Keeping It Clean - Riding along in Iceland’s needle exchange ambulance

Riding along in Iceland’s needle exchange ambulance

On a quiet Saturday afternoon, I make my way to a white van idling in the Red Cross parking lot. After knocking on the passenger side window, Hákon, a man in his sixties, opens the door and invites me in. The inside resembles a camper van, with two benches flanking a table, and a tea point in the corner. But instead of pots, pans and kitchen utilities, this van is filled with boxes of needles of varying gauges, syringes, alcohol swab packets, bandages, condoms, tampons and pregnancy tests, all of which are distributed for free to the drug users of Reykjavík.

Hitching A Ride

The ambulance is called Frú Ragnheiður after the Red Cross’s harm reduction unit, founded in 2009. A little more than 60 volunteers man the vehicle whose route is designed to reach as many drug users as possible five nights a week. Rather than preaching to their clients, the folks at Frú Ragnheiður simply provide them with safe equipment that reduces their risk of contracting infections or contagious diseases such as HIV.

Hákon, the driver on this particular two-hour trip, is a retired chef who was inspired to sign up after his daughter, a nurse, started volunteering. “I thought, if she can drive the van, then I’m sure I can as well,” he says, laughing. The first client of the night knocks on the door just after the two other volunteers, Eyrún and Guðrún, show up. A chatty man in his fifties with grey hair, he cracks a few jokes before talking about a leg injury he suffered years ago and the persistent pain it has left him with, which he tries to dull with drugs. After a while, Hákon tells him we have to get going, and the man thanks us before almost falling out the van as he misses a step.

On the way to the next stop, a hostel that is often frequented by those abandoned by society, Guðrún tells me some clients come in just wanting supplies but others want human interaction. Guðrún is a 34-year-old PhD student of anthropology who has just returned from a multi-year humanitarian mission in Africa. She’s been volunteering two nights per month with Frú Ragnheiður for the last half a year and would like to do more, but she says the shift planner is usually filled up. “Originally when I returned home, I had planned to volunteer to help women in need,” she says, “but when I heard about this project I was intrigued and signed up.”

Nobody shows up at the hostel and Hákon remarks that “it’s a slow night,” before moving on to our next stop, the women’s shelter Konukot.

“The ideology is all about reaching out to IDUs and educating them on how they can reduce the harm their lifestyle has on them.”

A big fan of harm-reduction policies, Eyrún, a 31-year-old getting her degree in recreation studies, joined the programme around the same time as Guðrún. The idea is not to punish risky behaviour, but to find affordable solutions to minimise the damage of said behaviour. The needle exchange programme is one such policy, which aims to improve people’s lives and reduce long-term costs for the healthcare system. “What we really need now are safe injection sites,” she says, referring to facilities where intravenous drug users (IDUs) can inject their drugs in a supervised and clean environment. Having such a place would reduce the number of needles left behind by homeless IDUs, such as in stairwells and playgrounds, as well the number of accidental overdoses.

As we leave Konukot sans visitors and move on to our last destination in Mjódd, a good 10 kilometres from downtown Reykjavík. The women tell me that it is a relatively new stop that was added due to the many drug users in the area. As we sip on instant coffee in the back of the van, they tell me that the people who use their services are quite diverse and face a lot of unwarranted prejudice.

Twenty minutes pass before Hákon tells us to buckle up and we had back downtown to close out the shift. When the ambulance pulls back into the Red Cross parking lot, Eyrún and Guðrún are in the middle of telling me that the number of clients they get per shift fluctuates a lot, when a man in his late 40s knocks on the door. He enters the van and timidly asks for two boxes of 24 gauge needles, a handful of syringes and some bandages. He is about to step out when I ask him how long he‘s been coming to Frú Ragnheiður. He sits down, thinks for a moment before answering. “I’ve been coming since the project started, I think, and it’s improved my life a lot. I’ve been healthier and feel better. I don’t know where I would be without it.”

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Prevention Is Better Than Cure
Frú Ragnheiður’s project manager on the vehicle’s five-year run

Number of Fru Ragnheiður clients per month.

A few days after my ride-along, I meet with Þór Gíslason, the project manager of Frú Ragnheiður. Þór says he was an unlikely candidate for the job at first, as he was a strong proponent of the abstinence model following his recovery from alcoholism. “It was an alien concept to me, meeting people’s needs instead of making them go to therapy,” he says. “The ideology is all about reaching out to IDUs and educating them about how they can reduce the harmful effects of their lifestyle.”

The Icelandic healthcare system has plenty of treatment solutions for people who want to get clean, but those who are still using drugs are often ostracised from society and denied the help they need. This is a void that Frú Ragnheiður seeks to fill. Client visits have soared from 157 in their first year in operation to 1,374 in the last year. Of those, a few hundred of their frequent visitors have shown notable recovery, with a reduction in infections and hospital stays, greatly reducing costs for the health care system. “Their health doesn’t just stabilise,” Þór says, “it improves, as does their quality of life.”

Unfortunately, the reality is that 2014 will most likely be the last year Frú Ragnheiður runs. Although it has numerous supporters, the project was always envisioned as an experiment rather than a permanent programme. The Red Cross believes it has shown that the state can save a lot of money by offering such needle exchange services, and hopes to hand it off to the city or healthcare authorities by the beginning of 2015. Although Þór has yet to receive any kind of response from those in power, the newly elected four-party city council majority recently released their coalition agreement which states: “An emphasis will be put on improving the position of the homeless and addicts. Harm reduction programmes will be bolstered or introduced where appropriate.”

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You can check out Frú Ragnheiður on their website.