Physician on the frontlinehttps://indianexpress.com/article/india/punjab-drugs-addicts-rehabilitation-clinics-5281085/

Physician on the frontline

Central to Punjab’s battle against drugs, the state’s OOAT clinics have been seeing a rush since the recent spate of deaths. Dr Singh attends to hundreds of patients a day, besides dealing with relentless phone calls, media interviews and some prying policemen.

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The clinic at Bhagupur has recorded the highest number of patients among 93 such clinics across the state. Dr Singh sees around 100-150 patients a day. (Express Photo by Jaipal Singh)

“Goli gatta (synthetic opioid),” says the 45-year-old in response to Dr Jaspreet Singh’s question about his addiction. “Which one? Tramadol (an opioid painkiller) or Alprazolam (sedative),” the doctor presses on. The man, a labourer from Tarn Taran, shakes his head, looks confused. All he knows is that he has been on “goli gatta” for the last 12 years. “Post ya afeem te nahi layi kadi (Have you ever consumed poppy husk or heroin)?” asks Singh.

It’s the patient’s first attempt at seeking help and he is uncomfortable having to talk in a room full of people, so he leans forward and mumbles: “Yeh te mehnga nashawa, asi dehadi dapa karn wale bande haan (These are costly drugs. We are labourers and can’t afford those.)”

Singh winds up his persistent line of questioning, prescribes “urine tests and counselling” and directs the man to the counselling room next door. It’s a little past 8 am at the Out Patient Opioid Assisted Treatment (OOAT) Clinic in Bhagupur, near Patti town of Tarn Taran district of Punjab. This OOAT clinic, set up in October 2017 as part of a pilot project by the state government to deal with drug addiction, has so far recorded the highest number of patients among 93 such clinics across the state. In July, for instance, the clinic at Bhagupur registered more than 2,000 patients.

Ever since the state recently reported a series of suspected drug overdose deaths, the crowds at these clinics have swelled. According to statistics provided by the Punjab Health Department, of the over 17,000 patients who registered for the OOAT programme since its launch last year, 12,000 were in June and July alone. Outside Dr Singh’s room and in the corridor that leads to the counselling centre and the room where medicines are dispensed, is a crush of people.

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The clinic opens at 8 am, but Singh’s work starts much earlier, at 6 am, when he begins fielding phone calls from patients, mostly drug users wanting to know when they should get to the OOAT clinic, or from local NGOs seeking to register new patients.

“I am the first point of contact for new registrations at the clinic. I assess patients and then send them to the counsellor’s room, where the patients are screened and their medical history is taken. The patient is then sent to the medicine dispensing room,” says Singh, explaining that patients are usually prescribed Buprenorphine, an opioid-based drug, in combination with another drug called Naloxone.

The room is now teeming with patients waiting for their turn. Singh calls the security guard and tells him not to send everyone in at once — “only in groups of 10”. The guard at the door says he has no option since there is a big crowd at the main gate. “Ask the policeman to control them,” he says.

It’s 9.15 am and more patients come in. “Their stories shock me,” says Singh. “Some say they take up to 80 tablets of Tramadol a day. It leaves me numb because a normal person can’t withstand more than one or two tablets… and here they talk of 80 to 100 tablets,” he says.

As he attends to a patient in his mid-30s — a driver who says he has been on Tramadol, besides frequently injecting heroin — Singh asks him why he hadn’t come to the clinic earlier. “I have been on drugs for 15 years. Sometimes, I would buy from the local grocery store, sometimes the chemist. But police are now very tough and it’s not easy to find what I am looking for,” he says.

Just then, Singh’s phone rings. It’s a call from a local religious committee, asking if they can bring some patients to the clinic. At 11 am, two men make their way through the crowd. They turn up at Singh’s desk and introduce themselves as being from the local police station. “We have been sent by the SHO sahib. Please give us the register with patient details,” says one of them.

Stunned, Singh takes a while to respond. “But we have instructions from the top not to share patient details with any agency. Sorry, I cannot give away any such information,” says Singh, picking up the phone to inform the local Sub-Divisional Magistrate. Sensing that it has not gone down well, the policemen leave the room. The patients look visibly nervous. “Don’t worry, we are not going to give away any details,” Singh tells the patient he is examining.

At 12.25 pm, his phone rings again. This time, it’s from a local NGO, which has brought some women drug users to the centre. The man on the phone says the women are in the next room. Singh gets up to attend to them. “There is no female staff at the centre so I try to speed up the registration for the women patients or give them medicines in a separate room,” says Singh.

He says he gets fewer women patients — about 20-odd in the last two months — because of the social stigma attached to admitting to drug use. According to the Punjab Opiod Dependence Survey conducted in 2015, nearly 1 per cent of the state’s opiod dependents are women. While he is on his way back to his room, people outside the counsellor’s room stop him. “We have been waiting since morning. Please do something,” says one of them. “We are trying to get more staff. Please bear with us until then,” assures Singh.

He later says, “There are five of us at the centre, including one counsellor. The number of patients is increasing by the day… we have asked for more staff.” Back in his room, there are more people waiting for Singh — reporters from two electronic channels. Singh agrees for a small interview before he sees some patients. As Singh winds up his interview, around 1.30 pm, one of his colleagues reminds him that it’s lunch time. “I will eat later. Let me see some more patients,” he responds.

Singh now has another visitor — Deputy Superintendent of Police (Patti) Sohan Singh, who walks in saying, “I have come to see if everything is alright.”

“You have been very helpful. But please deploy more security. It is not easy for one man to manage the rush. The other day, because of the huge rush, one of our mirrors broke,” says Singh. The DSP leaves, assuring Singh of more security. At present, there are four personnel from the Punjab Police, besides one security guard from the Health Department, to man the clinic.

It’s 2.25 pm and the crowd outside has thinned, though 10-15 people are still waiting for their turn. Singh gets up from his chair and asks them if they can wait for 10 minutes while he takes a quick lunch break. An office boy brings some langar food — three rotis and a bowl of dal. “My home is only 15 minutes away, but these days I hardly get time to go home,” says Singh.

Its 3.30 pm and Singh examines the last patient of the day and directs him to the counsellor’s room. “Officially, the centre shuts at 2 pm, but we ensure that no patient leaves without being examined.” At 3.45 pm, Singh gets a call. It’s from the Senior Medical Officer, who wants to know the number of patients registered for the day. Singh assures the officer that he would send the details by evening.

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Around 5.30 pm, just as he asks his driver to bring the car around, he gets another call, this time from an NGO saying there has been a drug withdrawal case and that they are rushing the patient to the civil hospital in Patti. Singh quickly packs his laptop and says, “I have to rush.” As he waits for his driver, Singh says, “After this case, I will hopefully go home and spend some time with my 11-month-old baby.”