No, I am not going to write about the night shift in a factory, or the third shift in a club. This is not an article about night watch, although sometimes in my work I do feel as a night guard. This is a story about the development of harm reduction programs.
Fieldwork in harm reduction programs is a method applied to decrease drug related harms among the hidden population of drug users, i.e. those who do not contact social and health institutions, as a result of which they are not included in such programs.
There are several subgroups among people who use drugs based on the lack of experience in drug use or the different ways of drug use, the isolation and specific internal communication. People who use drugs in smaller, isolated groups (mostly young people) have not sought help for their drug problem or do not consider drug use a problem, have no information about reliable organizations that deal with these issues and most often aren’t aware of safe injecting or blood borne infections. Consequently, in order to reach them and earn their trust, we have to apply different approaches tailored according to their needs. Therefore, fieldwork teams within harm reduction programs have a big role in the education of these user groups and carry big responsibility since they might be the only ones able to reach the population and help them.
In the years of experience working in this area I have had the opportunity to get in touch with many drug users, witness their needs and help them, or at times just hear them out. HOPS’s fieldwork team is active on the territory of Skopje with a quite intricate network of clients contacted daily. For a long time the activities were realized in two shifts. The first shift begins in the early morning hours in front of the methadone centre in Kisela Voda and the State Hospital, and the second on different locations though out the city with a previously determined schedule. In their daily work the field team observed several isolated groups of drug users not contacted during the two shifts. Hence the need to introduce a one more shift – the third shift.
The third shift for harm reduction is focused on supporting the hidden population of drug users. The goal is to reach new clients and provide them with all the services of HOPS’s Harm Reduction Program. As opposed to the first and second shift, which operates with fixed working hours, the third shift is more orientated towards the daily dynamics of clients and requires more flexible hours. This means working 24-hours, sometimes weekends and holidays.
Establishing the third shift began as volunteering job and was a painstaking process, considering how difficult it was to reach the clients, however freedom and creativity in the approach made the process interesting and challenging. The trust people from the community had in the team members helped us make the first contacts with groups from the hidden population. Even when we managed to make the contacts, the team worked long and hard to gain the trust of the groups themselves. We used different approaches, but mostly we had informal gatherings with the groups and our team adapted to the dynamics of their meetings, which was late in the evening, mostly in their homes, parks, clubs, etc.
After a while, the results of their work became visible, and the team was recognized by the community.
I remember one night, when we were invited to a client’s birthday party. They had purchased everything but cake and cookies (if you know what I mean). They announced there was going to be a ‘feast,’ however it wasn’t the feast we were used to. That evening for the first time we were faced with a situation where our reaction prevented heroin overdose. Due to our previous trainings, it wasn’t difficult to recognize a boy falling unconscious. We provided first aid in accordance with the recommendations for opioid overdose and called an Ambulance.
In our fieldwork we inform drug injecting people about safe injecting and blood borne infections, as well as HOPS’s harm reduction programs. Clients are satisfied with the services, however surprised at first at the realization that someone cares for them, their health and their rights.
The third shift proved to be a great link between people who use drugs and public institutions. The painstakingly gained trust helped us inform this hidden population on how to realize their personal health and social rights. It is a great example that shows how much it can be done for people who need help when there is a will. The hidden population exists, although it will remain unknown unless we take interest in these people and offer them our help.
Darko Veleski holds a bachelor’s degree in Social Work. At present he is working on his Master’s Degree at the Institute for Social, Political and Juridical Research, Department of Human Resource Management. He is active as a program assistant in the Program – Harm Reduction Services in HOPS – Healthy Options Project Skopje where he previously worked as fieldwork coordinator and a social worker in the drop-in centers.