HARM REDUCTION AS A PATH TO HOLISTIC REHABILITATION
Location
The idea is to use harm reduction through a low threshold programme and take Street drug users into holistic rehabilitation. The programme begins through community outreach where safe injecting messages are stressed. This is then linked to Opioid Substitution Therapy in Drop in Centres, and HIV Care Centres. Those choosing abstinence will be registered to a Half way Home where they will be taught to use computers through a visual recognition of alphabets. They then work together completing jobs outsourced from industries.
About You
Section 1: About You
First Name
ELDRED
Last Name
TELLIS
Website URL
Country
India
Section 2: About Your Organization
Organization Name
Sankalp Rehabilitation Trust
Organization Website
Organization Phone
022 - 23803550
Organization Address
1st floor S.S.Bengali School, Thakurdwar Road, Mumbai – 400 004.
Organization Country
India
Is your organization a
Non‐profit/NGO/citizen sector organization
Your idea
Name Your Project
HARM REDUCTION AS A PATH TO HOLISTIC REHABILITATION
Country your work focuses on
India
Describe Your Idea
The idea is to use harm reduction through a low threshold programme and take Street drug users into holistic rehabilitation. The programme begins through community outreach where safe injecting messages are stressed. This is then linked to Opioid Substitution Therapy in Drop in Centres, and HIV Care Centres. Those choosing abstinence will be registered to a Half way Home where they will be taught to use computers through a visual recognition of alphabets. They then work together completing jobs outsourced from industries.
Innovation
What makes your idea unique?
What makes the idea unique is that at Sankalp we have an entire continues of services. These begin with community outreach to those injection drugs on the streets of Mumbai to actually finally living together and working as computer operators in BPO. In between the drug users may actually utilise the needle syringes programme, the Integrated Counselling and Testing for HIV, Screening for TB and Hepatitis B, C, taking care of opportunistic infection along the way and if he were to be ‘rounded up’ under the Narcotics Drugs and Psychotropic Substances Act, then he would receive required attention n Prison as ell. It is therefore a very unique cover for streets drug users who were earlier not carried for at all. Sankalp Rehabilitation Trust also has Detoxification Camps for those choosing abstinence and these clients are then given an opportunity to learn to use the computer for specific ‘job work’. For those who did not even dream of being computer operators due to their illiterate status, thus acts as a huge booster to their self worth and is a motivating factor for staying clean. Of course all drug users may not opt for learning computers and they are placed with catering companies, security companies, ship breaking units or friends of Sankalp who may absorb them as office assistants.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
There is still time to assess impact on the ‘complete idea’. This is because the computer training which is part of building sustainable livelihoods has only just begun.
Yet the Harm Reduction Programme itself has achieved much. Firstly, when Sankalp Rehabilitation Trust first began working on the Streets, the number of injecting drug users was over 10,000. This number has reduced drastically over the last 10 years and the unofficial estimates of injectors in Mumbai can be pegged at 3000.
There is also success in sending some of the drug users back to their home towns. From Bangalore to Sharanpur and from Pune to Kolkata, hundreds have reunited with their families.
During the past 10 years that the programme has been running, almost 20,000 drug users have accessed the programme. This being primarily an HIV prevention programme, even switching from injecting mode to a non injecting mode of taking the drug, it is considered successful. Also being a low threshold programme, every service delivered like abscess management, nutrition or care for opportunistic infections are well received and have a positive impact on the drug user looking for help. The one indicator that shows success is the fact that there are fewer new cases of HIV among our clients. In prison as well, the fact that there is a ‘safe environment’ created by our project makes it easier for the inmates to stay drug free and are not sexually exploited as was the case earlier. The sustainable livelihood programme began with a first batch of 20 inmates of which 13 have completed the 6 months computer training and are drug free. They will move on after successfully completing the jobwork which will begin in November. This may take upto 2 months before the next batch begins.
There is not enough follow up on those who are drug free as they go back to their hometowns all over the country. They in turn continue to be ‘peer educators’ giving the messages of Drug Abuse and HIV prevention as taught to them.
Problem
The primary problem being addressed by the project is HIV prevention among Injecting Drug Users. Yet most drug users approach for help to get rid of their addiction. They may not understand the investment of themselves that it involves and often think it is simplistic enough like taking care of withdrawals.
Sankalp Rehabilitation Trust understands their needs and yet allows the drug users to address their problem as they prioritise them. Therefore it is important not to lose focus of the primary problem of HIV prevention. Since prevention cannot be done in isolation, the care component is also to be addressed. Hence care has to be that which may begin with detoxification but moves into all areas of health care like TB and HIV. For most injectors, Hepatitis B & C are also a grave concern especially since there is a very little talk of these from multilateral agencies.
The fact that Sankalp caters to street drug users, most of who have been using since early childhood, there is a low level of literacy and employable skills. In a world away from drugs, this reality can be most disturbing as most of them have only known crime as a source of catering to their day to day needs. Therefore while working through their emotional recovery and healing the past, the drug users have to muster the courage to begin learning afresh. Therefore true rehabilitation can only be achieved when the drug user has re-entered society and is contributing productively.
Actions
The organization which began with one drop-in-centre catering to about a thousand drug users a year is now having 4 drop-in-centres catering to more than 3000 drug users. These centres are low thosehold in nature and welcome every kind of drug user catering to various needs. Theses include abscess management; supply of clean injecting equipment, bathing facility or even a cup of tea. There is also a regular medical clinic which deals with regular complaints like cough or cold and screens all clients for TB and HIV after counselling.
Since many drug users are thrown into prison, the organization has a special rehabilitation centre set up in the main prison in Mumbai. There peer educators are trained to educate inmates on Drug Abuse abd HIV/AIDS in all barracks within the prison.
HIV related illness is an important component that is taken care of in the Community Care Centre for opportunistic infections. Here clients get complete clinical and nursing care and may be facilitated to Most importantly there are alternatives being built up for work. Some are placed in jobs as office boys and drivers and others are encouraged to work in the catering field and with recycling of waste. Most recent is an effort to develop programe for sustainable livelihood. Here the drug users are taught to use computers through a visual recognition approach and then taken through job work outsourced from companies.
Results
The expected results of the project are many. In fact, based on the various project activities, the indicators are in place. For example through regular use of clean needles and syringes, injecting drug users are reducing the risk of HIV transmission, which is instyrumental in bringing the incidence of HIV down over the past few years. Similarly those who are regular on Opioid Substitution Therapy and are not injecting any more have decreased the risk behaviour and this too reduces the incidence of HIV.
Those who are already infected, find acceptance and are able to take care of themselves through attending the self care workshops. They learn to be involved with their treatment once on Antiretroviral therapy so that adherence and compliance are maintained. This also contributes to a reduction in new HIV cases or that of re-infection.
Many drug users go back to their homes and families. This is very important in a metro like Mumbai, where the numbers seems to swell by the day. Back in their rural environment, they are able to get back to farming which is sometimes the only skill they have. Here it is important to understand that the benefit of their treatment is improving the quality of life of their families as well.
Last but certainly not least, about 25 percent of drug users quit using drugs, be it through our jail programme, Substitution and detox programme or HIV care. They then become productive members of society.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Next Year 2010
There is an immediate need to get a project steering committee in place that is made up of peoplefrom the general community. This committee will look specifically at the needs of the sustainable livelihood part of the project. They will need to make efforts to bring in continued jobwork from the corporate sector.
It is extremely important to get a space which is economically viable so that the group actually earns enough to sustain themselves. There will be a need to bring in other alternate sources of income for the group which needs to be studied.
Year 2011
A group of volunteers would need to be recruited to lend supervisory skills to the project. As the batches increase, it will not be feasible to have paid staff for those rehabilitated.
The Governing board may need to consider acquiring land for the organisation through the Government so that we could look for donors to help build our own centre and not be dependent on spiraling rents which will make the project unfeasible.
Other options for sustainable livelihood will need to be considered. One distinct possibility is the recycling of waste material in partnership with the municipality. This will also create more jobs for our ever increasing base of clients.
Year 2012
Continue to make efforts to build on the plans of the previous years. There has always been a need to have some ‘business’ model to make efforts sustainable. If none of the earlier attempts work to this end, then the most obvious effort would be to run a commercial Treatment centre under a new company to cater to the wealthy clients and use the profits from this effort to manage the project for the street drug users. There is a dire need for upper class clients to get value for money as there is a dearth of such centres in the city today.
What would prevent your project from being a success?
As this project began in a humble way almost a decade ago, it has seen steady growth. Therefore, although there have been many hurdles, some of which may have seemed insurmountable at that time, they have been successfully overcome with pure determination. Some possible hurdles are;
Lack of affordable space. This is really a big challenge for a city like Mumbai. Sometimes it seems that other bigger and more developed places around the world have more affordable spaces available on rent.
The second hurdle is corruption. This is one that keeps rearing its head just when you feel that you may have won the battle. It changes according to people who come ito position of power and often has no rational explanation.
The third possible cause for failure would be if some aspects of the project suffer from lack of funding. Over the years we see that donors give support for 2 to 3 years and move on. Yet work has to continue uninterrupted and the organisation always needs sufficient buffer before negotiating with a new donor. The factor is also to do with policy which can change due to international pressures. Right now there is a favorable climate to fund programmes which focus on prevention of HIV among injecting drug users. This was not the case when the project began and could change in the next 3 to 5 years.
How many people will your project serve annually?
1001‐10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for more than 5 years
In what country?
India
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Sankalp Rehabilitation Trust
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have any non-monetary partnerships with NGOs?
Yes
Does your organization have any non-monetary partnerships with businesses?
No
Does your organization have any non-monetary partnerships with government?
Yes
Please tell us more about how these partnerships are critical to the success of your innovation.
Partnerships are extremely critical for our work. We can consider ourselves partners with the Municipal Corporation of Greater Mumbai as three of our facilities have been rented out from their premises at discounted rates. This brings some sense of stability to the project site which is important as the centre needs to be located in the area where drug users congregate.
Another vital partnership is that with another NGO called the Lawyer’s Collective. They provide legal assistance without any charge. This assistance has helped us take up litigations in the interest of our clients against the Indian Government as in the case for The Right to Health Care for ALL or against Multinationals as in the Post Grant Opposition of Pegasus. The organisation also provides legal aid to all our clients in prison.
The third major partnership is with a co-fellow in Ashoka who has been working with Intellectually Challenged persons in Bangalore. Here the work on providing sustainable livelihoods at AMBA CEEIC, is being tried with drug users and those living with HIV in Mumbai. Since the street drug users have no education and their brains have been affected by years of Drug use, they can also be considered circumstantially intellectually challenged. The experiment is in its initial stage and can be considered to be having a great response.
There is a need for partnerships with corporates as well as with Research Institutes so that the innovations can be better finetuned for greater success.
What are the three most important actions needed to grow your initiative or organization?
Approximately 300 words left (2400 characters).
The Story
What was the defining moment that led you to this innovation?
First it is important to know that I am a person from the community of drug users who quit drugs at a time (1983), when there was very little help in Mumbai. Therefore my first response was to volunteer at the institute that helped me. This I took to a more serious level by getting trained in a Therapeutic Community in New York. I became the Executive Director of the organisation but was not happy dealing with a small group of middle class individuals. I quit the job and took a difficult assignment in North East India which is an area of high conflict and diverse problems. I worked there for 3 years setting up new organizations and building capacities to deal with the problem of Injecting Drug Use and HIV. While working in a very difficult area and away from my home, I realized that much of what I had begun doing here was not being done on the streets of Mumbai. This is what inspired me to reach out to the marginalized street drug users in Mumbai and begin developing a holistic and meaningful programme for these migrants.
The rest was really the response to the needs of the community as they surfaced. Having worked from streets to Prisons in the North East, I was confident with every new venture that had to be started and had the constant backing of a group of committed Trustees. Having the needs of the community at heart, gave me the courage to build a comprehensive programme that is meaningful to them.
Tell us about the social innovator behind this idea.
There isn’t much one can say of themselves. I would always rather have my work speak for itself and I believe it does.
When you have a low threshold programme and are willing to have the clients needs uppermost, then there are no conditions for treatment. They choose us rather than we choose them. They are able to get the service they want when they need it most. Acceptance gets personified and can be the single most motivating factor that brings about change.
Our clients become a social capital and when you view them as such, the impossible becomes possible.
How did you first hear about Changemakers?
Personal contact at Changemakers
If through another, please provide the name of the organization or company
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