Amsterdam harm reduction facilities – a brief guide from the point of view of a central European traveler

3 November 2016

October 9, 2016: Sunday

On my first day in Amsterdam I met a girl asking for a cigarette, and we chatted a little bit. I told her I am here for a week’s internship at De Regenboog Groep. She got a little shy, but told me that she is one of their ex-clients and used to visit their facilities a lot, when she had serious problems. She was a little bit drunk and smoking weed, but she has not been using hard drugs for a few years now, thanks to them, she told me. And this was my first impression from my internship.

October 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 De Regenboog Groep. I saw the vision — a beautiful dream of the whole organization written on one flyer: “We dream of a city where there is a place for everyone. In which people with wealth and people in (social) poverty live together and work together. In which we are involved in each other’s lives and reinforce each other. Where people who are capable of donating contribute to help develop society. In which the city is everyone’s home. Where nobody needs to feel desolate.”

A few words about history: the facilities in Amsterdam began to evolve at the beginning of the 1980s, when a lot of Germans came to Amsterdam. There was a big drug scene, a lot of people injecting. Germany then had quite a repressive drug policy. The quality of heroin was good, and there were lots of fatal overdoses. Amsterdam was finding some pragmatic solutions, and the municipality decided to deal in different ways with people from inside and outside Amsterdam.

This is when AMOC emerged. AMOC nowadays is a part of De Regenboog Groep, but back in the 1980s it was a separate NGO working mainly with German drug users. AMOC was improving drug users’ living conditions and trying to give them some basic care. It also helped the people get back to Germany (so the problem would be delegated back to the country they came from). Around 2004 AMOC merged with De Regenboog Groep. AMOC’s visitors are different than the other clients of De Regenboog Groep — they often do not have any legal status in the Netherlands and thus cannot access regular social and health services.

The city government was and is always pragmatic about drug policy. It wants to have clean streets and would prefer that non-Dutch people return to their country of origin.

Since the beginning of its history, Correlation has been trying to link with other EU organizations and build working networks and platforms. The first European project of De Regenboog Groep was for male sex workers.

1Rainbow Foundation – De Regenboog Groep: 60 workers, 1000 volunteers, 9 drop-in centers, 3 needle exchange programs, 3 consumption rooms, night shelters. If you are a foreigner, that’s all you can ask for. If you have insurance you can also try different work opportunities, buddy programs etc. The high number of volunteers is because the emphasis of the foundation is on a participatory society. Volunteers are more like a friend (buddy) to the client than a social worker.

Correlation is a European network hosted by De Regenboog Groep and has 180 member organizations. International activities began around 1997 with a project on male sex workers. The emphasis was always on sharing experience with countries where the target groups were coming from. The aim is always to achieve benefit for all parties. So Correlation always seeks effective interventions among marginalized groups (drug users, sex workers, etc.). Correlation’s 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. It develops processes that can be tried, used and challenged in different countries, with different clients and different situations.

Some more impressions:

  • They sell popcorn from mobile shops, together with a fair-trade organization, John Altman. It is a crowdfunded project (and the popcorn is really tasty).
  • They developed a chat tool for online interventions, which works well and is easy to use for other NGOs: the Social Intervention Tool (SIT).
  • And so many other tools, interventions, methodologies on their website — it’s definitely worth checking them out.

I met with Machteld Busz (International Program Manager) and Toon Broeks (Editor and Outreach) in a nice place at Frederik Hendrikstraat, a former squat transformed into a friendly, open-plan working area.

Mainline was formed in 1990, when HIV was spreading widely. It wanted to offer its clients information about harm reduction. Today it is published four times per year. Mainline also focuses on outreach work, but since there is almost no drug scene on the streets, it needs to find new ways of getting in contact with drug users. They map, monitor and try to find new groups.

Its outreach work mainly focuses on:

  • mapping the emerging chemsex scene;
  • GHB users outside big cities — usually isolated groups of young people;
  • the Thai sex scene; and
  • Eastern European groups.

The new challenges for outreach work are new ways of contacting clients — possibly online outreach or something similar.

Mainline also works at the international level: cooperation and spreading knowledge about harm reduction in Asia (Indonesia, Nepal, Pakistan) and Africa (Kenya, South Africa, Tanzania) and trying to establish and maintain organizations within the regions. So it teaches and trains about harm reduction, HIV, OST, etc.

Mainline has also developed useful harm reduction tools such as a card game about harm reduction and a board game about infectious diseases.

October 11, 2016: Tuesday

AMOC!

Situated in a nice area near the center of the city, AMOC was founded in the 1980s, mainly for German drug users. Nowadays it is in a big building with many facilities. If you still think multiculturalism is nonsense, you should check out AMOC: it’s a living organism and evidence that multiculturalism is not an opinion, which you can or can’t accept; it is the daily reality in Amsterdam. It is a house full of different nations, vulnerable and seeking humanity.

I met Conrad, manager of the whole place, a very friendly, open-minded guy from Germany. He likes a joke and has very personal contacts with the clients, as the rest of the staff do. I really enjoyed the warmness of the place all day during my job shadowing.

Ground floor. A walk-in center serves as a shelter during the day, open from 10:00 until 17:00. Eleni (from Greece) was boss of this floor for this day. Apart from Eleni there were mainly volunteers (Dutch, German, etc.) working and helping according to the daily schedule. You can stay all day, have some rest, play chess, watch TV, check email, have coffee, tea and a meal. You will meet people from all around Europe: Germany, Italy, Spain, Poland, Czech Republic, Romania, Russia, Slovakia, Greece, Albania, Georgia. The capacity of the center is around 60 people at a time, but sometimes there are more. So the clients are not on the streets anymore. These clients are not problem drug users, although they often use drugs, drink alcohol, smoke weed, are homeless, have no insurance in the Netherlands and other problems. AMOC helps them find more humane conditions, work etc.

Basement. Showers for clients, changing room. Night shelter for people without a home.

First floor. User room. This is the place with a drug consumption room supervised by professional staff. The capacity is around 12 people. You can smoke, sniff or inject substances here. So there is no drug taking on the streets. You can have your time, prepare the substance and stay as long as you need. There is no rush, so people can treat their body safely (or at least as safely as possible for this risky behavior). Almost no overdoses for a long time. Periods of a quiet and peaceful atmosphere.

October 12, 2016: Wednesday

Blaka Watra (drop-in center and drug consumption room) is situated in the same building as De Regenboog Groep’s HQ. 20 years ago in this area was a big heroin open scene, but 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, as one guy at the drop-in center explained.

This facility is mainly for people from Surinam (a former Dutch colony) and the Netherlands Antilles (still part of the Netherlands), but you can meet people here from all over the world (the former Yugoslavia, North Africa, etc.).

It is a day shelter for people in need (homeless and/or drug users) with plenty of opportunities for work — you can clean the place, help in the kitchen, clean the streets in the neighborhood, do carrier bike transport. The kitchen is run mainly by clients from Surinam who serve traditional Surinamese dishes. The place is big, open and decorated with different positive paintings by clients. You just feel good vibes here. People are in a harsh social situation, but they are at a healthy place, and not being a public nuisance on the streets, which is important for the city.

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

I also visited the GGD facility, the Municipal Health Center in Amsterdam South East (which offers complex care for drug users). The southeast of Amsterdam is a suburb with a big Surinamese community. GGD is situated in the park, and for regular citizens it’s not easy to realize that it is a harm reduction service – the same as with all the facilities in the city – as they are part of the neighborhood, with no nuisance around, no problems.

GGD is funded by the government. It provides complex care for its clients: somatic and psychiatric care, social work, long-term stabilization, OST. The capacity is 75, but they are not full – the situation has changed due to an obligatory stabilization program (psychopharmacotherapy, social work, finding a job, shelter, etc.), and nowadays there are not so many severely addicted drug users. Out of all the users only one or two inject substances, while the rest just smoke drugs. 15 years ago the situation was very different, and there were many more people shooting up.

I met Nelda, a GP who has been working in the facility for many years. The last resort, that’s how she also calls this place. “For people who are completely alone, we represent the last safe place reminiscent of 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 attending the ceremony. That’s very sad.” Nelda talks a lot about the complex, holistic approach for each client, and when she does you just believe her, because you feel the promise of humanity in her words.

October 13, 2016: Thursday

Volunteering for De Regenboog Groep

De Regenboog Groep has a total of 2000 volunteers in 14 different projects. Every volunteer spends 3 hours per week with the client – it’s more time than most of us spend with our friends each week. It’s a big responsibility. Volunteers are mainly part of “buddy” projects. To be a buddy means spending time with the client and trying to make some positive change in his or her life. The goals and issues are very different and depend on the individual needs of each group and each person. The most common situation is that clients have more than just one problem in their life. They are drug users, homeless people, psychiatric clients, people in deep social crisis, refugees, and so on.

The usual profile of the client is that they have a set of problems, including severe psychological problems, and no working social network.

There are 3 main groups of volunteers: people in a high social and economic position, young people after finishing university, and retired people. To become a volunteer you have to go through an interview, then you have 15 hours of training, and then you submit reports every 6 weeks to the coordinator. There is a team of 30 coordinators that manages 1200 matches. “Match” means good cooperation between the client and the volunteer. Usually a volunteer has one match or case.

Each coordinator selects volunteers, does intakes of clients, and does the matching of volunteers with clients. They also monitor the cases: each coordinator has around 45 actual cases. The matching is done mainly intuitively, and there are two main groups of interest: clients who need empathy and a relationship, and clients who need specific skills or education. So a successful teacher can help teach Dutch to Moroccan children, or a retired lady can help a younger mother with no other support.

The time of the volunteer program for each client is a maximum of one year. So a strong bond and a relationship usually emerge between the volunteer and the client. That’s probably the hardest part of this activity.

The work is not only good for 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. Because of this, the volunteers often become better parents, managers, etc. The volunteer is in a role of a buddy to the client; he is not in the role of a professional. He is here to help; he is not responsible for the result (in this role is the client’s social worker etc.).

Around two thirds of the cases or matches work well, and it’s successful work with measurable results.

October 14, 2016: Friday

De Kloof

This is the third drop-in or walk-in center I’ve visited. De Regenboog Groep runs 9 similar facilities, and there are other drop-ins run by different organizations (Salvation Army etc.). De Kloof was founded around 1968 by the Catholic society St Vincentius, and it’s the oldest shelter for homeless people in Amsterdam. It’s 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, which allows the visitors to arrange their affairs with the help of a social worker. Also there is probably the biggest changing room I’ve seen for clients. They take a shower and then exchange dirty clothes for new ones, which is how clothing is recycled in Amsterdam.

What I’ve learned:

Research can be a great tool when trying to promote new services in your country (drug consumption rooms, volunteer work). Research done jointly with other NGOs, universities or state institutions is probably the best option.

Cooperation at the local level is the key to success. In Amsterdam every facility is connected to other ones. The network works well, and it is not easy to fall right to the bottom before some institution helps you. We have those gaps in Czech Republic.

Volunteer work can help a lot in buddy programs, etc. A lot of people from regular society can experience a different world, the clients can profit from it, and good matchings can be strong and significant relationships.

The Social Intervention Tool, the online tool designed for the age of new technologies, shows you how to do outreach online on the Internet: how to get in contact with clients through the Internet.

Thanks to everybody from De Regenboog Groep, Correlation, EHRN, SANANIM and all the others.