For their own good

Burma
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Caged life: a man at the All Nations centre in Myitkyina, where new admissions are often locked in cages during the initial period of their withdrawal. © Martin Bader

Electric-green paddy fields and dark-brown thatched huts line the unpaved, pot-holed road to the outskirts of Myitkyina, the capital of Kachin, Burma’s northernmost state.

The high fences and barbed wire outside the sprawling block of land where the red tuk tuk stops are in stark contrast to the cows in the neighbouring fields and the children playing in the monsoon rain.

A large cross and biblical sayings decorate the interior of the Rebirth Rehab Centre – a Baptist-run rehabilitation centre for drug addicts – which appears at first glance to be a well-run, clean institution.

But behind the shared dormitories and mess hall is a dark mosquito-infested hut crammed with about a dozen skinny men with bloodshot eyes experiencing heroin withdrawal. They lie shirtless on the timber floor, trying to find some respite from the damp, humid air.

One man in particular sticks out. His legs are chained to the floor: punishment for smoking at the centre, which is banned.

After addicts are brought here by family members or anti-drug vigilantes, they are locked in the ‘detox room’ for days or even weeks, depending on the severity of their withdrawal symptoms. They have to relieve themselves in the corner and are not allowed out until staff decide they are ready.

‘I’ve been here for three days and I can’t sleep. There are too many mosquitos,’ said a 35-year-old user who wished to remain anonymous because of the stigma around drug addiction in Burma. ‘I’m fed up using drugs, I want to be clean.’

While the conditions are primitive compared to Western standards, for many it’s their only option for survival.

Every family has one

Violence has plagued Kachin State, which borders China to the north and east, and Shan State to the south, since the country gained independence from the British in 1948.

The Kachin, a Christian ethnic group in a Buddhist-majority country, have been fighting the government for their right to self-rule. But, in 2011, after 17 years of peace between rebels and the government, the long-standing ceasefire collapsed and fighting resumed, displacing an estimated 100,000.

Burma is the second-largest opium producer in the world. In Kachin and Shan States, the easy availability of cheap, strong heroin has helped fuel an addiction crisis that is not only destroying communities and economic development, but bringing with it skyrocketing rates of HIV and Hepatitis C.

Caged life: a man at the All Nations centre in Myitkyina, where new admissions are often locked in cages during the initial period of their withdrawal.

Martin Bader

Evidence of addiction is everywhere in Myitkyina, a dusty town along the Ayeyarwaddy River, filled with cheap Chinese goods and jobless youths. Used needles are strewn across the train tracks that go through the town, while signs hang in family-run restaurants pleading against drug use. A heroin hit costs just 60 US cents and children as young as 12 are users.

‘Every family has a drug user. It affects everyone,’ said Dr Tun Tun, the Myitkyina area co-ordinator for the Substance Abuse Research Association (SARA) – one of the few NGOs in the state that run harm-reduction programmes. ‘People need to realize it’s our problem, not the government’s.’

Strong arm tactics

In 1999, Burma launched a 15-year plan to stamp out poppy cultivation and, up to a decade ago, it looked like the nation was on track. But that deadline has been extended to 2019 following the tripling of poppy cultivation since 2006; it has reached almost 60,700 hectares, according to the United Nations Office on Drugs and Crime (UNODC). (Whether Aung San Suu Kyi’s freely elected new government – the first after more than half a century of repressive military rule – will aim for the 2019 target or not remains to be seen.)

Moreover, UNODC’s Southeast Asia Opium Survey in 2014 found that opium use had more than doubled and the use of heroin and methamphetamines more than tripled in poppy-growing areas of northern Burma between 2012 and 2014.

Tom Kramer, a researcher at the Transnational Institute who focuses on Burma’s drug market, said ongoing conflict and poverty, and demand for opiates in the region, particularly from China, were important drivers of opium cultivation.

‘Given all these factors, it’s unlikely opium cultivation will disappear and Burma will become opium-free any time soon,’ he said.

For impoverished ethnic communities who grow opium as a cash crop, it’s a solution to their hardships, not a problem – allowing them to put food on the table and meet other basic needs.

‘Drug use has become a kind of genocide. There is no rule of law’

Kramer described Burma’s drug policies in areas affected by decades of war, which focus on arresting and beating drug users and destroying opium fields, as ‘repressive’.

‘The drug crisis in Kachin State is an urgent warning of the failures of anti-narcotic policies in the past and a wake-up call for inclusive, informed actions that are in partnership with the local people in the future,’ he said.

‘What will be needed at the community level in the coming years is the provision of effective treatment services for drug users which are voluntary, based on needs, and respect human rights. As most opium-cultivating communities grow poppies as a livelihood strategy, the development of their communities should be prioritized, rather than arresting individuals and destroying their livelihoods.’

The repressive policies he refers to include the tactics of Pat Jasan, an anti-drug squad that was founded in 2014. Sick and tired of witnessing the impact that drug addiction was having on locals, members of the Kachin Baptist Convention banded together to launch their own ‘war on drugs’. Dressed in military-style uniforms and armed with batons and sticks, Pat Jasan members, allegedly numbering in the tens of thousands, publicly shame and beat drug users before removing them from their homes and putting them into one of 12 faith-based rehabilitation centres. Their destruction of poppy fields by force has led to open conflict with opium farmers and local militia groups.

Aung Gun, the Myitkyina head of Pat Jasan, calls it ‘a race against time to protect ethnicities and fight against the drug community. Drug use has become a kind of genocide.’

While their work has been praised for bringing the issue of addiction into the limelight, most drug experts are against their tactics, which violate basic human rights.

‘There is no rule of law. If farmers keep growing poppies, we will punish them,’ Aung Gun said, unfazed by the impact the destruction would have on people’s livelihoods.

Troels Vester, country manager of UNODC in Burma, believes providing farmers with an alternative competitive income, along with ceasing conflict, is the answer. UNODC is working with the government in Shan State to replace opium poppies with coffee. It’s estimated that by 2018 more than 1,300 hectares would have been converted to coffee and another 800 hectares reforested. All in all, $150 million is needed to change all opium cultivation in the country into coffee production, according to Vester.

‘There is a very close relationship between peace and illicit narcotics in Burma. On the one hand, conflict fuels illicit drugs; on the other, illicit drugs fuel conflict. We do not believe it is possible to have major progress in one area without progress in the other,’ he added.

Harm reduction

In Myitkyina, Naing Myo Htun and Aung Mai, outreach workers from SARA, jump on their motorbikes armed with gloves, clean needles and a safe needle-disposal box. Their mission: to pick up used needles and replace them with new, clean ones in a bid to reduce blood-borne illnesses. It is Burma’s version of other countries’ safe injecting rooms and needle-exchange programmes – part of the harm-reduction approach which focuses on preventing harm, rather than preventing drug use itself.

The men make five stops at popular injecting sites, from secret alleyways to grassy spots along the river littered with used needles and condoms.

‘I don’t let them leave. If no-one comes to pick them up at the end of the programme, it’s safer they stay here’

Back at one of SARA’s drop-in centres, men of all ages lie around on the floor chatting and listening to music. It’s here that drug users are able to come to hang out without being judged, but, more importantly, services including HIV testing, counselling and doctor’s referrals for antiretroviral therapy and suspected TB cases are available.

According to Dr Tun Tun, 30 per cent of injecting drug users in Kachin are HIV positive and 70 per cent have Hepatitis C.

Easy does it: a SARA community outreach worker collects used needles and drug paraphernalia from a popular shooting-up site.

Martin Bader

Despite the alarming figures, the harm-reduction approach is at odds with that of the faith-based rehabilitation centres which rely on teachings of the Bible and forced withdrawal without the support of medicines such as methadone.

‘It’s hard for the community to understand needle exchange. Because we come from a public-health approach, we want to show the data and show what we can achieve,’ said Tun Tun.

He explained that while he was trying to work with the centres, attitudes on how to approach drug addiction were ‘very different’, which made it ‘difficult to understand one another’.

Last year, the organization distributed about a million needles across the six Kachin townships where it has drop-in centres. If an addict wants to quit and needs assistance, SARA refers them to a government-run methadone programme.

For Tun Tun, the methadone approach to combating drug addiction is far better than forced withdrawal, which often means being locked in a cage.

'A gift from God'

Across town, Lulu Din is preparing a herbal concoction she administers to drug addicts.

She’s the founder of All Nations, another Christian-run rehabilitation centre in town that opened its doors in 2009 – and the only one that accepts women.

According to locals, drug addiction is also pervasive among women, who often resort to prostitution to fund their habit but are shrouded in secrecy because of stigma.

‘I heal drug users by saying that the power of drugs is nothing in front of God,’ she said.

‘By caring for people and providing treatment, it means users believe us, whatever we say.’

Din gives her 60 patients a herbal medicinal drink, which is ‘a gift from God’, three times a day and showers them frequently in salty water.

She claims that it takes drug addicts two weeks to get clean with this method before they proceed onto either a three-month rehabilitation programme focused on Bible teachings or a two-year programme for those who want to end up volunteering at the centre.

‘I don’t let them leave. If no-one comes to pick them up at the end of the programme, it’s safer they stay here,’ she said.

Addicts who also suffer from mental-health problems are locked in small timber cages at night for fear they may attack other patients.

Farmer Mau Nu from neighbouring Shan State arrived at All Nations three weeks ago after being picked up by Pat Jasan. For 20 years he smoked opium and injected heroin.

‘Drugs are so easy to find. In the beginning, my friends told me to try it once and I got addicted. I was stuck in it and haven’t had a chance to see my mother for more than 20 years,’ he said.

‘I want to go home but God has trapped me in this camp,’ he added dejectedly.

Sophie Cousins is a health journalist based in South Asia with a specific focus on India, Nepal and Burma.

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