There is a strong sense of achievement and positivity as you walk through the corridors of Sediba Hope Community Clinic in Bosman street, Tshwane. Interacting with people involved in COSUP makes one realise that most of these young people have not had many opportunities in life and many have grown up in very difficult circumstances. Yet, these people, many of whom were on death’s door not so long ago, are hopeful and triumphant, and on track to a new life.
Mpho was a hardened street kid who left home 10 years ago. Addicted to heroin, he parked cars by day to make enough money to get his daily fix to keep the dreaded heroin cravings and withdrawals at bay. At night, he would spike and pass out on the streets. “I was a hole and nothing to myself,” recalls Mpho. One unfortunate occasion, Mpho came close to overdosing and needed to go to hospital. The fear of the looming cravings was too overwhelming for Mpho, but thankfully COSUP was able to offer him an alternative in opioid substitution therapy (OSTs) and helped him get his life back on track. COSUP believes that people who use heroin, like people with high blood pressure or diabetes, may need medicines to help manage their medical condition. This saves lives, reduces risks and improves the lives of people and their community. A year later, Mpho is still on his medication and has gone back to school. He has also enrolled in a life skills course offered through COSUP. “I feel happy now. I feel like I am myself again. I know who I am and I am a changed person.” Mpho is off the streets and off drugs, living with his family again. “I am just happy,” says Mpho with a smile.
So many of the people in this programme are perfect examples of what happens when people join hands and work together to help those in need. The peers support programme of COSUP is, in itself, a success story. Peers are people who were harmful drug users who went through COSUP’s assessment and intervention and who are now healthy and working for COSUP. They provide a strong network of care and support to people in the programme. The fact that they have been through similar trials enables them to reach out to people and encourage them to enrol in COSUP and improve their life.
The growth of COSUP sites also shows the success of the project. Initially just focusing on the city centre of Tshwane, COSUP now has eight sites, from Soshanguve to Mamelodi to Daspoort. Each site is unique and faces different challenges, however. Peers are invaluable to the programme because of this. Issues in Eersterust are, for example, vastly different to the prevalent issues in the city centre of Tshwane. Eersterust is a community where almost every family is battling with drugs on some level, yet they have a much stronger family structure compared to young people using drugs in the city centre of Tshwane where there is almost no parent involvement.
Peers are familiar with the circumstances on the ground because they have been through them themselves. For years Rethabile was addicted to nyaope, but today she is a peer employed by COSUP and is proud of the contributions she is making to women who are struggling with a drug addiction. “I enjoy being a peer because I get to help others going through the same things I went through. I am in a better position to help them because I understand their circumstances.”
Sister Kate van den Berg, who is part of the COSUP team at the Sediba Hope Community Clinic says, “If a programme does not have ‘street cred’, no amount of campaigning is going to win addicts over. Part of COSUP’s street credibility is because of the peers.”
While the results that this programme is working are there, COSUP faces daily challenges. Constantly trying to break stigmas and decriminalise drug use, COSUP is up against competing services that end up causing more damage than good. Slowly, however, people are starting to see the value in community orientated primary care which is why the sustainability of the programme is imperative.
van den Berg also stresses the importance in getting people to realise the deeper health problems prevalent among the majority of harmful drug users. There is a dire need at the primary health care level to diagnose and treat mental health illnesses. Because there is very little knowledge of mental health conditions on the streets of Tshwane, so many people go undiagnosed. These people are self-medicating and taking drugs to try cope with their problems. “South Africa needs to realise this and treatment for mental health conditions needs to become available at the primary health care level. Then we will see a lot less people using drugs.” van den Berg proclaims. Further, when people do not have to live on the streets and sleep under bridges, and proper housing is offered to the poor, drug use will decrease as well.
Despite these challenges, the City of Tshwane is on a good path because of COSUP. COSUP’s staff are forward thinkers, showing leadership in drug treatment through harm reduction and community based care. Thanks to the programme, people are on their ARV and TB medication and are healthier. Many have gone back to school and others are doing courses like welding to equip them with skills that can enable them to contribute to society. People in COSUP are finding purpose in life and families are being restored. Sister Linda Makala, based in Mamelodi, says: “It’s amazing to see someone that you first found in a dumpsite who is now in the programme, they are working. They are positive and hopeful.”
The COSUP programme has helped kids like Mpho make real connections with the people around them and fight their addiction in the long term.