A post by Elsa Browne, SMMGP Operational Lead.
On a particularly sparkling sunny morning this week and on a visit to my former home town of Durban, I drove from the upmarket suburb of uMhlanga in the north through the troubled city centre where recent xenophobic clashes had made the BBC news, to the less salubrious southern suburbs where the addictions treatment clinic of Dr Lochandra (Lochan for short) Naidoo is located. Dr Naidoo is a Durban GP, and since 2014 President of the International Narcotics Control Board, the first Southern African; and family practitioner to be elected to that role. In this role, he works with high-level delegations from the World Health Organisation and makes presentations to the UN’s Economic and Social Council and the Commission on Narcotic Drugs. Dr Naidoo was a founding member of the International Society for Addiction Medicine in the 1990s and a plenary speaker at the ISAM conference in 2014.
Like many of his counterparts in the UK, Lochan is passionate about all things related to the subject of addiction. He works as the clinical lead of a private residential rehab in Merebank south of Durban, which he established some 20 years ago as a young general practitioner. On arrival at the spotlessly clean and welcoming clinic I was met by the centre’s psychosocial therapist and shown around the premises, including meeting the genial chef. The walls of the clinic are decorated with posters carrying familiar slogans – Dr Naidoo did a residency at the Hazelden Centre in the US during the 1990s. In a country like South Africa with its many competing health priorities, his determination to keep addiction prevention, treatment and policy on the agenda is crucial and has led him from national partnerships to his current position and international links.
None of the above however takes his focus away from the starting point: people who use drugs problematically. Each and every individual that enters the clinic is case managed by Lochan in person, together with the wider multi-disciplinary team of trained professionals, psychiatrist, psychologists and social workers. The drugs of choice of people that come through the door reflect local trends and are ever more challenging, including an upsurge in the use of heroin or heroin based drugs mixed with anti-retrovirals. Opioid substitution medication – expensive in South Africa – is prescribed. He dismisses a question about his views on pursuing abstinence with a smile and a small shake of his head: “I believe we can all be fully integrated human beings”. And further: “Often the architecture of a troubled life is shaky and unstable. I don’t offer to treat addiction, it’s there. What we do is, together we build a new structure adjacent to the old one, a strong and stable one. And when the new construction towers over the old one, people come across and inhabit it permanently”.
In order to be funded for treatment, people entering treatment have to navigate the South African system of medical aid provision or employee assisted programs. In a genuine and innovative collaboration with its population, the clinic has a web-based system for patient notes and treatment plans (Roots), developed by Lochan, that patients themselves can log into from anywhere allowing them to share it freely with anyone, such as family members and even employers. Once the recommended 28 day programme is completed (longer for some), graduates are welcome to continue to log in to Roots, come to the clinic, attend the drop in, use the facilities such as the computer room, build enduring relationships and provide a glimpse of a possible future for those entering treatment.
As we browsed the SMMGP website together, Lochan was envious of our “brilliant resource” – and wanted to know who funds us. I explained that until fairly recently we were able to attract government funding, but given the current parlous state of funding for the addictions field in the UK, we were in a sense in a similar position to our South African primary care counterparts in terms of zero government financial support for clinical networks. He is concerned that there is no academic centre of excellence for addictions in South Africa and will continue to strive to position the country strategically on the international addictions platform, as he did when he was invited to present on addiction as a non-communicable disease (NCDs) at the United Nations General Assembly high level meeting in New York in July 2014. The meeting undertook a comprehensive review and assessment on the prevention and control of NCDs – chronic diseases that affect the poorest in the world.
As I prepared to leave, I asked whether people from the leafy northern suburbs of the city come to the clinic too. “Of course” came the response “when they are ready”.
Dr Naidoo may have been envious of our comprehensive guidance documents and supportive network, but as I walked out through the rainbow collective of people leaving the morning “Contemplation Meeting” that reflected true diversity including across the spectrum of recovery, I felt envious too. There is much we can learn from each other and you may find Lochan popping up on the SMMGP Clinical Forums sometime soon.
– Elsa Browne
SMMGP Operational Lead