COAST REGION is among regions in the country facing the serious problem of Substance Use Disorders (SUD) in the country.
The government through the Ministry of Health and Regional Health Department has been working hard in collaboration with various stakeholders in finding ways to deal with the problem which has been increasing in recent years, mostly affecting able bodied youth who are supposed to contribute to the nation’s economy and take care of their families.
Social-economic factors, poor childhood upbringing and position of the regionbeing the gateway to other destinations in and outside the country which makes it easy to access drugs have all been cited as some of the reasons which are contributing to the problem.
One of the remarkable initiatives which have been taken by the government through its health department in the region is joining hands with Tanzania Health Promotion Support (THPS) in running Medically Assisted Therapy (MAT) clinics, being part of Afya Hatua project under the funding of US Centre for Disease Control (CDC) / PEPFAR at Tumbi Regional Referral Hospital in Kibaha Town and at Bagamoyo District Hospital since 2020.
Currently, there are over 723 beneficiaries attending these two centers (295 at Tumbi center and other 428 at Bagamoyo center).
Dr. Victor Noah, In charge of Tumbi MAT Clinic says that the treatments in these clinics are delivered through directly observed therapy (DOT), whereby beneficiaries are required to attend clinic daily to take medications.
“This method helps in making sure that the beneficiaries take their medications as required, which is very vital for them to gain full recovery,” he states. Individuals mostly enrolled for SUD treatments at MAT clinics are those around 25-49 years of age though there are those who start engaging in drugs use as early as12 to 19 years of age.
Apart from receiving treatment for drug addiction, beneficiaries are also receiving free vaccination for Covid 19. They are also screened for Tuberculosis, HIV and Hepatitis.
Possibility of being infected with these diseases for individuals who are already in substance use is very high due to their tendency of sharing injections they use while taking drugs, which increases the risk of them being infected. As of December, 2022, Tumbi MAT had identified more than 19 beneficiaries living with HIV who have been enrolled in care and treatment services.
Besides providing MAT clinic services, the project also works at community level through Civil Society Organisations (CSOs). There are three sub granted CSOs namely Organisation of Youth Against Risky Behavior (OYARB), Youth and Community Rehabilitation (YCR) and Life and Hope Rehabilitation Organisation (LHRO).
The CSOs conduct their activities through 49 Community Outreach Workers (COWs) and three Social Workers. Some of the activities which are conducted by the CSOs include community outreach for awareness on the dangers of SUD, linkage of individuals with opioid use disorder (OUD) to MAT clinic, Methadone Anonymous sessions.
Pre- MAT information and counselling to individuals who are already in opioid use disorder. The journey to fully recovering from substance use disorders usually take up to three years, and during this time most of the individuals face a lot of challenges including stigma from the society, and in some cases from people within their own families.
This challenge has been one of the reasons for the beneficiaries to quit medications and return to addiction.
According to Dr Mwanahamisi Katundu, Clinical Psychiatrist at Tumbi MAT Clinic, about 40-50 percent of individuals who are in drug use have mental illnesses.
This group needs psychological support and close supervision to enable them to remain in medications to full recovery.
She says there is still negative perception on the use of Methadone treatments from their family members since they believe that the medications will result in them being infertile and even cause death. False beliefs from family members are contributing to the majority of people who use drugs {PWUDs} to delay in joining medical assistance.
“There is still misconception among communities regarding the use of Methadone treatments to individuals affected with SUD since they believe that a person who is using the medications may end up dying or become infertile.
This is contributing to them failing to seek the services on time or quit the treatments”, she states.
Dr Joshua MharagiTHPS MAT Program Officer says in dealing with the challenge of quitting medications, there is ongoing tracing of the defaulters through the use of Community Outreach Workers (COWs) and ex- PWUDs who do the tracing on a daily basis.
Social Workers conduct family therapy and reunions as well as visiting the families where necessary. There is also psychosocial therapy and counselling conducted individually and in groups to enhance the importance of behavioral change and adherence to Methadone treatments.
“We are also conducting meetings with Local Government Authorities (LGAs), religious leaders and other stakeholders in creating awareness and reducing stigma to this group. In addition to that, all clients are linked back to CSOs for Methadone Anonymous sessions (twice a week), psychosocial therapy and counselling, engaging into Income Generating Activities (IGA), family therapy and home visits as well as other activities which help in continuum of care.
Highlighting on the success of the project, he mentions that by December 2022, retention at both Tumbi and Bagamoyo MAT clinics has remained above 74 percent. On the other hand, over 170 beneficiaries were reunited with their families and have resumed their livelihood activities.
In addition to that, on average each CSO enrolled a total of 32 clients and managed to trace back 20 defaulters per month. THPS Regional Programme Manager, Dr. John Roman says the project also focuses on preventing the problem of SUD within communities and not treating individuals who are already affected alone.
“That is why we are using different approaches to make sure that awareness on the dangers of involvement with drugs and sensitization on getting medications on time is well spread across the area”, he explains.
Facilitation of Income Generating Activities (IGA) has had a number of positive results to beneficiaries. Hellen Swai, a Social Worker at Tumbi MAT clinic says that stable clients are encouraged to enhance their educational level to be able to employ themselves or get employed.
Participating in IGA reduces the chance of relapsing into drugs, it helps in increasing client’s socio-economic status and thus reduces stigma and discrimination.
“Through working with Kibaha Education Centre (KEC), we have managed to provide short courses to a total of 108 beneficiaries, whereby 102 of them were trained on driving while other 6 beneficiaries received trainings on cooking, tailoring and carpentry.
In addition to that, with the help from the project, a total of 7 groups from beneficiaries were able to access loans released by the District Council.
Deborah Lema is one of the beneficiaries at MAT Clinic Tumbi who has a lot to thank MAT project for. She testifies how being enrolled at the clinic has totally changed her life.
“After I started using drugs in 2011,I was in a company of bad friends and we often did whatever we could to get money for buying drugs. We used to steal and assault people and force them to give us money. I used to go missing from home for a number of days and my family members totally lost hope in me.
I was in and out of medications for quite a long time, which made me delay to recover. It was until I was enrolled at the MAT Tumbi clinic about two years ago that I started to be faithful in taking the medications and I started to recover. I am so grateful for this assistance I have received from THPS and Tumbi Hospital,” she says.
Deborah is now a Community Outreach Worker (COW) working with the project through Organisation of Youth against Risk Behavior (OYARB), in creating awareness among communities of the dangers of engaging in drug use.
Being a past defaulter herself, she is now working with the project to trace defaulters and encouraging them to return to the clinics.
