To reduce the risk of transmitting coronavirus disease 2019 (COVID-19), countries all around the world are implementing various restrictions to public movement and contact. In South Africa, there is currently a lockdown period which was initiated on 16 March and was scheduled to be in place until 21 April. However, a recent extension was announced, which will keep the country under restrictions for an additional two-weeks. Under these lockdown restrictions, people may not leave their place of residence except for clearly defined reasons outlined by the South African Government. These restrictions have a substantial impact on street-based people, especially those who use drugs and are likely to experience additional complications when their movements are restricted.
On The Frontlines With People Who Use Drugs
Living on the street and not being able to move around is problematic, particularly if there is a need to purchase drugs on a daily basis. Unfortunately, those who are opioid – referred to as nyaope, unga and whoonga – dependent face the challenge of needing daily doses of the drug. Street-based people have to risk being stopped and detained by the police during their journey to acquire drugs, often resulting in dire consequences.
There have also been reports of sellers increasing the prices of their products as well as some people pooling their money, buying greater quantities and then reselling amongst their communities at an inflated cost.
The challenges faced by street-based people who use drugs are compounded by the fact that the sources of money they usually have access to are unavailable during the lockdown. With most middle-class people at home isolating, there is very little opportunity to make money through ‘scurreling’ or by selling various items to people moving through the streets.
No Fixed Place of Residence
In Cape Town, street-based people, who currently have no fixed place of residence, are being relocated to various secure sites. Theoretically, this relocation is voluntary, and consent is given by the individuals being moved, however, there have been numerous reports that contradict this. There have been many individuals who expressed interest in being taken to a secure site, based on information and anecdotal reports on the conditions and facilities offered at the secure sites.
Civil society organisations have facilitated the transfer of many street-based people to the secure sites, ensuring that they are able to take their essential belongings to the site and that they arrive safely.
On-site, individuals are allocated to a designated tent where they will reside for an undetermined period of time. At the Strandfontein site [Fig.1], individuals sleep close to one another, and in addition to the potential exposure to COVID-19, those experiencing severe opioid withdrawals are afforded little to no privacy, unless they brought a small camping tent with them. On my initial visit to the site, I focussed on identifying and recording the details of those experiencing withdrawal from opioids. My approach was to engage compassionately with those in withdrawal, to listen empathetically and acknowledge the pain and distress they were experiencing. Over the four hours I spent on site, I engaged with more than 25 people who were going through painful withdrawals.
Figure 1. Inside one of the marquees housing hundreds of street-based individuals who have been relocated to Strandfontein, Western Cape, South Africa.
Withdrawal Symptoms: A Sobering Experience
The severity of withdrawal symptoms ranged from mild to severe. Witnessing friends and clients who I have had long-standing relationships with, going through the excruciating experience of opioid withdrawal. broke my heart. No one should have to suffer through this. And for those who don’t have the lived-experience of going through opioid withdrawal, the overwhelming pain and distress can make living seem unbearable.
What this looked like was human beings vomiting, crying and begging for assistance of any kind. Anything to stop the ‘turkeying’ (colloquial term for ‘withdrawing’) and alleviate the indescribable pain, allowing for them to fall asleep, even if for a minute. To look into a human being’s eyes who is going through this is a sobering experience, which reaches the core of your soul and tugs on any sense of empathy one may have.
While sitting with a friend next to his tent, he cried ‘Why me?’ As the tears staggered down his face, sticking to his clammy skin, he said to me ‘They don’t understand what it’s like to turkey, to experience this. They never will, but they laugh and mock me’. I never asked my friend who ‘they’ were, but I could only assume it was others, residing under the same tent. I sat with my friend for a while longer, mostly in silence, as he tried to close his eyes and dissociate from the pain.
Essential Harm Reduction Brings Hope
As I write this, I can say that many of my friends and others I met during my visit who were suffering, have received support. Many of those in mild to moderate withdrawal have been given an adequate supply of symptomatic medication to relieve some debilitating symptoms. While some others have been initiated on an opioid substitution therapy program, where they are currently receiving methadone or buprenorphine-naloxone. Currently, there is a coordinated effort from multiple stakeholders to try and upscale this support. In addition, multiple entities have pledged financial assistance to ensure that the support is sustained into the future.
While devastating, I left with some optimism knowing that there are organisations and individuals who care, and who were working relentlessly to ensure others, like my suffering friend, receive support and relief.
* SANPUD is a registered non-profit organisation made up of member peer-led organisations that share a common purpose – to defend the rights of people who use drugs. We further seek to dismantle myths, hypocrisy and bad science that inform societies understanding of drugs, their use, and the people who use them.