Uganda

Dear all, Today's our official "wrap-up" day here on the coast: tomorrow we return to Nairobi, flying out the following day.
 
Of course it all seems a bit bittersweet at this point, having finished all the people part of the work; just some reports to finish, documents to collate & the follow-up. Beth will be going out to the rehab center this afternoon to do some more yoga with the group since most of our time here has been focused on the acupuncture.
 
This week training the drug detox staff probably went the smoothest of the 3 trainings – in part because Beth and I have found our stride, are fairly well-practiced and know how to piece all the bits together. Also though, The Omari Project has been great about facilitating us and the training – they even supplied us with a laptop for several days to do our reporting and make up contracts, etc.! Quite the treat after weeks of internet cafe-ing it, which always entails walking through muddy puddles for some distance, limited hours of availability, faulty and sloooow connections.
 
As most of you know, the NADA acupuncture protocol training that we have been providing was originally developed to address heroin addiction, and only later was found to be useful for Post Traumatic Stress Disorder (like for victims and responders at 9/11, Hurricane Katrine, etc.). So I have been excited to see how this training would go over with this population of heroin addicts.
 
We spent the first part of the week at the rehab center in Malindi – meeting under cashew trees with staff and volunteer counselors, outreach workers, and the clinical officer (like a nurse practitioner). The 19 residential clients (all heroin addicts going through detox) prepared lunch for us, and were very conscientious about allowing us time & space for our meetings, being quiet during the yoga nidra sessions & like that. They also were great big brothers and sisters for Judah: played soccer w/him, gave him all sorts of little presents, and spent hours talking and laughing with him and with us. Unless you've worked with drug addicts in recovery, your preconceptions about this population are probably not completely accurate.
 
The trainees – many who are ex-addicts themselves – really appreciated receiving the treatment as well as learning the technique & material. In our session the morning after their first treatments, most people reported the usual improved sleep and energy, a few said their hearing or vision had improved, lots of clear heads. One guy, though, said he found the treatment to be an "immune booster" and that his libido had markedly increased, so his partner had not slept well at all the night before. We pointed out that this was not the purpose of the treatment, but appreciated his input.
 
When it came time for the rehab clients to receive their first treatments, there was a lot of hesitation. We discussed their concerns (these conversations were all in rapid Swahili) which mainly entailed whether the treatments were painful, what the treatment would do for them & the like. The acupuncture trainees also started off by talking about all the negatives (if you feel dizzy, if you get a headache, etc.) so when we adjusted the delivery to start with why the treatments would be useful, the clients became more interested. One of the most vocal clients who did not want anything to do with receiving needles in the ear became one of the first to scoot his chair forward for treatment.
 
The trainees, who had already needled each other several times did a great job and we were able to do close supervision on point location. One of the trainees especially seemed so plugged into the work that I think he must have done auricular acupuncture in a past life – such a natural.
 
During the time the needles were in, the usual calm & quiet descended except for one guy who just couldn't stop laughing. He had a big grin on his face the entire time, and his fits of giggles set everyone else to smiling.
 
After the treatments were done, we discussed the experience. Lots of the usual comments: "I felt like I was in paradise," "I feel relaxed & cool," "I feel less stressed." Besides the laugher, another guy said he cried, which he expressed as a feeling of relief and release . . . letting go of some of his past.
 
He was one of the 3 guys I did personal interviews with the following day. The residential clients tend to be from well-to-do families who can afford the care. The exceptions are those whose communities or extended families have collected for their detox, or those who the Omari Project staff supports out of their own pockets (these tend to be addicts who show very strong desire to quit, following all suggestions and directions in preparing for detox, like decreasing dose, not spending time with old friends, etc.).
 
Although heroin in Kenya is pretty easily obtainable and cheap, detoxing here (or anywhere) is not so easy or cheap. The Omari Project offers services for the least expense. Those from poor families or no families are unable to pay for the residential detox services (which are about $100 per month). These folks have to rely on the outpatient and drop-in services (which are free at the Omari Project). Consequently, successful withdrawals using only these services are minimal, and Shosi – the project coordinator – is excited to have another tool (acupuncture) to support these as well as the residential clients.
 
Anyway, by Wednesday afternoon, we traveled to the newly opened Watamu residential facility – a beautiful old Italian home, very run down, but sort of magical building and grounds. There were only 4 clients currently staying here (it opened in May), and one was an Italian girl of 22 who'd grown up in Kenya. Her family runs a local hotel, and she herself is quite beautiful, speaks fluent Swahili, English, Italian and some other languages. She's been addicted since age 15, has a 5 year old son, and came into the center on Monday with a 1.5 gram a day habit, and was also taking huge amounts of sleeping pills. She is actually a good friend and old dope partner of one of our trainees – a beautiful Muslim woman who is smart, well-presented, and totally motivated to stay clean.
 
Because there were so few clients, we offered treatments to the community around the center. The population is mostly Muslim, so we treated women in one section and men in another. The women came in mostly in full burkas (head scarves & veils), only lowering them when they would receive treatment. We were very careful (more than usual) to ask before taking pictures. The men ranged from rasta beach boys with dope habits to respected elders in the Muslim community. Most of these latter wore Konzo's (the long robes) and embroidered hats. Some had beards dyed red. Lots of character in those faces!
 
We offered this type of treatment twice in Watamu, and then did a similar day of treatment at the Malindi main office and drop-in center. Graduation was Saturday, and it was sad to say goodbye to this group. I'm looking forward to seeing data on whether the project's success rates improve (as far as #'s of people able to successfully withdraw and stay clean), as such changes could only have positive impact not only on the addicts themselves, but on their families and the community at large.
 
Hoping all is well wherever this finds you, and signing off from
Malindi, Kenya,
Megan.