By Dan Williams
KABUL (Reuters) - Look closer at the drawings on the wall of the Sanga Amaj clinic, and a wrenching motif emerges.
One 11-year-old's family tableau shows father and mother huddled over heroin kits as their sons watch haplessly. Another sketch is of smiling youngsters around a poppy plant that has been crossed out in red, like a traffic no-go sign.
Taken in sequence, they're an ideal depiction of the recovery that Sanga Amaj, one of three U.S.-funded drug clinics for women and children in Afghanistan, offers in modest measure to the most overlooked and vulnerable of the country's many opiate addicts.
While addict babies born to drug-using mothers are familiar in the West, experts say the Afghan phenomenon of parents exposing their young to second-hand opium smoke, or actively encouraging them to partake, is unique and largely unexplored.
"When kids are testing positive like this, then there has to be a serious problem," said Thom Browne of the U.S. State Department's Bureau of International Narcotics and Law Enforcement Affairs (INL), describing the pressure that program staff are under to conduct studies even as they treat patients.
Some children are admitted with latent drug levels as much as 15 times higher than that of heroin users in the United States, Browne said, blaming the purity of Afghan poppy products and a high tolerance developed though protracted inhalation indoors.
"We don't know the long-term effects of this on the kids' brains, their development, their emotions. It looks like there's a can of worms here -- not just in the high addiction rate, but in the level of addiction," he said.
A low-slung complex of dormitories and workshops on a side road near Kabul University, Sanga Amaj began four years ago as a clinic for female addicts, housing 20 at a time. Their young children were also put up for convenience, but staff immediately noticed that some showed withdrawal symptoms of their own.
The 15 boys and girls now there range from 3 to 10 years in age. Seven are healthy, staying while their mothers undergo a 45-day detoxification and re-education course in rooms just across the leafy courtyard. The other 8 are in recovery.
Parwana is 9 but looks younger, her growth likely stunted by the opium to which she says her widowed mother introduced her and a 5-year-old brother who is also in Sanga Amaj.
"We came here to be fixed, so that we don't sleep and feel dull all the time," she told Reuters through a translator.
"Before, I didn't know the enjoyment of life. I was unwilling to eat. I always had headaches. Now I feel like I'm normal."
KORAN, NO METHADONE
Her treatment has a distinctive Afghan feel. Days at the clinic begin with 4 a.m. prayers, and imams help with counseling.
"In the West we use the 12-step (rehabilitation) model that draws on Judeo-Christian principles, here we draw on the Koran," said Preeti Shah, INL officer at the U.S. embassy in Kabul.
Sanga Amaj and the other clinics provide basic medication for withdrawal symptoms, but in line with the Afghan stigma on opiate use they appear to frown on heroin substitutes such as methadone and insist patients go cold turkey.
While the relapse rate for those who have undergone addiction therapy is not known, up to a quarter of women return, said Abdul Basir, one of the Afghan coordinators at Sanga Amaj. There are fewer child re-admissions, he said.
Fewer still would fall back into drug use if their original care were longer. According to Fadilan Abdul Kayong of the Colombo Plan, an international group that advises the Afghan government on narcotics awareness, child addicts need a minimum 90-day care program -- double what is now available.
As Afghanistan is the No. 1 exporter of opiates, the world's focus is on cracking down on production rather than fighting domestic addiction that, by some estimates, plagues a staggering 1.5 million out of the population of some 30 million.
"So far the Afghan authorities have taken steps to eradicate the problem from the country," Shah said, but she lamented the lack of help for the U.S. efforts -- including from abroad.
Out of 40 rehabilitation clinics in the country, 30 are paid for by Washington, she said. Most are for men and youths, while three new clinics for women and children are under construction.
In rural areas, harsh economics can exacerbate the problem. Women eking out a living at carpet weaving have been known to blow opium smoke on babies to keep them calm. The drug also prevents child workers from chafing at long hours on the loom.
Shah shrugged off the scale of the challenge -- a common response from those working to relieve Afghanistan's war ravages.
"I care about the numbers, but I care more about the people," she said.
(Editing by David Fox)
