DAR ES SALAAM, Tanzania — Every morning, hundreds of Tanzanians make their daily sojourn to a breezy open-air methadone clinic at Muhimbili National Hospital. The journey is not always smooth. Some travel on overcrowded local buses, and others walk for hours in Dar es Salaam’s sweltering heat.
One by one, the patients are called to a window, where a nurse behind a metal grate offers a plastic cup filled with liquid methadone. They drink the viscous concoction under her watchful eye, after which they can continue their day without craving heroin.
“For a long time, I couldn’t live without heroin,” said Stamil Hamadi, a 34-year-old woman with a heart-shaped face and calming presence. “I decided to try methadone to become a new Stamil. My health began improving, and I started gaining weight.”
Muhimbili’s methadone clinic is the first of its kind in mainland sub-Saharan Africa. Few governments, donors or nonprofits in Africa work with heroin users. Médecins du Monde (MDM), an international nonprofit that serves heroin users in Tanzania, estimates that fewer than 1 percent of drug users on the continent have access to support services, let alone treatment plans like methadone.
Tanzania is a striking exception. In 2009 the national government publicly declared that its drug users needed evidence-based treatment options. With aid from the United States and Canada, Tanzania’s Ministry of Health approved a comprehensive plan to help prevent and treat heroin addiction.
This AJ+ short documentary follows Stamil Hamadi, an addict and sex worker who has cycled in and out of treatment since 2012. She hopes to kick the habit for good, but every day is a struggle.
Heroin use has surged in the U.S. in recent years, and it has gained popularity elsewhere around the world. According to the United Nations Office on Drugs and Crime (UNODC), there are more than 500,000 heroin users in East Africa, where popular Indian Ocean drug trade routes make landfall. Nearly 60 percent of these users may live in Tanzania, UNODC believes, with a heavy concentration in the port city of Dar es Salaam.
Soon after heroin entered Dar es Salaam in the 1990s, its cruder form — brown instead of white — snaked its way into bustling urban neighborhoods like Temeke, where Hamadi lives. A dose of brown heroin, known on the street as brownie, costs as little as a dollar. (White heroin is sometimes called Obama.)
“[The port] provides a lot of economic benefits, but unfortunately it also provides opportunities for an illicit trade in drugs,” said Brian Rettmann, who coordinates the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) in Tanzania. “Prices for heroin here are some of the lowest [in the world], which has really caused an epidemic.”
Since the country’s per capita income is just under $700, heroin’s low price allows Tanzanians across income groups to try it.
Some heroin users scrape the money together through odd jobs like helping bus operators find passengers. Others turn to illegal means. One of Hamadi’s friends boasted an eagle tattoo on his chest, symbolizing how he swoops down, quickly steals and gets high. Many female heroin users at some point pay for their addictions through sex work.
As in many other places around the world, heroin in Dar es Salaam takes its firmest grip among the young, unemployed and bored. Hamadi was 18 when she first smoked heroin, as part of a koktelin (“cocktail”) with marijuana. She lived with her father but would sometimes stay with a friend for several days at a time. While partying with her friend one night, Hamadi met a man who, in 1998, offered her an oddly strong joint.
“Honestly the first time I didn’t feel good,” Hamadi recalled. “But then I missed it the next day. I felt cold and had symptoms of fever. [The man] told me it was not fever. It was addiction. I asked him what addiction was because I didn’t know. He told me to sniff this thing. I took two hits and all of a sudden I felt cheerful and strong.”
Hamadi fell in love fast, with both the guy and the heroin. Ellen Tuchman, who researches women’s substance abuse at New York University, said this story is not uncommon. “We know that social networks of women matter a lot, from adolescence onwards,” she said. “If she has a male partner, he can be very influential in getting her to start [using].”
Though most Tanzanian women either sniff or smoke heroin, within two years Hamadi started experimenting with needles. She was seeking the purer highs she remembered from when she began using. The same year, she gave birth to a healthy baby boy. Her partner supported the family, she said, by conning people into believing he was a fortuneteller.
Around their son’s fourth birthday, Hamadi recalled, her partner developed a toothache that didn’t go away. She said his jaw swelled and he died within a few months, cause unknown.
“I felt so lonely,” Hamadi said. “He protected me until the day he died. [Until that point], I didn’t know how to sell my body. I didn’t know how to steal.”
Hamadi entered both those professions after his death. She found regular clients, and when sex work didn’t fulfill her financial needs, she broke into people’s homes and stole their iron pots.
Several years later, Hamadi participated in a class for people who inject heroin at MDM. (The nonprofit operates independently of Muhimbili.) As the teacher explained the dangers of sharing needles, she realized her partner had shown symptoms of HIV. Suspicious of her own status, she volunteered for a test and learned she was HIV-positive. “I’m glad I learned before I got more problems,” she said. “I now use [antiretroviral] drugs.”
She was growing tired of the way her life was progressing. Her son lived with his grandmother, and she was rarely consulted on any family decisions. Sex work and robbery had their difficulties and indignities. It was getting more difficult for her to inject heroin, since the veins in her arms and legs had been used so often. She became impossibly frail.
Fortunately for her, this was when the Tanzanian government began consulting with international donors to offer heroin users a path out of addiction.
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