Etegameno Rehab year long closure most worrying

Poor alcoholics and drug addicts in need of institutionalisation have nowhere to go.

10 February 2019 | Health

Catherine Sasman



Despite the pervasive problem of substance abuse in the country, the only state rehabilitation facility, Etegameno Rehabilitation and Resource Centre, has remained closed since April last year.

While Cabinet has been presented with a budget that could see the centre re-opening at the start of the new financial year – this April – the consensus is that it should never have been closed despite the crippling cash squeeze in the public sector.

“The closure leaves a huge void; there is an absolute need for it to be opened again. I cannot understand why government did not bother to keep it open,” said Tony Jarman, a recovering alcoholic.

Jarman, a former patient at Etegameno and sober for many years , is involved in a community support group, the Circle of Friends, that provides assistance to alcohol and drug addicts, and is fully conversant with the critical situation addicts can find themselves in.

“The need for a state-run facility cannot be overemphasised. Addicts usually do not have money and can hardly afford a private facility,” Jarman said.

The rehabilitation centre was closed because the Ministry of Health and Social Services (MHSS) could not afford to contract the re-quisite team of multi-disciplinary specialised professionals such as occupational therapists, psychologists, psychiatrists, and nurses.

“We cannot implement the rehabilitation programme without these professionals,” said deputy executive director of the ministry, Petronella Masabane, but acknow-ledged that the closure of Etegameno is “very serious”.

Masabane said a submission for a budget for staff at the centre has been submitted to Cabinet. She expressed hope that this will be approved, which could mean that the rehabilitation centre can once again open its doors. “As soon as the budget is approved we can create multi-disciplinary posts.”

During the year the centre has been closed, its remaining staff was engaged in community outreach programmes, social mobilisation and awareness-raising campaigns.

The Etegameno centre usually has an intake of 80 patients – five intakes over a five-week cycle – for alcohol and drug addicts. It does not cater for any other addictions such as gambling, sex or pornography.

Rene Adams, programme manager for the substance abuse, prevention, drug control and rehabilitation department of the MHSS, said people with substance abuse can approach social workers who are available at state hospitals.

Social workers provide therapy sessions, which often help people get sober or off drugs if they so decide.

Adams said not all alcohol and drug users need to be institutionalised; this is usually considered a last resort. “The best is if people can stop using substances within a community setup,” Adams said.

However, there are always people too sick, with too little insight in their own behaviour, in need of institutionalisation, as provided for in the Mental Health Act and the Liquor Act.



The impact

“The closure has a huge impact on people who cannot afford private treatment. It is precisely a lower socio-economic environment which can aggravate substance abuse. The fact that many people have nowhere else to go for help is causing great harm to the Namibian community,” said Charine Glen-Spyron, clinical psychologist and CEO of Bel Esprit, a private mental health clinic in Windhoek.

Namibia buckles under pervasive alcohol and drug abuse. A 2017 study ranked Namibia third in Africa.

Here, the substances of choice are alcohol, marijuana (dagga) and crack cocaine. This is aggravated by the relatively recent entrance of tik – or crystal methamphetamine – which is becoming “very common.” From all indications, tik first entered the country's borders from South Africa where it is devastating families. “This is the most dangerous drug in the world. It causes complete misery!” Jarman said.

Extremely worrying, he added is information - though difficult to confirm - that tik is now being manufactured in Walvis Bay.

Glen-Spyron says most worrying is the 80% to 90% comorbidity of substance abuse and mental illness, and the havoc it causes to families and communities.

Often misunderstood is the danger in the use of dagga – or other substances – which can trigger psychosis. This is why a professional multi-disciplinary team is required in running rehabilitation centres – to deal with detoxification as well as mental health issues.



Taxation?

There is a perception that the closure of Etegameno was because substance abuse rehabilitation is not considered a priority for the government. This, opined social worker and operations director at Bel Esprit Verona du Preez, is because substance abuse is often considered a self-inflicted disease.

However, she says that a WHO study has confirmed that substance abuse is related to the availability of such substances.

With shebeens mushrooming all over the country seemingly unchecked, it goes without saying that alcohol abuse – and its concomitant consequences - will escalate.

The WHO proposes a certain percentage of sin taxes to go towards treatment and rehabilitation, and Du Preez therefore proposes an amendment to the Liquor Act to make provision for that. “That is how you can guarantee that Etegameno's, community groups and foundations are open,” Du Preez suggested.

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