseng and curcuxan (turmeric), among “other herbs”.
“Do you want hips too, or just butts?” the lady asks us.
“Both,” we respond.
“If you want both, you can swallow one and insert another into your anus,” she explains, noting that it works best if we ingest one brand and use another as a suppository.
What are the side effects, we ask? Sleepiness, they say; use the drug at bedtime. And to crown it all, they give us a number to call if the body reacts or if we are dissatisfied.

We question the prices; one of the ladies says the pills are a worthy investment that will pay off by attracting rich and good-looking men. “You will not regret. Tell your boyfriend to send you money to buy a dress you like – just don’t tell him (that you are using the money to buy these pills),” she advises. “After using these products, you will be hot cake. Men will chase after you like never before.” The women giggle and nod their heads.

Side effects
Later on, we speak with Dr Mike Magoma, a senior pharmacist, who confirms that C-4 is used to alleviate allergy symptoms. “Its side effects include increase in appetite, so people take advantage of them to gain weight,” he explains.

Some of them have multivitamins too, making it easy to gain weight. However, the growth is not specific to particular parts of the body.

Asked how inserting the pills in the anus helps, he says: “I have never heard of such a method of administering the drug. This is the first time.”

Finally, he cannot comment on Cypomex because there are no specific ingredients listed.

Meanwhile, back at the shop, we ask the four women to introduce us to a lady they say is a professional nurse who offers injectable butt boosters. “Many of those who inject people in this River Road claim to be professionals yet they are not,” the women say, “But we can assure you, (this one we are recommending to you) is a real nurse.”
The “nurse” operates clandestinely and in constant fear of law enforcers. If you walk into her “clinic” by yourself, she will swear upon her life that she doesn’t know what injections you’re talking about.

Tiny stall
And to support the lie, her tiny stall sells a weird combination of items: five hair wigs, three bags, one bottle of Albedazole (usually for deworming) and tens of bleaching creams, among other insignificant things. These are her decoy.
My friend will act as her client. The nurse only allows us into her “clinic” because we were referred by Maggie, but she (nurse) refuses to divulge her name or the name of the drugs she intends to use on my friend, her client. She only says they are supplements.
“You know this trade is illegal. I can only show you the substance once you raise the Sh20,000 and make up your mind that you are doing this,” she says, bragging that some of the unnaturally large hips we see in the streets are the work of her hands.
To defend the price, she tells us how risky it is for her to import the illegal drugs – from ordering, and re-labelling the packages to throw off suspicion, to dodging government operatives at entry points and bribing their way through checkpoints. By the time the products rest in her hands, she has agonised and prayed they reach safely.
Ms Florence Rotich, a Kenyan working as a nurse in the United States, clarifies that there are no known supplements that can enhance one’s body in such a manner, and that only exercise and orthopedic surgeries by a professional doctor can bring the much-desired curves.

Marketing gimmicks
“These are marketing gimmicks. They don’t work,” she says. “There are no medications of any kind that are proven to work except surgical interventions. For instance, fat and cells can be removed from the belly and injected in the butt in what is called fat-grafting,” she explains.

“Minimal enhancements can also be attained through exercise. Once the belly gets flatter, the butt naturally appears bigger and leaner.”

We set out to find user reviews. A university student who claims to have doubled her hip-girth through an injection in a River Road clinic says she does not know the name of the substance used on her, “but it worked”. We ask around and discover she may be referring to steroids or silicone gel. These are said to be commonly used in Nairobi.

Ms Rotich says that although illegal in the US, the dangerous practice of using injections to grow big backsides still booms there. It has been nicknamed ‘Brazilian back’ because the trend is believed to have originated from the beach-rich Brazil, where every girl dreams of rocking a bikini without being conscious of a sagging or imbalanced body.

Plastic surgeon
Pop stars like Beyoncé, Kim Kardashian and Nicki Minaj, who flaunt what is deemed the perfect body shape, also seem to have inspired fans across the planet to seek to look the same.

But very few can afford the services of a plastic surgeon, thus the demand for cheaper, dangerous options.
For instance, silicone was traditionally supposed to be injected into pouch-like fillers and inserted surgically on each side of the bottoms, but some shoot it directly into the buttock tissues, causing leaks.

This silicone can travel to other parts of the body, with potentially fatal side effects.

If silicone is accidentally injected into blood vessels, it can travel to the heart and lungs, causing death. The materials are also soft and don’t stay in a single location, leading to hard lumps called granulomas,” writes Healthline, an online platform where professionals share medically reviewed content.

Attempting to flush these substances out of the body could do more harm than good, leading to scars and inadvertent spreading of the materials. This increases the user’s risk of side effects.
Steroids, on the other hand, are common performance enhancers for athletes and bodybuilders because they are anabolic, meaning they increase bone and muscle mass.
A Healthline article by Dr Cynthia Cobb, a nurse and faculty member at Walden University, states that anabolic steroids help the body’s muscle cells produce more protein, which leads to increased muscle size and strength and, at the same time, allows the body to produce more Adenosine triphosphate (ATP), which energises the muscles to move. However, this only works if the athletes work out in addition to using the steroids.
It is this science that beauticians bank on to pump up the buttocks.
Dr Kireki Omanwa, a gynaecologist and obstetrician, says both steroids and silicone have a detrimental effect on human body functions, with infertility being the common result for the two substances. They also interfere with the proper functioning of the heart and other body organs.

Medical situations
“Steroids are not good. Even in medical situations, they are used in limited and specified areas, like on autoimmune conditions. Patients put on steroids have to be closely monitored as it could affect not only their reproductive health but also the general functioning of the body,” he warns.

Steroids enhance one’s appetite, leading to increased body weight and laying thee ground for metabolic syndrome. Dr Omanwa notes that excess amounts of fat affect the reproductive system. “Body Mass Index of more than 30 has dire consequences. It affects the way the endocrine system, which produces hormones, works, which in turn destabilises other functions of the body,” he explains. Sadly, steroids are readily available over the counter in Kenya, which should not be the case.

Silicone, on the other hand, induces an inflammation, resulting in the hyperactivity of the immune system as it tries to fight the foreign bodies. That is how secondary infertility sets in.

“To conceive, the immune system has to be quiet (not hyperactive) because pregnancy is another foreign body too. Using silicones and trying to get pregnant don’t go hand in hand,” explains Dr Omanwa.
There have been reports of rogue practitioners using fake or nonmedical-grade silicone, like silicone sealants (cement) used in household construction to seal bathroom tiles and floors.

In Florida, a woman died after falling victim to cement injection. These rogue practices are feared to have ended up in Africa and closer still, Kenya. On River Road, there are more risks than just the questionable composition of the drugs. Unlicensed providers operate in unsterile environments, which could increase the risk of infections and even death.

Testing products
Besides our attempts to get government assistance in testing the products to ascertain their ingredients, we try a number of private laboratories. The University of Nairobi lab, premised within Kenyatta National Hospital, comes highly recommended, so we pass by their lab. They tell us they do not have the capacity to test them, and refer us to the Kenya Medical Research Institute (Kemri).
At Kemri, the woman in charge of the microbiology laboratory keenly studies the writings on the packaging of the products and says the tests we need are for chemicals rather than for microorganism contaminants like bacteria. They usher us to the Kenya Public Health Research, which runs the national food safety and nutrition programme. “We only deal with food and mycotoxins. You might have to go to Kemri or NQCL,” the last lab offers.
Almost every lab we speak to tells us the same thing: there is a lack of capacity to break down our samples and analyse them. And so we leave it at that, not knowing what it is women are actually injecting or ingesting in their efforts to achieve the treasured “figure eight”, and also wondering exactly what kind of dangers they are exposing themselves to as a result.