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Ukraine: Learning How to Advocate for a Cause

To help further their mission, harm reduction activists in Ukraine understand that they need to deal with government agencies as part of their advocacy work. One of the biggest challenges has been advocating for the ability for patients to receive the medication at pharmacies with a prescription from a doctor, instead of having to personally come to the Methadone sites every day to receive the medication.

The Director of the local NGO “Happy Future for You” in the city of Chernivtsi, Yulia Palagnyuk recently posted a blog post [ru] about their advocacy work. The post was published on the blog of the Association of Substitution Treatment Advocates of Ukraine (ASTAU). The organization's project focuses on teaching tactics how to interact with health care agencies as a way for advocating for their cause. Yulia, who is also a substitution therapy patient, wrote what achieving their goal would mean:

Как я уже выразилась, рецепты – это предвкушение свободы, свободы передвижения, свободы выбора, свободы, свободы и еще раз свободы!!!!!

As I already mentioned, a prescription is a taste of freedom, freedom of movement, freedom of choice, and simply freedom, freedom, freedom!!!

        

Opinion poll among patients, picture taken from the ASTAU blog

As a first step of the project, Yulia conducted a survey among the other patients to monitor the situation and recruited a group of activists for additional work. The next step involved conducting a training event for the activists. Yulia wrote [ru]:  

Нас было человек 15, плюс, переодически присутствовал наш врач-нарколог, который сам почерпнул информацию, интересующую его по теме зак. базы. Кроме преследуемой активации, информированности, сообщений о работе и планах проекта при поддержке МФ «Возрождение», все участники тренинга написали заявления на имя Директора Черновицкой РГО «Светлое будущее для тебя» с просьбой лоббировать их интересы в адвокации внедрения рецептурной формы. Да, еще, мы уделили внимание статистике и во многих других моментах, но и сделали акцент на процент утечки препаратов! Спасибо Павлу Скале, он предоставил мне материал, в презентации вы увидите утрированные акценты и мизерные фактические количества!

There were 15 of us, in addition to our narcologist doctor, who was also present at some sessions. He also learned new things especially in the field of legislation. Besides teaching advocacy, raising awareness, and learning about the future project plans, all participants provided written statements asking the Director of the Chernivtsi NGO “Happy Future for Everybody” to lobby on their behalf for the provision of medication through prescription. We also discussed statistics concerning the issue, and we were especially focused on the problem of the diversion of the medication [to the black market]. I am grateful to Pavel Skala for the material, which shows that the percentage of drug diversion is exaggerated, you can find this in my presentation.

Training event, photo taken from the ASTAU web-site

The next step of the project was the drafting of appeal letters to the health care authorities. Yulia is convinced that the support from the ASTAU [ru], especially in the legal area, cannot be overestimated. The activists had access to resources, such as existing legislation that is available on the ASTAU website. A packet of documents with various orders, laws, directives was attached to the appeal letter despite it being fairly routine. However, she wrote “the small things matter!” and they also signed up for a meeting with the department head.

Planning of future steps, photo taken from the ASTAU web-site

Yulia also described other steps her organization is undertaking in promoting the idea of provision of substitution therapy medications through prescriptions. She posted [ru]:

В поисках понятливых представителей СМИ, подготовили материал о своей организации, о проекте при поддержке МФ «Возрождение», нашли достойного журналиста. Нынче работает над изданием статьи, над имиджем организации и над доступностью изложения сути проекта о рецептах для больных, нуждающихся в них людях. Провели рабочие встречи с неправительственными организациями – союзниками и попросили поддержать нашу инициативу письмами. В процессе. В конце месяца планируем провести тренинг с медперсоналом, …. Хотим сделать телемост с замечательным польским врачом Эдгаром, который еще много лет назад рассказывал о необходимости программ ЗПТ. Когда к нему приезжали наши представители, он с возмущением мог рассказать одну из своих обыденных ситуаций, приводивших наших в недоумение. Например, когда к нему вламывается взмокший полицай и говорит : «Вот, я только что на улице забрал у наркомана банку с метадолом, на те вот, держите!» На что пан Эдгар Божек отвечал: «Нет, ну нормально? Я даю, он – забирает! Ты иди, вон, забири у человека без ноги костыли! Нет? И это тоже больные люди, поймите уже наконец!». Вот такой вот доктор! И мы хотим или записать его на тренин , чтобы прослушать его разговор об актуальных вопросах или же через скайп, вообще, сделать живое общение, вопрос-ответ.

We also wanted to promote our organization through the media, so we prepared some material about this project funded by the Renaissance Foundation, and found a decent journalist. Currently he is working on an article which would promote our organization and would clearly present the project's idea aimed at helping sick people receive the medication through prescription. We also organized a meeting with other non-governmental organizations – our partners – and asked them to support our appeal initiative. It is currently in the process. At the end of the month, we are going to conduct a training event for medical personnel, and we would like to organize a teleconference with a fantastic Polish doctor named Edgar, who has been promoting substitution therapy for many year. When our representatives visited he told them stories about his practice. For example, a police officer came to his place and said “I have just taken away a package of Methadone from a drug addict, here it is, take it!” And Dr. Edgar responded, “Why did you do this? Why have you taken away something that I had just given him? So would you take away crutches from a person without a leg? Please understand that these people are also sick!” This is a real doctor. We would like to film his talk to be able to show at training sessions or to have a live chat with him through Skype.

Yulia believes that the main goal of the project is to change Ukrainian public perception of replacement therapy. She is going to develop a special presentation on this topic. She wrote [ru]:

Смысл основной – это чуть поменять отношение и к программе, и к нам, и к рецептам! Затронуть тему выноса, вернее, утечки. В общем, проблему наркомании, как начало истории. …… Что алкоголь, приносящей намного больше вреда большему проценту населения, продолжает красиво рекламироваться и продаваться, что наркомания-это не дурная привычка, дурная привычка – это ковыряться в носу, раскидывать носки и грызть ногти, а это тяжелое заболевание, и если б знали, как его лечить, давно бы помазали лоб зеленкой и «до свидания»! Много всего интересного, просто и ясно! Я обязательно поделюсь после презентации!

The main goal is the change attitudes toward the program, toward us, and toward prescription. And to discuss the issue of diversion. To discuss the issue of drug addiction starting from the very beginning… To discuss that alcohol harms a much higher percentage of the population and continues to be advertised and sold, but that the drug addiction is not simply just a bad habit. Bad habits are picking your nose, throwing your socks around the house or biting one's nails, but drug addition is a serious disease, and if there was a cure then everybody would already be happy. There are so many interesting and clear facts! I will share them with you when my presentation is ready!

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