November 17, 2008
Afghanistan: Women and the Silent Addiction to Opium
BY Nadene Ghouri
One of three young siblings addicted to opium at a treatment center in Kabul.
Freshta stared blankly at her children as they lay listlessly on the bed. She picked one of them up, a scrawny shaven-haired boy who is 4 but looks more like 18 months.
"I had five boys," she explained. "I only have three left."
Freshta and her surviving children are all opium addicts -- just one family among tens of thousands of women and children addicted in Afghanistan.
"My mother-in-law beat me when the children used to cry or make a noise. And she beat me when I didn't do the work she gave me. The children were always trying to distract me, wanting to play."
The young mother boiled opium in water and made her children drink it to keep them quiet. She then started to take it herself to help her sleep. "It made me forget my beatings so I took more. Now, two sons are dead and these three are sick," she said.
Freshta's story reflects the plight of many women in Afghanistan. Born into the fiercely conservative Pasthun tribe in the city of Kandahar, Freshta had no way to escape her mother-in-law's brutality.
The young mother boiled opium in water and made her children drink it to keep them quiet. She then started to take it herself to help her sleep.
In the end, it was her husband -- "a good man," she told me -- who brought her to the Sanga Amaj treatment center in Kabul. It's the only drug rehabilitation facility for women in the capital. The husband took his family to Kabul in secret for the sake of his remaining sons. Freshta said that her in-laws would never have allowed them to come had they known of their plans.
"This is Afghanistan!" said Dr. Shaista Hakeem, the clinic's coordinator, as she showed me around. "Mothers-in-laws can be more dangerous than drugs sometimes," she laughed wryly.
The facility she runs is scrupulously clean, with a well-tended rose garden. It's funded by the Colombo Plan, an inter-governmental organization launched in the early 1950s to promote economic and social development across Asia and the Pacific. It provides 20 beds on site; the rest of the treatment is dispensed through a community outreach program run by a handful of social workers.
Two doctors and a team of nurses and occupational therapists work with the women -- usually for one to three months -- and provide vocational training, such as teaching tailoring skills, to help them survive once they leave. Despite these efforts, it's a woeful provision in a country that the United Nations estimates has 1 million drug addicts -- 130,000 of those believed to be women.
"Once home, we visit them for up to a year, and three times a week during the first three months," after being discharged, Hakeem explained.
The cheerful 41-year-old trained as a doctor in Kabul in the 1970s, at a time when the city was far more liberal and prosperous than it is today. She said she "fell into" drug treatment work while living as a refugee in Tajikistan in the 1990s. It was at the height of the Taliban's brutal regime, when female doctors were banned from practising in Afghanistan.
Dr. Shaista Hakeem, the clinic's coordinator, with a daughter of one of the women being treated for addiction.
"Afghan society treats addicts as criminals," Hakeem told me, sitting in her cramped office. "But I don't see them that way, especially when I see the poverty and problems they face. Our treatment is 80 percent psychological and 20 percent medical." As she talked, two toddlers belonging to one of her patients wandered in and out. The place is a refuge as much as anything else.
With no access to heroin substitutes, such as methadone, the treatment is basic. Each woman goes through a slow withdrawal process in secure surroundings with plenty of counseling and kindness. Just being heard and given a haven has an enormous positive effect on the women, Hakeem said, may of whom have to deal with crippling poverty.
Although billions of aid dollars have poured into the country since the fall of the Taliban in 2001, the majority of Afghans still live on less than $1 a day and have little access to basic amenities, such as clean drinking water and sanitation.
One woman at the clinic, who identified herself as Medina, said she couldn't remember her age but thought she was about 28. A shrapnel injury from a bomb explosion left her hand severely damaged. She began taking prescription painkillers to ease the pain but had no idea how addictive it could be. When her husband left her to find work in Italy, she became depressed and began mixing the pills with heroin.
Admitting that she had a problem and seeking help was the most difficult part.
There are few trained doctors left in Afghanistan. They've either fled the country or prefer to work as well-paid translators in Kabul's bubble economy, which is driven mainly by foreign aid.
"In my society, being an addict is like a shame," she explained. Hakeem talked to her often by phone, but the woman was too scared to seek help. "In the end, I was so sick, I didn't even have the energy to take more drugs," Medina said. The clinic eventually convinced her to come in. "You can use medicine but you can also use words of motivation to heal," she said of Hakeem's persistence to get her help. "Aunty [Hakeem's nickname among her patients] is curing me with both things."
Medina's injuries could have been treated by a doctor, but for many Afghans ordinary medicine is out of reach.
There are few trained doctors left in Afghanistan's public hospitals. They've either fled the country or prefer to work as well-paid translators in Kabul's bubble economy, which is driven mainly by foreign aid. A translator can earn up to $250 a day, while a doctor in a state hospital earns approximately $50 a month.
There is one intensive care unit in Kabul serving a population of 30 million. Three state psychiatrists practice in a country where the traumas of war are as common as the poppies growing in the rural fields.
Quack doctors often fill the gaps charging $10 for a consultation, and many of them work in cahoots with unlicensed drug stores and pharmacies, selling over-priced and often illegally imported drugs to the desperate.
"Sosegon, Temezepam, Ibruprofen 600, Phenobarbital and Valium. We see so much of it," Hakeem said. "The opium dealers are ruthless but so are the drug stores. Prescription meds can cost around $20, whereas a gram of opium or heroin is just $2."
So many women are depressed or suffering from hysteria, she said, and their road to addiction often starts with sleeping pills or painkillers.
There are growing numbers of male addicts visible on Kabul's streets; many of them congregating in the former Russian cultural center -- a broken down building where a portrait of Lenin still hangs from the wall.
Medina, shown here being treated at the clinic, became addicted to painkillers after a shrapnel injury. When her husband left her to work in Italy, she became depressed and began mixing the pills with heroin.
Although the police have recently begun rounding up street addicts and throwing them in jail, many in Afghan society prefer to look away from the problem of addiction among women, with officials refusing to acknowledge that the issue exists.
Of the 402 patients the clinic treated in 2007, Hakeem believes that only 19 have relapsed, and all of those had family members who were also addicts. It's the reason why Medina's brother has been sleeping in an annex in the garden.
"We aren't supposed to take men but if I didn't help him, treating her would have been a waste of time," Hakeem said.
Hakeem's biggest worry are the many children who become addicted. If they don't, their mothers find it impossible to seek treatment because there's no one to look after the children at home. Hakeem would like to start a children's unit and kindergarten but said she desperately needs funds.
The story of Khadija, who has been in and out of the clinic, shows how easy it is for entire families to fall into addiction. She lost her husband and all but one of her brothers to war. "My last brother came to my house one day and I was so depressed I couldn't move," Khadija said. "He asked me to try his opium and I did. I forgot my pain."
To fund her habit, Khadija started to beg. While she was out of the house, her two children stole her drugs and began using too, she told me. Soon after, all of them were begging on the streets.
"We made a couple of dollars a day but we didn't buy food, just drugs," she said.
Khadija and her son and daughter were all treated at Sanga Amaj last year. But the children ran away and Khadija relapsed. Only her 12-year-old daughter, Gul Pari -- which means flower fairy -- came back to the clinic and is now drug free.
"I thought to myself, 'I'm smart now. I can think! I want to learn.' But my brother would not give me permission to go to school."
"She weighed 40 kilos when she first came in," said Hakeem. She was a little nothing."
The young girl didn't know that what she was doing was wrong; she just remembers the warm comfortable feeling the drugs gave her. When she stopped, first her feet hurt, then she began to hurt all over. "I couldn't eat and I was vomiting all the time. I was very scared," she said. When asked why she ran away from the clinic, she replied, "My brother wanted us to. We climbed over the wall in the night."
She keeps a photograph of her brother on the wall. It shows a portrait of a hollow-cheeked expressionless youth.
After she got clean, Gula Pari wanted to go to school. "I thought to myself, 'I'm smart now. I can think! I want to learn.' But my brother would not give me permission to go to school."
He also told her that he wanted their mother to continue using so that he would have someone to take drugs with. Khadija nodded, revealing that her son didn't even know that she was again being treated at the center, otherwise, "He would never have given me permission to be cured."
In Afghanistan, a man's word is law -- even if the man in question is a 13-year-old heroin addict.
Nadene Ghouri is an award-winning reporter who specializes in social affairs and human interest issues. She lives between London and Kabul and has been reporting the changing situation in Afghanistan since 2001. She has previously reported for both the BBC and Al Jazeera English.
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