In a recent incident at Gateway of Recovery, a Private Drug Rehabilitation Centre, located at Nungoi Pourabi, Imphal East, an inmate was allegedly beaten to death. This incident has gained a lot of attention in the eye of the public and media. The deceased who had fled away from the Centre was caught and brought back at the centre and there he took his last breath. This is a painful incident; individual responsible for such incident should be taken to task. No sane person will condone the incident. Though the intention of serving the Drug User community may be real, but taking lives of fellow Drug Users even if it not deliberate, is a punishable offence. It is important to recollect that this is not the first incident of its kind. Deathsin the Drug Rehabilitation centres have been happening, but this is perhaps the first time that public at large have taking note of the situation, many Civil Society Organizations and Non-Governmental Organizations started condemning the incident widely. The said Rehabilitation Centre was burnt down, JAC was formed, compensation, from what was reported, was provided to the grieving family.
The outcome of this incident has opened the flood gates of questions rather than factual or satisfying answers. The question of how it happened, is partly answered through media, but why it happened, has not been answered satisfactorily. Many opined that such rehabilitation centres need to be banned and even called for closure of all private Rehabilitation centres in the state. Some have even compared Private Drug Rehabilitation Centre to cottage industries and an imminent person during a discussion in a TV channel called (or rather declared), all private Rehabilitation centres as an illegal entity. He even compared to the treatment of these centre as a treatment provided by local quacks (Maibas).
These are disturbing issues, as many of us miss the wider picture. If there is something illegal, it is definitely the drug availability in the state, which goes unchecked and not the efforts of community leaders, who are working to establish rehabilitation centres which respond to the menace of drug abuse in the State. While the law takes its course on the incident and brings justice to the deceased, it is time to analyse objectively whether we should start treating private run non-funded Drug Rehabilitation centres as a liability rather than an asset of the State? This is also a matter of debate and opinion. Of course, one can surely question the quality of services provided in the private Rehabilitation centres in the State; overcrowding, lack of professionals and professionalism, unhygienic conditions, overcharging of fees, forcible detention, violation of Human Rights, so on and so forth. One can even opine to the extent that Drug Rehabilitation centres, if not monitor properly, can be a place of abuse; physically, mentally or otherwise. But declaring all Private Drug Rehabilitation centre as unlawful and comparing all these centres with local quacks, is not only unfortunate but could be misleading.
There are more than 50 private self-funded Drug Rehabilitation Centres in the State. Some of the private Drug Rehabilitation centre are more than a decade old. They are self-sustaining, provide services and job opportunities to the community and provide a structured space where the drug users get opportunity to assimilate back into the society, after been treated. Many started with good intentions, taking the needs and demands of a community-initiated response, hoping that it will lead to true involvement and empowerment of drug user’s community. The initiative of these include start-ups of Post Rehabilitation Programme such as developing Mid way Home and establishing Income Generation Programme (IGP) for Alcoholics and Drug Users. Though few, these are initiatives taken up by the private run Rehabilitation Centre without taking the help of any external funding. There are very few such community led initiatives in the country, in general, and therefore more than anything, we need to understand the impact they are making by undertaking research and scientific studies. We should also consider preparing the Standard Operating Protocols and State Policies on Drug Treatment for running the private rehabilitation centres in the State, which effectively do not exist. Stronger intersectoral dialogues and engagement with existing drug rehabilitation centres and community leaders, will help making these SOPs and policy on drug treatment most relevant and effective.
Every citizen has the right to form association - It is a fundamental Right enshrined in the Constitution of India under Article 19(1)(c), work as a Voluntary Organisation (VO) in any social development sector he /she wishes to propagate, be it in the area of Women, Child, Environment, Education, Differently abled, Aged, Poverty and even Drug Use. Just as everyone has the right to propagate supply, demand or harm reduction of Drug policies; Therapeutic Community (TC) is one such model where numerous Drug Rehabilitation Centres in the state are adopting with letter and spirit. The underlying principle of TC is that community of drug users understand the problem of a drug user better.
At the best, one can accept the action of the staffs and conduct of the officials in the Rehabilitation centre as illegal; but it is too far-fetched to declare all private Rehabilitation centre illegal. As the country gives freedom to form associations that work for people’s development and wellbeing, remarks not drawn from these constitutional remedies, may be seen as insubstantial. We are not alone. Punjab as a state is alleged with mushrooming of private Drug De Addiction Centres in the smaller towns, villages and cities in Punjab.
There are many reports on human rights violations and financial exploitations reported in the media, with allegations such as mistreatment, overcharging and enslavement of the patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003685/. Punjab has three kinds of Drug De Addiction and Rehabilitation Centres - The MSJE funded at NGO Settings, Department of Health and Family Welfare funded De Addiction Centres at the Hospital settings and the Private or self-funded. They are monitored and reports provided to the concerned authority. This is as per ‘The Report of the Special Group on Drugs Constituted by Government of Punjab’. 'Comprehensive Action against Drug Abuse (CADA) August, 2018. This is the underlying difference between the two states. We have yet to established a recognised regulatory body. How do you classify self-funded Drug Rehabilitation Centres as illegal if no recognised regulatory body exist?
To comprehend the issue better, let’s look at some of community approaches adopted at different times in the state of Manipur to tackle the issue of Alcohol and Drug use. This in not with the intention to negate or ridicule any movement. In fact, Manipur as a state is doing much better than other states in terms of Drug use care, prevention or treatment. The early HIV intervention among Injecting Drug Users, Formation of Drug Users Organisation, HIV network and adopting Harm Reduction policies at an early stage of HIV epidemic, are classic examples.
Manipur is one state in the country which has also experimented with many approaches to respond to the menace of alcohol and drug abuse. Some of such approaches which one can highlight include, shaming of Drug Users, humiliation in the public places, alcoholics and drug users were shot at thighs as a punishment, were even forced to swim in the cold middle of night during winters, there were also Meira paibis, the local torch bearers, who came to the fore front as a part of the community response. Many say that the outcome of such ‘punitive’ approaches has actually led to Manipur being made a ‘dry state’.
The mushrooming of private Drug Rehabilitation centres is also a part of community response. Whether it is in the interest of the state or has become a liability – the jury is out in the open. We can empathise with some of the Rehabilitation centres in the state, which has been running with a selfless objective to serve the community better. One of the points which needs mention is that the private drug rehabilitation centres in Manipur, incur the running costs without any external support, which speaks of the interest and passion of the leaders of this movement in the state. This include the limited income and the large expenditure they have to incur for the mess (three meals a day), electricity, Rent, water, payment of staffs (including doctor and nurses), travel, cooking gas, medicines. Well, it is also important to note that many of the fees remain due and unpaid; most of the family of drug users are by and large from the lower or middle income strata, the fee collection rate never touch 70% in any point of time, in private Rehabilitation in the state (USERS Manipur & CoNE). No response to a situation is perfect.
Taking the current situation into account, the following are some of the suggestions which may help the Private Rehabilitation Centre conduct the service more humanely and effectively:
1. The State should recognise the existence and work of Private run Rehabilitation centre. They should jointly work out on mechanisms/funding avenues for proper Capacity building of staffs of drug treatment centres on a regular basis or when needed.
2. A drug policy needs to be in place taking into account the State specific needs. It should not be a generic piece but should consider addressing the issues such as the what is happening in the present context of Private Rehabilitation Centres, combating current pandemics and the likes, including a post Rehabilitation programmes for the Alcoholics and Drug User Community.
3. A regular surveillance and support mechanism which is external, free from biases, should be in place to help regulate the Rehabilitation and Drug Treatment. It should not be a toothless body, but should consist of individuals and institution who should not just monitor and recommend but can mentor these centres to become an asset of the state. The surveillance mechanism should also identify policy level gaps, estimates and disaggregation and classification alcohol and Drug Users.
4. A specific state guideline/ SOP should be developed. It should not be a copy and paste of previous guidelines as developed by the Ministry or AIIMS. It should be workable and state specific. The present guideline as developed by the Ministry or AIIMS are silent on the issue related to runaway clients or how to deal with functionaries when they started relapsing in the centre itself.
5. Private run Rehabilitation centre should recess their goals, and jointly address the issue regarding the quality of service. Strong measures should be taken to do away with issues such as (but not limited to) overcrowding, lack of professionals and professionalism, unhygienic conditions, overcharging of fees, forcible detention. A consensus state level (not built on difference or conflict) Redressal cell, should be established to address the grievances of inmates.
The author is Chief Functionary, Makers Foundation, IPA IBUNGO DRUG DE ADDICTION & REHABILITAION CENTRE, Manipur. He can be contacted at [email protected]
Endorsed by Community Network for Empowerment (CoNE) & USER Manipur