July 24, 2003

If it wasn’t for the Marie Adelaide Rehabilitation Centre, drug addicts and their families would have nowhere to go, writes Robin Fernandez

Drug abuse may be an individual’s choice but for that individual’s family it is a never-ending nightmare. Each family member becomes a co-dependent. Statistics compiled by various agencies estimate the number of drug addicts in Pakistan at four to five million. But this is nowhere near the figure of those whose lives it disrupts.

There are approximately 20 million people who are directly affected by the problem even though the actual number of addicts is one quarter of that, according to Derek Dean, a board member of the Marie Adelaide Rehabilitation Centre (MARC).

Speaking at an awareness programme held to commemorate World Anti-Narcotics Day, Dean said no family member of an addict was ever able to lead a normal life, as he recounted the ordeals suffered by family members. “The family often becomes dysfunctional. Tension and depression set in,” he said.

Addicts, too, are cut off from their families — and whoever else was once close to them. One addict, the father of three children, used to burn his wife and force her head into a tub of water. Another male addict gave his mother sleeping pills, so that he could steal money from her. A third slit the throat of a man.

The brutalities can rise significantly as the addiction level grows. Dean and other representatives of organizations dealing with public health and social problems of addiction believe that rehabilitation and recovery will free both the addict and his family.

But before that can happen, they say, our society would have to play a significant role in the rehabilitation of addicts by joining awareness campaigns and helping families bear the cost of rehabilitation.

“Effective policing can check but not control drug trafficking,” observes Brig. Saleem Akhund of the Anti-Narcotics Force (ANF). Such an effort requires a string of other measures aimed at throttling its demand. Brig. Akhund describes awareness programmes as a key component of that effort. “It is important to reach those most vulnerable first. Youth between the ages of 15 and 25 have consistently been identified as a target group. We need to make them aware of how drugs can destroy them as well as the society in which they live,” he says.

The ANF official called upon philanthropists to open new drug treatment centres in place of those that had closed down over the past few years. The number of treatment centres has shrunk from 213 to 76 in recent years, the official pointed out.

Terming the government-run treatment centres “ineffective” and the private owned ones “too expensive”, he said the Marie Adelaide centre was among the few that had maintained its effectiveness while opening its doors to all income groups.

“Up to half a million addicts in Pakistan are hooked on to heroin. One million addicts regularly take charas and hashish. While the rest are downing tranquilisers with alarming frequency,” says Thomas Zendil, the country representative of the U.N. Drug Control Program, quoting from a recent survey.

The same survey, he said, recorded a high incidence of syringe and needle use by the addicts. The UNDCP official counsel’s parents and teachers to be candid with their children when it comes to drugs.

“Hold an informed discussion with them. Don’t forbid the outright use of drugs. Explain to them how it can disrupt their lives and that of their families,” Zendil said. Children who learn awareness are less likely to become addicts.

Dr Qasim Brohi, of the Mental Health Institute in Hyderabad, advises mothers and teachers to look out for abnormal behaviour in their children and those under their care. “If you do notice changes in them, don’t be shy. Strike up a discussion with them on drug abuse,” says Dr Brohi.

He also unveiled some interesting figures about addicts and mentally ill patients. Nearly half of all mentally ill patients abuse cannabis, one quarter of them have social problems and another quarter suffer from biological dilemmas. Drug addiction is somewhat of a geographical reality. “We are sitting on a silver belt. Opium is growing on our borders,” he points out. In his opinion, heroin is not too much of a problem right now.

But another menace has reared its ugly head. The habit of inhaling glue is becoming common in Pakistan, according to MARC workers. “The reason for this is quite simple: glue is cheap and most of the population is poor,” the organization says in its latest report. Currently, MARC is treating 20 glue inhalers at its Sanghar centre. The toughest task for drug-rehab centres is to get the inhalers — and other substance abusers — to admit to their dependence.

 

House of Hope

Quoting figures from a study, the Marie Adelaide Rehabilitation Program says in its annual report that Pakistan has an estimated 4.5 million addicts. Only four years ago, it notes, the number of addicts stood at 3.01 million. That means between the years 1999 and 2002 drug taking among the population almost doubled.

The same trend was noticed at the Marie Adelaide Rehabilitation Centre, where the number of inmates grew from 120 to 170 in the same period (1999-2002). The centre is located on a farm some 260 kms northeast of Karachi in Umeed Goth, a tiny village in district Sanghar. It has humble origins and despite its evolution as Pakistan’s first drug rehabilitation facility, it has operated under a shoestring budget and severe physical conditions.

For a fairly long time, MARC had no proper building in which the patients could be kept. A mud shack was all it had. Nearly all the patients used to sleep out in the open. Former patients recall how Brother Norman Wray had to turn on his car-lights during their late-evening meetings with them. “We are still pretty much a jungle operation or a boomerang ranch if you will,” he jokes.

Unlike other rehab centres in the country, MARC does not confine addicts to the four walls of a house. Their daily routine is crammed with outdoor activities, from a half-mile jog in the morning to farming chores, as well as collecting firewood and feeding farm animals and cleaning after them.

The skilled workers among them, however, are put in charge of various repair jobs needed in and around the farm. Neither the patients nor the staff is entitled to special privileges. “Everyone from Brother Norman to the newest arrival eats and drinks the same food and is expected to do every kind of chore,” an MARC worker said. “There are no privileges offered to anyone. Each person must do his share of work.”

 

Impossible dream

Few can understand the work of Brother Norman Wray better than last year’s Magsaysay laureate and pioneer of Pakistan’s leprosy programme, Dr Ruth Pfau, “...I have had the opportunity to do a lot of crazy and pretty impossible things. But Brother Norman has done and is doing the totally crazy and the impossible — and it has come out beautifully,” Dr Pfau said in a tribute to the MARC director and founder.

“My heart is with the [drug rehabilitation] programme,” says the leprosy doctor, confessing her personal attachment with the work of Brother Norman. It had been that way since she had a chance encounter with him a few decades ago.

“He was talking about exactly the things I was thinking of. He wanted to fight for the people who didn’t have hope,” the German-born nun said, pausing to repeat her words in Urdu for the benefit of her audience at a drug awareness programme.

“Of course, there was no organized movement for drug rehabilitation then. It was done on an individual level by Brother Norman. From then on we kept an eye out for each other’s work,” she said.

Around this time military strongman General Ziaul Haq, an acknowledged benefactor of the anti-leprosy programme, donated a small farm in Sanghar to the Marie Adelaide Leprosy Centre. “I thought of accommodating leprosy patients there but in the end the idea sort of fizzled out,” she said.

Teasing Brother Norman, she said he must have been happy at the failure of her plan. Dramatically, she decided then that the Marie Adelaide Centre would turn the farm over to Brother Norman for his drug rehabilitation effort.

For three to four years, Dr Ruth did not go back to the farm. When she finally visited it again, she was amazed to see eucalyptus trees planted everywhere. “Just like the growth of the eucalyptus, his programme has expanded from one humble seed to lots of big trees,” she said, finding a metaphor to match. “Those trees now give shelter and shade to scores of people.”

 

Causes of addiction

Despite the hopelessness of his cause, Brother Norman’s clarity of vision remains undiminished. He recognises drug abuse as only a symptom of a problem created by society’s lopsided economic structures and its social mores. He advocates greater tolerance for drug abusers, who “still wait to be blessed by God for abstinence-based sobriety”. It is this spirit that lies at the core of the MARC’s work.

Brother Norman Wray says his programme staff have come across girls with drug problems as well. These females are usually sent to the psychiatric wards of local hospitals, as MARC can’t accommodate them in their all-male dormitories. “There’s no real place for them,” he says sadly.

An addiction is usually caused by lack of love and intimacy. The drugs or intoxicants are used to medicate one’s pain. And it has fatal consequences.

MARC workers take a holistic approach towards addiction. “We encourage addicts to open up and share with us their inner feelings,” Brother Norman explains. “Total openness helps people to find courage and they eventually vomit the truth out. Constant meetings are scheduled with the staff.

“At MARC we stress the spiritual. Each person depending on his belief-system is encouraged to share with others his religious inspirations. The addicts are overcome by fear that they are not loved and cared for.”

One of the lessons reinforced in the minds of the addicts is that they are not responsible for their addiction, or even their recovery. Through the use of a meditation book the MARC founder stimulates the spiritual thoughts of the patients.

Daily readings are conducted in English, but just so that everybody understands, the translated text is also read out. Other handy literature translated into the vernacular is available for patients at both the centre and the halfway house. Some of these works have had a lasting impression on recovering addicts all over Pakistan, says coordinator Javed Khan.

 

‘Waiting lists are growing’

There are roughly 170 inmates at both MARC’s rehab centre in Sanghar and the half-house in Karachi. But the waiting lists are growing all the time. There are currently 94 children on the waiting list of the rehabilitation centre, according to Brother Norman.

Most of the children seen at the Drop-In Point sniff glue and use marijuana. To deal with this challenge, MARC has initiated an adopt-a-child scheme that makes a single individual responsible for the rehabilitation of a child addict.

Usually the rehabilitation lasts six months and costs the foster parent Rs3,000 a month. Though most of the addicts are brought to the centre by their families, there are a few who come on their own. The youngest inmates are aged between 7 and 9 years old.

These boys, mostly Bengalis, are addicted to the smell of glue. Yet heroin and marijuana continue to be the most commonly abused drugs, with most inmates hooked on either of the two drugs at various points in their lives. There is, however, a sprinkling of alcoholics to be found at the rehab centre. Patient contributions cover a little less than one-third of the overall expenditures.

 

Miracles do happen

For addicts, the possibility of relapse is always high. Almost 90 per cent of the addicts are destined to be lifetime slaves of their drug habit. Yet the miracle of recovery occurs every now and then.

For 35 years of his life, Arfeen remained addicted to drugs. Then, one fine day in the mid-90s, Arfeen learned to kick the habit. Today he is a family man who sells candy on the street.

After spending six years in recovery, Steve Judd wound up working for the MARC. Judd, who battled addiction for 17 long years, has held down the job of assistant manager for the past five years.

The Halfway House, a facility that aids individuals as they re-enter society, is virtually run by recovering addicts. “This place has changed my life. I would have been on the streets otherwise,” one inmate said tearfully. The house provides a sound platform for recovery because it encourages fellowship and contacts between peoples.

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