There is a waif-thin young man in a group outside an office in the Civil Hospital in Kapurthala, Punjab. Unshaven, with a mop of hair looking like an oil slick, he looks bored and zoned-out. His skin sags over his cheekbones, creating pits below his eyes. In ankle-length skinny jeans and a tattered T-shirt, he slouches over an old Bajaj motorbike, waiting for something. There seems nothing extraordinary about him, except that he is handcuffed and chained to the bike.
This man is one of the hundreds of people thronging everyday to Navjeevan Kendra in Kapurthala’s Civil Hospital, an hour-and-a-half from Amritsar, seeking treatment for drug addiction. Most users are brought in by their families or NGOs, though many are known to come of their own accord. Even prisoners, like the aforementioned young man, are brought in for evaluations and treatment from time to time.
I try hard not to stare.
Punjab’s drug crisis has reached deep within its cities and villages, making users out of every imaginable demographic: policemen, teachers, school kids, housewives, sex workers, farmers and domestic workers. Punjab’s rate of drug-related crime towers over other states, with reports stating that at least 50 percent of inmates in its jails are either convicted or facing trial under the Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS).
But for the past 13 years, well before the government acknowledged the drug crisis, Navjeevan Kendra has been quietly, but surely, toiling round the clock to provide relief to thousands of drug users, their families, and sometimes, entire communities. A 30-bed facility with a small kitchen with home cooks, the rehab centre offers a roster of the foremost medical treatments for drug addiction.
Till date, Navjeevan Kendra has treated over 15,000 drug users in the state. As Dr Sandeep Bhola, its consultant psychiatrist tells me this, he seems nonchalant, kind eyes blinking through clear, rimless spectacles. An award-winning technical expert and master trainer for the UN Office on Drugs and Crime in South Asia, Dr Bhola is also an advisor to the government on its rehabilitation and de-addiction programmes.
VICE spoke with him to know what it’s like to run a deaddiction centre in a state notorious for its drug crisis.
VICE: What got you into this line of work?
Dr Sandeep Bhola: I chose psychiatry honestly because I didn’t want to go for what everyone else was doing, and when I did my post graduation in 2003, psychiatry and de-addiction programmes were a very unexplored field. I felt this was an area that I could make a difference. When I first joined, we never had specialised de-addiction centers in the state. We got the support of the district administration in introducing the latest medicines, specialist services like counseling, and vocational rehabilitation. We had 15 beds. As things progressed, we had to increase that to 18, then 20, then 25 as the patient load was constantly increasing. We currently have an inpatient capacity of 30 here, and a five-bed rehabilitation centre close by.
The footfall at NK is about 400-500 people for various programmes, though I screen about 80-100 people a day.
What’s the most challenging thing about running a de-addiction centre?
It’s challenging to get what I call the ‘hidden population’ out to come and seek treatment. These are women, sex workers, children, members of the LGBTQ and other marginalised communities, who need safe spaces to access treatment. This centre with over 400 people coming every day, is not one. We desperately need a solution for that.
Secondly, there’s the issue of sustaining treatment. After the programme is over, people skimp on their follow-up visits and it’s simply not possible for us to keep track of this, looking at the volume of visitors we have daily. People stop taking the medicine and stop coming to us. It is very difficult for us to claim whether the particular person has recovered or relapsed. And then sometimes when users relapse, their families come back and pounce on us.
They don’t understand that recovery depends on the treatment but also on the users. They expect that someone who has been an addict for 7-10 years should recover within a week and get upset that it takes longer. De-addiction is a very stressful process for users and they often shout and quarrel and talk all sorts of rubbish.
In 2017, you started Navkiran Kendra, a separate de-addiction programme just for women. Why this need for a separate one? What are the unique challenges for that particular demographic?
Women are usually dependent on their male partners for addiction and de-addiction, both. We see that until the male partner is ready to quit drugs, the female partner is not able to. If the lady has children, then it's very difficult for her to start any kind of treatment, even as an outpatient.
Then, the families are not very supportive of women, and female drug users are much more stigmatised. They also don't have any decision-making powers in their family.
Many female users we see are also sex workers. They see drugs as the solution rather than a problem. Drugs for them take away the stress, shame or guilt they experience in that profession. So it's more difficult for them to desire to quit drugs, and it's even more difficult for us to bring them to further treatment.
They also have a number of other illnesses and ailments related to their profession. De-addiction is a small part of that project. We can’t look at addiction in isolation. There are a lot of other factors involved.
How has that been?
When we started in 2017, we were only getting a few cases. Not many women would come forward. Then, fortunately, an organisation called India HIV AIDS Alliance piloted a project in Kapurthala.
This is the only place in India they're running it.
In this programme, we’re provided with outreach staff made up of people who were previously drug users who have come out of their addictions and are ready to work for their communities. They know where to go, where the hot spots are, which women are using drugs. They motivate them to come to the institution, get them to do a thorough health check and accordingly start treatment. We link them to the government or NGO social welfare schemes.
Till June last year, we had registered about 106 female patients under this programme.
What’s the craziest thing that has happened here?
A long time ago, I got a call in the middle of the night, because about seven people from the inpatient ward—two of whom were ex police officers—tried to escape. They beat up the security guard, tied him up and then left.
It was in the middle of winter, so they didn’t get very far. They were caught by the police who put them in the lockup. I went to the station to pick them up and brought some blankets in my car. The policemen offered to send a van to accompany me for my security, but I refused. The patients are like my children. I don’t believe in using force to restrain them. I took all of them back, and it was all so emotional, they started weeping and promised never to do this again. Two of them are still in the centre, the others have left.
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This article originally appeared on VICE IN.