For those of you not used to this reflex, know that it is brought about unconsciously. Sometimes, it may be due to an odd sensation in the throat, but mostly it is behavioural. This behaviour is acquired as one emulates one’s peers and elders repeatedly exhibiting masterful displays of this difficult skill. A novice will just give a short cough-like noise and spit out a small amount. However, as one gains competency, the reflex starts with a visceral roar of throat clearing. This vibrates and awakes the secretions from deep down one’s throat and propels this forward into the oral cavity. Expertly, the tongue receives this gooey ball and mixes it with saliva. All this is accompanied by a tremendous noise “khaak!” The whole process, being a reflex, remains unconscious and ingrained in most Nepali’s psyche. The fait accompli is the spitting that follows this visceral growl.

As the spit ball is gathered in the mouth, the person then unconsciously turns his or her head and propels this salivary rocket out of the mouth with a loud “thoo!” This thick mixture usually is directed towards the ground where it embraces the dust and the heat. As the secretion dries, the indwelling germs break free from their sticky shackles and gain independence. For any reflex there is usually a precipitatory event, but for the “Khakarne” reflex there appears to be none. Mostly it is habitual. As one gains mastery of this difficult and shameless act, one can operate in a completely autopilot mode.

I have witnessed many people display this reflex to varying degrees of expertise. I was fortunate to meet a true master in a lady who could talk to you and produce a masterful display of the “Khakarne” reflex will minimal interruption. As she continued to talk, I was awed by this masterful display. Like an expert concert conductor, she was able to produce this every 6-7 minutes oblivious of the mini-puddles that were forming around her. Surely, we as Nepalis and as a nation should feel proud of this reflex. I propose that we take ownership of this unique “Khakarne” reflex. We should make sure that it is written in the medical curriculum so that it is enshrined in our medical history books for generations to come. Amen.