The fight against substance abuse begins with prioritising between the two facilities

Drug: The absence of a national detoxification centre may weaken Bhutan’s fight against the growing issue of substance abuse, but without a rehabilitation centre, the country is unarmed to even begin the fight.

To address the increasing cases of relapse among drugs users and the number of people waiting for rehabilitation services after detox, the country needs a rehabilitation centre more than a detoxification centre, health officials said.

The issue of prioritising between two critical facilities has come at a time when the country, led by the Youth Development Fund, has just renewed its efforts to aggressively address the growing number of substance abuse cases.

“The main issue is a lack of a rehabilitation centre that has a capacity to take in more clients,” health ministry officials said.

Following a detox, which lasts for about 10 days, the hospital has to refer clients to a rehabilitation program, where they spend at least three months.  However, since the existing rehab centre doesn’t have the capacity to take all clients that are detoxed, the clients go home.

“Sending them home increases the chances of relapse, which is why we aren’t doing detox aggressively,” health officials said. “If we want to we can, but it’s not benefitting anyone.”

The need for a detox centre came up last week during a meeting among officials from YDF, health, police and narcotics.

It was learnt during the meeting that the health ministry had diverted the budget for the planned 50-bed detox centre in Gidakom to build the mother and child hospital.

The health ministry had given a Nu 80M budget to YDF to build the rehabilitation centre.

Why and how the health ministry decided to share its budget with a civil society organisation is not known, but the plan initially was to spend Nu 50M on the rehab centre in Tshaluna, and the remaining Nu 30M for another rehab in Kanglung, Trashigang to cater to the increasing number of alcohol dependents in the east.

The health ministry had prioritised a mother and child hospital over a detox centre, given the country’s high rate of infant and under five-child mortality. “We’re yet to achieve the MDG target in these areas, which was why we gave more attention to mother and child hospital,” health officials said.

According to them, the plan was to increase the existing 10-bed detox ward to 20 in the hospital, after shifting the mother and child services to the new hospital.  Also, since detox services were available in regional and district hospitals, and even in some basic health units, health officials said they decided to hold the detox center’s construction.

There are today five clients, including a female, who are undergoing detox at the hospital, while five females and 15 males are currently undergoing treatment and rehabilitation program at Serbithang.  Another 17 are also undergoing treatment at Samzang retreat centre in Paro, which is managed by Chithuen Phendhey association

Serbithang’s rehab manager, Loday Zangpo, said none of the 15 male clients undergoing rehabilitation are relapse cases but three, he said, are “judiciary cases,” referred by the courts.  Five of the male clients are referred from the three regional referral hospitals.

“Since we have limited beds, we can’t take in relapse cases,” he said. “Every month, we have about five to six clients on the waiting list.”

The rehab has 16 beds for males and eight for females.  When unable to take in clients, and if families can afford, the rehab refers them to India.  Most are sent to Siliguri, while some go to as far as Chennai for rehabilitation programs.

“In case of female clients, the turnover among youth is less and most of them are in their 30s,” he said, adding that most female clients are alcohol dependents.

Since its establishment in 2009 until last year, 216 male clients, 64 between 15-24 years, have completed treatment and rehabilitation program at Serbithang rehab centre.

From 2010 until last year, 71 female clients, including 19 who were between 15-24 years, have completed their treatment at the rehab.

Health ministry and hospital authorities agree that ideally there should be both detox and rehab services in place to address the problem better.

Psychiatrist at Thimphu referral hospital, Dr DK Nirola, said all hospitals should provide detox services to give quick intervention to patients, and then either refer them to a rehab or put them on medication.

“What we need to have in place depends on the demand,” he said. “One way to go forward is to allow YDF to have a detox centre, which can be run by health personnel.”

If the Gidakom detox centre had come through, there were plans to replicate the 28 days rehab program that is offered in one of Chennai’s rehab centres.  With 10 days detox and good counselling, the rate of relapse would drastically drop, he said. “But the problem is we don’t even have one qualified counsellor today.”

Sonam Pelden



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