From hustling on the streets to recovery: a young man’s triumph over drugs
Harm reduction centre succeeds where rehabs often fail
Musawenkosi Mphomphotshane at the Bellhaven centre. Photo supplied (Bellhaven)
As a school boy, Musawenkosi Mpompotshane helped to support his mother. When he was 16, he got a job handing out pamphlets on weekends and he contributed to the family expenses. Good with his hands, he helped build an extension to his mother’s shack in Mayville, Durban. And, when his alcoholic father became physically abusive to his mom, he intervened.
“He wanted to beat my mother, but he stopped immediately after I interfered,” said Mpomphotshane.
But as the years rolled on, Mpomphotshane would come to play a very different role in his mother’s life.
He was first introduced to crack cocaine (known locally as ‘“rocks”) in high school. At first, he used it on weekends. The drug made him feel uninhibited, and it didn’t stop him from passing his matric year. But it soon became his only priority.
“When I would get paid, I [wouldn’t] think about normal things, I don’t buy clothes, or toiletries, I just buy rock.”
After burning through his own income, he soon turned to his mother.
“I stole from my family,” he says in a voice heavy with guilt. “Cattle, phones, money … I sold everything in my [mother’s] house. There was nothing left; only a bed and a wardrobe. Then I stripped the door and sold it … Then the windows.”
“You are the one who is supposed to support me,” he recalls his mother crying out. “You’re the one who’s supposed to stand with me, and now you’re taking from me. Why?”.
He left his family and began a life of homelessness on the streets of central Durban. He was in his early twenties.
Drug use on the rise
A steady rise in hard drug use over the 2000s and 2010s in the port city has seen many youngsters leave their homes, leading to growing homeless encampments in parks and under bridges.
The trend is national. A recent study found that between 2002 and 2017, the percentage of South Africans who admitted to recently using cocaine (powder or crack) had increased 88-fold.
By 2020, it was estimated that there were 140,000 people using crack cocaine and 400,000 heroin daily, many using them concurrently.
A 2017 report from interviews conducted in Cape Town, Pretoria and Durban found that people often use hard drugs to cope with trauma; abuse by family members is a common root cause.
Mpomphotshane has never put things in these terms, but he regards his father as playing a key role in his trajectory.
He was raised by his grandparents in Mthatha, Eastern Cape, after his parents went to find work in Durban. He grew up surrounded by a large group of siblings and cousins. “There were so many children,” he says. “So there’s no love - it’s just living.”
When his mother had enough money to buy a shack in Durban, she collected her children. But at the same time, his father’s alcoholism had become the central source of strife in the family.
“Sometimes my father would steal my mother’s money, and then we’d have no food,” says Mpomphotshane. “My father was having a lot of problems with other people. It was at the point where people wanted to kill him.”
Some threatening men came looking for his father at his mother’s house:
“I didn’t want something bad [to happen to] my father. I loved him. I was praying, maybe he’s going to change.”
Like many drug users GroundUp spoke to, Mpomphotshane believes that if his father had played a more supportive role in his life, he would never have needed to rely on substances.
“There were so many things I wanted to talk to him about, but I couldn’t. I wanted to share stories with him; I wanted to share life with him. I gave up on that,” says Mpomphotshane.
A drug dealer holds up a plastic bag containing packs of heroin in Tshwane. Photo: Jesse Copelyn
Endless hustle
Mpomphotshane doesn’t remember how long he had been using “rocks” before he turned to heroin. Crack is a stimulant, it energises people. While it can elicit feelings of euphoria, it can also cause hypervigilance and paranoia. As Mpomphotshane began to feel increasingly wired and unable to focus or sleep, he soon began smoking capsules of whoonga (heroin) in order to calm down.
After using it for long enough, he soon needed regular doses in order to avoid withdrawal.
“After you feel those pains [withdrawal], you don’t enjoy [heroin]. You only smoke it to take the pain away,” says Mpomphotshane. “And as you smoke more, you suffer more. If you smoke five caps, then the next time you smoke four, you won’t sleep. You have to reach that amount every time or more than that.”
To keep this going, homeless people who use heroin need to hustle around the clock to make enough money to secure the next hit. This often leads them to take more stimulants to stay awake. Crack is one option, and appears to be more widespread in KwaZulu-Natal than other provinces.
But interviews GroundUp conducted in low-income neighborhoods of Durban, Pretoria and Cape Town, all suggest that “speedballing” or “speedbombing” is an increasingly common alternative. This is when crystal meth and heroin are combined in a single injection. The heroin prevents withdrawal, while the meth allows a person to continue earning.
During his life of homelessness on the streets of Durban, 26-year-old Mpomphotshane would use crack cocaine three times a day, and would smoke about five capsules of heroin. To support his drug use, he spent long hours collecting and recycling scrap. The fear of heroin withdrawal was ever present – fever, aches and fatigue – all of which can arrive within a few hours after the last hit, and which are only resolved by taking more heroin.
One day, while working on the street, Mpomphotshane fell short, and couldn’t afford to buy his next hit. Fearing withdrawal, he went to a local harm reduction centre, called Bellhaven, to seek out methadone – a medication which blocks opioid withdrawal.
Showers provided by the Nina Manzi project in the yard at Bellhaven. Photo: Jesse Copelyn
Recovery
Had Bellhaven been a traditional rehab centre, Mpomphotshane would have been required to check in for about six to eight weeks. He would have had to stop using drugs entirely or face expulsion. Methadone would have been provided for the first week or two, if offered at all. After that, he would have had to suffer through the feverish nights that accompany withdrawal.
But at Bellhaven, people don’t stay overnight, and the program isn’t on a set time frame. Instead, people can drop in for counselling or medical services indefinitely. They don’t have to stop using drugs to receive help. Methadone is provided for as long as needed.
Clovis Dusabe, a nurse at Bellhaven, explains: “We tell patients, we work with you, we work toward your goal. If your goal is to completely stop, let’s work towards that. If it’s slowing down, let’s help you do that”.
Many people who use drugs are not ready to be in a place that forces them to stop using substances altogether. On the day Mpomphotshane registered at Bellhaven, he was simply hoping to avoid withdrawal after failing to score. But once registered, he received a medical checkup. The health workers then provided him with a small cup of methadone.
“After I drank, I was tired, I didn’t want to hustle anymore,” says Mpomphotshane. “The nurse told me not to smoke because, I’d overdose [combining methadone and heroin increases these odds]. And I was scared of overdosing. So I didn’t go back to hustle.”
“I was praying this thing [methadone] might work, because if it doesn’t work, I’m not going to sleep, and I’m going to have to go steal something [to buy heroin] … But I was surprised, because I slept. I woke up in the morning, and still I don’t feel nothing [no withdrawal].”
“That’s when I saw myself change. I said, ‘No, this thing is working.’ So I started to change, I called my mother.”
Mpomphotshane spent more and more of his time at Bellhaven. He began using methadone in place of heroin, and checked into a shelter with the help of the organisation. He started attending counselling sessions offered by Torres Luna, Bellhaven’s psychosocial worker. And for the first time in a long while, he started bathing regularly, using the free showers provided by the Nina Manzi project on Bellhaven’s premises.
It became a place of rejuvenation. He steadily began repairing his relationship with his mother. Mpomphotshane now spends every weekday at the centre, and hasn’t used heroin since February last year.
His success is echoed by others at the centre, many of whom had no initial interest in rehab or sobriety.
Sfundo Parack tells GroundUp that when he came to Bellhaven, he simply wanted to reduce his intake of heroin. The centre helped him do this - from ten caps of whoonga a day down to one. But over time, he grew more ambitious.
“I thought, what’s the use [of continuing]? It makes no difference whether I take one cap a day [or nothing]. Sometimes I’d even forget to take, so I’d rather stop.”
He soon began counting the days since he had last used. It’s now been two years.
The welcoming entrance to the Bellhaven harm reduction centre. Photo: Jesse Copelyn
Harm reduction versus rehab
GroundUp spoke with over a dozen people at Bellhaven. Many said that the organisation’s flexible approach was the first thing that worked for them, after numerous failed stints with abstinence-based rehab centres.
Neo Vilikazi explained: “Rehab makes you stop now. Here [at Bellhaven] it’s a journey. It’s up to you … It’s step by step. You fall down, ok, let’s get up little by little.”
For Vilikazi, rehab is often doomed to fail as soon as you’re back on the street. “When you do see [drugs] again, eish it’s going to trigger fast. First day you come out of rehab, surely you’re going to smoke.”
Drop-in centres like Bellhaven operate differently, as the recovery process doesn’t involve a stretch of abstinence in isolation from the rest of the world. Instead, it’s integrated into ordinary life over time.
Melokuhle Sibiya said, “In a rehab, they give you a specific time. After this time, you must be done with the program; you must stop smoking. But when you first stop, you must first give your body time to get used to the idea of not smoking because for maybe 20 years, you’re used to the same routine every day. It’s very hard to change that routine in two months. So it takes time. You’re going to fall and then pick yourself up again and again.”
“Rehabs expect a miracle, but here they give you time. They know … it’s not going to happen just like that,” she said, snapping her fingers.
Their views are supported by research. A study which tracked heroin users at two state-funded rehab centres in Johannesburg revealed very low success rates. Three months after treatment, two out of three had gone back to using heroin. Many of those who had stopped were simply on other drugs, like crystal meth.
A man measures out a dose of methadone, after picking up the medicine from the TB HIV Care centre. Photo: Jesse Copelyn
Methadone programmes needed
One reason for this high failure rate is that state-funded rehabs in South Africa do not offer methadone or only provide it for one to two weeks.
Clinical trials show that centres which provide the medication for at least six months (called methadone maintenance therapy, or MMT) are far more successful.
An MMT pilot program in Durban, which was the precursor to Bellhaven, produced promising results. A study found that six months after the clients had been initiated, 81% continued to pick up their doses and a similar percentage continued to receive psychosocial services.
But methadone is only part of Bellhaven’s success. Recently it ran out of money to provide the medication. Since last year, its clients have had to get their doses at a separate centre run by health services organisation TB HIV Care. Yet this didn’t stop its clients from spending their days at Bellhaven.
Group counselling sessions are packed with people speaking about everything from their trauma to practical strategies about managing money.
In one room, people crowd around a pool table. Two young children who spend their time at the centre run around laughing, and are routinely scooped up and hugged by clients. The smell of soap wafts in from the yard, where some homeless people are taking showers for the first time in a long while, an experience that many say has brought them back their dignity.
It’s a universe away from the South Africa just outside the centre, where substance users told GroundUp that they are called parasites, beaten by police, discriminated against by health workers, alienated from institutions that could instead have helped them. In this context, many substance users regard Bellhaven as an oasis.
Asked why he continues to spend his days at the centre, Mpomphotshane responds, “I feel like people around me here are my family. There’s no judgment here.”
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