A Hitchhiker's Guide to Harm Reduction in Amsterdam

November 4, 2016

Deep compassion and cool-headed pragmatism - these are the essence of harm reduction in Amsterdam. Read about the adventures of a Czech social worker, David Pešek, who spent a week-long internship at the Regenboog Groep in Amsterdam to see what daily life is like there!

9/10/2016 Sunday

I arrived in Amsterdam. Had a busy time lately in my work in Prague, Czech Republic.

Tomorrow, I start my internship at the Regenboog Groep. I am staying in the guesthouse managed by the German Seamen's Mission (an association recognised by the German Protestant Church). Essentially, it's sailors who run the place. I recommend it.

I needed a drink (non-alcoholic of course, because I don't drink alcohol), so I went out to check out the market. On the way, there was a girl asking for a cigarette; I don't smoke ready-mades, so I offered to roll her one. We chatted for a bit. I told her I was here for a week's internship at the Regenboog Groep. She turned a bit shy, but told me she was an ex-client of theirs, and used to go to their facilities a lot, when she was in serious trouble. She was little bit drunk and smoking weed, but she hasn't used hard drugs for few years now, thanks to them, she told me.

So, this was the first impression from my internship.

10/10/2016 Monday

In the morning, I had a meeting with Katrin Schiffer – Network coordinator of Correlation – European Network – Social Inclusion & Health. This network is part of the Regenboog Groep. We met at the HQ of the organisation, close to the Central Station. I saw the vision – the beautiful dream of the whole organisation – on a leaflet: "We dream of a city with room for everyone – where people with wealth and people in (social) poverty live together and work together – where we are involved in each other's lives and support each other – where people who are capable of donating, contribute, in order to help develop society. Where the city is everyone's home. Where nobody needs to feel isolated."

A few words about history, perhaps: The Amsterdam facility began to evolve at the beginning of the eighties, when a lot of Germans came to Amsterdam, and there was a big drug scene, with a lot of people injecting. Germany had a quite repressive drug policy at that time. The quality of heroin was good, and there were lots of fatal overdoses. Amsterdam was finding a pragmatic solution and the municipality decided to deal in different ways with people from within and outside Amsterdam.

This is when AMOC emerged. Nowadays, AMOC is part of the Regenboog Groep, but back in the eighties, it was a separate NGO working mainly with German DUs. AMOC was bringing human comforts to the lives of DUs, and trying to give them some basic care, as well as helping people to get back to Germany (so that the problem would be delegated back to the country where they came from). Around 2004, AMOC merged with the Regenboog Groep. The AMOC clients are different from other clients of the Regenboog Groep. They often have no official status in the Netherlands, no rights, and therefore cannot access regular social and health services.

The city government was, and remains, pragmatic about drug policy. They want to have clean streets, and would prefer non-Dutch people to go back to their countries of origin.

Right from the beginning, Correlation has sought to establish links with other EU organisations and create effective networks. The first European project of the Regenboog Groep was for male sex workers.

Rainbow Foundation – the Regenboog Groep

160 workers, 1,000 volunteers. nine drop-in centres, three needle exchange programs, three consumption rooms, night shelters. If you are a foreigner, that’s all you can ask for. If you have insurance, you can also try out various work opportunities, buddy programs etc. The high number of volunteers is down to the foundation's emphasis on participation. Volunteers are more like a friend (buddy) to the client, rather than a social worker or the like.

Correlation is a European network hosted by the Regenboog Groep, and nowadays has 180 member organisations. International activities began around 1997, with a project on male sex workers. The emphasis was always on sharing experience with the countries of origin of the target groups. The aim has always been to achieve the greatest possible benefit for all. So Correlation always seeks effective intervention among marginalised groups (DUs, sex workers, etc.). The Correlation starting point was a methodological approach – not focusing too much on the variety of target groups – with the idea in mind that different working fields can learn from different approaches. They make patterns that can be tried, used and challenged in different countries, with different clients and different situations.

Some further impressions

•    They sell popcorn, in a partnership with the John Altman fair-trade organisation, from mobile shops. It's a crowdfunded project, and the popcorn is really tasty.
•    They've developed a chat app for online interventions, effective and easy for other NGOs to use. Social Intervention Tool – SIT
•    There are many other tools, ideas for intervention, and methodologies on their website – check it out.

Mainline is a magazine for drug users, published by the Mainline Foundation, which serves the drug-using community by offering health- and prevention-related services. It serves to break the ice with the client, and the texts are respectful to the client's situation.

I met Machteld Busz (International Program Manager) and Toon Broeks (Editor and Outreach work) in a beautiful place at Frederik Hendrikstraat. It's a former squat, which has been transformed into a friendly open-space working area.

Mainline was set up in 1990, at a time when HIV was spreading widely. They wanted to deliver HR information for the clients. The magazine is now published quarterly. Mainline also focusses on outreach work, but since there is almost no drug scene on the streets, they are challenged to find new ways of getting in contact with DUs. They map, monitor, and try to find new groups.

Outreach work mainly focusses on:

•    Mapping the emerging chemsex scene.
•    GHB users outside big cities – usually isolated groups of young people.
•    The Thai sex scene.
•    Eastern European groups.

The new challenge for outreach work is to find new ways of contacting clients in these modern times – possibly on-line outreach or something similar.

Mainline also works at an international level – cooperating and spreading HR knowledge in Asia (Indonesia, Nepal, Pakistan) and Africa (Kenya, South Africa, Tanzania), and trying to establish and maintain organisations within the region. So they provide training on HR, HIV, substitution etc.

Mainline has also developed some really useful tools for harm reduction. They have a card game with info about HR in terms of cocaine and crack. They have a board game about infectious diseases, and a lot of other entertaining material.

11/10/2016 Tuesday

AMOC!

Specific facilities for groups of foreign nationals. Situated in a nice area near the centre of the city, AMOC was founded in the eighties, mainly for German drug users. Nowadays it is a big building with many facilities. If you still think multiculturalism is a nonsense, you should check AMOC, it’s a living organism and evidence that multiculturalism is not an opinion that you can just accept or deny – it's the daily reality in Amsterdam. A house full of different nations, vulnerable and seeking humanity.

I met Conrad, manager of the whole place, a very friendly open minded German. Likes to joke, and has very personal contact with the clients, as do the rest of the staff. I really enjoyed the warmth of the place, during my day of job shadowing.

Ground floor. Walk-in centre. Shelter during the day. Eleni (from Greece) was boss of this floor for today. Apart from Eleni, there were mainly volunteers (Dutch, German, etc.) working and helping with the daily schedule. Open from 10:00 till 17:00. You can stay all day, rest, play chess, watch TV, check out emails on the internet, have some coffee, tea and something to eat. You will meet people from all around Europe: Germany, Italy, Spain, Poland, the Czech Republic, Romania, Russia, Slovakia, Greece, Albania, Georgia, and so on. The capacity of the centre is around sixty people, but sometimes there are more. So the clients are not on the streets any more. These clients are not problematic drug users, although they often use drugs, drink alcohol, smoke weed, are homeless, have no insurance in Holland, or have other problems. AMOC helps them to secure more human conditions, find work, etc.

Basement. Showers for clients, clothing room. Night shelter for homeless people.

First floor. User room. I met Maria (from Poland), who was in charge of this floor today. This is the place with a consumption room, professionally supervised. Capacity is about twelve people. You can smoke, sniff or inject substances here, which reduces street drug use. You can take your time, prepare the substance and stay as long as you need. There is no rush, so people can behave as safely as possible towards their body. Almost no overdoses, over a long period of operation – a quiet and peaceful atmosphere.

12/10/2016 Wednesday

Blaka Watra (Drop-in centre and Drug Consumption Room) is situated near the central train station, in the same building as the Regenboog Groep HQ. Twenty years ago, this area was a big open heroin scene, now it’s clean like the rest of Amsterdam – “maybe too clean,” you hear sometimes, even from Dutch people. Blaka Watra (Black Water) is a lake in Surinam that has healing powers, I was told by one guy at the drop-in, when I asked about the meaning of what seemed such a weird name.

This facility is mainly for people from Surinam (a former Dutch colony) and the Dutch Antilles (still part of the Netherlands) but when you visit the drop-in centre, you'll see people from all over the world (former Yugoslavia, North Africa etc.).

It's a day shelter for people in need (homeless and/or drug users). There are plenty of work opportunities here – you can clean the place, help in the kitchen, clean the surrounding streets, work as a bike courier, and so on. The kitchen is run mainly by Surinam clients, with a menu of traditional Surinam dishes. The place is big, open and decorated with various positive paintings from clients. You just feel good vibes here. People are in a harsh social situation, but are in a healthy place, not creating a public nuisance on the streets.

I met sister Hortense is a lovely older lady, who has been working as social worker in Blaka Watra for 15 years now. She is from Surinam and has a lot of respect among the clients. She has strong faith, which helps her a lot in the work, with deep compassion and a heart full of love for the clients. It was so peaceful just to sit by her and feel her acceptance. Similar workers are so needed for the wandering souls of our clients, and the Regenboog Groep is full of those workers.

In the afternoon, I visited the GGD Municipal Health Centre in South East Amsterdam (a care complex for drug users). South East Amsterdam is a suburb, home to a sizeable Surinam community. GGD is situated in the park, and it would be easy (as with all the city facilities) to miss that it's an HR service – they're just part of the neighborhood, with no nuisance, no problems.

GGD is government-funded. It provides complex care for the clients: somatic care, psychiatric care, social work, long-term stabilisation, methadone and heroin substitution. Capacity is 75, but they are not full. Nowadays, there are fewer severely-addicted users. Out of all the users, only one or two inject, the rest are smokers. Fifteen years ago, the situation was very different, and there were far more shooters. The change is related to the mandatory stabilisation program (involving psychopharmacotherapy, social work, job-finding, shelter etc.).

I met Nelda, which is a GP in the facility and has worked there for many years. The last resort, that’s what she calls this place. “For people who are completely alone, we often represent the last safe place that feels like home. When a client dies, we go to his funeral. Sometimes the staff from the facility and a few other drug users are the only people at the ceremony. That’s very sad.” Dr Nelda talks a lot about the complex, and its holistic approach to each client; and when she does, you just believe her, because you feel the promise of humanity in her words.

13/10/2016 Thursday

Volunteering in the Regenboog Groep

One in five Amsterdam residents live alone – be a volunteer and help them make a better life. The Regenboog Groep has a total of 2,000 volunteers in fourteen different projects (for different target groups). Each volunteer spends three hours a week with clients – in effect, more time than most of us have to spend each week with our friends. It’s a big responsibility. Volunteers are mainly part of “buddy” projects. To be a buddy means spending that time with the client and trying to make some positive change in their life. The goals and issues vary widely, according to the needs of each group and each person. They may be drug users, homeless people, psychiatric clients, people in deep social crisis, refugees, and so on. The typical client profile is someone with more than one problem, no effective social network, and with severe psychological problems.

Volunteers tend to come from one of three main groups: people in a high socio-economic position, young university graduates, and retired people. To become a volunteer, you have to undergo an interview, then you are given fifteen hours of training, and then you provide a report every six weeks to the coordinator. There is a team of thirty coordinators, who manage 1,200 matches. (In this context, a 'match' means a working partnership between the client and the volunteer – usually, each volunteer has one match.)

Each coordinator selects volunteers, manages client intake, and matches volunteers with clients. The coordinator also monitors the cases, with each coordinator having a caseload of about 45. The matching is mainly done intuitively, and there are two main groups of interest: clients who need an empathetic relationship, and clients who need specific skills or training. So, a successful teacher might help to teach Dutch to Moroccan children, or a retired lady might spend time with a young mother who needs help with her children and has no network of friends to help her.

The volunteer program for each client has a maximum duration of one year. A strong bond tends to develop between the volunteer and the client. That’s probably the hardest part of this activity.

The work is not only beneficial for the clients: The volunteers also learn a lot – to have a different perspective on their own lives, to learn how to be patient, or how to stimulate people. Thanks to this, the volunteers often become better parents, managers, etc. The volunteer's role is that of a buddy to the client, not a professional. He/she is there to help, but is not responsible for the outcome (that is the responsibility of the client's social worker etc.).

Around two-thirds of the cases or matches work well, with measurable positive results.

14/10/2016 Friday

De Kloof

This is the third drop-in or walk-in centre I’ve visited. The Regenboog Groep runs nine similar facilities, and there are other drop-ins run by different organisations (e.g. the Salvation Army). De Kloof was founded around 1968, which makes it Amsterdam's oldest shelter for the homeless, originally founded by the Catholic Society of St Vincent de Paul. It is situated in the heart of the city, in the basement of an old building. There are several big rooms. The biggest one is the cellar, where clients can have a cup of coffee and get something to eat. Above all, it’s a place to find some peace and quiet, allowing visitors to arrange their affairs with the help of a social worker. Also there is probably the biggest clothing room I’ve seen for clients: They take a shower, then exchange dirty clothing for new, which is the way clothing is recycled in Amsterdam.

Conclusion

What I’ve learned:

Research can be a great tool, when trying to promote new services in your own country (consumption rooms, volunteer programs). Research supported by NGOs, a university, or government agency is probably the best option.

Cooperation at a local level is the key to success. In Amsterdam, each facility is connected to others. The network works well, and tends to prevent people slipping through the gaps (as can happen in the Czech Republic).

Volunteers can help a lot in Buddy programs, etc. Their experience of a different world is something that the clients can gain from, and good matches can have a very positive effect.

The Social Intervention Tool is an online tool designed for the technological age, showing how to do online outreach and how to contact clients through the net.

End

Thanks to everybody from the Regenboog Groep, Correlation, EHRN, SANANIM and all the other organisations involved, for making this happen.

Mgr. David Pešek, pesek@sananim.cz
Head of Contact centre SANANIM (low threshold facility for drug users in Prague, Czech Republic)

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