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Taking A Pledge
Taken from Express Healthcare, May 2010
Sankalp Rehabilitation Trust has been providing dedicated care and support to over 2,000 street-based drug users and seeks to combat the spread of HIV/AIDS in Mumbai. Sonal Shukla takes a look at this unique endeavour
Project Hunar offers its members introductory computer instruction through a visual recognition approach
Ram Prasad is a happy man today: not only is he free from an appalling drug addiction, but also has a job, which has helped him to earn a living with dignity. Ram Prasad ran away from his home in UP at the age of eight and came to Mumbai. Soon after he arrived in the city, the streets became his shelter and he became addicted to drugs. To feed his addiction, he started stealing and ended up in jail several times. His health deteriorated due to consistent drug use. Like other street-based drug users he was on his way to a slow and painful death, until one day he heard about the Sankalp Rehabilitation Trust through a peer educator (peer educators are former drug users who are trained and empowered as outreach workers, to go into the field and meet drug users), which changed his life.
Today, Ram Prasad is himself a peer educator in Sankalp, and is determined to help others like him. Not only did he break free of the addiction but also received support, care and a source of income with the help of Sankalp. Today, Sankalp is helping over 2,000 street-based drug users like him in Mumbai.
The NGO received the prestigious Red Ribbon Award in 2008, awarded by UNAIDS every two years at the International AIDS Conference, designed to honour and celebrate community-based organisations for their outstanding initiatives that show leadership in reducing the spread and impact of AIDS.
The Start
“We support safe injecting, because they will inject anyway. They should not use reused syringes and die of AIDS”
Sankalp, a Hindi word meaning ‘taking a pledge’, has been providing dedicated care and support to street-based drug users and seeks to combat the spread of HIV/AIDS in Mumbai, India. Sankalp was started in 1995 by Eldred Tellis, a former heroin user himself.
“I took a centre’s help to treat myself and then worked there and rose to become an executive director. But then I realised that they were not willing to respond to the persistent HIV/AIDS problem in the street-based drug using community, hence I dropped them and went to the North East of India,” shares Tellis. There he involved himself with drug abuse treatment work which took him to states of Manipur and Nagaland. He worked with HIV problems and helped many of the drug treatment centres to incorporate HIV prevention in their programmes and build capacity locally. Today, Tellis is globally recognised for his understanding of scientific and psychological techniques used in reforming drug users.
“I realised that there was a need to address this problem in my own hometown, Mumbai, too,” says Tellis. For 15 years now, his NGO has been actively working for the street-based drug users, but with a difference. What makes Sankalp different from other NGOs working in the same area is its approach, which goes beyond just curbing the habit and HIV/AIDS prevention, and tries to bring drug users into the mainstream of society through regular rehabilitation efforts.
Step by Step
Sankalp has seven Drop in Centres (DICs) near the drug-using hotspots in Mumbai. These DICs provide holistic care to street-based individuals (called clients), who use brown sugar, a crude form of heroin. Clients are offered basic medical care, opioid substitution therapy, treatment referrals, and extensive one-on-one and group counselling, as well as advocacy and support throughout their rehabilitation. Sankalp has 10 peer educators at each centre at present. Each peer educator is assigned an area where they distribute clean needles and syringes to drug users. They let them know about Sankalp services and disseminate information on HIV prevention. These peer educators also collect used needles and syringes.
“If the needles and syringes are thrown away around areas like railway stations and bus stops where one finds these drug users, they can even injure an innocent person and pass on illnesses like HIV and Hepatitis C,” shares Tellis. As he points out, almost 20 per cent of street-based drug users today suffer from HIV/AIDS, and almost 80 per cent suffer from ailments like Hepatitis C. The peer educators also give primary health treatment to these drug users who suffer from many ailments and injuries.
Sankalp has an ambulance which picks them up when required and brings them to DICs. From DICs, the clients are sent for health tests to the main public hospitals in Mumbai. One of the peer educators takes them to the hospital as a nursing escort and thus trains them how to access healthcare. Once back from the hospital, they are counselled by trained counsellors. Due to their weak health, these drug users suffer from many ailments, including TB. Sankalp, in collaboration with DOT centres of the Government, has been doing TB screening for them. All the DICs are equipped with eight doctors, nurses and 10 counsellors who carry the process of treatment and rehabilitation further.
The Right Approach
Each peer educator is assigned an area where they distribute clean needles and syringes to drug users
All the DICs are equipped with eight doctors, nurses and 10 counsellors
The NGO has been working unceasingly to offer a sustainable livelihood once the drug users are free of their addiction
The NGO has been following the ‘Harm Reduction Philosophy’, which aims to minimise the harmful consequences of drug use. The first consequence which is minimised is the incidence of HIV/AIDS and Hepatitis B/C, by giving the drug users clean needles, syringes and oral substitution. Due to oral substitution, they do not feel the urge to take drugs. “By giving them oral substitutes, we actually reduce the crime which they might commit to buy the drugs. We support safe injecting, because they will inject anyway. So, it is better they don’t use the dirty, reused syringes and die of HIV/AIDS,” says Tellis. Once those clients approach the centres, their health needs are taken care of. “The Harm Reduction Philosophy is a unique approach that we follow to counter this serious issue of drug abuse in street-based drug users – which is the most forgotten area as people don’t even like to touch them. Besides treatment and counselling, we also feel responsible for their rehabilitation. In extreme cases, we have been giving them ‘Nivara’ – a place to stay in one of our centres,” shares BN Bhagwat, Chairman, Board of Directors, Sankalp Rehabilitation Trust.
The HIV positive patients among the drug users are handled by a special support group. They are given nutritious food and extra vitamins regularly. “We give them nutrition every day. We ask them to pay Rs 3 for the kichadi. If they come and sit for the sessions, they are given a meal,” says Tellis.
Prison Therapeutic Community
Many of the clients, who used to come to DICs for the oral substitution therapy programme, would suddenly drop out. “We would find out that they were rounded up by the police and thrown into jail just because they were drug users in the past. I later realised that some of them were also exploited sexually in jail,” states Tellis. To keep them safe in jail, Sankalp initiated ‘Project Nischay’ at Arthur Road Prison in 2004. This project has directed a therapeutic community to help with the rehabilitation of incarcerated drug users and prevent HIV/AIDS transmission. Sankalp’s medical officers visit the prison three times a week to conduct health check ups. The project co-ordinators work closely with prison authorities to provide care in the separate barracks for Sankalp’s clients.
The networking partner of Sankalp extends free legal aid to those in need and the staff reaches out to clients’ family members to prepare them for court hearings, and provides follow-up counselling and care for clients after their release.
Counselling and Rehabilitation
Sankalp provides counselling and rehabilitation with a difference. The NGO has gone much beyond just sharing information about HIV/AIDS and how to prevent it, with drug users. The clients are counselled about how they should take care of themselves, and relapse prevention is conducted, which has been instrumental in reducing the risk of relapsing. Explains Tellis, “We look at relapse triggers – such as how should they save money, not keep too much money with themselves, how they should be more responsible and how they should get back in touch with their families and once again build relationships, anger management etc. Part of the prevention is that those drug users should not use drugs again.”
Challenges Galore
The biggest challenge facing this NGO is to retain its staff. As Tellis points out, once counsellors and other support staff is trained, they become an asset to the organisation, but pay inadequate according to Government standards makes them leave the organisation after some time. “The Government issues us Rs 8,000 as rent which is not enough to acquire an adequate place. We hope to get some land from the Municipal Corporation in a prime location to continue this work,” states Tellis.
Rehabilitating drug users is crucial, believes Tellis. However, doing so has become a huge challenge for Sankalp. Rehabilitation comes under the purview of the Ministry of Social Justice and Empowerment whereas HIV/AIDS prevention is looked after by the Health Ministry, and both give monetary help only pertaining to their scope. Tellis expects much more convergence between the two, which in his opinion will give impetus to the rehabilitation of the needy. The support that Sankalp is getting from the AIDS Control Society in Mumbai is meant only for working with injecting drug users as they are considered at high risk of HIV/AIDS.
The NGO provides a helping hand to those who are still not at high risk. These drug users are sent to detoxification camps by the NGO. Each year, Sankalp has three to four detoxification camps of 15 days each. A regular camp has 15 to 20 clients, of which approximately 25 per cent stay clean on a long-term basis. JJ Hospital Nursing Association is offering space for these camps at Aksa Beach.
Project Hunar
The NGO has been working unceasingly to offer a sustainable livelihood once the drug users are free of their addiction. In May 2009, Sankalp launched a partnership with Bangalore-based NGO AMBA CEEIC, geared at providing sustainable livelihood training to a group of recovering clients. Project Hunar offers its members introductory computer instruction through a visual recognition approach, help in developing professional skills, participation in educational sessions, and assistance finding group work in the data entry sector. In addition, the residential nature of Hunar ensures the consistent availability of medical, psychological and peer support, thereby creating a holistic environment in which to grow. “We are now putting all our efforts in finding the corporate tie-ups which will help us further expand the reach of this project,” says Tellis. The NGO now is trying to set up small BPOs for its clients. Working with the municipality for garbage recycling is also on the agenda as most of the street-based drug users work as garbage collectors.