Grind in the prison house

"Don't worry about injecting drug use here. Indonesian kids wouldn't do that; they're good kids. And anyway, they're scared of needles." So went the conventional wisdom in the mid 90's, when I was working with the Pelita Ilmu Foundation. Pelita Ilmu started life doing outreach to schools, so they should know, right?

As we all now know, wrong! And I should have known better. When I used to hang out with kids in Jakarta in the early 70's, sometimes they'd say: "Watch out for him; he's a morphinist!" That was the 'in' term for a 'junkie' then, but they didn't actually use morphine. Dr. Erwin Widjojo, who set up the Drug Dependency Hospital (RSKO) in Jakarta around that time, tells me it was heroin they were using then. Not injecting; if they wanted an extra-fast high, they would slice the skin on their forearms with a razor, and rub the heroin into the wound. I still sometimes meet users from that period. Mostly they wear long-sleeved shirts to cover the scars.

Anyway, I bought that 'wisdom' right up to 1998, when by chance I sat in on a meeting at the Kusuma Buana Foundation. They were working with slum kids in Warakas in north Jakarta. The meeting was reviewing the program, assisted by Prof. Irwanto of the Atma Jaya University. I was shocked out of a reverie when Irwanto talked about some of the kids there injecting drugs. I visited the place, and found he was right. They apparently used the wasteland under the elevated toll road that borders the area. Dug some more, found out that there were others who were also concerned, such as George Loth of UNAIDS and of course David and Joyce Gordon.

To cut a long story short, several of us got together, with support from Project Concern International, to hold a seminar/workshop on responding to drug problems (but actually on harm reduction, although we hadn't started to use that term then). This five-day meeting in September 1999 involved several experts, including Nick Crofts, Dave Burrows, and Palani, who went on to help us build the foundations of the harm reduction response here.

Of course, a meeting of this nature cost a lot, and there was no funding available then for such controversial activities. So I was tasked to visit Australia to drum up some money. Obviously the prime target was AusAID, who was already running an HIV program here. In Canberra, I tried to persuade them that there was an urgent need to add drugs to this program. They were polite, but didn't seem to offer much hope. I talked to Nick in Melbourne; he put me in touch with Alex Wodak in Sydney, who put me in touch with a retired Australian ambassador to the region. I met him for coffee on a Saturday morning, the last day of my trip. He understood the need, partly because he'd already seen the effects, and also because (if memory serves me) he had a family member with a drug problem. He promised to use whatever contacts he still had in AusAID to lobby for support.

Those contacts must have been influential. On the following Monday morning, back in Indonesia, I received a call from the local AusAID head, telling me that Canberra had allocated 300,000 Australian dollars to the HIV program to be used for the response to drugs in Indonesia. Funding of our meeting was to be the first priority. As you can imagine, we were over the moon.

I'm reminded of this ten years later as I try to drum up interest in the health care challenges in the prisons here. The current AusAID-funded HIV program (HCPI) is doing a fantastic job responding to HIV in the prisons in Java and Bali, as did the earlier USAID-funded program. I'm sure the new Global Fund Round 8 and 9 programs will build upon this. But although HIV is a major problem in the prisons, the health care challenges are much broader and entrenched. Over-crowding, with many prisons at 300% over-capacity, limited funding (a health care budget of less than $50 per prisoner per year), poor sanitation, limited water supplies, a sporadic drug supply system, and limited human resources (some prisons are dependent upon doctors in local health centres) are only a few of the problems.

The prisons department, both at national level and locally, are clearly determined and striving to address this challenge. But they need much more help - and unlike some in Indonesia, they are very open to assistance from anyone who has the expertise and is willing to help. But who is willing to put up the cash? Any ideas? Do I need to make another trip to Australia with cap in hand?

Babé