Treating Addictions in Kenya: The OMARI Project
June 30, 2009
Beth Cole and Megan Yarberry
From May 12 to May 17, 2008 Megan Yarberry and Beth Cole trained 14 The Omari Project (TOP) personnel in the NADA (National Acupuncture Detoxification Association) 5 needle protocol proven useful for supporting drug withdrawal. Original plans were to train 20 staff from TOP and a regional private hospital, however due to work commitments, only 14 were trained. Five of the trainees are ex-addicts who have successfully completed the Omari Project’s detox program.
The Omari Project has residential, outpatient, and outreach services all along the coast for treatment and prevention of heroin addiction, and for prevention of HIV transmission. Outreach services offered at these various sites include drug and HIV/AIDS education, risk awareness, advice for withdrawal, provision of condoms, transport to sites for HIV testing, transport to Comprehensive Care Centers for CD4 counts, treatment for opportunistic infections, and Anti-retrovirals (recommended for drug users with a CD 4 count below 300), information on home detoxification, one-to-one counseling sessions and Narcotics Anonymous meetings. Families can also obtain information and advice, and all can receive referrals. The residential sites offer a place for clients to withdraw in a supportive setting with onsite counseling staff, health services, meals, religious services, activities, regular group and individual counseling.
The training commenced with the class gathering in our open air classroom under cashew trees. Following an introduction to acupuncture and the NADA technique, Megan gave a demonstration of the technique using Beth as a model. While providing a similar training for Post Traumatic Stress Disorder for Kenyan refugees at the Mulanda Transit Center in Tororo, Uganda we quickly learned that a demonstration is worth a thousand words. Trainees treated patients sitting on plastic chairs on the concrete slab that serves as the main meeting place for patients at the Malindi residential treatment center.
Patients as well as the community at large were treated at the Watamu residential facility and drop-in center. The population here is mostly Muslim. Respecting the community’s culture, women were treated in a room separate from the men. Treatments were also provided at Omari’s office. A loud speaker and music were set up outside the office to attract potential clients as there was no time to advertise. This method devised by the trainees was quite effective. During the course of the training, 281 acupuncture treatments were provided in clinically supervised sessions. The Malindi residential facility nurse stated that after 2 days of treatments, agitation and anxiety were greatly reduced at the primary rehabilitation facility. Several clients said that prior, unsuccessful rehabilitation attempts ended badly due to stress and fighting, so increased tranquility at the site will be an improvement to the environment. Many clients reported greatly improved sleep, often described as “sleeping like a baby,” or “sleeping how I did when I was a child.” compared to prior nights filled with nightmares.
Visiting again in December 2008, RMF’s Megan Yarberry met with TOP staff, volunteers and clients, among whom 9 were NADA specialists, to discuss project progress, challenges, goals, and to answer questions about provision of the NADA treatment in various TOP work settings.
Of the original 14 people trained, most are providing regular treatment at the rehab centers in Watamu and Malindi, and at the DIC (central offices in Malindi). At the DIC, TOP has acquired a new meeting hall to accommodate group activities, which include acupuncture sessions.
Much of TOP’s funding comes from UNODC and USAID. These agencies prescribe outreach worker activities for a 40 hr week, and because acupuncture is not on this prescription, staff members provide acupuncture on a 6th workday included to accommodate non-USAID/UNODC activities such as counseling and other support work
There has been NO negative feedback about acupuncture sessions (which, among this clientele, is significant). Clients report being more relaxed, a decrease in anxiety, and improved sleep. Shosi, the local coordinator for the NADA program, said “Patients are more composed, more focused, and participatory in group discussions and activities. There is no other change in the program that can account for these shifts.” Staff confirmed that the sites where clients are receiving acupuncture are notably calm and relaxed since initiation of the acupuncture protocol. They also said that for clients coming out of hard detox to be getting good sleep is nothing short of remarkable, in their experience.
Implementation of the NADA protocol during the initial phases of detox when clients are in a stage of agitation, discomfort, and are receiving pharmaceuticals was discussed. Megan advised TOP staff that acupuncture is extremely useful at this stage of detoxification. In the past, clients did not receive acupuncture during the initial phase of detoxification, and received only medications. Beginning in January 2009 clients were offered acupuncture as well, with the result that medication use during this phase was reduced by half. TOP administrators report that residential clients who drop out of the program have reduced from 1-3 per month to 0-1 per month. Further study is needed, but no other significant programmatic changes have been implemented during this period than the addition of acupuncture. Reaching out further into the community this spring inmates and wardens at Malindi prison started receiving acupuncture treatments once every week.
Since the mid 1980’s, heroin has been available in the towns along the Kenyan coast. The impact of heroin and other drug use has had dramatic consequences for the local communities in the form of increased HIV transmission through unsafe sex and shared needles, increased crime to support drug habits, and a growing number of people facing illness, imprisonment, and death.
In response, The Omari Project (TOP) was established in 1995 to provide education and services to addicts, families, and communities. It is one of only 2 drug detox facilities in sub-Saharan Africa. TOP is a non-governmental organization created with technical and financial support from The Bristol Drugs Project, the British Council, and it reports to the United Nations Office on Drugs and Crimes..
Current services include a residential treatment facility as well as community outreach programs in education, prevention, and rehabilitation. Areas of focus are drug detoxification and HIV/AIDS prevention. In partnership with a local doctor, TOP has developed expertise in the management of withdrawal. Top uses a combination of pharmaceuticals, counseling, and rehabilitative activities.
TOP receives strong community support, and works to test and adapt rehabilitation approaches that have been successful elsewhere. Acupuncture is one tool not currently available to addicts in Kenya that has been used successfully in Europe and the US.
The addition of an acupuncture component to an opiate detoxification program can lead to a 50% increase in program retention for completion of the recommended length of stay. Program retention is most strongly correlated to treatment success.
The implementation of acupuncture within a treatment setting also decreases need for pharmaceutical drugs, and decreases hospital referrals. Patients receiving the treatment often report an increased sense of well-being, and a decrease in debilitating symptoms associated with detoxification.
In December 2007, Real Medicine Foundation (RMF) Whole Health Team Project Coordinator Megan Yarberry met with staff and clients of The Omari Project. TOP Project Coordinator Shosi Mohammed shared information about the project’s history, treatment protocols, and challenges.
“The Omari Project staff is a dedicated group of people with real concern and commitment for the health of the local community” says Yarberry. “They have a strong organizational foundation and expertise in the management of withdrawal that would be even more effective with the addition of a proven treatment tool like acupuncture.”
In May, the Real Medicine Foundation’s Whole Health Team will provide acupuncture training to workers from The Omari Project and Tawfiq Hospital. The training will include the NADA’s 5-needle protocol.
The acupuncture training will take one week, and the RMF team will facilitate on-going technical and material support for The Omari Project. After the training, The Omari Project staff will be able to provide acupuncture services to its clients on an on-going basis, with technical and material support from the Real Medicine Foundation.
The Real Medicine Foundation is currently gathering support for this project in the form of supplies and financial donations.
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