Expanding Prevention, Treatment, and Recovery Support Services in Kenya, Africa, and Beyond: An Interview with Dr. William Sinkele

2016·0.22 MB·English

by  White, William L., Sinkele, William

Selected Papers of William L. White
www.williamwhitepapers.com
Collected papers, interviews, video presentations, photos, and
archival documents on the history of addiction treatment and
recovery in America.

Citation: White, W. (2016). Expanding prevention, treatment, and recovery support services in Kenya,
Africa, and beyond: An interview with Dr. William Sinkele. Posted at www.williamwhitepapers.com
Expanding Prevention, Treatment, and Recovery Support Services
in Kenya, Africa, and Beyond
An Interview with Dr. William Sinkele

William L. White
Emeritus Senior Research Consultant
Chestnut Health Systems
[email protected]

Introduction: The Background
purpose of the
Recovery around the Bill White: Bill, it is a pleasure to finally get
World interview to interview you after an extended
series is to inform correspondence over the years. Could we
addiction begin by having you share some of your
professionals and background and how you came to focus on
recovery advocates the areas of the development of prevention,
in the United States treatment, and recovery support services?
about innovative
approaches around Dr. William Sinkele: I also come from a
that globe that support addiction recovery. family background marked with alcoholism. I
One such approach I have closely followed was a Dominican Catholic priest for many
for some time flows from the work of Dr. years stationed in various posts in Eastern
William Sinkele, founder and Director of USA. I was a daily drinker until I was 43 and
Support for Addictions Prevention and also had been on a regular 20 mg of Valium
Treatment in Africa (SAPTA). Dr. Sinkele due to a chronic medical condition I have. In
also co-founded the Redhill Treatment my 40s I began a Doctorate in Ministry at
Centre in Kenya and served as Assistant Catholic University in Washington, D.C. A
Director of Joseph's House, an AIDS psychiatrist switched me from Valium to
hospice for homeless men in Washington, Xanax. So in my 40s I began to have
DC. I recently (April 2016) had the substance-induced psychiatric episodes.
opportunity to interview Dr. Sinkele about his One time I was walking down the street I
life’s work. Please join us in this engaging thought I was able to see into buildings with
conversation. x-ray vision and my heart seemed to be
racing wildly. I thought it was cool. But when
I got back to the seminary and a colleague
of mine who was doing a doctorate in
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nursing took my pulse, it was normal. In while another 5.5 percent were dependent
another incident, I was waiting in a line for a on alcohol use; [11.3 percent of 20,000,000
movie and I thought I could see another self [15-64 years olds]: Abusers: 1,160,000;
in front of me. So I went to a doctor who did Dependent: 1,100,000. Total who needed
a liver scan and it showed early liver damage counseling interventions: 2,260,000
from the years of drinking. I began going to Kenyans. 3.7 percent were abusing tobacco
AA meetings in 1968 in Washington once a while 4.5 percent were dependent on
week. But I heard from a fellow Dominican tobacco use; Abusers: 740,000; Dependent:
priest in recovery that you needed to give up 900,000. 1.6 percent were abusing khat (a
all mind and mood changing substances. So stimulant) while 1.5 percent were dependent
I came off cold turkey from my Xanax and on khat use and finally, Abusers: 320,000;
sleeping pills. Also at this time I joined the 7 Dependent: 300,000. 0.4 percent were
a.m. AA meeting at the Westside Club in abusing marijuana while another 0.4 percent
Georgetown. It was one of the best decisions were dependent on marijuana use: Abusers:
I made. 80,000; Dependent: 80,000.
A recent survey for the risks of Non
Bill White: How did your work in Kenya Communicable Diseases in Kenya showed
begin? that 13 percent of the drinkers were binge
drinkers: 23 percent were men and 3 percent
Dr. William Sinkele: Even early in my women.
childhood I said I want to go to Africa and For those persons who inject drugs
work. The opportunity came in 1990 when (PWID), it has been estimated that Kenya
the Dominicans were sending over 6 of us to has 30,000 with probably four times that
start the Dominican Fathers and Brothers in number smoking heroin. Fortunately,
Kenya and recruit vocations from Kenya, methamphetamine use here is still very low.
Uganda, and Tanzania. After six months in
Kiswahili language school in Tanzania I Bill White: Could you describe the history of
returned to Nairobi and was chosen to be the addiction treatment services are available in
regional superior for East Africa. I was the Kenya?
Dominican regional superior for eight years.
During this time I started to work with the Dr. William Sinkele: Addiction treatment in
regional bishops to develop a treatment Kenya began in the 1980s in western Kenya
center for priests. However, it did not work when a Kenyan priest got sober and started
out. So with another American Catholic a “Treatment” center. Actually it was having
priest we will able to start Red Hill Treatment one or two AA meetings a day and that was
Centre (outside Nairobi) with the support of treatment. But it was a beginning. Then in
Archbishop Ndingi of Nairobi. It was open to the early 1990s, with another American
Catholic priests from the region with alcohol priest, we co-founded the Redhill Treatment
problems as well as the ordinary lay people Centre outside of Nairobi. It was for Catholic
with alcohol and drug problems. priests and the ordinary alcoholic but it was
on the more expensive side. For the last 20
Bill White: Could you provide our readers an years private addiction treatment services
overview of the prevalence and patterns of (mostly AA-based) have sprung up over the
alcohol and drug problems in Kenya? country; many of them started by graduates
of my addiction counselor institute. We have
Dr. William Sinkele: In 2012, NACADA (the about 60+ treatment centers approved by
government anti-drug agency) published a NACADA. We have only 2 government
survey of alcohol and drug use and for the facilities that offer addiction treatment but
first time used the DSM-IV TR assessment NACADA is supporting the establishing of
to determine alcohol and drug ten new centers in the Kenyan countries. In
abuse/dependency prevalence. About 5.8 the last year, with support from CDC,
percent of Kenyans were abusing alcohol
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methadone centers have been established: anyone.] Most of the addiction counselors in
two at the Coast and one in Nairobi. the treatment centers were men and women
in recovery with good will but not addiction
Bill White: What recovery mutual aid counseling training. A few counselors had
fellowships are currently available in Kenya? BA or MA in counseling with little clinical
experience or evidence-based addiction
Dr. William Sinkele: AA started in Nairobi in training.
the 1980s and has many meetings in
Nairobi. For reasons I really do not Bill White: What is SAPTA’s primary
understand it has not caught on too well mission?
outside of Nairobi. There are plans to
establish an AA central office in Nairobi and Dr. William Sinkele: SAPTA has a fivefold
in Mombasa at the coast. One of the main foci:
challenges has been the lack of AA material. 1) Alcohol and drug abuse evidence-
These two offices hope to help remedy this based prevention science, especially
situation. for children, adolescents, and young
adults.
Bill White: Is there an organized recovery 2) Alcohol and drug abuse (AUD/SUD)
advocacy movement in Kenya? treatment through outpatient services
and alcohol and drug treatment
Dr. William Sinkele: At the moment there is programs especially focusing on the
not an organized recovery advocacy poor, those in slums, and those who
movement in Kenya. are marginalized, e.g. injecting drug
users, female sex workers, and
Bill White: Is there funding of prevention, LGBT.
treatment, and recovery support by the 3) Recovery programs: understanding
Kenyan Government? SUD as chronic disease
Dr. William Sinkele: Funding for treatment management.
has been limited. Up to fairly recent we only 4) Training on evidence-based addiction
had two publically funded treatment centers: counseling and prevention science
one in Nairobi at the largest mental illness and continuing professional
hospital and another at the Coast in education courses for addiction
Mombasa. Most of the treatment centers in professionals and others; preparation
Kenya are privately owned. for addiction counselor certification
exam (ICCE).
Bill White: What were the circumstances 5) Research on
that led to the founding of SAPTA? alcohol/drugs/HIV/mental illnesses;
advocacy for access to treatment.
Dr. William Sinkele: I left Kenya in 2000 and
decided to leave the priesthood. I then Bill White: How is SAPTA organized and
worked in Washington, D.C. as the assistant funded?
director at a men’s AIDS’ hospice. But I
could not adjust to living in America so I Dr. William Sinkele: SAPTA is a Kenyan
returned to Nairobi in 2004 without a job. I registered nonprofit organization, or as they
saw that in Kenya there was no diploma level called it here, an NGO: nongovernmental
training (entry level counselors) on addiction organization. Presently we are funded
counseling. So with funding from Ford through the fees we charge for addiction
Foundation, I started SAPTA and we started prevention and treatment training and
a diploma in addiction counseling with a through the Global Fund for our two centers
Kenyan lady with an MA in counseling but in Nairobi which focuses on the WHO
with no clinical experience in addiction prescribed services to those who inject
counseling. [At that time there was not drugs. We have 2,700 People Who Inject
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Drugs in our program of which 380 are created an evidence-informed
women who inject. SAPTA has almost 200 alcohol/drugs/HIV risk reduction
of its heroin using clients on methadone. I intervention. It is called, “Steps to Healthy
have to say that for many, the use of Living,” and consists of 12 psycho-
methadone has been life changing. educational lessons facilitated by trained
peer educators. More recently, with further
Bill White: What are the major service SAMHSA funding, it has been adapted for
programs provided by SAPTA? alcohol/drug abusing female sex workers
and another edition for men who have sex
Dr. William Sinkele: SAPTA has been with men/male sex workers. We are hoping
implementing evidence-based harm these Key Population alcohol/drug/HIV risk
reduction interventions since 2011 funded by reduction intervention could be up-scaled
USAID and Global Fund in Nairobi. SAPTA across sub-Saharan Africa through the
is currently funded under Global Fund for Linkages/ FHI360 program.
two outpatient/outreach PWID programs in Steps is 12 psycho-educational
Nairobi. We have reached over 2,700 PWID lessons of 1 ½ hours each intended to be
of whom 300 are women who inject drugs. delivered over a six-week period (that is, two
We have nearly 200 of our clients on lessons given per week). It incorporates
methadone at the Mathare Hospital evidence based substance abuse practices,
Methadone Clinic. We have seen dramatic namely, motivational interviewing, cognitive
improvements in the health of these clients behavioral coping skills (e.g., drink refusal
and even improved hopefulness in their skills), introduction to Alcoholics
lives. Under the outreach model SAPTA has Anonymous, and relapse prevention. It also
60 peer educators, eight outreach workers, contains lessons on alcohol and risky sexual
and five pathfinders who go to the dens to behavior, and alcohol, and how to engage in
distribute clean needles and syringes and a healthy living lifestyle.
other commodities to the PWIDs. The Anyone who has a problem with
delivery of services guided by the World alcohol or drugs can benefit from this
Health Organization recommended program. The original format was designed
interventions for PWIDs. for an adult heterosexual audience. The
The other major services are format is intended to be a group presentation
substance abuse prevention and treatment with eight to ten people per group as the
training, especially the diploma in addiction ideal number for a group presentation.
counseling. In the future we hope to offer a Peer educators who either do not
distance learning mode of diploma in have current problem with alcohol or drugs
addiction counseling to spread to areas can facilitate the program. Also anyone in
outside Nairobi and also to the other sub- recovery from alcohol or drug abuse with six
Saharan countries. months of sobriety can also facilitate the
We also do outpatient treatment program. Who also might benefit from the
counseling at our main center in downtown training? ART adherence counselors would
Nairobi and do research with other major find the training helpful to offer assistance to
researchers (American and Kenyan those are HIV+ and drinking. The peer
institutions) on alcohol, drugs, HIV, and educators are trained by SAPTA trainers in
AIDS. a five day training program. The first two
days gives the participants the basic
Bill White: Could you describe the peer knowledge of the effects of alcohol and
education model used within SAPTA’s Steps drugs, their relationship to risky sexual
to Healthy Living Program? behavior and ART, an introduction to
Alcoholics Anonymous and the first three
Dr. William Sinkele: With funding from steps, and the healthy living. In the last three
SAMHSA, colleagues, including Evans days of the training the peer educators are
Oloo, head of training for SAPTA, and I
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taken through each of the lessons in order to (Kenyan HIV government agencies) and am
know how to present them. on the Kenyan government committee for
The Steps uses a manualized regional drug experts for East African
approach so that the peer educators can be Community (Kenya, Uganda, Tanzania, and
guided to give an evidence-based Rwanda) in preparation for UNGASS April
presentation. They will have a manual to 2016 (the meeting of world leaders to
guide them. determine the new worldwide policy on
drugs). I am the chairman of the Kenya
Bill White: How is the Steps to Healthy prisons-probations-stakeholders psycho-
Living Program disseminated within Kenya? social committee. Under the CDC HIV grant
for prisons in March 2016 I trained the top
Dr. William Sinkele: As we find funding, prison’s AIDS Control Unit management
most likely through PEPFAR and CDC HIV committee for AUD/SUD disorders and HIV
programming, we intend to spread the Steps management. I am a consultant to the
program into the prison systems, the Ministry of Health on their proposed national
disciplined services, the female sex worker alcohol risk reduction strategy as well as
communities and LGBT communities, as joining a new Ministry of Health technical
well as the ordinary alcoholic. My intention is working committee for national substance
to get it into the slums and villages in Kenya abuse management. I am a Global Master
and across sub-Saharan Africa. Trainer for Addiction Counseling and
Addiction Prevention Science under the
Bill White: What do you feel are SAPTA’s ICCE Colombo Plan which is supported by
most important achievements to date? INL.

Dr. William Sinkele: One major Bill White: Can you tell us about your
achievement is that we are the largest trainer research efforts?
of addiction counselors in Africa with over
300 who have graduated with the diploma in Dr. William Sinkele: I call myself “an in-the-
addiction counseling (entry level counselor). trenches interventionist” who is attempting to
Most of our graduates are Kenyans but we create evidence-informed (confirming they
also have graduates from Ethiopia, Somalia, are evidence-based practices that will need
Malawi, and Tanzania. grants for research) addiction treatment
Another achievement is that we are interventions that are culturally relevant to
one of the largest programs in Nairobi our African situation and that are
dealing with over 2,700 people who inject economically affordable, scalable, and
drugs. And we developed the Steps to sustainable. Working with FHI360 and the
Healthy Living program and adapted it for International Centre for Reproductive Health
female sex workers and for those who have in Mombasa several years ago, we ran a
sex with men communities. randomized control study of an alcohol-risk
reduction intervention I had designed for six
Bill White: What are your involvements with personal counseling sessions with female
the government agencies to address sex workers who were drinking
prevention, treatment, and recovery in hazardously/harmfully but not addictively.
Kenya and beyond? This intervention was so successful that
even a year later they had still reduced their
Dr. William Sinkele: I am a senior drinking to safer levels and they had less
consultant to NACADA (the Kenyan gender-based violence from their clients
government antidrug agency); on the than the control group. There are now 4
Technical Working Group for Key scientific journal articles on this RCT.
Populations (people who inject drugs, SAPTA will sign a MOU with KEMRI
female sex workers, men who have sex with (the Kenyan government research agency)
men, prisoners) with NACC and NASCOP to develop alcohol/drug related proposals.
williamwhitepapers.com 5
We are currently working on writing a exam. A year ago in Bangkok, Thailand with
proposal for a study of TB among PWID. several other worldwide addiction
SAPTA with Dr. Carey Farquhar, Professor, organizations they launched the
Department of Medicine, Division of Allergy International Society of Substance Use
and Infectious Diseases, Departments of Prevention and Treatment Professionals,
Epidemiology and Global Health, Director, ISSUP (http://issup.net/en/) which intends to
International AIDS Research and Training become the prime professional organization
Program, are also writing proposals on representing addiction prevention and
PWID, HIV, and Hepatitis C. Dr. Alicia treatment specialist worldwide. We will be
Monroe-Wise of the University of launching soon ISSUP-Kenya to represent
Washington won a small grant from Fogarty the substance abuse professionals of
for study of Hepatitis C among PWID at Kenya.
SAPTA’ centers. SAPTA has on its board 4
principal investigators in the substance Bill White: Are there ways that our readers
abuse/mental health and HIV and AIDS could help support the work of SAPTA in
fields. Kenya?

Bill White: Can you tell our readers about Dr. William Sinkele: Depending on grants is
the ICCE UTC and UPC programs and how necessary but there always is the in-
they intend to build the addiction prevention between period for grants when you are
and treatment program in Africa. really financially struggling. So we need to
find ways for financially sustainable
Dr. William Sinkele: Two years ago, eight of programs. I would appreciate anyone who is
us from Africa and eight from Asian countries willing to support us financially or who could
were chosen by the International Centre for connect us to possible American donors.
the Certification and Training of Addiction A few readers may consider coming
Professionals (ICCE through the Colombo to Nairobi to volunteer to work with us for
Plan: http://colombo-plan.org/icce) to be the periods up to 6 months. I can’t pay anyone.
first Global Master Trainers on a new For $50 one can get at the airport a three-
Universal Prevention Curriculum (UPC). month visa which can be renewed for 3 more
UPC was designed by a team of American months. English is spoken in Nairobi. All of
prevention science specialists led by Dr. Zili the training is in English. Volunteers could
Sloboda, former director of NIDA's Division work with our trainers. Also Nairobi and
of Epidemiology and Prevention Research. It environs has some of the best wild life parks
was funded by the USA State Department’s which could be visited while here.
International Narcotics and Law Areas we could use technical training
Enforcement Bureau (INL). INL had several on include relapse prevention, adolescent
years before also funded ICCE for the treatment, women treatment, clinical
Universal Treatment Curriculum (UTC). [I supervision, family therapy, sex addiction
was also trained as a Global Master trainer treatment, mindfulness-based relapse
on UTC.] Through these two curricula ICCE prevention, and trauma/PTSD treatment.
with INL support is building up the capacity We need advice on telehealth solutions for
building in both prevention science and SUD prevention, treatment, and recovery
addiction counseling in 43 countries in the APPs. Also we are looking for treatment
world. They also have a two-week training programs: evidence-based treatment
on women and substance abuse treatment planning; psycho-educational material and
(“Grow”) and another two week training on software for treatment planning, and any
recovery. SAPTA is the first training institute addiction books for our library.
in Africa to sign an MOU with ICCE to offer Another possibility is real-time
in Kenya the UTC and UPC training as well training from the States via Skype or Vsee: 8
as prepare Kenyans to take the ICCE a.m. Eastern Standard; 4 p.m. Nairobi,
sponsored addiction counselor certification Kenya. If any organization has training
williamwhitepapers.com 6
videos they can send them to me via: absolutes in Africa: 1) God’s love for all
Dropbox or Google Share. people at all times; and 2) whatever you
While I am in the States for the ATTC planned will change. My own involvement
NFAR Technology conference at the with AA has helped sustain me and keep me
beginning of August 2016, I would sober. The Dominican Order when I was a
appreciate anyone who could organize priest also was supportive as was my
fundraising for our work. If my expenses Kenyan wife when I was married. My wife
were paid I could travel and give talks. From died a couple of years after we were married
21st-23rd September I will be at the TOT so now I am a single parent to nine children
LGBT substance abuse training in (six stepchildren of my wife’s first marriage
Minneapolis. If anyone knows of a donor and three young men from Rwanda I
who might be interested in our work, you can “unofficially” adopted after they came to
introduce us. Kenya after the genocide). My kids have
One of my dreams is to buy land for supported my work. Over the last couple of
two farms, one near Nairobi and another at years I have begun to practice mindfulness
the coast that we would have greenhouses and compassion meditation practices, part of
both to raise food for our PWIDs and their it to recapture my early career contemplative
children and to have financial support for orientation and also to ground me in the
them for income-generating activities. middle of the many activities I am involved
Eventually we would open also a in.
rehabilitation center for those needing longer
term treatment. Bill White: What are some of the most
I know this seems a long list of things important lessons you have learned that
I am looking for but our needs are many and would be of potential benefit to others
our resources limited so we would seeking to expand treatment and recovery
appreciate any support to increase the support services in Africa?
effectiveness of our training, treatment, and
research programs. Dr. William Sinkele: While I do believe that
inpatient treatment is important and
Career Reflections necessary, in Africa it will always cater to a
relatively small number of people. I believe
Bill White: What have been the greatest that we need task shifting to more
personal challenges you have faced in this community-based evidence-informed
work? prevention, treatment and recovery. We
need a massive scale-up of manualized-
Dr. William Sinkele: Work in this field has guided peer educators supported by a
not been financially rewarding to me. I am digital-based mentoring system and
poorer now than I ever was as a priest with distance learning platform.
a vow of “poverty.” Just keeping SAPTA A new and exciting area is e-health/e-
alive over the last few years has been a counseling/e-digital solutions to prevention,
major challenge. But we have had several treatment, and recovery. Our adolescents
“miracles” that have kept us going. I have and young adults are very digital. The female
been blessed with a dedicated staff who sex workers and men who have sex with
have stayed in the fight despite financial men, even when they are drunk, are more
challenges and offered excellent services to likely to hold onto their phones in order to be
our students and our clients. in contact with their clients and friends.
I think we are facing a possible public
Bill White: What has sustained your health epidemic across sub-Saharan Africa
involvement for all of these years? if we do not systemically face the issue of
people who are HIV-positive and drinking.
Dr. William Sinkele: My own faith in a loving The negative consequences are many
God has sustained. I say there are two leading to a greater progression of morbidity
williamwhitepapers.com 7
and mortality. One of the things I really fear Bill White: Dr. Sinkele, thank you for taking
is the development of ART resistance this time to share your experience, strength,
through drinking, missing dosages, and and hope with our readers.
developing ART resistance and then,
through unprotected sex, passing on both Dr. William Sinkele: Bill, thank you for this
the HIV infection and the ART resistance. opportunity. I have admired your writing for
Another issue is our adolescents and many years and was happy that we had the
young adults. Kenyans are the most chance to personally meet at a NAADAC
Westernized of the East African countries. conference years ago. I can be contacted at:
There are good points and bad to this. I [email protected] also I am willing
believe that many of our younger to Skype with anyone: bill.sinkele. Additional
generations are facing major challenges of information is available at www.sapta.or.ke
alcohol, drugs, mental illness, and process
addictions, specifically pornography. We Acknowledgement: Support for this
need to intervene early and often with them. interview series is provided by the Great
We need to set up an adolescent addiction Lakes Addiction Technology Transfer
treatment program. I am advocating with the Center (ATTC) through a cooperative
Ministry of Health that we set up a national agreement from the Substance Abuse and
task force of psychiatrists, psychologists, Mental Health Services Administration
pediatricians, addiction specialists, (SAMHSA) Center for Substance Abuse
educationists, and church and mosque Treatment (CSAT). The opinions expressed
leaders to address the critical substance herein are the view of the authors and do not
abuse-mental health challenges of our reflect the official position of the Department
children, adolescents, and young adults. of Health and Human Services (DHHS),
I have been advocating for 7 years SAMHSA, or CSAT.
that SAMHSA fund an ATTC for Africa from
several points in Africa: East, West, and
Southern Africa. The population of sub-
Saharan Africa in 2015 was 962,286,000:
more than three times the size of the USA. If
there are ten ATTC regional centers in the
USA, surely we need several regional
ATTCs in Africa.

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