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An important cause of vulnerability in our society is the extremely poor health and hygiene conditions. This is partly due to lack of education and awareness but primarily due to very limited access to health and hygiene facilities. Save the Children Fund estimates that 10 million Pakistani children have no healthcare. According to the Economic Survey of Pakistan 2005-06 a mere 0.75% of the GDP was spent on the health sector. The Social Policy Development Centre (SPDC), 2004, demonstrates that out of every 1,000 children who survive infancy, 123 die before reaching the age of five. A large proportion of those who survive suffer from malnutrition, leading to impaired immunity and higher vulnerability to infections. Human Conditions Report (2003) points out that about 40 percent children under 5 year of age are malnutrited. About 50 percent of deaths of children under 5 years are due to malnutrition.

Provision of health care is an essential part of SEHER’s programs aimed at empowering the vulnerable. Beyond healthcare components within each program areas SEHER also initiated additional services i.e. free medical camps, mental health services/awareness, and counselling (CIC) for high risk youth of HIV/AIDS during the reporting period following interventions are done:

Free Medical Camps
Six free medical camps were arranged in different poor and deprived areas of Balochistan. Details are given in the table below:

Provision of Mental Health
Markaz Nafsiati-ElaJ (Psychotherapy Center) has been providing psychotherapeutic services under the umbrella of SEHER. Some 1671 IDUs received counselling and other psychotherapeutic help. The table below provides the details of mental health provided to the IDUs:

SEHER believes that preventive measures are as much important, even more important than the protection/cure of the disease because the less people will become ill the less efforts and resource would be required for their treatment. Therefore SEHER has organized different seminars and walks for awareness regarding drug abuse, HIV prevention, water borne diseases, communicable diseases and mental health. Details are given below:

Counselling and Information Center (CIC) for High Risk Youth (HIV/AIDS)

The Narcotics Control Force estimates that there are almost 5000 drug addicts in Quetta City. Most of these are local Pashto speaking while roughly 5% are Afghan refugees. Sixty-five percent of the drug users are in the 9 to 19 years age group. This age group is most vulnerable to HIV/AIDS, because most of them are Injecting Drug Users (IDUs). To prevent an impending epidemic of HIV/Aids it is necessary to provide drug users, and high risk youth, awareness through counselling and information. For this purpose SEHER, in collaboration with the British High Commission, Islamabad, set up the CIC in Quetta in May of 2005.

Catchments areas for the (CIC) counselling and information center included Ali Bhoy Road, Old Bus stand, taxi stand, news paper market, Jinnah road, Circular road, Mission road, Kasi Road, Kasi Graveyard, Satellite town Graveyard, and Habib Nahala. Drug users are concentrated in these areas. CIC set up an office on Mechongi Road which is in the center of the city. It was easily accessible not only to the drug users in the known dens in the vicinity in this regard following intervention and efforts are done:.

Analysing the situation of Injecting Drug Users (IDUs)
CIC rigorously analysed the phenomenon of focused primarily on the Injecting Drug Users (IDUs) and found them most vulnerable group exposed to the risk of HIV/ AIDS and Hepatitis B & C. They need information, counselling, psychotherapy and medical they suffer from several physical diseases and psychological problems like nightmares, hallucination and phobias, CIC provided the drug users treatment of such physical problems and psychological problems.

Motivating the IDUs:
Team of Sociologists paid several visits to the most known hideouts of the IDUs namely the Habib Nallah, Mission Chowk and the New Bus Terminal to look for drug users. Serious efforts were made to mobilize and motivate them to visit the CIC. Some 700 drug users were approached of which around 422 visited the center regularly. In the center the drug users were given assurance that the staff would only facilitate the process of an addiction free life but ultimately they have to take the primary responsibility of leaving the habit. CIC Psychologist conducted individual and group counselling sessions with all 402 registered IDUs. Religious education to the IDUs was also part of the counselling sessions.

Medical Services
CIC also focused the physical treatment of the injecting drug users. Qualified MBBS doctor were available all the time. Medical section of the CIC provided the following services:

Rehabilitation Efforts:
Creating awareness regarding HIV/AIDs may not produce the desired results in isolation unless and until rehabilitation measures are not taken. Rehabilitation efforts were accompanied with follow-up mechanisms. Which were based on Religious and Social bases, some of them are given bellow:

After a thorough reflection and analysis, religious education was made a part of the treatment and rehabilitation efforts. “Fazail-e-Amaal” is the guiding book during sessions with IDUs.

Health and hygiene is a big problem of the IDUs, usually their overall look and personal hygiene is in very bed condition. Constant awareness is provided to the IDUs. CIC also provide basic necessities, (soap, towel, nail cutter, comb, and shower facility) to maintain their health and hygiene condition. Taking daily shower was part of their rehabilitation/ treatment and very strictly monitored.

Child Protection sessions for IDUs/DUs are planned because most of these IDUs/ DUs are usually found in dirty places such as garbage dumps, and garbage picker children are bound to visit these garbage dumps. These children pick the used syringes, some used by the IDUs and sometimes they are sexually abused by the IDUs which puts these children at high risk of HIV/AIDs. SO it was thought appropriate to include Child Protection and HIV/AIDs orientation sessions for the IDUs. So that on one hand the spread of the HIV/AIDs multiplication could be reduced and on the other hand, children who are already vulnerable could be saved. Regular sessions on HIV/AIDs and Child Protection were held with IDUs.

It has been observed that in many cases the IDUs are willing to give up drugs but continues to use it due to peer pressure. So in CIC , it was a minimum criteria for the client to spend at least 8 hours daily in CIC. In order to retain the client’s interest, recreational activities were made part of rehabilitation and treatment. Purpose of the activities is to engage the IDUs interest during stay at CIC and keep them away from their drug users’ circle. All kinds of indoor games, including sega game and the television were provided for IDUs interest.

Psychotherapeutic Exercises:
Psychotherapy played a very major role in the activities of the center. Through different psychotherapist exercises IDUs were probed about their past in order to know the real cause of their addiction. They were hypnotized during the counselling session for gave up and reduce the drug. Especially physiologists tried to build very friendly and trust worthy environment. Through these exercises it become to know that what are the reasons which caused the apparently sensible people to get into the drugs. One of the main reasons was simply living in religiously and culturally strict life-style where there is little room to express oneself. Which lead them towards distant relationships and eventually escaped through drug.

Family therapies:
During the counselling sessions with the IDUs it was learnt that the role of the family plays a critical role. In most of the cases, IDUs have complaints that their families do not trust them, even if they recover. Some IDUs even shared that they treated themselves and were determined that they never treat themselves again, because the family’s attitude towards them did not changed. The feeling of not being trusted was really very painful for them and very often it became the driving force for the client to restart the drugs. Thus keeping the critical role of the family the process of Family Therapy was initiated. It was discovered during the probing that culturally those families in which the generation gap was comparatively bigger, the members were more inclined towards drugs. Family therapies become the major component of CIC because many IDUs have conflicts and domestic problems which cause the relapse of the IDUs. Experience of family therapy provided that If their domestic problems or conflicts are solved, many IDUs can prevent from relapse. Involving the family of a client in rehabilitation efforts from the beginning not only generates confidence in the IDUs but also develops the relationship between the family members and the IDUs.

In the family therapy, family members of the IDUs are also called in the center and they are asked different questions regarding their behaviour towards the client in terms of acceptance, trust and future role of the client within and outside the family. They are further suggested that if they really want the client recover they must follow the psychologist’s suggestions. The family members are sensitized of the severity of the issue and they are informed of the discomfort of they will be facing by the client in the next couple of days as the IDUs who want to quit the addiction they face some medical problems for the time being; they suffer from motions and body ache; they become very weak, and sometimes they get angry pretty soon. Family therapy can not be in placed without the cooperation of the family members it is almost impossible for the patients to recover from their addiction.

Awareness raising Seminars
Awareness raising regarding all risks involved in drug abuse among the DU/IDU was an integral part of the activities. For this purpose awareness raising seminars were conducted for the IDUs at CIC, other rehabilitation centers (where patients had been referred) and on spots in the field where the DU/IDU used drugs. these seminars included those carried out at Kasi Road Graveyard, Bus terminals, Kachara Kundi and Habib Nala the main spots of drug users. At the end of each fresh clean syringes and information material was also distributed among the IDUs and advised them not to use the syringe by multiple partners or again and again.

Provision of Small Businesses for IDUs to be Rehabilitated:
Financial stability of the client plays a critical role in rehabilitation of the client once he has given up drugs. They need to be facilitated to have income generating opportunities. In this context, CIC has facilitated such IDUs to initiate small businesses. Fourteen (14) IDUs were provided assistance to set up small businesses.

Referral / Physical Treatment to Other Centers/ services.
The IDUs are referred to other treatment centers because CIC is a counselling center. CIC does not have facilities to provide physical treatment or detoxification of the IDUs but many of the IDUs demand to be detoxify then such IDUs are referred to treatment centers. The organizations, which are working on the treatment of the drug addicts in Quetta are Aaghosh, Piyam-e-Seher, Nai- Zindagi, Anti-Narcotics Force and Social Welfare department. Fifty five IDUs were referred to relevant organizations.