Drug users in Phnom Penh were once without self esteem, felt ashamed and worthless and had no concept that they were entitled to, and deserve, the same quality of life and health care as other Khmer citizens. Previously, no services existed for the adult drug using community and until Korsang was founded in 2004, there was no needle exchange programme serving adult intravenous drug users (IDUs).
Holly Bradford, Korsang founder and technical advisor shares the story.
Many hospitals and clinics in Phnom Penh discriminate harshly against intravenous drug users (IDUs), including IDUs living with HIV. Commonly, doctors refuse to admit or treat them, regardless of how critical their health situation is. Patients who are admitted are frequently ignored and go untreated for days. In hospital, neglect and withdrawal without medical assistance, means nearly 100 per cent of IDUs living with HIV leave before finishing treatment. Those unfortunate enough to become involved in the Cambodian drug user detention system befall the same fate.
Korsang is a grassroots harm reduction programme in Phnom Penh working with the Khmer population to prevent HIV and other drug related harm. HIV transmission among IDUs in Phnom Penh is a growing problem, with an estimated infection rate of 34 per cent. The two main reasons are lack of proper education about the risks of drug use and poor access to good health care services.
For IDUs living with HIV, there is a serious lack of public services. Unsanitary living conditions and lack of access to antiretrovirals (ARVs) and other HIV medicines, means many people are prematurely and unnecessarily overcome by opportunistic infections. Many infections develop as a result of abscessed injection sites and in some cases are fatal.
The focus of the Korsang team is to engage in intensive, harm reduction street-based services. We do not discriminate against clientele based on age, and serve a population of over 3,300 users between 12 and 55 years of age. Korsang targets Cambodians who are engaged in injection drug use and yama use, who are at serious risk of HIV and other health-related hazards that accompany drug use and high-risk sexual behaviour. Korsang staff visit 20 areas where street-based injection drug use is a serious issue and sex worker areas where yama and unprotected sex go hand in hand. We have created multiple educational programmes to reduce the risk of HIV infection among IDUs and offers a menu of services and options for the drug users of Phnom Penh including a drop-in centre, citywide street-based outreach, needle and syringe distribution, peer education, methadone transportation, methadone case management, referral and advocacy, a transitional living programme and HIV testing.
Since Korsang began serving drug users, many opportunities to reduce the risk of drug-related HIV transmission and other drug related harm have increased. Our on-site medical services have been invaluable in this sense. Since drug users in Cambodia have no immediate access to medical care, Korsang has an on-site medical infirmary with a full time doctor and a medical crisis team of three full time staff and three part time staff. The medical team treats an average of 1,000 drug users each year, and case manages and advocates for another 250 drug users who require in-patient care at a local hospital. The majority of our participants have never been to see a doctor and are therefore unvaccinated, undiagnosed and untreated for other chronic illness such as diabetes, thyroid dysfunction and asthma.
The Korsang medical team is not only responsible for administering basic first aid in the field, but also for the transportation of sick and injured participants to our infirmary and the hospital. If a participant is hospitalised, the team is responsible for making sure food is provided, along with a mat, mosquito net and water. Hospitals in Cambodia provide no personal provisions, so the medical team provides 24-hour supervision and advocacy to inpatient participants. The team also provides Direct Observation Treatment (DOT) for participants on ARVs and tuberculosis medication throughout Phnom Penh. Outsourced services to local hospitals are paid for by Korsang and include pre- and post-natal care, midwife consultations, deliveries, minor and major surgery, X-ray and electrocardiography, severe emergency trauma services and all in-patient care. Finally, the medical team also tends to participants who die, ensuring each has a proper cremation and burial.
Some of the medical issues that participants are treated for include: HIV and AIDS and related opportunistic infections, injection-related infections, for example: cellulites, abscesses, endo-cardnitis, skin ulcers, septicemia, gangrene, hepatitis B and C, as well as acute tetanus. We see a fair amount of needles that have broken off and are lodged under the skin. This situation requires minor out-patient surgery, which our clinic provides. Other medical conditions are less associated directly to injection related behaviour, but are linked with the harsh and chaotic lifestyle drug users who live in Cambodia endure. These conditions include, but are not limited to: gun shots, stabbings, machete wounds, stoning contusions, broken bones, amputations, tuberculosis, eye infections, pregnancies and subsequent births, sexually transmitted diseases, chest infections, parasites and food- and waterborne disease, malnourishment and vitamin deficiency, as well as an array of other medical problems.
The medical clinic is dedicated to providing the best possible health and medical care for all IDUs, providing care which is focused on the patient, their needs and desires. The staff focus is on the whole patient, not just the illness or condition, and every patient is treated with dignity, compassion, confidentiality, respect, and as a person who is involved in decisions regarding their own treatment and care.
It is clear to Korsang that drug users need, and are entitled to, medical facilities that are 100 per cent dedicated to their special needs, services that do not discriminate, stigmatise or criminalise them. We hope our model will spread to other locations, both regionally as well as globally.
Holly Bradford, Korsang, Cambodia