THE OMARI PROJECT

WATAMU, KENYA

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INTRODUCTION

Since the mid 1980s heroin has been easily available in the towns of the Kenya Coast. The drug is brought from South Asia by air and by sea. A growing number of mainly young people, particularly those working in the tourist industry, have become addicted to the drug.

As a response to the problem of heroin use in Watamu and other Kenyan coastal towns, The Omari Project (TOP) was established in 1995. It is managed by a committee of elected local volunteers. TOP aims to test and adapt approaches to the rehabilitation of heroin users which have met with success elsewhere.

In coastal Kenya TOP is the only established counselling and rehabilitation service. The initiative has strong local support from a concerned community alarmed by the death, imprisonment and destroyed lives of young people in their midst. In Watamu alone, out of a heroin-user population of about 70, at least nine users have died since 1993.

Middlesex University, UK has provided an advisory role concerning the development of the project. In 1995, 1996, 1997 and 1998 the British Council in Nairobi supported this local initiative. The development of the project's activities started in 1995 with an intensive counselling and training programme which was carried out by Maggie Telfer, director of the Bristol Drugs Project, UK with Susan Beckerleg of Middlesex University and other TOP members.

The counselling approach of the Bristol Drugs Project proved popular with heroin users in the very different setting of Watamu. Considerable interest in the project was shown by heroin users and key community members living in nearby Malindi. During the third British Council sponsored training programme in 1997 the Fatah Women's Group of Malindi received training and now play an active role in the Project.

By 1998, 54 volunteers drawn from the local community in Watamu and Malindi, had completed training and were awarded certificates issued by the British Council. Active volunteers have continued counselling, rehabilitation and prevention work. They are Muslim and Christian and include school teachers, health workers, shop keepers and tourist boat operators.

COUNSELLING AND DETOXIFICATION SERVICES

In partnership with a local doctor TOP has developed expertise in the management of withdrawal from heroin. The doctor has reduced his fees and modified his treatment regime. Drugs, such as Methadone and Lophexidine Hydrochloride, used in Europe to aid withdrawal, are not available in Kenya. Originally, Largactil was administered for three days along with Benzodiazepines (Valium) to aid sleep and reduce anxiety. Many users complained that Largactil injections were too strong and produced unpleasant side-effects. Since then the use of Largactil coupled with Valium has been varied, with other options now used, including Thioridazine (Melleril) which is less sedating and has fewer side effects. Anti-inflammatory, analgesic and anti-diarrhoea preparations are used as well, or in lieu of, the 'major' tranquillisers.

In Europe, besides conventional pharmaceutical drugs, a range of 'alternative' therapies are used to treat drug users. For example acupuncture is very popular. TOP has started to draw on the expertise of local therapeutic systems. Several local healers have been approached and initial discussions held about the use of Swahili and Giriama traditions of massage and of herbal medicine in detoxification and pain management.

Project assessments based on reports from users in Mombasa and Malindi indicate that injecting of heroin is on the increase. This use provides an additional route for the spread of HIV infection in an area where rates of heterosexual transmission are high. Users in Watamu, however, appear not to have made the switch from inhaling to injecting. This may be largely due to the educational and advice work of TOP.

THE PREVENTION PROGRAMME

With funding from the UNDCP, a part-time Youth Drugs Prevention Worker was appointed in early 1998 for the period of one year. He developed a programme of drugs education in collaboration with TOP volunteers who had already initiated work in schools within the District. This programme builds on the early voluntary efforts and extends the work into schools, colleges, professional associations and youth clubs along the Coast.

THE WORK PLACEMENT PROGRAMME

In 1998 a UNDCP funded Work Placement Officer started work in assisting heroin users in finding gainful employment and achieving a drug free lifestyle. Many local business people support the aims of TOP. They have demonstrated their commitment by paying for the treatment of individual heroin users. Some have expressed willingness to give work experience to former users. The project builds on this good will. The Work Placement Officer aims to sensitise large and small businesses and other potential employers to the work of TOP.

DEVELOPMENT OF THE RESIDENTIAL PROGRAMME

The 1994 Narcotic Drugs and Psychotropic Substances (Control) Act makes provision for the establishment of rehabilitation centres, but none has been set up. Meanwhile TOP is leading the way in tackling problems arising from the use of a drug which is not controlled by cultural norms, and appears to be the only development of its kind in Kenya. Therefore the existing TOP initiatives and the planned residential rehabilitation centre are attracting national interest. The residential centre will be the only resource offering free treatment in the entire country.

The Omari Project decided to open a residential rehabilitation centre in a rural location, away from the usual environment of heroin users. The Project has acquired a plot of land located in a peaceful, rural setting which will be an ideal location for the residential centre.

Over the past two years discussions had been held with heroin users and TOP volunteers regarding the most appropriate regime for a residential centre. Within this setting, drug users would be temporarily removed from the pressures of making money through tourism, of the drugs trade and of fellow users who may not support the efforts of one of their group to change. Within the residential setting rehabilitating users will be able to regain their health and to develop strategies for living a drug free life.

The British High Commission in Nairobi, under the DFID Small Grants Scheme, has awarded the Omari Project KSH 2 million (£20,000) for the construction of the residential centre, which should be completed by June-July 1999. The residential centre will comprise two blocks of rooms, toilets, showers, kitchen and dining/meeting area. The centre’s buildings are designed to accommodate 20 residents and five workers in a simple style that is in keeping with the local surroundings.

About KSH 7 million (£73,000) running costs, over three years, have been granted by the UK National Lottery Charities Board. This grant will be managed by the Bristol Drugs Project, the UK partners of the Omari Project. The money is to be spent on salaries, food, medicines and administrative costs.

A provisional regime for the residential centre has been drawn up taking into account the views of users, the advice and experience of the Bristol Drugs Project and the ideas of TOP. Residents will be offered advice, information, counselling, support in withdrawal, and rehabilitation including work placements. New arrivals will be assigned a 'buddy' who will offer support and explain how the centre works. During the first two weeks in the centre users will not allowed any visitors. They will go into the nearest village under staff supervision. Rehabilitation will be effected through individual and group counselling sessions. Physical exercise through walking, swimming and football will be encouraged.

Comments by email to - susan.beckerleg@lshtm.ac.uk