Serving people and saving families

Nadira Gunatilleke

Teenagers and young adults are increasingly becoming alcohol users and ultimately abusers. They begin by experimenting with drugs and alcohol. Some develop mental disorders while others are driven to dependency by peer pressure. The use of heroin, Corex D, benzodiazepine and psychoactive drugs, cannabis are the common substances used. IV drug use is rare. The number currently quoted could be the tip of the iceberg. Estimates for Colombo alone show there are 200,000 substance abusers.

The productivity of those afflicted clearly would be less than those who are not. But very few would know this. Families suffer hugely when someone is addicted and become in many instances helpless victims too while the victim descends progressively into a dark world.

These views were expressed by Consortium of Humanitarian Agencies (CHA) Executive Director Jeevan Thiagarajah in an exclusive interview with the Daily News.

Following are excerpts:

Q: Who and what is included in the Lifeline concept promoted by you and CHA?

A: People in their everyday lives are challenged or forget to pay sufficient attention to their bodies. This could be due to aging and adjusting to retirement. The health of men over 50 and women over 40, have mentally and physically challenging afflictions. They have to be trained to cope and mitigate their conditions. The other is addressing issues related to abuse and use of substances, issues related to children including phobias, anxiety, stress, obsessions, those who are HIV positive and health care of those forced into commercial sex.

Q: Can you give details about some of these areas?

A: (1) Geriatric Care Pathways for Aging supports older adults with a range of assessments. These could include cognitive ability, decision-making capacity and memory loss; mental and emotional health status including Depression, Anxiety, and Dementia and promotion of community and emotional support networks.

(2) Health checks for men over 50 include Blood pressure checks, for Cholesterol, Colorectal cancer.

It also includes Diabetes screenings, Immunizations, checks for Heart disease, Obesity, effects of Smoking, Alcoholism, Prostate Cancer, Osteoporosis and checks on teeth.

(3) Health checks for women over 40 include Breast, Cervical, Colorectal, Skin cancer and Heart disease screening and guides to dealing with Menopause. Some facets applicable to men are common to women. Managing Menopause is an opportunity to guard against health risks including osteoporosis.

(4) Women trafficked for sex fall victim to physical and mental health problems and are linked with the following chronic health problems: Physical and sexual health - reproductive problems, HIV, sexually transmitted infections (STIs), Uterine infections, Menstrual pain, Chronic hepatitis, Cervical cancer, Gastro-intestinal disorders, repeat terminations of pregnancy and trauma. Mental health issues include - depression, mood swings, low self-esteem, suicidal tendencies, drug and alcohol dependence, dissociation and post traumatic stress disorder.

(5) The mentally challenged cope with Intellectual Disability, Cerebral Palsy, Seizure Disorder, Autism and Neurological Impairments.

Those affected need Service Coordination links, Day Habilitation, Residential Services and Employment Services.

(6) Children’s issues include anxiety disorders experienced in many different ways as an alarm system signaling danger or a threat. Pressures often come from outside sources (such as family, friends, or school), but they can also come from within. Thousands of kids experience the stress of divorce. How they’ll react depends on their age, personality, and the particular circumstances of the separation and divorce process. What kids worry about is often related to the age and stage they’re in.

(7) Dilemmas of HIV-positive people are still rarely talked about openly. People with HIV can play an important role in strengthening community-based prevention, support and care services. If HIV-positive persons are involved in leadership roles, organizations are more likely to identify and respond to the real needs of HIV-positive people and their families.

(8) Abuse and dependency on substances is a common societal phenomenon. Reasons are many as are solutions. Understanding those reasons and connecting with early knowledge and solutions is vital. In some of these areas people have access and means to seek care. A majority though are ignorant, do not pay sufficient attention or are unaware of the potential and resources freely available.

Q: Is it possible to set up support systems?

A: (1) Supporting the creation of community groups which work on specific target groups i.e. mentally challenged (the National Institute of Mental health has designed modules for awareness and proposed a half way home complex),

(2) The physically challenged can be provided with individual, group or apartment style residential alternatives, emergency residence, transitional residence, low-income rental apartments, day, group day habilitation, certified day habilitation and transportation services.

(3) Individualized plans for each student based on their unique needs and goals can be developed.

(4) Adults with developmental disabilities to be provided with retirement options, group activities, community outings, volunteer options, and more.

(5)The 35 + menopause clubs (the Menopause Society of Doctors has soldiered valiantly for 12 or more years),

(6)Those who are substance dependent and the afflicted including with cancer can teach others how to deal with it.

(7) Persons and dependents of those HIV positive can be assisted in several ways. Children who are born HIV positive who sometimes do not know their situation even when in their teens need counseling, partners of those HIV positive need advisory services, patients sliding from HIV to AIDS need nutrition which minimally can be sent as soups etc to for example the IDH Hospital by donor families who care, dependents of those sliding from HIV to AIDS need protection particularly children where the parent is dying. Some are destitute and a facility where essential dry rations, donated by members of the public, can be collected and made available for those afflicted and in need to come and collect what they need periodically will help.

Facilities for lab tests is another critical need. So is linen and towels for those HIV positive to use to prevent infection from non HIV positive persons. There is also a need to help with funerals especially when there are those still prejudiced against those who die of AIDS.

Q: Who can become partners?

A: Professionals with knowledge to impart and be resource persons for individuals. Volunteers, service providers, those willing to invest in services, workplace managers willing to spread the knowledge, those who can contribute by leading on the themes. Ultimately the people in need are the target groups of this article. Lifeline is a service with potential for many partners.

Q: While you have promoted a broad agenda, you are aggressively advocating interventions for substance misuse. Why?

A: For example, Colombo has the highest number in prisons for substance misuse related offences.

Following are the cumulative annual figures for the whole country of those committed for drug related user offenses and the numbers related to Colombo.

(Sri Lanka) (Colombo)

1999 – 8938 / 7360

2000 – 8351 / 6992

2001 - 8002 / 6821

2002 - 9817 / 7976

2003 - 10388/ 9102

2004 - 10519 / 8012

2005 - 13435 / 8769

2006 - 10384 / 7730

2007 - 11478 / 8610

2008 - 11065 / 7609

2009 - 13319 / 9936

2010 - 13378 / 9658

What this reveals is that substance misuse and those committed are largely from Colombo and we are likely to have a much bigger unreported number nationally. These figures relate to drug related abuse and not alcohol which also probably has high consumption rates.

There is a move to send substance abusers for rehabilitation and the National Dangerous Drug Control Board and its head need to be lauded for their current efforts. A 2007 Act makes it possible for persons to voluntarily seek treatment or be sent by Court for treatment on production by Police. Neither is successful for want of sufficient facilities to seek or be sent for treatment.

Q: What is the background to this?

A: Addiction is a disease that has a profound effect on the addicted individual, as well as on his/her loved ones. Alcoholism and drug addiction are a family disease. By addressing the physical, emotional, mental and spiritual dimensions of those afflicted, this enterprise helps family members and loved ones begin their own recovery so we treat the whole family, including the children.

Teenage and young adults are becoming alcohol users and ultimately abusers. They begin by experimentation with drugs and alcohol. Some develop mental health disorders while others are driven into dependency by peer pressure. Use of heroin, Corex D, benzodiazepine and psychoactive drugs, cannabis are the common substances used. IV drug use is rare. The number currently quoted could be the tip of the iceberg. Colombo alone has 200,000 such persons. The productivity of those afflicted clearly would be less than those who are not. But very few would know this. Families suffer hugely when someone is addicted and become in many instances helpless victims too while the victim descends progressively into a dark world.

Q: What do you see as an opportunity to intervene?

A: Such a programme provides family members and loved ones with the skills and tools necessary to begin their own healing process and develop their own resiliency. Educational programmes combined with community convened group work, lectures and presentations addressing various dynamics of the disease of addiction can be implemented.

Children from 7 to 12 years old from families who have been hurt by addiction need help too. The children’s programme is a haven of help, hope and healing which helps children learn about addiction through age-appropriate activities so they realize that the disease is not their fault, they are not alone and they are not to blame. Children should be able to talk openly in a safe, supportive atmosphere and encouraged to express their feelings about this cunning, baffling disease.

Drug free communities with grants are for the purpose of helping communities that are riddled with substance abuse. Through these grants, the communities can heal, and those in charge can work to alleviate the drug abuse in their neighbourhoods. They are a great resource and a positive force in the battle against drugs. An important community intervention would be to document and collect facts. Determine how drugs are affecting the community, how many people in the community are affected and what kinds of outreach programmes or processes would help those individuals. Investigate the drug issue and learn where they’re coming from, who the vehicles are that are taking these drugs to the community and more.

Magistrates who need to determine directions for those produced in Courts need confidence that treatment facilities would render the required services professionally and progress reported. The Police need to feel that they could live without quotas of addicts who need to be sent to remand.

They could potentially turn the concept of the current quota into a positive tool with respect to the number of persons they successfully direct into treatment facilities which should ideally be located in the midst of the greatest pockets of abusers. The care givers need to be multi-dimensional and service costs need to be met in a sustainable manner. The families and importantly the beneficiary have to also take responsibility including potentially paying some of the associated costs of services.

Unfortunately, only a handful of them are aware of the existence and the intent of the Drug Dependent Persons Treatment and Rehabilitation Act of 2007. The real success would be the day an unproductive addict is treated as a human asset capable of beating their habits and have pathways for their recovery and opportunities for sustainable decent lives.

Q: Are there risks?

A: Threats would be from drug traffickers, sellers and corrupt elements that can impact on the safety of care givers. It is no secret the revenue from the sale of drugs is substantial. Any idea which disturbs such revenue streams are likely to be treated with alarm. By incorporating law enforcement officers as partners, risk associated will be mitigated to an extent.