‘Many rehabilitated drug addicts are relapsing’
DRUG and substance abuse has been on the rise in recent years. As a result, cases of mental illnesses have shot through the roof, threatening to overwhelm public mental health institutions. The Sunday Mail’s Gender and Community Affairs Editor FATIMA BULLA-MUSAKWA (FBM) talked to DR NEMACHE MAWERE (NM), the chief medical officer of Ingutsheni Hospital — Zimbabwe’s largest mental health institution — about this and more.
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FBM: Can you outline the state of affairs at Ingutsheni Hospital with regard to patients admitted for drug abuse-related illnesses?
NM:
That is the biggest challenge we have, because the number of patients being admitted keeps rising.
For instance, the acute admission ward for male patients, which is Khumalo Ward, has 98 beds, but usually, we have more than 220 patients admitted at any given time.
So, we have to keep discharging those who would have improved slightly so that we can admit more.
We are not admitting them just for detox. We are mainly admitting people who are losing their minds, those who are having hallucinations, hear voices, are aggressive and violent, and those who are being difficult to live with.
So, they are the ones we are admitting in order to stabilise them.
Once they are stable, we quickly send them back home.
Sadly, they are going back to the same toxic communities.
As a result, they are bound to return. It becomes a revolving door of sorts. There is a high turnover of patients but, at the same time, we cannot do much because there are so many in need of our services.
We cannot sustain the situation, because we have to feed them and we don’t charge them user fees.
If we charged user fees, it was going to be better.
So, we don’t have the resources.
We are sharing a very small cake as a national referral centre.
Everybody in any part of the country can come to Ingutsheni.
FBM: So, if your services are free, how are you managing to keep your head above the water?
NM:
It’s free; the patients don’t pay user fees. We have got some long-term stay wards; we are always full because, when you recover, we should step you down from this acute admission ward.
After that, the patient goes for rehabilitation, where they engage in activities that help them recuperate properly.
Ideally, a patient should stay for a minimum of three months in a unit in order to recover fully.In our case, very few are staying for up to three months.
We also have a situation where relatives do not return to collect patients when they have recovered. They just dump them because they do not want to face the same problems they would have faced before the patient was admitted.They would rather leave you with us for as long as possible.
We also have district health centres sending their patients, which they also don’t come to collect upon recovery.
So, we end up getting crammed up with people who have been discharged but are still stuck in the system.
FBM: What kind of drugs are being abused by the bulk of your patients?
NM: The most common drug is crystal methamphetamine.
It used to be cannabis, which has now fallen behind.
We used to have problems with people who abuse cough syrups like BronCleer, which now has also fallen down the pecking order.
We are also having challenges with patients abusing substances with more than 50 percent alcohol content.
But I think crystal meth is the biggest challenge we have.
FBM: From your interactions with the patients, do the health authorities have an idea where the crystal meth is coming from?
NM:
“You have people as old as 70 years engaging in drug abuse. Presently, I am looking after a 75-year-old patient who had problems with an illicit alcoholic brew (krango). He told me he just could not stop drinking this krango. So, all age groups are affected, but, of course, the most affected are teenagers, up to those in their 30s. We have also noticed that this is fast becoming a big problem among females”
I don’t know.
People are trying to make some local variations, but definitely, the bulk of the drug is coming from outside our borders.
In South Africa, around 2013, they had this drug they called Tik.
It is the same thing we now have, which is crystal meth.
The drug’s side effects include loss of appetite; users do not feel hungry.
It makes the user feel energetic; they can go and work, listen to music and feel like they can do anything.
But the challenge is the mental health problems that arise from its use, one of which is paranoia, which can be very bad.
People can end up committing crimes because of that.
So, you have people committing crimes, causing malicious damage to property, assaulting others and, in some cases, committing murder.
FBM: Based on your assessment, which
age groups are most affected by the drug menace?
NM:
All age groups.
You have people as old as 70 years engaging in drug abuse. Presently, I am looking after a 75-year-old patient who had problems with an illicit alcoholic brew (krango).
He told me he just could not stop drinking this krango. So, all age groups are affected, but, of course, the most affected are teenagers, up to those in their 30s.We have also noticed that this is fast becoming a big problem among females.
Drug abuse is mainly associated with those who engage in prostitution.
Because crystal meth is an expensive drug, which costs about US$5 a sachet, sometimes one uses a sachet a day.
So, you can imagine that not many people will have US$5 daily to sustain that habit.
As a result, they end up stealing things from their houses and doing all sorts of things to get the money for drugs.
FBM: In your opinion, how can Zimbabwe solve this problem?
NM:
Let us fix the community.
We know where the drug peddlers are; we know them as a community.
Unless the community decides to take action, we are going nowhere.
People must have some resistance committees, some vanguard committees, to look after the community and make sure we know who are pushing the drugs so that we take care of our children. That is why I was talking about the discharge plan.
When you discharge patients from hospital, there must be a plan to follow through with regards to helping one rehabilitate back into the community, rather than just dumping patients back home.
Also, one must have people looking after them at home after recovering.
So, unless the community is involved, we are fighting a losing battle.
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