By Kernjeet Kaur Sandhu
My name is Kernjeet Kaur Sandhu. I was born in Winnipeg, Manitoba, Canada. My parents, Satnam Singh Sandhu and Iqbal Kaur Sandhu, are from the region of Punjab in northern India. My parents came to Canada in the early 70s. I could spend hours explaining how motivated and hard working my parents were and are. They made the impossible, very possible for us as kids growing up. My schooling was all in Winnipeg.
My first trip to India was in 1992 and it was a very influential trip for me. I quickly grew very attached to my extended family in India. I came back to Canada and started to read and write Punjabi so that I could continue communication with my family overseas through letters.
Throughout my travels back home to India, I noticed the need for medical services in the rural areas of Punjab and this motivated me to do more and think bigger. I chose the medical profession quickly after my Bachelor’s degree so that I could go back to help the people of Punjab. It was a very clear motivation for me right from those early trips to Punjab.
Today, after having obtained my MD and finishing my medical residency from the United States of America, I travel to India once or twice a year to provide health services to rural communities. I have also traveled to Haiti to do similar work and tropical medicine is an area of interest to me.
My focus in recent times has been on the increasing drug use in the Punjab region, primarily heroin, cocaine, and synthetic opiates.
Punjab and the severity of addiction
Addiction plagues the people of Punjab quite a bit so I felt motivated to help this population. Overall, though even just basic health care needs are not really met in Punjab, so seeing the above peaked my interest.
Addiction problem is quite severe right now. Around 76% of total users are between the ages of 18-35 yrs. Fifteen out of 100 males take opiates between the ages of 18-35 and 4 out of 10 are addicted. (Source PODS-Punjab Opioid dependent survey). Common addictions are to mostly opiates and derivatives of opiates for the most part.
Banned products typically come across the borders from Pakistan or Afghanistan. They are also produced locally within Punjab.
Youth get access through dealers, of which there are plenty. Unfortunately one village can sometimes have multiple dealers. Also, lots of drugs of abuse are available at pharmacies without prescriptions, especially opiates and benzodiazepines. This creates for an even higher likelihood of addiction given the easy access.
Reasons behind addiction
Mostly, that patients are bored or that they just did it as part of peer pressure. In India, it’s due to multiple reasons as the youth struggle with access to education and lack of infrastructure. Even after getting an education the youth are left at times with no prospects for jobs which can be frustrating and challenging. To distract the mind many turn to drugs. It is also all the old trauma Punjab has faced from partition to operation Blue Star, all these traumatic events take their toll on a population.
Addiction can create chaos in people’s lives. So people then start to deal with financial struggles amongst other issues. Farmer suicide is linked to this as well, as farmers sell off their land to get their drugs and then end up taking other drastic measures as well.
Increasing addiction amongst women
Even the stigma of addiction surrounding women is starting to lift. Meaning that we are now starting to realize that women are affected as well as men. That it cannot be just a “male” disease process. The thing with addiction is that, when you understand the actual disease process and realize that it’s truly a disease, only then can you start to appreciate that it can truly affect anybody. There are clear genetics and environmental factors linked to the “addicted brain”.
I go to Punjab at least once a year. I have been doing this since 2011. Border towns such as Tarn Taran, Amritsar and Moga seem to be more affected so I focus on these areas. I typically do mostly awareness, though at times when I team up with a psychiatrist we will implement treatment programs as well. The treatment in Punjab currently is mostly buprenorphine based. This is opiate replacement therapy to help curb cravings for addicts and still treat their addiction. Currently, in Punjab Buprenorphine is used quite often for addiction treatment.
Counselling and mental health is still not as emphasized, however I feel that if it was there would be a nice balance of addiction treatment. The general population seems to lack a basic understanding of the actual disease process of addiction, which is why awareness and education are so important. Addiction is a chronic relapsing disease. It is about getting to know yourself, what led to the addiction, processing that experience that led to addiction and then moving past it. Components of addiction are genetic so it may not all be in the control of the patient. But admitting to addiction and acceptance are key parts ofhealing past the disease. During our awareness programs we try to make people realize what they are facing when they become addicts. We also try to focus on the disease more and what effects it has on the body as this can also help. Once patients realize how toxic these drugs are and what they do in the body, that can sometimes be motivation for change. In terms of education, the emphasis is on prevention. If we can get these patients to say NO to drugs, well that is the biggest most important first step. For this I like to start young, in the schools, around grade 4-5 and then try to see them at least once a year every time I go back.
Addiction is very prevalent and talking about it is very stigmatized. It is not “appropriate” to be an addict and it is not appropriate to talk about the addiction or the mental health linked to the addiction. So we are starting to see Punjabis come out of it but you have to be willing to be open and share your feelings about this. There is no shame in addiction or mental health problems. Be strong and focused. Move forward in understanding your addiction and in seeking the help you need. You are not alone; there are plenty of people to help you with this and plenty that struggle with Addiction.
For more information on our work and resources on addiction log on to: http://www.punjabidoc.com/.
Kernjeet is currently based in Winnipeg, Manitoba practicing at Harbourview Medical Center doing primary care with addictions. She also does part-time work as a consultant in Addictions, Downtown at Health Sciences Center.