Wednesday, June 12, 2024

Drugs and Diseases of Despair in Covid-19 Botswana 

Botswana has always experienced the problem of drugs and substance abuse, including disturbing high levels of alcohol abuse, and alcoholism (the alcohol levy imposed on alcohol in 2008  is a clear demonstration of this phenomenon.) How has the Coronavirus pandemic, and the restrictive health measures put in place to curb mass transmissions, infections, and high levels of hospitalization, impacted this social problem? Is there a resurgence of the problem in the wake of mass unemployment (20 000 lost jobs according to Statistics Botswana, 2021) and traumatic quarantines and isolation created by lockdowns? How is this idling chunk of the workforce responding to their blighted situations? How are the youth, also experiencing mass unemployment, responding to these adverse situations in terms of drug use and substance abuse? What are the resulting public health consequences? Are there any resources, including social support, comprehensive treatment options, harm reduction services, now in place to help those facing severe exposure to vulnerability, and therefore most likely to respond by turning to drug use and substance abuse?

It is our fear as  non-State actors  that social isolation, and limited access to rehabilitation resources and centers is causing drug addicts and alcohol dependent Batswana towards alternative psychotropic drugs and illicit alcohol products. It is our fear that income-rich Batswana are turning to illegal online drug marketplaces that is pushing many towards deviant behavior. We live in a moment of great anxiety. We argue in this article that the heath, medical and psychological consequences of these radical changes in daily lives, in lifestyles, in moral economy, and in public and social spaces, is poised to compel the nation to the precipices of unprecedented psychological distress, intolerable economic hardship, escalated appetites for substance abuse and dependence (not to mention food insecurity and diminished access to health and widened health and economic inequalities.)

Every day Batswana lose their jobs. Every lockdown brings with it unfamiliar lives and hardship. Every death brings with it painful grief and anguish and every business closure brings with it income loses and alarming human insecurities and indignities: all of this in a new world where just about every citizen feels deprived of vital relationships, useful opportunities and the hope for a better future. What is the impact of all these frightful things on individuals? On families? On communities? We agree that community-wide containment does decelerate the pandemic. But this does not mean all the results of face-to-face prohibitions are positive. The benefits of human-to-human transmission protocols are necessary, and useful, but their long term outcomes threaten to breed social outcomes that are terribly harmful; and these include addictions, mental illnesses, and general national poor well-being, especially among socially marginalized groups, and specific jurisdictions like poor neighbors, affluent suburbs and depressed economic blights. Social conditions under which Batswana lived for ages; education, economic stability, food productions and entrepreneurship have all been turned upside down. This ordinary order of things is rapidly becoming a thing of the past. Normal is not returning back any time soon.

What is to be done?  

Civil society organizations are uniquely placed to give voice to groups and communities impacted by drug use, drug policies, drug-related health, and social and economic issues. In developed countries civil society organizations are always in the forefront of issues relating to drug abuse prevention and treatment; alongside private corporations and philanthropist organizations. It is, I think, time business empathy is invited to help Batswana deal with these issues. The burden imposed on individuals, households and communities by Covid-19 restrictions is so heavy it is obvious government is not anywhere near enough to even address this problem.

But there is one thing that government can do: a comprehensive technical assistance document detailed enough to help other social actors in the areas of diseases of death and diseases of despair. Restrictions imposed to fight Covid-19 have impacted the usual patterns of drug use in Botswana. This is clear from police reports and records. Border closures and domestic lockdowns have resulted in scarcity of classic street drugs. This situation has been exacerbated by social distance requirements that have upended recreational settings like bars, clubs and social gatherings. It was in these settings that stimulants were normally abused. Are homes and households now to become substitutes for these disrupted recreational settings? What exactly is happening in these households? Are new drug use cultures emerging there? If so, what are the social implications?

Social research has long settled the issue of drugs in households: violence, spouse abuse, violations of children, diseases, erosion of values and disproportionate defraying of incomes to drugs, among other horrors.

Our position is that integrated care is critical in addressing alcohol and drug problems. By this we mean new data-informed and driven interconnected strategies interfaced with public policy at four levels: funding, capacity-building and operational structures, service delivery and clinical interventions. Civil society works with specific target groups. It is better placed to provide innovative services for those that use drugs. Through its research-based interventions it can help bring new information, knowledge and independent expertise to public policy, enhancing, in the process, the legitimacy, quality, and understanding of drugs-related policy initiatives; from drug use policies, to harm reduction, law enforcement and legal dispensations. Government has neither the money nor the institutional capacity to do these things alone.

As it exists now drug abuse policy operates at the levels of ideologies and discourses about prevention. Civil society, on the other hand, has started moving towards measurement interventions; emphasizing social impact assessment and evaluation, and harnessing policy imperative to positive change results. Furthermore, we don’t believe that there should be a cost-benefit analysis approach to law enforcement and budgets and the lives, or deaths, of human beings.

For a country the size of Botswana, plagued by mounting budget deficits it’s not a good decision to take the responsibility to address drug-related issues away from parents, communities, law enforcement agencies and data-backed and science-driven interventions. We further worry that post-Covid-19 health systems, given the traumatic experience of the disease at individual and family levels, and community and world of work levels, are going to struggle trying to balance continual health care, coordination, and adaption of person-centered approaches and abstract conceptual policy frameworks. Government must start investing in staff training, interagency relationships and civil society organizations now. But even this will just be the beginning to a social problem that is bound to replicate and get worse.

Let me explain. Death of despair is an area of sociological concern that has growing literature whose academic reputation has been sealed by the outbreak of this pandemic. Defined for a laymen; it is characterized by worsening economic inequalities, severe feelings of hopelessness about personal safety and personal fortunes. It takes many forms under different circumstances. Under Covd-19 conditions research already shows how deep feelings of personal inadequacy and group disadvantage are driving large numbers of people towards deviant behavior, including suicidal ideation, disposition to violence, taking to drugs and heavy drinking and general personal recklessness and moral abandon; for the last, especially, insensible impulses to murder and indifference towards consequences for personal misconduct. These things are happening in Botswana: rape, sexual gender violence, passion killings and violent robberies.

Unavailability of basic necessities and status symbols, including financial income, drive most patients to maniac actions and habits. Loss of employment, and guaranteed income, just worsen such behaviors. And so does low pay and terrible working conditions. Add to these, social isolation, and research shows the majority of people studied, in America at least, remain without much reason to believe in a better future. Death of despair feeds diseases of despair: alcoholism, drug overdoses, liver cirrhosis, depression and fatalism. How Batswana do you know who are out of work? How many of them have lost regular incomes? How many have changed from being the people you used to know? How many are neglecting their personal health, indulging in injurious and risky behavior? How may are drinking more? How many are turning to drugs?

Our economy has always been weak, in a structural sense. It is now getting weaker; for the first time since independence large numbers of the rich are getting poorer, and many households are falling from middle-class status. And the poor? Well, the poor are staying poor. Income and economic stagnation are driving everybody crazy under the Covid-19 economy. And this death of despair is permeating whole social relationships, professional networks, personal lives, public institutions and communities; all fabrics of society. Grief daily strikes Batswana in multiple ways; loss of a loved one, retrenchment, bankruptcy, premature and unexpected terminations of personal relationships. Under such an atmosphere many turn to poor substitutes for personal freedom, happiness and social relevance; things like alcohol, and behavior changing drugs, believing such habits can improve matters, and only to learn the hard way that these things actually make matters worse, that such habits create unhealthy dependences, and life threatening addictions…which lead to further depression, and death, in some instances.

This where Botswana is right now. Deaths arising from Covid-19 infections. Deaths in response to economic hardships and financial embarrassments. Deaths resulting from severe psychosocial impairments and deprivations. Deaths resulting from hyperbolic discounting; that is to say, those Batswana who assess the weight of the problems and difficulties they are currently experiencing under Covid-19 conditions, and then discounting the value of long-term social outcomes, under the impression the long-term outcomes will never come to pass, a feeling particularly true with suicides, and many heavy and reckless financial spenders.

Thanks to the Covid-19 pandemic, Botswana has come to such a pass that a country that once impressed the world with its mineral financial statistics is now presenting to the world just this disturbing depression inventory of emotional despair: feelings of excessive sadness, personal resignation, hostility, defeat, irritability, loneliness, apathy; even awful inability to experience pleasure and reward (the primary reason why alcohol drinkers always force the hand of government to shutdown drinking outlets to their own disadvantage.)  These are terrible feelings. They destroy motivation and action. They destroy interpersonal relationships. They breed reckless, risky, and unhealthy acts like excessive spending, low physical activity, harmful sexual behavior, drug abuse and mental health problems.

Why is this the case? Why  Batswana are responding to this situation this way? Human beings need, as matter of fact, purpose, connections, fellowship and social balance in the way they do things, in the way they behave toward each other. Batswana are not an exception to this rule. This may sound ridiculous but many people finding themselves all alone, deprived of friends, barred from the normal routines of their lives, jobless, all the money gone, being told what to do, when, and how, just collapse into various forms of irrationality and madness. Death of despair arises from exactly such circumstances and such feelings and dilemmas.

But what is the meaning of this? Is the situation completely hopeless? Is the future dead? Our answer: there will always be another day. What matters is what Botswana government does to reverse this tide of doom.

To illustrate let’s share a story. Algerian born French writer, Albert Camus, observed in his classic, The Plague, correctly, that all things evil in this world are perfectly represented in all the plagues; and this, I am afraid, is just as true with the Coronavirus and Covid-19 pandemic. Camus was both a writer and a philosopher, and a philosopher best qualified to inquire into and explicate the perils of plagues like the one under whose withering shadow we live now: an existential philosopher. One thing critics don’t emphasize enough about this remark is the undertone of hope that he assigned to people, ages and communities ransacked by the terrors of plagues. Camus argued that life under a plague is a moral test, and the instinct for survival under such horrifying conditions, ‘helps men to rise above themselves’-the reason, perhaps, why no vital civilization has, as yet, been completely obliterated by a plague.

What makes people to endure, and survive, the hard conditions imposed on their lives by crippling pandemics like Covid-19? What does a life like this mean? The life Batswana live now as I write under Covid-19 conditions; during the most appalling circumstances and situations imaginable?

What is the meaning of this?

Camus argued such is ‘life, that’s all.’ Sounds silly, but note; he further observed that under the tyranny of the plague individual destinies more or less disappear, or become less pronounced, diminished-in substance but not value-and only ‘a collective destiny, made of plague and emotions shared by all’ reigns. I have no intention to jar ordinary minds, minds struggling to survive, with philosophical speculation. But I should, I think, emphasise the simple reality that critical thinking is essential to surviving such conditions, that it is essential to find solutions to the crisis and social problems that arise from health pandemic conditions, and turning our backs on critical thinking is just as bad as turning our backs on logic, science, and common sense.

Let me return to the problems of drugs and addiction under Covid-19. This disease has not only destroyed decades of development effort; it is destroying lives and communities-anything that destroys a national economy is a death threat to every citizen; no person, or civilization, can live without nurture.

But here we are, lying prostate under the dominion of a relentless plague. What is to be done? How are we doing? Where are the exit pathways from this pandemic, this nightmare?

Like most extraordinarily powerful realities Covid-19 is giving voice to extraordinary impulses. It is rousing and inflaming terrible passions and fears in the most frightful manner. It is not easy, or desirable, to live under the grey shadow of death, to walk the same path with death, or to give ear to mass, incoherent conversations about death and human survival. This is something normal to philosophers like Camus but is sure isn’t normal to the ordinary Motswana.

But here is another simple reality: under this horrible banner stripped with disease and death the old problems-love, security, status, joy, pleasure, sex, entertainment, illusions, magic and fantasy (the strongest human urges and impulses)-also exist, and they stubbornly refuse to be submerged under the ocean of daily lamentations and sorrow. It is really not surprising that drug and alcohol addictions are becoming more problematic, that gender-based violence is getting more accentuated, and, more disturbing, that shelters for victims and rehabilitation facilities for drug patients are overstretched…people are fighting, struggling to survive, and unfortunately it is in such situations that both the worst and the best attributes of human beings fall into sharp relief. What is needed right now is humane response to human tragedy, a thinking and enlightened government, educated and solid policy responses.

We will survive.

Meanwhile, there’s a terrible cocktail of life playing out there in society; everyone bored, feeling suffocated and alienated under the cohesive lock of health restrictions, mandatory isolations and quarantines, is devoting themselves to cultivating new habits, bad or good, rewarding or destructive, wise or foolish; everyone is designing new lives, new habits, new fantasies and new destinies for themselves under the terror of untenable circumstances and frightful conditions…is it really surprising that personal misfortunes and social problems are rising in households and communities throughout Botswana, and alongside these difficulties other Batswana hardly sleep at all working around the clock to save life and the nation?

Human endurance, that’s where our salvation will come from.

That’s why I say government should mobilize and deploy the hands of all Batswana to help out; especially civil society organization which have experience and expertise working under such bleak conditions. If we are to win this war we must be able to ask the right questions, and formulate the right strategies.

It is here that sociological imagination easily lends itself.

How easy is it to live in a world shaped by death, painfully lonely death, and instant peril in every corner, every street and every neighborhood? What is the capacity of human beings to share in suffering that cannot be seen? How do we deal with the unkempt consternation born of private and public lives suddenly, and without warning, struck down and bent toward fatalism, by a disease unknown and incurable? Just how many Batswana can cope with such a situation; such horrid conditions?

Batswana are strong people. Unfortunately, we live in very fragile communities. Covid-19 hit us badly in that dreadful reality; the Achilles heel of our public life: economic vulnerability. When it arrived here it found unprotected and vulnerable households, most of them managed by unemployed, or unemployable, single mothers; hundreds of thousands of them. It found hundreds of thousands of loitering youths in similar economic conditions. It found just about every community-urban and rural-dependent on alcohol sales for survival, entertainment, social relevance, personal self-esteem and income; no living warmth, just a brooding picture of desolation hovering over shamed individuals, unstable households and bleak communities.

It found us economically naked; a society stripped of social virtue and human dignity; a sick society, as well: hundreds of thousands on pills for HIV/AIDS, Non-communicable diseases and a palpable spirit of fatalism hanging in the air; every sunrise, every sunset.

What Covid-19 invaded in Botswana was a broken society. High levels of alcoholism, divorce, violence against women, girls, and children, and too much dependence on an inefficient government for just about everything; broken lives hanging on a thread.

I want people to see where the Botswana drugs and addiction problem comes from; and why it is problematic under Covid-19 conditions, and why it is bound to get worse and to particularly note how its trajectory is likely to affect post-Covid-19 society. This is a serious problem and it affects every person, every class, every community and all public policies government is putting in place to promote recovery. 

In fact, it is absolutely essential that government starts preparing a restoration technical report on this issue right now if we are to prevent catastrophic defeat in the future.


Read this week's paper