Sunday, 28 June 2009

Thoughts on Detoxification, Treatment and Rehabilitation of Drug Addicts in Maldives

The problem of heroin addiction in Maldives is of undeniable concern for our entire community. We are fortunate that our leaders are thinking out of the matrix, on finding ways to deal with this issue and have probably initiated work that brings new hope for those struggling to cope with heroin addiction and the burdens associated with it.

I think, the idea of getting expertise from the international community, bringing them home to run a rehabilitation program in our country is definitely a better idea than sending big batches of addicts to rehab centres outside the country for long periods . In this way, we will have the opportunity to benefit from the time-tested methods of addiction management within our own socio-cultural milieau, and allow the opportunity for better community rehabilitation, especially facilitating the inclusion of family in the rehabilitation process.

Further, the idea of having a detoxification centre as announced by President Nasheed is again wonderful thinking. Definitely, detoxification is the first step involved in the treatment and rehabilitation for addiction and having the opportunity for detoxification in our country is an absolute must.
However, I was wondering whether we really need another 'centre' for detoxification?

In 2000-2001, a small unit for detoxification was built within DRC, Himmafushi. However, it is left for one to evaluate how well this unit was used to achieve its goal. If one reads the Auditor General's Report on NNCB, we do get to feel, that this centre and NNCB along with several components of its program are definitely worthy of further scrutiny.
Are we for example, using the available resources in terms of infrastructure to deliver proper services? Why don't we develop the centre which we already have to deliver additional services? If we do not have enough counsellors, psychologists, NA senior members, etc...can we not employ such technical people from the international community so that the recovering addicts can get proper and desired treatment (until we have trained enough people in the field) ?

I do believe, we need to detoxify each and every client who enter our treatment and rehabilitation program.... but my problem is this: do we need to invest in a new 'Detoxification Centre' in terms of infrastructure and do we have the manpower required for such a commitment?

Considering the limited resources we have and thinking of the existing facilities already available within the country, I was wondering why we may not go for options such as training groups of doctors or primary care physicians in the detoxification process instead and allow them to detoxify the clients in the general hospital setups in the country. Yet, I do understand, there may be some hazards associated with this, such as safety and security concerns of others admitted to the hospitals...but there are ways to overcome such hazards too.

Another option would be to send mobile teams of medical personnel along with deaddiction specialists to the island communities and to conduct detoxification camps. The team could conduct 1-2 week detoxification camps, start meetings and educate the community while based on these islands and then hand over the follow-up to those in the health centres. Those needing further care may be referred to other sources of help which may be available within each island, for example, there may be counsellors or people who could work as mentors, etc...

Many countries have special detoxification wards within the hospital set-ups. This is something that could perhaps be done in some of the regional hospitals in Maldives.

By allowing these people to be treated by the doctors in their island communities through detoxification in Regional hospitals and/or health centres, we will be providing the opportunity for rehabilitation within their own communities, while they are still with their parents , family members, religious scholars and peers. Thus, intergrating de-addiction management (at least the most basic and fundamental) within the existing health care system of the country.

Further, if the island communities can start small NA and NARANON meetings in the islands for those who undergo detoxification (with the help of NGO's who are already conducting such meetings in the country) this would be a golden opportunity for many to come out of this malice. NA members need encouragement and support from these island communities so that they can start and support these groups until they can run it by themselves.

Such a method of care may be especially useful for first timers . However, those who are unable to benefit from simple detoxification alone, or those with other comorbid problems or whose addiction severity demands further care and long term rehabilitation with the guidance of mental health and deaddiction experts, can be refered to the rehabilitation centres. Again, one could question whether those with history of offending and without such history need to be segregated....while they undergo such long term rehabilitation.

I have personally been involved with such detoxification camps in some of the South Asian countries and worked at some of the detoxification wards in general hospital setups and also in mental health set ups. I am aware that it is well received and has been found to be cost effective and reported to be useful.

These ofcourse are just some of my thoughts as I ponder on why we need to invest on another detoxification centre, while we have so many existing facilities that can be triggered with a single program to reach to every addict in the country, no matter which island they are living in. The emphasis of plucking these people away from the home island and bringing them to another Centre worries me.

What is required is additional training of primary health care professionals all over the country by a team of deaddiction professionals, dedicated only for this purpose who would take the responsibility of leading, monitoring, establishing minimum standards, facilitating and following up the program all over the country................!!!!....

Alternatively we may choose to just clap our hands as the ribbon for a new detoxification centre gets cut!


The Shadowrunner said...

This is what we need - but I don't think it'll happen so easily; have you seen how the mullahs scream that "there is no coming back" for drug addicts?.

It will take a great revolution of society before such steps can be effectively taken through.

naseer said...

Earlier, a group of maldivian doctors partnered with an American firm to take-over the rehab facilities in Himmafushi, and also invest in re-developing the facilities and introduce scientific methods of detoxification and rehabilitation. However, somehow an agreement between the government and that party was not reached in a later stage. I wonder such a partnership could be arranged again, so that we can utilize help from professionals of other countries.