LIVING ON THE MARGINS: FOCUSSED GROUP DISCUSSIONS WITH DRUG USERS
IN 5 CITIES OF PAKISTAN
EXECUTIVE SUMMARY
Introduction:
To understand the perceptions, attitudes and practices of
any population, FGDs can be a very useful tool. Where FGDs have some limitations, it has many advantages as
well. One major advantage is that when
it is conducted with any marginalized or stigmatized population it can help to
understand the most complex situations in a holistic manner.
In the following discussions with drug users the
effectiveness of FGDs emerged in a pronounce way. The community of drug users who is otherwise a marginalized and
stigmatized population has shared their perceptions on variety of issues in
great depth. The group setting
motivated the participant who otherwise may not have discussed their issues in
such length.
Aims and
objectives of the study:
·
To
collect information on knowledge, attitude and practices of drug users
·
To
collect knowledge pertaining to experience of services set up for drug users
·
To
highlight barriers to accessing services
·
To
highlight barriers to safer use
Methodology:
The methodology used
in the entire process was participatory with emphasis on experiential
learning.
The protocol and
guide to conduct FGDs was developed in the capacity building workshop. Each question in the guide was discussed
within the purview of the objectives of the study and was finalized with the
consensus of the group
The FGDs were
conducted and transcribed by the lead consultant and his team assisted by NGO
teams from Peshawar and Lahore. A
facilitator from Peshawar was used to facilitate FGDs in Quetta and Peshawar
both whereas, facilitator from Lahore was used to facilitate groups both in
Karachi and Lahore. Transcribers from
Peshawar and Lahore were also used during this process.
A workshop on data
collation was held once the data was collected.The NGO participants were taken
through the entire process of collating the data manually. Reading transcripts, picking themes from
transcripts, looking at qualifiers, understanding the linkages between
statements were some of the skills that were emphasized in this three days
workshop.
Findings:
Some of the major findings are as follows:
1. Perception on health and its
link with drug use:
Majority of drug users link health with a drug free
life and sickness with drug use. They
see drug addiction as the most harmful disease. However they consider drug use to be a disease that has its roots
in emotional set backs in people’s life.
2. Disease and modes of
transmission:
Most participants have good knowledge of different
communicable diseases. AIDS and
Hepatitis emerge as two diseases that majority of participants know of.
They know the modes of transmission of these
diseases. The knowledge on how these
diseases are contracted is gained through television or is given by
organizations working with the drug users.
3. Drugs their potency and use of syringes:
Participants are naming various drugs that they use. Majority is naming heroin as the most used
and potent drug out of all. The other
drugs used are Charas, Opium, Bhang, Alcohol, Pharmaceutical injections and
tranquilizers. The mode of use differs
from one drug to another. Heroin is
consumed mainly through injections and sniffing. Majority feels that injection is the most lethal mode of
consuming drugs but the instantaneous effect it has on the drug users mitigate
the danger. Participants say that
syringes are available at drug stores but at the point of drug withdrawal no
one waits for new syringe and would use whatever is available.
4. Barriers in treatment:
Mostly non availability of funds act as a barrier in
getting oneself treated for drug use.
Other hindrances are inhuman attitude of staff at the places of
treatment, dirty facilities and unavailability of space at the treatment
centres.
5. Organizational facilities that should be there for drug users:
Majority wants clean water and bathing facilities at
any new treatment centre that is set up.
They also desire efficient and polite staff at such institution. Placement opportunities at these facilities
is another requirement pointed out by most participants.
Conclusion:
It is evident from the discussions that drug users
are isolated as a population. The
society does not accept them as productive and useful members and tries to push
them to periphery. However, what is
emerging from these discussions is that at the periphery other marginalized
populations do not accept drug users and co-existence with other stigmatized
population becomes an added problem for drug users.
Drug users exist with a deep sense of guilt. The sense of guilt is linked to their
peripheral status. As the drug users
survive in complete isolation without any support system, it leads to very low
self esteem resulting in a totally indifferent attitude towards self and its
improvement. Health or related issues
such as safety and prevention from disease is generally not a priority for drug
users. Any improvement in the health
status of drug users or effort towards harm reduction has to follow an
integrated approach that encompasses all the needs of drug users such as
counseling, family support, peer support, employment opportunities and
treatment facilities. Some recommendations
to improve the existing situation of drug users are as follows:
Recommendations:
·
For Behavior Change Communication (BCC), the link between
health and religion can be useful.
Messages promoting cleanliness should be conceived
·
Interventions should aim to provide a more tailored family
environment for a drug user. This can
be achieved through counseling with the families of drug users
·
Since
most people consider physical symptoms to be enough in identification of a sick
person, therefore it is essential that interventions and BCC materials should promote
the role of qualified doctor or health care providers at street level to
diagnose illnesses.
FOCUSSED GROUP DISCUSSION
1.
INTRODUCTION:
Focussed Group
discussion (FGD) has been acknowledged as an effective methodology for gauging
community’s perceptions. In most
situations where multiple methods of qualitative research are used, FGDs
enables to develop a comprehensive insight into the issues that are being
researched.
To understand the perceptions, attitudes and practices of
any population, FGDs can be a very useful tool. Where FGDs have some limitations, it has many advantages as
well. One major advantage is that when
it is conducted with any marginalized or stigmatized population it can help to
understand the most complex situations in a holistic manner.
In the following discussions with drug users the
effectiveness of FGDs emerged in a pronounce way. The community of drug users who is otherwise a marginalized and
stigmatized population has shared their perceptions on variety of issues in
great depth. The group setting
motivated the participant who otherwise may not have discussed their issues in
such length.
The need for the FGDs stem from the following objectives:
2. AIMS AND OBJECTIVES OF THE
FOCUSSED GROUP DISCUSSIONS:
·
To
collect information on knowledge, attitude and practices of drug users
·
To
collect knowledge pertaining to experience of services set up for drug users
·
To
highlight barriers to accessing services
·
To
highlight barriers to safer use
To
accomplish the aims and objective of the study a research design was formulated
(Annexure-1). Capacity building of NGOs
was part of the research design.
3. WORKSHOP ON CAPACITY BUILDING:
The workshop was held in
Lahore from September 7th-9th 2002. The objectives of the workshop were as
follows:
·
To assess the current
skills of select NGOs representatives in qualitative research methods
specifically Focussed Group Discussion (FGD)
·
To develop a guide
through group consensus for FGDs drawing upon the work experience of the
participating NGOs
·
To transfer skills in
facilitation and transcription of FGD to participants
·
To finally assess the
skill level of participants in facilitation and transcription of FGDs before
the initiation of data collection
At the end of the
workshop the lead consultant discussed the outcomes of the 3 days workshop with
the Chief Technical Adviser of the project.
In the discussion it was mutually decided that due to time constraint
and lack of skilled facilitators and transcribers it would be advisable for the
lead consultant to involve only those people from the participating NGOs who
had previous experience of facilitation and transcription. Thus, a single team of facilitator and
transcriber was selected from the group.
This team assisted the consultant and his team to conduct and transcribe
the FGDs in Quetta and Peshawar.
(workshop
report annexure -2)
3.1. SELECTION CRITERIA:
An entire session on
selection criteria of focussed group participants was held at the first
workshop. The NGOs present at the
workshop shared their experiences around ages of the drug users, their living
arrangements, support systems and marital status. The aims and objective of the study were kept in perspective
during these discussions. Finally after
some deliberations, following was the criteria that was decided by the entire
group:
GENDER:
MALE
AGE:
25-35 YEARS
AGE
OF DRUG USE: 3 YEARS OR MORE
VENUE
OF DRUG USE: STREETS
3.1.1. DEMOGRAPHIC DATA:
In the first
workshop, while developing the tool for the FGDs, participants discussed the
importance of demographic data in any study.
Understanding the usefulness of demographic data, the group decided to
include the following demographic details in the FGD guide:
NAME:
MARITAL
STATUS:
·
MARRIED
·
SINGLE
·
DIVORCED
DEMOGRAPHIC INFORMATION (CONT)
·
WIDOWER
·
SEPARATION
LIVING
ARRANGEMENTS:
·
IN THE HOUSE WITH
PARENTS
·
IN THE HOUSE WITH
WIFE AND CHILDREN
·
IN THE HOUSE ALL
ALONE
·
IN THE HOUSE WITH A
FRIEND
·
STREET/PARK
·
OTHERS
CURRENT
EMPLOYMENT STATUS:
·
EMPLOYED
·
UNEMPLOYED,
·
IF UNEMPLOYED, SOURCE
OF INCOME
3.2. PLENARY SESSION:
At the end of the
workshop a plenary session was held.
The entire group participated in the session. Each representative of the participating NGOs were asked the
convenient dates for conducting FGDs in their respective areas. After some discussions the dates for
conducting FGDs and arrangements for logistics were mutually agreed upon
between the chief technical adviser and the group. It was also decided that in total 39 FGDs would be held in 5
major cities of Pakistan. The
distribution of these FGDs was as follows:
Karachi 12
Quetta 6
Peshawar 6
Rawalpindi 6
Lahore 9
4. DATA COLLATION WORKSHOP:
The data collation
workshop was held in Lahore from September 23rd to 25th
2002. The goal of the workshop was to
build the capacity of participating NGOs in data collation. The objectives of the workshop were as
follows:
·
To revisit the entire
exercise of FGDs and reflect upon the lessons learned from it
·
To understand the
process of data collation
·
To practically
collate the data of the FGDs
(Agenda
of the workshop Annexure-3)
5. METHODOLOGY OF THE FGDS:
The methodology used
in the entire process was participatory with emphasis on experiential
learning.
The protocol and
guide to conduct FGDs was developed in the capacity building workshop. Once the group understood the objectives of
the workshop they developed the framework for protocol as well as the guide for
FGDs. Brainstorming and discussions
were held for developing selection criteria for participation in the FGDs. Brainstorming sessions were also held to
devise a portion on demographic information on participants in each FGD.
Each question in the
guide was discussed within the purview of the objectives of the study and was
finalized with the consensus of the group.
In the first instance close to 30 questions were developed but during
group work and brainstorming sessions the length of the guide was limited to 25
questions.
The determining
factor in cutting down the size of the guide was the attention span of
participants. The group agreed upon
that since participants would be at different levels of expression due to the
point in drug use therefore short but precise guide would be more effective in
getting relevant information.
Exercises around
facilitation and transcribing were held through the workshop. This was done to orient participants to the
process of FGDs. Reportedly the
participants pre tested the guide at their respective projects in mock FGD
setting, however, there was no suggestion of any change in the guide from the
participants.
The FGDs were
conducted and transcribed by the lead consultant and his team assisted by NGO
teams from Peshawar and Lahore. A
facilitator from Peshawar was used to facilitate FGDs in Quetta and Peshawar
both whereas, facilitator from Lahore was used to facilitate groups both in
Karachi and Lahore. Transcribers from
Peshawar and Lahore were also used during this process.
A workshop on data
collation was held once the data was collected.The NGO participants were taken
through the entire process of manually collating the data. Reading transcripts,
picking themes from transcripts, looking at qualifiers, understanding the
linkages between statements were some of the skills that were emphasized in
this three days workshop.
6. FINDINGS OF THE FOCUSSED GROUP DISCUSSIONS
DEMOGRAPHIC INFORMATION:
Marital Status:
Majority of participants
are not married and are single. There are many who are married. There are few
who are divorced and there are fewer who are widowers.
Living Arrangements:
Similarly living
arrangements vary. Majority (154/427)
live on streets, while most live in a house with their parents. There are many participants who live in a
house with their wife and children and many also live in a house all by
themselves. Less live in a park and
less also live close to open sewers.
Lesser are living with a friend in a house while lesser are also living
with a brother in a house. Few live at
a bed for a night arrangement.
Employment Status:
The employment status also
differs from each other. Majority is
unemployed. Most beg for money. More are washing and cleaning cars while
many do daily wage work. Less gather
old paper and sell it to earn money.
Lesser are taking money from
their parents or brothers regularly.
Few work at a hotel and fewer steal from others to earn money.
PERCEPTIONS:
HEALTH:
Majority is perceiving
health as Allah’s gift and blessing.
Living a happy life with the family that is based upon mutual respect is
seen as a gratitude to Allah for this blessing. Leading a more structured life such as getting up in the morning,
saying prayers, bathing and spending time with ones family is seen as a link to
healthy life.
“Health is Allah’s blessing, a person should have his meals on time,
bathe, brush his teeth, get up in the morning, respect his parents and look
after his wife and children"
Health is also described
in context of drug use. Most feel that
health is a gift that is enjoyed by people who do not use drugs. The simile that is used by the participants
is that a drug user is like a corpse.
There is an indication that keeping away from different addictions
brings one close to physical well being and mental health. More participants suggest that keeping away
from niswar, cigarettes and other drugs is a sign of healthy life. A link is also established between health
and work. Less feel that a person who is doing all his chores is a prime
example of health.
“Drug use is bad for health, by using drugs the blood in the veins gets
burned and there is no strength in the body”
“Our life is like that of a dog.
We are lying in gutters, in environment that smells bad. We have wasted a precious thing like health
in hands of drug use”
A connection between
religion and health is also established in the discussions. Most describe health as abulation and saying
prayers five times a day, whereas, many feel that health is following the
straight path and when a person says her/his prayers on time, all kinds of
sickness keeps away. Less feel that one
should eat well, sleep well and that is what health is all about while lesser
think that leaving heroin is the only way to health.
“Health is Allah’s blessing that has been given by Allah. One should obey Allah and adhere to the
saying of prophet Muhammad (peace be upon him)
Health is also linked to
spiritualism. Most participants
consider health to be spiritual strength.
An equal number feel that health is a keepsake the protection of which
is commanded by Allah. However, more
think that drug use is a disease from which everyone in the house suffers.
There are few who consider
health to be an asset that needs to be safeguarded. Fewer participants link health to prosperity and happiness. Very few say that health is
intoxication. Similarly a single person
is saying that he has no idea what health is.
“Health is a good thing. It is
life. It is prosperity and it brings
happiness”
Conclusion:
Health is seen as Allah’s
blessing or Allah’s gift by majority of participants. This perception is built upon linkages between health and
religion. Generally, cleanliness is
seen as a pre requisite to perform any religious obligation in Islam. This has emerged strongly in discussions
around health. According to participants
healthy life is holistic in every sense of the word. It is a life that is fulfilling both worldly duties as well as
spiritual demands. Since the focal
point in participants’ life is drug use therefore, link between drugs and
health emerges as the second dominant pattern.
Drug use is seen as unhealthy and a practice that hinders prosperity and
happiness.
Recommendation:
·
For Behavior Change
Communication (BCC), the link between health and religion can be useful. Messages encouraging cleanliness will be
reinforcing the perception of participants and would be easily comprehendible
by most. In addition to these messages
promoting healthy practices can also follow from these perceptions. These messages can be short, precise and
focussed on aspects of life that participants are highlighting as positive
practices in their lives in the discussions.
Healthy person:
As health is seen in context of drug use so is a healthy person. Majority feels that a healthy person is one who does not take drug. According to Most participants healthy person has certain worldly duties to fulfill and some of these duties are owed to the society, while others are towards ones wife and children.
“Healthy person is one who is willing to fulfill duties attributed to him by the society as well as whatever are his duties towards his wife and children”
“A responsible person of the society is a healthy person”
Many participants
linked being healthy with being disease free, while less add certain physical
attributes to the condition of being disease free.
“A
healthy person is that who does not feel tired when walking. Can run and pick up weight. He should be full of life and vigor”
Healthy person is also perceived as someone who has worldly blessings. More consider healthy person to be well settled in life, happy, working during the day and having some money as well.
For less people healthy person is one who is regular in saying his prayers and is fond of cleanliness.
Lesser consider a
person to be a healthy person only if he does not have AIDS.
Few make the
connection between a healthy person and his sexual performance.
Conclusion:
Health and being healthy is linked with life without drugs. Happy family life, employment and structured work environment are desirable options highlighted by participants in most discussions.
There is a link
between disease and health too. Being
healthy for many means being disease free.
· A wish to return to family life and structured environment is dominant in most discussions. Interventions should aim to provide a more tailored family environment for a drug user. This can be very challenging and uphill task but is possible through regular counseling and support services for the families of drug users.
Sickness:
Majority of participants consider drug use as the only sickness, while most of them point out heroin as the precise name for sickness. Heroin is called a curse and a living death in almost all the discussions.
“The biggest
sickness is drug use. For drug use we
live on foot paths and inject ourselves with needles”
“Sickness is not bad
at least one recovers from it but use of heroin is a disease from which a
person neither dies nor lives. Our
lives are worse than that of a dog”
Discussants live in an environment that is considered uninhabitable by all standards including the drug users themselves therefore a direct link between sickness and un hygienic living conditions is evident in the discussions.
Thus, More suggest that falling sick is directly linked to filth, garbage and germs that are present in the environment they live in.
Following this less participants suggest that sickness is not caused by anything except Allah’s will.
“Sickness is a
blessing from Allah. This is a way of
Allah telling us that we are on the wrong path”
“Sickness is Zakat of body i.e. Charity for well being of the body”
Conclusion:
The focal point
remains drug use. Most participants
point out drug use to be the only form of sickness. They consider use of heroine to be a disease. Other linkages of sickness are with
unhygienic living and eating conditions.
All this is very contextual to
the environment in which most of drug users are living.
Recommendation:
·
Within the context of
harm reduction clean spaces should be created for drug users. This will enhance their ability to question
their addiction to drugs in a non-stereotype environment and negotiate their
support from within that environment.
Linking apparent physical condition to sickness is emerging
as a strong pattern in these discussions.
The cosmetic condition of a person such as facial looks, complexion,
height and weight is used as an indicator for gauging health and sickness.
Majority participants think that physical condition reflects sickness in a person.
“The color of the face, clothes and way of speaking tells
you that a person is sick”
“It is visible from the eyes. The eyes are yellow as if one is suffering from hepatitis”
More link the identification of sickness to a person’s inability to move from one place to another. They also link weakness to the physical condition of a sick person.
Less feel that they would be able to identify a sick person by pressing her/his nails, if after pressing the nails the color reflects yellow then the person is sick, less also suggests symptoms that helps in identifying a sick person. These symptoms include not eating well, cough, cold and indigestion
“A sick person would not eat, would cough a lot and would not be able to digest food properly”
“A sick person would feel feverish, eyes would ache. She/he would suffer from headache and
stomach ache”
An equal number of people suggest that a sick person would always convey her/his sickness verbally.
“Nobody knows if someone is sick. Only doctor can tell. Diseases such as AIDS and TB are never visible”
In most
discussions a link between psychological conditions and drug use is being
established by participants. Majority discussants feel that drug use has its
roots in psychological disorders.
“Drug use is a
psychological disease”
“Drug use is nothing
except it takes over the mind”
For more drug use is equivalent to death or committing suicide and many from them feel that drug use stems from inability to deal with problems. Many participants also link drug use with eating and describe eating food as a form of intoxication, while an equal number feels it is a curse. There are less participants who link drug use to destruction and devastation of a being.
“Drug use is destruction and total devastation of a human being. If there is animosity between two people there is no need to kill anyone, just put the person on drugs and the person will die in no time”.
Lesser participants are also establishing a link between drug use and blood. According to them intoxication is present in human blood. Many of them feel that drug use is a habit.
“Drug use is a
habit. It is a necessity just like food
or eating. As one cannot survive
without eating, similarly a drug user cannot survive without drugs”
Lesser participants describe the potential of drug use and suggest that when someone is using drugs, he forgets about all essentials in life.
“Drug use makes one
forget everything even food. The only
worry is that of drugs”
Few participants are building a linkage between drug use and sexual performance of a man
“People use drugs for their mental extravagance, generally drug use enhances the sexual power. People on drugs can spend more time during sexual activity without getting discharged”
Conclusion:
It is evident that
drug use is being seen as a habit that overpowers a person and leaves the user
with not many options in life. Most
participants feel that drug use is linked to psychological disorders while next
major theme is the impact drug use has on user’s life.
Recommendations:
·
Since participants
are describing drug use as a psychological affliction therefore programs and
intervention should focus more on counseling to discover the causes for people
acquiring this habit
·
Some probing around
early childhood and growing up experiences of drug users would assist in
devising an appropriate protocol for counseling.
Link between health and drug use:
Majority of
participants feel that there is a link between health and drug use. Most of them think that drug use has a
negative impact on health.
“Drug use destroys health, a person looses his self respect, start asking people for charity. Forgets about his parents and then gradually forgets himself”
“Drug use burns blood.
When a person uses drugs then heart does not pump new blood”
A common perception
on drug use and health emerging in discussions highlights the progression of
drug use that eventually leads to death and many also define the link between
health and drug use as a habit leading to death of a user.
Loosing face in society is being attributed to drug use and more perceive the link between health and drug use as something that brings disgrace for everyone related to the drug user
“It not only
disgraces the person directly involved in drug use but it also blackens the
face of the entire family of the drug user”
Similarly more feel that drug use effects the body of the person and finally kills the person.
“Drug use destroys the health of a person. It effects the inside of the body. A drug user is thrown out of the house. It kills the conscience of a person. It is psychological cancer”
Less link health with
drug use by suggesting that if a person stays away from drug use, he will
remain healthy.
Less explain the
impact drug use has on health
“Drug use has a very negative impact upon health. A person cannot walk and is dependent upon others. Watery eyes constantly blur the vision of a user”
Very few feel that
there is no link between drug use and health.
According to them if drugs are used sensibly then nothing happens to the
health of the user.
Conclusion:
Majority of
participant feels that there is a link between health and drug use. Most suggest that drug use effect human
health negatively. They elaborate on
negative impact that drug use has on health.
Another link that is
emerging in these discussions is between health, drugs and family or personal
reputation. Participants feel that drug
use not only destroys health but it brings shame and humiliation to self and family.
This thought process
can stem from a deep sense of guilt that is very much part of the package that
each drug user carries with him. In
discussions they constantly blame themselves for most of the problems that there
families face.
Recommendation:
·
It is positive that
most participants feel that drug use is bad for health. The BCC materials can further strengthen
this point of view by delivering messages on how drug use specifically effect
human body.
·
The element of
humiliation is expressed as an outcome of drug use. The process of blaming self and feeling guilty is also linked
with drug use. With this knowledge, it
is essential that counseling should be an integral part of interventions and
programs. BCC materials should also
emphasize the strengths of a harmonious family life and how it can assist in
mitigating the damages of drug use eventually leading to a drug free life.
DISEASE:
Names:
Majority participants have heard about AIDS. Many of them name tuberculosis and cancer as the two diseases they hear about from different sources. Hepatitis is another disease that many people say they know off. Less point out malaria, typhoid, fever and cough as some of the diseases that are commonly talked about.
Modes of
transmission:
AIDS:
Participants express their knowledge of modes of
transmission of disease in the context of drug use and needle sharing. Majority feels that AIDS is contracted
through sharing syringes. Most think
that AIDS is contracted through sex with a woman other than ones wife. Most also suggests that AIDS is contracted
through sharing needles, having sex with a female sex worker and or with a
transvestite.
“Kissing on lips,
doing sex with female sex workers or with transvestite can transmit AIDS”
More have pointed out that AIDS can be contracted by a child from infected mother.
More also feel that use of toothbrush for brushing teeth can be a cause for transmission of AIDS. An equal number think that AIDS is spread through sharing of clothes, shoes and towels with an infected person. More suggest that sex without condom can be a cause of AIDS. Contaminated blood can be a source of transmitting AIDS and more also suggest that blood that has not been tested can transmit the virus causing AIDS. An equal number feels that AIDS is a gender specific disease and only women contract it, whereas, majority of them think that only men contract AIDS.
“Only men contract AIDS because when a man does not get a woman then he uses his hand i.e. masturbation”
According to many lack of oral hygiene such as not brushing teeth results in AIDS. Almost an equal number say that sharing food with infected person can also transmit AIDS.
Less participants think that sharing shaving razors can be a source of infecting others, same number feels that piercing nose and ears can transmit AIDS. Lesser suggest that the instruments used for dental work by dentist can be a source of infecting people with AIDS.
Few think that AIDS
is spread through dental work such as getting a tooth pulled out. Very few feel that getting a tattoo on the
arm can be a source of contracting AIDS.
Similarly very few feel that AIDS is contracted by using the same
bathroom that has been used by a patient infected with AIDS.
Hepatitis:
Majority of participants think that Hepatitis is caused by eating things that increases the level of heat in the body.
“I Know that Hepatitis is caused by body heat. Once I had one kilo of dates, since dates are hot therefore I had Hepatitis”
Once again
Hepatitis is seen within the context of drug use, drug users living conditions
and the modes of consuming drugs. In
other words for most of the responses in the discussions a common back drop is
the uninhabitable living environment.
Therefore, according to most dirty environment can be a reason for
contracting Hepatitis, while other feel that by sharing needles one can
contract Hepatitis C.
Less feel that
Hepatitis is contracted by being careless in eating whereas, lesser think that
Hepatitis results from sleeping with a Hepatitis carrier.
Conclusion:
Most participants have shown familiarity with two diseases i.e. AIDS and Hepatitis. The knowledge is based both on true facts as well as myths and believes. Other diseases that participants have talked about are common ailments such as cough and cold, fever due to malaria and typhoid, stomach problems and constipation.
·
In majority
participants have pointed out needle sharing as a major cause of contracting
AIDS. If this is a result of some
intervention then further reinforcement of these messages are needed especially
in cities where ID is the main mode of consuming drugs
·
The myths that are
reflected in participants responses need to be addressed in a comprehensive
campaign on modes of transmission of AIDS and Hepatitis
Disease that may cause death:
According to the majority AIDS causes death. Most feel that Hepatitis can also be the cause of death. Most also consider Tuberculosis to be a cause for death. An equal number of participants think Cancer to be a disease that ends in death. Less participants term Heart Attack as a fatal disease.
The other diseases that lead to death are consuming heroin, blood pressure and Asthma, when drugs are wrongly injected, diabetes, Cholera or small pox.
Conclusion:
Majority knows all the diseases that can or may result in death. Most participants have the knowledge that AIDS is fatal and so is Hepatitis. Tuberculosis is also seen as a disease that can lead to death.
Recommendation:
·
There is some level
of knowledge about fatal diseases in participants. If fear approach is to be used in the community of drug user the
knowledge can be reinforced through different messages especially those around
AIDS. AIDS can be linked with drug use
in BCC messages
Knowledge on disease contracted through drug use:
Majority participants
feel that drug use can lead to AIDS, whereas, most also say that Hepatitis can
be contracted through drug use. Most
think that cough is a direct result of drug use too. Many feel that Tuberculoses
is caused by drug use. Less suggest
that drug use in itself is a disease.
Less also think that fever is an outcome of drug use while lesser
consider dysentery as a disease caused by drug use.
Few think that drug
use makes a person easily irritable.
Fewer feel that drug use effects the sexual potency of a man negatively
and the person is unable to perform sexually.
Prevention from
Disease:
Drug use remains the
backdrop during this discussion as well.
Majority of
participants feel that best prevention from disease is to give up drug use. Most of them think that one should not use things that add to body heat. Most of them also suggest that a person should abstain from sex except with his wife whereas less of these participants feel that best way to protect oneself from AIDS is to use a condom while doing sex with anyone. Lesser of these feel that people should not share syringes. There are few who think that for shave from a barber a person should insist upon a new blade each time.
Participants are also
suggesting ways for leaving drug use.
Majority feels that one should say prayers regularly and that would help
in giving up drug use. A more
structured and regimental life style is suggested by most who feels that if one
follows a routine of getting up on time each morning and going to bed on time
every night, one can give up drug use. Less
participants feel that welfare oriented organizations should come forward to
treat drug users so that they can leave the habit of drug use.
There are other
suggestions in terms of prevention such as leaving heroin, taking showers twice
or thrice a day, when go to a dentist always tell him to clean his instruments,
eat well.
Conclusion:
The perceptions on
prevention are accurate to some extent.
However, they are being expressed in context of drug use. Most people think that by giving up drug use
one can prevent oneself from diseases.
There are some
misconceptions too especially around contracting Hepatitis. A commonly perceived way of contracting
Hepatitis in discussants is through eating food that is considered hot in terms
of its side effects. Therefore, mostly
people relate Hepatitis to body heat and things that add to the body
temperature such as different foods etc.
Recommendation:
·
Most participants are
linking disease with death and according to them one way out is
prevention. It would be appropriate to
focus on the linkage between disease and death and promote precaution and
safety as the best prevention.
·
Hepatitis as a
disease needs to be explained with all the modes of transmission. The perception of participants regarding
contracting Hepatitis by eating foods that are perceived hot in terms of their
side effects needs to be addressed.
This can be done by conveying easy, clear and understandable messages on
how Hepatitis is contracted.
Qualification of a doctor:
Alternative medicine,
illiteracy, lack of awareness about health facilities and inaccessibility to
health services acts as a backdrop in building up perceptions around medical
community. Thus, it becomes essential
to get a doctor defined by participants in discussions.
In these discussions majority of participants feel that a doctor must have an MBBS degree.
“Doctor is one who has an MBBS degree. Must have gone to a college for 5 years, should have studied science in these five years”
“A doctor should be in a hospital. He should be a
specialist. He should check the patient
and use his brains for diagnosis”
“Doctor is a person who prescribes expensive and English medicines for ailments and disease”
Lesser of the participants feel that a doctor is a person who has work hard and has passed exams at his own esteem. Lesser also feel that a doctor should be an ordinary human being.
“Doctor is an
ordinary human being like us”
Few believe that doctor is one whose medicine is effective.
“Doctor is one whose
medicine is effective for any disease or ailment. It really does not matter where he is working. Any person sitting at open sewers but giving
medication that helps a patient is a doctor”
Fewer think that a doctor is someone who has gone through the training of a compounder and has dispensed medicine. Very few feel that a doctor is someone who performs genital surgeries to convert men into Zenanas.
Conclusion:
Majority of participants considers a qualified person to be a doctor. They have described the degree and the venue where such a person should be present. However at the street level what has been observed is that people generally approach those health services that are mostly referred to them by their peers irrespective of what the qualification may be of the service provider. Mostly the objective would be quick recovery from the ailment.
Recommendation:
·
It is encouraging to
discover that most people are knowledgeable about proper medical services. However, at street level there is a visible
gap between knowledge and practice.
Generally preference is for quick fix arrangements. This emphasizes the need of quality medical
services for drug users at street level with a component of medical monitoring
during the process of drug use.
·
The other alternative
can be to build the capacity of existing service providers at the street
level. Incentives of trainings can be
offered to these service providers if they complement the work of qualified
health care providers and refer their patients to recognized health care
facilities.
Sources of Information on disease:
Majority of
participants name different organizations as the main source of information
about disease. Following are some of
the names that are being cited by participants:
Karachi Organizations Hospitals
Azam Hospital Jinnah
Hospital
-do- Isa Nagri Centre
-do- Burns road Centre
-do- Marie Adelete
-do- Madadgar Pakistan
Sanghar Brother
Norman
Quetta Milo
Shaheed Combined
Military Hosp
-do- Nai Zindagi
Rawalpindi Nai
Zindagi
Peshawar Dost
Foundation Lady
Reading Hospital
Sherpao
Hospital
Lahore Nai
Zindagi
Most say that their
source of information is a doctor, whereas, almost the same number say that
they get the information from Radio and television. Less quote peers as their source of information. Lesser find it out from newspapers and
magazines. Few link it with their own
personal experiences, while fewer think that their source is general public
that they come across in daily life. A
single person got the information in a walk against drugs.
Conclusion:
It is apparent from the above information that different organizations and hospitals are playing an effective role in transmitting knowledge on disease to masses however, what cannot be ignored is the fact that there is a visible gap between knowledge of the drug user and their practices.
Recommendation:
· Although there is some level of information on disease being disseminated at street level, there is still a need of giving out more information through culturally appropriate messages as a gap between knowledge and practice is evident in these discussions.
Barriers to safe use:
Kinds of Drugs and mode of use:
While identifying drugs and modes of use of these drugs majority of participants describe Heroin as one kind of the drugs which is mostly taken by using a foil (pani) whereas, many suggest that it is taken through sniffing (sunghara) as well. There are less who think that heroin is smoked in a cigarette. Less also describe that heroin is taken through a syringe, while lesser think that heroin can be sniffed through the nose.
Other ways of taking heroin are mixing it in the curry and eat it and mixing it with lemon and taking it.
Participants are also describing that heroin can be mixed with medicine or drugs for consumption. One such mix is with mandrix (tablet) and putting it on burning coal and inhaling it, while few mix it with Avil in a syringe and use it.
Very few think that heroine can also be taken by putting it in the eyes and very few also say that heroine can be burnt on a burning coal along with a dead scorpion for inhaling purposes.
The second drug that majority cite is called “Charas”. Most think that charas can be taken in a cigarette, while most also say that charas can be taken through a water pipe.
Less say that charas can be consumed by putting it on a burning coal and few describe that “sulfi” is also a mode of consuming charas too.
The third drug named is “Bhang”. One way of taking Bhang is to mix it with almonds and other nuts and eat it while few make juice of it.
Many participants name opium as a drug. Most of them suggest that opium can be taken by putting it on a hot skewer and inhaling it. Less of these think that opium can be consumed in water or tea and few say that opium can be taken in form of a tablet or a square piece. Very few say that a cigarette can be laced in a mixture of water and opium before smoking.
Many participants also describe pharmaceutical tablets as a drug while less participants name “Samad Bond” as a drug. Most of these suggest that “Samad Bond” can be used by spreading it on a handkerchief and smelling it.
Many participants suggest pharmaceutical injections to be a drug that can lead to intoxication. Most of these describe Diazepam to be one such injection. Less consider the mixture of Avil and lemon juice to be a good intoxicant. Few people also think of mandrix as an intoxicant drug.
Less also consider cigarette a drug. Lesser name “Niswar” as a drug, while, few describe alcohol as a drug.
Other drugs named are Petrol and Cocaine.
Most Potent Drug:
In order of ranking majority participants consider Heroin to be most potent amongst the drugs that they use.
“Heroin is the most
lethal intoxicant rather it should be termed as barbaric intoxicant”
“It is difficult to
leave the addiction of Heroin. It is
one intoxicant that takes the parents away from their own children”
“Intoxication of
heroin is like a magnet it pulls a person towards itself”
Most describe opium as highly potent. Most also say that pharmaceutical are the highest in potency. Less (67/427) suggest that sniffing is the most potent whereas, less also think that tablets are potent.
Lesser say that “charas” is highly potent. Lesser also consider Bhang to be potent. Few name alcohol to be a strong intoxicant. Fewer describe cocaine as high in potency. Very few consider that Samad Bond has potency and very few also think that the most intoxicant drug is “Roti”.
Conclusion:
Participants are sharing their knowledge on drugs and its use in this section. This provides an insight into the kind of drugs that are commonly used and perception of users on potency of drugs.
In this context while ranking most participants consider heroin to be the most potent of all the drugs. Opium is cited as the second most potent whereas, Charas is the third most in its intoxicant value.
· Participants are pointing out their preference for different kind of drugs through this section. For any ongoing or future intervention it would be useful to understand the reason drug users are using certain specific drugs. This will assist in harm reduction generally.
Most dangerous
modes of consuming drugs:
On naming the most dangerous mode of consuming drugs majority participants feel that taking drugs through injection is most lethal mode.
“Injection can cause immediate death. If it is person is injected in the wrong vein death becomes inevitable and that too in minutes”
“Injection is life threatening. Also one spends more money if one is using injections however, a
person does not get tired and works like a horse if injected with heroin”
Many people consider that “sunghara” (sniffing heroin) is the most dangerous way of using drugs.
“Sniffing is dangerous. One who sniffs dies immediately. Heroin has different chemicals in it. There is a pipe that is used in sniffing and as soon as you sniff there is a danger of dying”
“Sniffing is bad.
Brain gets infected and white worms fall from the nose”
Availability of syringe:
Clean syringes are linked with safety from disease. Thus, in case of drug users it is essential to gauge whether syringes are readily available or some extra effort has to be made to procure clean syringes.
On availability of syringes majority say that syringe is available although a little expensive.
Less say that syringe
is available without a problem from stores
Lesser say that Nai
Zindagi gives out syringes
Few describe that
syringe is available from medical store but pharmaceutical injections are not
available till you know someone at the medical store.
Fewer say that if the
medical store person is known to the drug user only then he gives the syringe
to him.
Number of people using each other’s syringes:
Procurement of new syringes is a pre requisite for safety from communicable disease and infections. On using each others syringes majority say that people use each other’s syringes.
Participants
reflect upon number of people using he same syringes and link it with the total
number of people using syringes.
Talking
about old syringes and its use by drug users, participants feel
Conclusion:
The above information provides perception of drug users in terms of risk they take while using drugs. It also describes the actual situation in connection with the availability of syringes.
The availability of syringes is explored in context of drug use. It is evident that getting new syringes is a costly as well as time consuming exercise. Since the need of drug is immediate at the point of withdrawal therefore any effort to get clean syringes is seen as a huge task. In such a scenario whatever is available at the venue of drug use is considered a blessing.
Recommendation:
·
This section has
initiated the process of highlighting the barriers in safe use. Future intervention can use this information
to address these barriers
·
Although participants
are aware of the high risk behavior but the immediate need of drugs overcomes
any fear that they may have and they use whatever is available. This defines a need that has to be
immediately satisfied. Thus,
availability of syringes should be made at all hours and closer to the known
venues of drug use.
Things drug users do to buy drugs:
For
generating money to buy drugs, drug users use different means. Majority participants say that drug users
sell their blood to get money for buying drugs.
“Do not know the number of such people but there are many
mostly at Mayo Hospital”
They describe the
percentage of drug users that may be getting their money by selling blood
“20% to 30% people sell blood to earn money for drugs”
“10 out of 100 sell their own blood to earn money for drugs”
The participants have
knowledge of precise amount that the blood is sold for.
“For one bottle the donor charges Rs. 100 to RS. 150.
Sometimes the people who are taking blood take two bottles and they say that
they have just taken one bottle”
“50 out of 100 sell their body for drugs”
The dominant gender
in selling sex is also identified in the discussions
“Boys get bad work done to them for drugs”
“New generation is very much involved in anal intercourse”
Another means of earning money for buying drugs is identified as being part of the drug selling set up and few say that people sell powder to get money for their own drug use as well as provide drugs to other.
Other ways of earning
money to buy drugs are offering ones wife for sex and steal shoes from the
mosques to buy drugs.
Conclusion:
This also
provides an insight into how different high risk behaviors are compounding into
a hazardous situation and making them more vulnerable to any and all infections
and diseases. What is evident is that
drug users have multiple sex partners as well as they sell blood to hospitals
as donors. This not only create a high
risk for drug users but it also pose a major risk for all those who are
accessing those blood supplies unless the hospital is testing all the blood
before it gives it for any kind of use.
Recommendation:
· Sometimes high-risk behavior has a direct link with low self-esteem. This section speaks of a wide range of issues that are linked with self-esteem. Taking a lead from this it would be advisable to use a more integrated approach to address issues surrounding the drug users.
· This section is also highlighting behaviors in drug users that add to the existing risk of drug use and make them more vulnerable to contract infections and disease. Interventions and messages should address risk and dangers attached to such practices in drug users.
Barriers in switching from a more dangerous mode of taking
drugs to less dangerous one:
Switching from injection:
For majority switching from injection to any other form of consuming heroine is not an option because according to them injection mixes with blood and the intoxication is most high in its form.
“The injection mixes with the blood and the intoxication is great. One cannot get the same kind of high while using sunghara or puni”
“The most cruel form of intoxication is injection. The high remains with a person for a longer time”
There are many who feel that injection is easily available and is cheaper that is why they do not want to switch to any other mode of consuming drugs.
“Through injection intoxication is immediate, sunghara on the other hand infects the brain and worms fall out of the nose”
Very few say that it is the easy accessibility of injection from every medical store that discourage them to consider any other mode of consuming drugs
“Injection is available from any medical store whereas for Powder one has to travel some distance”
Switching from sunghara:
Majority participants feel that the decision of switching from one mode to another is mainly determined by routine and the high.
“Sunghara is very
dangerous but previously the powder available was good but not anymore
therefore for proper intoxication sunghara is best”
Prices can be a determining factor in choosing the modes of consuming drugs.
“The prices have
gone up and because of that less powder is available and that is the reason
that most people have opted for sunghara”
“Intoxication takes
over quickly through sunghara and it is cheaper too. One puri (dose) is available for Rs.20.
Cleanliness can be a reason for deciding a certain mode.
“Puni blackens the
hands and face whereas sunghara is not at all messy”
Perceptions on different modes of consuming drugs is in the backdrop of choices between the modes.
“Injection can cause
disease. It can cause boils on the skin
whereas, Sunghara does not have any such side effect”
Conclusion:
Reasons for not switching from what is being defined as most lethal modes of consuming drugs are listed above. Mostly it is the immediate feeling of intoxication along with price of drugs that is determining the choice of mode too. Safety is not primary in such situations although the risk is comprehendible. This also reflects upon the gap between knowledge and practice of people who are using drugs. The contributing factors that help people in making decisions are also evident from these discussions.
Recommendation:
·
Interventions
mitigating risk factor face an uphill task.
Populations/communities practicing high-risk behavior opt for such
behavior because of many factors therefore before promoting any practices it is
essential to study all the factors that promote high-risk behavior. Thus, what is suggested here is to look into
factors that may be causing people to choose high-risk behavior and one such
factor could be very low self-esteem.
·
Through the
discussions several contributing factors to decision making are emerging. Most contributing factors can be addressed
through BCC campaigns. A good example
would be to deliver messages on using a new syringe each time consuming
drugs. This will help to remove
misconception around the use of syringe.
Reasons for Drug use:
Majority describe “in appropriate company” to be the
reason for getting addicted to drugs. Many think “Unemployment” to be the reason for their getting hooked on
drugs. Few feel that “domestic problems” led them to drug
use. Very few feel that it is because
of “heightened sexual potency” that
they became drug users.
Conclusion:
Barriers in Treatment:
Discussants express a
wish to live a drug free life and the only way they see this happening is
through treatment. However, getting
wholesome treatment involves different barriers.
Majority say that they do not have the money to get treatment.
“To get treated for drug use one needs money. We do not have the money to buy very basic necessities of life, from where are we going to get money for treatment”
“We do not have money.
Organizations take money for treatment”
“Most places do not have many facilities and then generally drug users are kept for 10 days or so at these places therefore treatment is not effective. A drug user should be kept of at least 2-3 months for effective treatment and then some employment opportunities should also be there”
Many feel that it is the mal treatment at organizations that discourages drug users to access treatment centres.
“Normally workers at organizations are cruel. They beat drug users and treat them badly”
“At some organizations drug users are tied with ropes and
given strong medicines. They are
treated worse than animals”
“At one organization they keep mad people with drug
users. There is a single bathroom and
that too without any door. It is a bad
situation. I would never want to go
there again”
“Generally in all these places staff is very rude. They misbehave and use foul language”
“There are iron cages where drug users are kept in
confinement. One would prefer to die
than to be thrown in such a place”
“Unless the parents or someone from the family does not
accompany the drug user it is difficult to get into any place providing
treatment”
Less participants think that free treatment should be offered if drug use is to be eliminated.
Few suggest that the period for treatment should be longer than 10 days.
Very few say that
they are not motivated to get treated
“Why should one get treated? Parents and siblings have left us. What is there for us now in this world?”
“Once a drug user, always a drug user. Even one can get treated but still would be treated with contempt. There is no hope or reason to get treated.”
Conclusion:
A wide range of barriers are described by the participants in these discussions on switching from more dangerous mode to one of a lesser degree. They range from lack of finances to lack of motivation. However, each barrier has varying experience behind it.
Participants in their discussions have shared different experiences. Some of the narrations are based upon hearsay while others are attributed to personal experiences by most participants.
Recommendation:
·
It is easy to identify the barriers and strategize ways
and means to remove those barriers but the caveat here is to use caution in
suggesting such strategy. Only those
strategies should be suggested that are realistic doable and sustainable in
long run.
·
In terms of specific recommendation it is suggested
that a more integrated approach of treatment is used in treatment centres. Staff should be trained to handle clients
with low self esteem. A respectful and
humane attitude towards the drug users should be maintained in a professional
setting. Monitoring of staff is essential. Refreshers and follow ups on counseling
techniques should be offered regularly.
·
Staff burn out should be seen as a realistic outcome of
working with a population with special emotional needs and staff working
directly with drug users should not be overworked.
Police behavior:
Police behavior is a flashpoint in almost all the discussions. Majority of participants say that police treats drug users very badly.
Police behavior
towards drug users is reported as inhuman.
“Police is barbaric.
The behavior cannot be summed up in words. They catch us without any reason and then are cruel to us”
Participants also
share ways of safeguarding themselves against police harassment.
“We do not wear clean clothes because if police catches us
in clean clothes they search us and take away what we have. Normally you would see drug users wearing
dirty clothes it is only because if we wear clean clothes police think that we
have money and would come after us”
Very few say that
police is involved in drug paddling itself.
Society’s behavior towards a drug user:
On reflection upon society’s attitude towards drug users majority feels that people treat drug users very badly.
“A dog has more respect than a drug user in this society”
“A Hindu will get water from a hotel but if we go they say
run away mawali”
In discussions
participants also discuss the severance of family support system when a person
gets into the habit of using drugs.
“Even ones own parent hates him if he is a drug user”
Treatment meted out
by the society is termed as derogatory.
“People treat us worse than beggars”
“Someone else will commit a mistake but a drug user will be
blamed”
“People hate us”
“Shop keepers will not let us stand in front of their shops
they feel that our presence effects their sales”
“People give us water in plastic bag”
Less participants say that drug users are treated well by the society.
“There are people who hate drugs but not drug users”
Feelings of drug users upon society’s behavior:
“Neither do we
feel angry nor feel bad when we are under the influence of drugs. We only feel bad when we are not
intoxicated”
Few feel nothing as according to them they are themselves involved in theft.
“We ourselves are involved in theft therefore when people behave badly we do not mind”
Fewer say that they do not feel anything because they deserve the kind of behavior people show towards them.
Ideal behavior expected from the society:
Majority say that the
society should behave well towards the drug user
“Good behavior should be shown towards the drug users. Love, affection and sympathies should be part of society’s behavior”
“Love and affection should be shown towards the drug
users. They should be treated like ones
own children”
“Good behavior, drug user should be treated royally and he
should be counseled and generally people should give him a chance”
“If people do not have pleasant things to say they should
not be unpleasant as well”
“We should be treated like a human being. I understand it is our fault but it is
beyond our control”
Names people use for drug users:
Majority say that drug users are generally called “Jahaz” (airplane). Most say that drug users are called “Powderi” too. Less say that drug users are addressed as “Charsi” while, lesser say that “Nashai” is a common name for drug users. Few say that “Heroinchi” is a common term used for drug users. Very few say that “Mawali” is normally used for a drug user. Similarly very few say that people use phrase “Azab aa gaya” (the curse has arrived) for drug users.
Feelings when called such names:
Majority participants say that they feel bad when they are addressed with any of the above names
“When it is withdrawal time and somebody uses fowl language,
I want to cut myself as well as the person using such language with a blade”
“When somebody uses such language I get disappointed and
want to take drugs”
“I want to kill the person with a pistol”
“The heart burns at such language”
Less say that they do not feel anything when people use such names.
“Once intoxicated neither is there any worry of religion nor
of the world”
Conclusion:
This section mainly deals with society’s interaction with drug users. Police, family, friends, acquaintances, peers forms society and play a pivotal role in the lives of drug users. Most participants are complaining about society’s lack of acceptance of drug users in this section.
Police behavior is
seen as unfair and inhuman, whereas, severance of family ties adds to the
isolation of drug users. The negative
attitude of friends, peers and acquaintances further makes a bad situation
worse. Labeling of drug users and
stigmatization process starts during this isolation and in absence of an
alternative support system drug users become vulnerable to abuse and
harassment. Self esteem is deeply
affected by all this and indifferent attitude towards oneself is reflective in
behavior.
Recommendation:
·
Interventions have to
be designed that are more holistic in nature and content. In current context what may be advisable is
that more integrated approach is used to work with drug users. This may mean sensitizing police and other
people who are part of drug user’s environment as a first step.
·
At the second level,
issues around self such as self esteem and self respect have to be
addressed. For doing this a process
oriented approach needs to be developed in the treatment centres where
socialization processes as well as issues such as self respect and self esteem
are explained through exercises and different processes.
·
To develop any
process it is suggested that formative research should be conducted
Views on existing organization that are working for the
benefit of drug users:
Karachi:
In Karachi there is a mix response in participants on treatment facilities. Majority of participants talk about Edhi centre. Most of them say negative things about Edhi’s set up.
Complains can range
from cruelty of staff to poor food quality and unhygienic living conditions.
“The food smells of medicine and they do not provide any
medication”
“I have seen Edhi but it is a very dirty place. People walk around naked and they make a
person do a lot of work and also they feed the meat that they obtain through
charity”
Some reactions are
stronger than others.
“Edhi is a seller of dead bodies, when we die he will sell
us also”
Less participants are complimenting the work of select organizations, who according to them are doing good work and are more humane in their treatment with the drug users. Most of these people talk about Nai Zindagi.
“There is this
organization in Lahore called Nai Zindagi.
I went there once, it was very clean.
Food was good. Dr. Tariq Zafar
hugs everyone at the centre”
Lesser take the name of the organization run by Dr. Salim Azam.
“Dr. Salim Azam has
an organization. They charge Rs. 15,000
or 16,000 and gives different color medicines”
Few say that they know of an organization on Burns Road.
“There is an
organization on Burns Road. It belongs
to some Maimons. They only take those
who have money”
Fewer also say that Gudo Bandar is another place for treatment but the facilities are not good as it is a set up for people with mental illness and does not make any distinction between a sane person and a person suffering from mental disorders.
“Gudo Bandar also offers treatment but they treat people very badly. They feed rice that even donkeys would not eat”
Other organizations
that are pointed out by very few participants are as follows:
Alkalam Trust- Isa
Nagri
Organization at the
board office
Brother Norman’s
organization
Organization opposite
Avari Towers
Sadaqat Maktab
Lahore:
In Lahore participants are not mentioning many organizations that provides treatment to drug user. Majority say that they know of Nai Zindagi. Most of these know that Nai Zindagi provides employment and very few of them compliment Nai Zindagi’s set up.
“Nai Zindagi is a successful organization. They give a kind of a tablet that makes one feel as if one has consumed Heroine”
Less say that they know about Caritas’s hospital. Lesser are saying that treatment is done at Government hospitals as well as mental hospital.
Few participants know
of Billa Hakim who gives tablets for Rs.10 and at each visit he dispense two
days’ tablets.
Very few name Sadaqat
clinic as a place for treatment but have negative things to say about it.
“They get hold of a person and beats him. Shave the heads of inmates. They also put a cold blanket on the drug
user. I have seen all this myself”
Rawalpindi:
In Rawalpindi majority of people say that they know of Nai Zindagi. The feedback on Nai Zindagi is positive.
“Nai Zindagi is an organization that provides employment”
“Nai Zindagi is an organization that is in Angoori”
Less name Icane, Nijaat, Naya janam as good organization in Rawalpindi where staff is pleasant and behaves well with the drug users.
Very few say that
Naya raasta also provides treatment facilities.
Peshawar:
In Peshawar, majority of population talks about Dost Hospital and another hospital in Hayatabad. Less are talking about Sherpao and Lady Reading hospital. According to them these two hospitals provide good services.
“They look after a person very well. In the morning breakfast is given. People love the drug users at these
places. Treatment is provided”
Very few say that
they know about Nai Zindagi.
Quetta:
In Quetta majority of participants know about Milo Shaheed Trust and have mix feelings about it:
“Milo Trust gives out medicine and encourages exercising the
body”
“Milo Trust use electric current as a treatment. They put the person the in water and beat
him to the point where he dies. There
is just one bathroom and 40 people”
“Initially Milo Trust shuts a person for 4 days. Then gives some tablets for 8 to 10 days and
then puts the person on drip. They also
provide facilities for exercise and give lectures on how to spend ones life”
Less say that they know of Nai Zindagi.
“8 people that I know have been to Nai Zindagi”
“Nai Zindagi is an organization that gives employment”
“Nai Zindagi is a successful organization. It provides a tablet that makes one forget
heroine”
Few say that they have heard Nai Roshni’s name.
“In Nai Roshni they provide facilities for bathing, food and also give tea. It is the best”
Few also took the name of Isa Nagri and Zinda Umeed.
“They give such a tablet that one sleeps for 3 to 4 days and
then they give tablet for health. They
do not give these tablets in hand they put them in mouth”
“The Isa Nagri and Zinda Umeed people give medicine. If the pain is unbearable then they give
tablet for vomitting”
“They use a battery that pulls the pain out of the legs”
Fewer say that they
know of social welfare office at Bolan.
A doctor Mark is there to treat drug users.
Organizational facilities that should be there for drug
users:
When asked to describe an ideal set up at treatment facilities, majority feels that water for bathing should be there at all such facilities. Most of them think that treatment should be offered at such facilities.
“There should be services that offer treatment to drug users. Thus, if drug users want to get away from this curse of drug use, it is possible”
Many suggest that the
environment at such places should be good, while an equal number thinks that
the staff should be good and should treat drug users with love and
affection. Many also think that there
should be work to keep people busy at such organizations and that such places
should be clean.
“Staff should be nice and polite because drug users are easily irritable and short tempered and have low self esteem”
“Whatever the set up drug users should be kept busy. There should be work for them at the place”
Less feel that there
should be medication for all painful symptoms.
Lesser are thinking
that the duration of stay at such places should be longer.
“The stay should be at least for two months. When a drug user sees people doing so much for him, he will also realize that he needs to leave this bad habit”
Few suggest that there should be medicine for blood cleansing while fewer feel that a good doctor should be there on the premises. Very few think that first of all brothers and sisters should trust the drug users.
Things that are
needed for assisting drug users in abstaining from drug use:
In order to refrain from drug use majority say that there should be some form of treatment available.
“One should get
medicine. Medicine for strength because
when a drug user leaves drugs then for 15 days one feels very weak therefore
medicine for strength is very essential”
Some also describe the duration of treatment.
“There should be at
least one month’s treatment”
Employment is also seen a cure and most say that there should be some form of employment made available for drug users.
“There should be
work 24 hours a day. Keeping busy is
the best thing”
“Employment should
be provided and if someone does not work he should be put in jail”
Hard physical labor is seen as a solution to the problem of drug use. The rationale suggested by participants is as follows
“The work should be
laborious so that the person gets tired at the end of the day”
Less people say that there should be bathing facilities
Lesser participants think that people should speak nicely to drug users. There is also a desire to build bridges with ones family except the effort to do so should come from the family.
“The family should
speak nicely with a drug user. They
should always speak about positive things and say nothing negative”
“The easing out from
the drug addiction should be with love and care”
“We should be
respected and given some status in the society”
Lesser participants think that organizations should cooperate with drug users.
“Staff at the
organizations should be good and well meaning.
There should be cleanliness and facilities for eating”
“The environment
should be peaceful and full of happiness”
“One should be given
the chance to sleep peacefully”
“Religious practices
should be promoted at such places”
Few people say that the best thing is to stay away from bad company
“One should leave
the company of drug users”
Fewer feel that there should be no domestic worries
“For us whenever
there is tension at home we again start taking drugs”
Fewer also feel that good accommodation should be there for drug users.
Very few think that people selling drugs should be apprehended.
Person who can
change the habits of drug users:
Majority feels that it is the drug user himself who can change his own habits of drug use while most of these think that a drug user should be provided with employment for him to leave drugs.
“Unless a drug user is not determined to leave drugs, nobody can help him in anyway. A doctor can only try his best but will be unable to do anything if the drug user is not willing”
“A good way to leave
drug use is to leave the company of drug users”
“If a drug user is
provided with employment, he will be busy and will not think about drugs”
Many consider organizations to be the ones to change the habits of drug users.
“If people are
polite then organization can bring the change like Nai Zindagi”
“There are so many
organizations working such as Mental hospital, Caritas, Sadaqat clinic, Darul
Rahmat and Brain centre”
Many also feel that family and relatives can bring the change.
“Parents should
control their children. They should not let them out of the house. Should see to it that if the child is going
to school or college he should keep good company”
“If family trusts
the drug user then change can occur”
More think that government can bring the change.
“Government should
develop bathing facilities for drug users”
“If government wants
it can change the entire scenario in a single day”
Less say that doctors can bring the change, lesser (20/427) think that friends can be the ones who can change the habits of a drug user.
“Friends can counsel
friends to leave drugs”
“If there is a
friend who is a sympathizer too, he can assist his friend to leave drugs”
Few consider that it is the supreme power of Allah that can bring the change.
Qualities in a
person who can assist a drug user to change his habits:
Majority feels that a person who can assist a drug user to change his habit should have the qualities of cleanliness.
“Should be very
clean, should not be a drug user, should always be talking about good things,
should speak in a loving manner”
Most say that the person who can assist a drug user should have leadership qualities.
“Should be a leader
and only that person can be a leader who has been a drug user and then has
recovered from the habit and it should have been good 10 to 15 years since he
has left using drugs. Only he can do
something as he knows what a drug user goes through. A leader reminds you what should be done and what should not be
done. He should speak politely and
should talk about things other than drugs.
Obviously when the mind will not think about it then gradually a person
would forget about drugs”
Less say that he should be someone who speaks nicely.
“He should speak
nicely and should arrangements of a business for me”
Lesser are saying that he should be someone who encourages the drug users to leave drugs.
Ver few feel that such a person should keep the drug user with his own family and should not smoke or do anything that is consider bad.
Conclusion:
In this section participants reflect upon the institutions and organization working with and for drug users in all the 5 cities. They also make comparisons and point out the shortcoming in many set-ups. However, most of the opinions are based upon hearsay rather than experiences of participants. In the end they provide a wish list of things that they would want to see changed in these set-ups. Most of all they desire polite staff at these organizations. They also want jobs that keep them busy and away from trouble which in this case is drug use. There is also a demand for medication to ease the drug withdrawal process. Another wish of most participants is that the period of stay at such organizations is longer.
A more realistic analysis of drug users demands reflects that it may be very difficult for organizations to meet all that is being asked for. Most of what is being wished requires a well knitted and well organized institutional infra structure.
Recommendations:
·
The demands should be seen against the backdrop of
existing organizational infra structure and strong networks should be built
between organizations that are working to combat drug use.
·
Private sector partnerships should be developed. Social responsibility in corporate sector is
no more a western phenomenon.
Corporations should be approached to assist organizations in creating
mentally and physically occupying job placements.
·
Programs should involve recovering drug users as they
may be able to properly articulate the needs of drug users. They will also be the best people to develop
strategies that are more conducive for drug users.