By Jennifer Carpenter
A young, thin woman with short hair hurries through Tirana’s morning bustle – weaving through noisy, dusty car traffic and crowded, narrow streets. Her bracelets clang with her stride – her heels keep time on the hot asphalt. It’s all part of the routine.
Her daily walk takes her down a short pedestrian street along a wall covered in ivy. She takes her usual dive into a shaded opening – disappearing from the surrounding rush. Suddenly, the sound of shouting and car horns fade in the overgrowth – now it’s only crunching leaves and grass that reveal her slowed, calm pace.
She follows a path to an old greenhouse, now used as an office. Filing cabinets and desks are wavy shapes through the glass – a dozen “Stop AIDS” posters hang on the windowpanes, bleached by the sun. There are a few people inside; she waves to man stacking papers.
At the backside of the building, she leans over an open window and exchanges smiles with a man, her nurse, sitting inside. He hands her a plastic cup, filled with water and a fizzling little white pill. As she reaches out, the sunshine catches faded purple dots and scratches on her arm.
She downs the drink.
The distant sound of rustling leaves signals the arrival of another patient – and her exit. She heads in the opposite direction, walking past the greenhouse’s entrance: the front door of Aksion Plus.
“Ortencia!” the man stacking papers calls from inside, “Can you come in here, please?”
Ortencia enters and swaps greetings with Altin Bashllari, her doctor. He monitors her progress on the Methadone Maintenance Therapy (MMT). Aksion Plus has operated a MMT program since August 2005, with support from UNICEF. Bashllari and the staff manage almost 140 patients, including Ortencia.
“Methadone fools my body,” Ortencia explains, motioning to the open window at the back of the greenhouse,
“Every little pill helps me forget about heroin, for a while.”
Daily doses of methadone can help numb a heroin user’s symptoms of withdrawal – their need to have another hit. The stronger the methadone dosage, the less physical desire for heroin.
“Ortencia is on a long-term plan,” Bashllari explains,
“She started treatment three months ago, on a high dose. Every few weeks or so we’ve been lessening that prescribed amount, in hopes of slowly weaning her off methadone completely.”
Bashllari asks Ortencia how she is feeling. A few days ago Bashllari decreased Ortencia’s dosage again. She is nervous:
“I don’t want to go back to injecting again. I am staying strong,” she explains. Despite her anxiety, she seems to be adjusting well. Bashllari notes her fuller cheeks and more energetic attitude.
A woman calls from outside. Ortencia turns and sees Enkelejda Ngjelina, a social worker, holding an espresso and a packet of Aksion Plus brochures. She joins Ngjelina for conversation outside, at a picnic table hidden in the cool of the ivy overhang. Ortencia’s bright white tank top and jeans almost glow in the shade.
“Enkelejda speaks to me like a friend, not like I am her patient,” Ortencia says.
They spend a few minutes catching up with each other almost every day. Their discussion usually revolves around Ortencia’s daily life – her afternoon work for Aksion Plus, inventory at her family’s store, and her evening plans with her 5-year-old son.
“I do this every day for him,” she explains,
“He is my reason for living.”
Starting to Talk
Ortencia first injected when she turned 16 years old. Now, at 27, her body is a testament to her long road of recovery. Her bright eyes and wide smile give way to a past naivety, yet her calm, earnest poise reflect her learned maturity and inner grace.
“In the way I started, I didn’t know what I was doing,” Ortencia recalls. Her teenage boyfriend introduced her to heroin, promising it would “take away the stress” of high school peer pressure and her parent’s threats of divorce. She was injecting regularly by the time she turned 18 years old.
“I was injecting in dangerous places. One time I had swelled legs for two months, and it hurt to urinate,” she adds. Then, she pulls back her white jeans to reveal small, deep black holes at her hip sockets.
“I was even doing it when I was pregnant,” Ortencia admits,
“After delivery I said I would stop it. But three months later I was injecting again.”
She shakes her head and looks at Ngjelina. Ortencia has gone through MMT twice before. During her last treatment, Bashllari was afraid she was continuing to inject while taking methadone – a dangerous combination that often causes overdose.
“She used to come in here looking thin and exhausted. She couldn’t even open her eyes,” Bashllari remembers.
When Ortencia was caught diverting (stealing methadone and exchanging it for heroin), Bashllari started tapering her dosage. Ngjelina kept asking for regular meetings, but Ortencia wanted to talk less and less.
“I was tired. I was tired of my problem,” Ortencia admits,
“I knew I had to stop. So one day I went to Enkelejda, and then to Altin. I started to talk and they listened.”
“Methadone really plays only a 20% role in getting a user to quit – patients must change the very ways in which they live their lives,” Bashllari explains. A change in jobs, friends, diet, and support system all play an important part in helping a drug user from falling back into the cycle of addiction.
For Ortencia, all of these factors came together for her third attempt with MMT. She is proud to state she has not used heroin for three months.
“I started to get more involved at home. I help with our family’s store,” Ortencia explains.
“When I was using heroin, my father was very angry, and my mother was not listening to me. But now, things are much better. And I am happier now that I spend more time with my son.”
“I am pleased with Ortencia’s attitude. This time I can see the treatment working. We see it in how she behaves,” Bashllari notes,
“She has a real desire to talk when I meet with her now. She is actively involved in making a difference for herself.”
At the picnic table, Ngjelina and Ortencia discuss the importance of Ortencia’s support system – both outside and within these ivy walls.
“Building trust is such an important part of this treatment,” Ngjelina says,
“We have an relationship wherein what trust I give, she gives back.”
Recently, Ortencia has been giving even more – especially to others.
Spirit of Addiction
Two months ago, Aksion Plus hired Ortencia as an outreach worker, responsible for meeting with injecting drug users and explaining the services available at Aksion Plus. Most afternoons, she makes an effort to meet with fellow drug users and pass out information about MMT.
Ortencia is one of two female outreach workers, making her a particularly valuable member of the Aksion Plus team. For the most part, female drug users are not as involved in the culture or communities that form among heroin users. It is more common for female heroin injectors to be financially supported by their families or other male drug users.
“Women are harder to locate then men. But I can reach out to them easier than the boys. I know the language of which they speak,” she says,
“I can relate to women, particularly mothers – I know what they are going through.”
“She is a model for many female drug users who want to change,” Bashllari says,
“Her experience is very valuable, and she can spread the information easily.”
In white, she even looks like a white little Methadone Pill. For some drug users, she is their only dose of routine in a chaotic world.
Ortencia takes pride in helping fellow drug users
“This is my way to stop people from starting,” Ortencia explains,
“To stop this spirit of addiction.”
A new face passes by the picnic table. Ortencia jumps up to greet her friend, a young drug user. They have shared many in-depth discussions about sniffing and injecting heroin, and the risks of HIV. She had invited him to explore Aksion Plus a few days ago. She is pleased to see he decided to drop by.
She introduces him to Ngjelina, who invites him inside for an informal interview. They head for the greenhouse. Ortencia stays behind, finishing her cigarette and relishing in the shade if only for a few moments more.
Ngjelina turns and thanks Ortencia with a smile. Ortencia waves,
“Until tomorrow,” she says.
Ortencia then ducks out from the ivy-enclosed repose of Aksion Plus – back into the noise and heat of Tirana’s streets. It’s all part of the routine.