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are the first door they come through - we tell them they don’t need
a number, they don’t need documents, they don’t need anything to
come to us. It becomes a first step for their treatment – it’s very
important to have easy access with no problems and no barriers.’
If the nurse notices someone with a problem they will refer them
to one of the doctors, who offers antibiotic treatments and basic
primary healthcare as well as methadone programmes. If the service
users are found to have serious medical conditions, however, they
are referred to the relevant facilities. ‘We don’t have specialists here,’
he says. ‘If they have problems such as hepatitis C, we will send
them on to the normal health services. What we do is not really
clinical work, it’s more like social work. The most important work is
done by the nurse team.’
And are there plans to open more consumption rooms in the
city? ‘The local community has recognised that it’s important to
have the facilities, because these people have an illness,’ he says.
‘But they don’t want to be the only quarter to have them – they
say new facilities should be in other quarters. I’d like to see more
opened, but that depends on the council and if the local
communities can be persuaded. Hopefully they will.’
Manel Anoro will be speaking more about dignifying harm
reduction in his session ‘From Can Tunis to Sala Baluard’, to
be held on Wednesday at 16.45 in Room 7.
‘There are fewer people
consuming drugs in the street
and there is actually less crime...
There is always a police car near
Sala Baluard – maybe that’s not
really necessary, but the
community say they want it.’
Sunday 11 and Monday 12 May 2008 – DAY ONE/TWO –
Daily Update
– 5
community what you are doing, and if people start complaining to
the papers and the TV then it can lead to a bad situation. But after
a while it becomes clear that these facilities are not problematic.’
It’s now five years since the facility opened, so does this mean
the objections have died down? ‘They see that Sala Baluard has
not been bad for the community,’ he says. ‘There are fewer
people consuming drugs in the street and there is actually less
crime than before. There might be small amounts of consumption
and selling immediately around the facility, but that’s all. There is
no violence and no major problems. There is always a police car
near Sala Baluard – maybe that’s not really necessary, but the
community say they want it.’
So is it possible to quantify the effect the facility has had on public
health in the city? ‘It’s very difficult to know the exact impact,’ he
says. ‘There are around 180-200 injections taking place each day in
the facility. That’s a lot of people and a lot of injections – one person
might do two or three injections. If we didn’t have Sala Baluard, then
most of those injections would take place in the street. We have
around 100 overdoses a year in the facility – if they were happening
outside of Sala Baluard then it’s possible that a large percentage
would die. So it’s a big impact, but it’s difficult to measure exactly.’
Overseeing the injections, however, is only part of the job. Staff
at the facility provide the service users with vital medical cards and
other documents, and offer a pathway to a range of treatments
and care. It’s extremely difficult to access health services in Spain
without the right documents, and many of those using Sala
Baluard have chaotic lifestyles – in addition to substance misuse,
many are rough sleepers and may not be Spanish nationals.
‘Many are from outside Spain and the EU,’ he says. ‘They might
be sleeping in the street so they lose papers or the papers are stolen
– we don’t have a lot of people coming to us with all their papers in
order. We can provide them with health cards and other documents
and help them replace lost passports. We give out health cards
because if you don’t have a health card, you can’t do anything.’
The facility provides a first point of contact where the health of
the service users can be assessed and from where they can be
referred to other services, medical or social. ‘We say “come here –
you can do an injection” and then we can start to work with them.
Otherwise it would be impossible to work with some people
because they don’t go to the doctor, they don’t go anywhere. We