Rehabs in need for revamps

It was "out of curiosity" that Mohammad Limon (not his real name) first took marijuana with his friends nearly two decades ago. But soon he started taking the substance regularly and got addicted.

A few years of dabbling in weed, then heroin and finally yaba, Limon became heavily reliant on drugs. His desperate parents got him admitted to rehabilitation centres in Dhaka and Gazipur several times.

But what he experienced in the centres left a deep scar on his mind. In his own words, he was treated "like a criminal" without any compassion or understanding.

"Beating, punching and being left to starve as punishment or giving sleeping pills are the ways of treatment in the rehabs," Limon told The Daily Star.

"Whenever I became restive because of my addiction, the hospital staff would beat me up with sticks and punch me. This inhuman treatment at times was unbearable for me. I still have nightmares," he added.

Limon's words speak volumes about the approaches of treating patients at many private rehabilitation centres in the country. The Daily Star spoke to 10 such people who got admitted to these centres and got a similar picture.

According to the National Institute of Mental Health survey in 2018, there were around 36 lakh drug addicts in Bangladesh.

Of 351 residential rehabilitation centres across the country, 105 are in the Dhaka metropolitan area, said the Department of Narcotics Control (DNC).

There are no rehabs in 20 districts.

But the actual number of rehabs could be around 1,200, with many centres, like the Mind Aid Hospital in Dhaka, running without a licence, said sources at DNC.

Many of them do not have trained doctors and nurses despite a gazette notification by the home ministry on July 2, 2005 making it mandatory for those centres to have full-time doctors, psychiatrists, and trained nurses, said sources.

With no proper monitoring by DNC, the responsible government department, the centres are virtually run by unskilled professionals, resulting in many patients relapsing even after getting treatment, they added.

More worryingly, there are reports of deaths at the rehabilitation centres. In the last three years, at least 17 bodies have been recovered from rehabilitation centres across the country, according to police data.

The recent death of Anisul Karim Shipon, a senior assistant superintendent of Police (ASP), at the Mind Aid Hospital once again brought the issue to the fore.

Video footage of the incident showed some staff pinning him down and beating him up until his body became motionless. The hospital authorities, however, said Karim died of cardiac arrest.

'SIGNBOARD ORGANISATIONS'

Experts working in the drugs prevention and correction fields said most of the rehabilitation centres are "signboard organisations" and lack the necessary trained workforce and other facilities.

"Except for a very few, the majority of rehabilitation centres are not rehabilitation centres at all. Inmates in those centres are kept in locked rooms with shackles in hands and legs. This is not treatment; this is abuse," said Dr Arup Ratan Choudhury, a member of the National Drug Control Board.

Dr Arup, also  president of the association for the prevention of drug abuse, said private rehabilitation centres have been mushrooming across the country with the rise of addicts of different kinds of drugs.

A rehabilitation centre must have a psychiatrist, clinical physiologist, counsellors and other health workers. There should also be enough space for physical activities for patients, according to DNC guidelines that laid out at least 14 criteria for rehabilitation centres to get a licence.

"But those are absent in most of the private centres, and health workers are basically unskilled," said Dr Arup.

Rizmi Akter (not her real name), a private university student, shared her experience of being treated for her addiction to yaba at one such rehabilitation centre in Uttara.

"I stayed in a small room. When I got adamant for drugs, they gave me sleeping pills but when I refused to take medicine, the ayahs and nurses beat me. I became mentally depressed," she said.

What an official of the DNC found during a raid in a rehab centre also paints a grim picture.

"In that facility, we found a ward boy who never worked in any rehabilitation centre before and has no training. His uncle just brought him there to do the job," said the official, wishing not to be named.

He said rehabilitation centres hire strong men and women to serve the admitted patients. They are often called bouncers, a professional group employed by a nightclub or similar establishments to prevent troublemakers and other unwanted people entering or to eject them from the premises.

'IT'S A DISEASE, NOT A CRIME'

Mekhala Sarkar, associate professor of the psychiatry department at the National Institute of Mental Health, thinks there is a lack of understanding on treatment of the people on dope. The knowledge to guide them towards a healthy and meaningful life is also absent.

"Drug addiction is a psychiatric disorder. It's a disease and it's not a crime. We have to understand it first. Treating a drug patient requires a highly organised and systematic approach," she told this newspaper.

A general nurse or ward boy cannot handle drug addicted patients as they sometimes get violent. But finding the right professionals is a challenge too, she said.

"People often do not feel encouraged to take up the job due to social stigma. In rehabilitation centres, attendants of patients are not allowed. So, hospital staff alone have to attend the patients, which is highly risky. Unfortunately, they do not get incentives for taking all the risk. That's why we are not getting enough skilled professionals, said Mekhala Sarkar.

Bazlur Rahman, former director general of the DNC, said a taskforce can be formed with close cooperation of the home ministry to strictly monitor the activities of the rehabilitation centres.

"Now the DNC has a good number of manpower and they can also take action if they find any irregularities."

Contacted, DNC Director Md Nuruzzaman Sharif said they have already monitored all the rehabilitation centres and their status. Actions will be taken against those who violated the rules, he said.

"We will sit with the owners of the rehabilitation centres very soon to send a strong message that any sort of physical or mental torture is strictly prohibited and if any complaints are found, licenses of those will be cancelled," he told this newspaper.