The Research Project

2007-06-27: St. John's, NL

It's a wrap!

If this entry is a bit sketchy, please forgive. Our visit to St. John’s (the ninth and final city on our tour) was far too short. Because of some prior commitments and a necessary, last minute schedule change, we were able to stay there for less than 24 hours. There was nothing we could do about it. This was unfortunate, because St. John’s is the hotspot for drug use in Newfoundland and Labrador.

In our few daylight hours free of work commitments, we did a brief walking tour of the downtown on our own and had lunch (yes, I had cod tongues - they were delicious) and saw what we could see. We then spent the rest of our time at the AIDS Committee of Newfoundland and Labrador (ACNL) in their new home in the Tommy Sexton Centre in Pleasantville, an area of St John’s which used to be a military base. It’s a bit out of the way - a ten-minute cab ride from downtown.

The Tommy Sexton Centre was completed about a year and a half ago, at a cost of approximately $1.4 million. When ACLN moved out there, expanded its services, which now include an emergency shelter, transitional and supportive housing, a support for people who use drugs, and supports for people throughout Newfoundland and Labrador who are living with HIV/AIDS. It is a handsome building, well placed in its environment. The office and meeting spaces are very attractive, as is the four-bed short-term shelter. The transitional apartments for people living with HIV/AIDS are close to elegant. We were able to see one of them because it was at the moment unoccupied. I was particularly impressed with the thoughtfulness that went into the planning of the building to make it accessible for people in wheel chairs, and to achieve at one and the same time privacy for each of the housing programs and the ease of transit between those units and the administrative area for staff members who required it. Finally, the colour scheme is absolutely gorgeous.

Michelle Boutcher is the E.D. of ACNL. She welcomed us, introduced us to the staff, described to us ACNL’s services, and ensured that we had an excellent tour of the place. The services include personal support, nursing care such as hepatitis inoculations, information on safer sex and safer drug use, etc. All their services are available to people using drugs.

This is also true about their short-term shelter. Though not a “wet” hostel per se, it welcomes people currently using drugs, the only restrictions seemed to be that they not use on the premises. This is important for all the residents, and especially so for youth. This openness allows them to be honest about their use and not fear being thrown out. The Shelter is open 24 hours a day. Three meals a day are provided, and residents can stay there up to three weeks. Staff is on site for 24x7 and provides individual support, life-skills teaching, and links to services and resources.

ACNL’s programming for people who use drugs is run by Fred Andersen. Fred seems unrufflable, quiet and determined. His task is to implement recommendations of an assessment of the needs of people in St. John’s who inject drugs, which was completed last year, in a community which has many barriers to services, is wary of change and in which the stigmatisation of people who use drugs is endemic. Drug users in St. John’s, especially those who inject, seem younger than those in other parts of Canada. Their drugs of choice are not wildly different, really. Just about everything is available, if you know where to look for it; but illegally-acquired prescription drugs are especially common among those who inject.

The service for people who use drugs is comprised of a mobile van and SWAP (Safe Works Access Program). SWAP runs out of a small room, right near the ACNL’s reception area. SWAP provides services and information to help prevent harms that can result from injecting drugs, tattooing, piercing and other activities that have a potential for health risks. The distribution of safer crack smoking equipment is barely in its infancy at the moment, but if volunteer SWAP worker Tara Dillon has her way, SWAP will soon be offering crack kits. Because of the ACNL’s out-of-the-way location, few people obtain their safe drug use materiel here. Most of the distribution is done through the outreach van and through liaison with other agencies.

Fred took us to visit one if the drug program’s partnering agencies, Street Reach. Street Reach is situated in a house in downtown St. John’s and targets youth age 15 to 29 who have multiple issues, including addictions, housing, prostitution, poverty, justice, health, etc. They provide food, resources, information and support to youth and anyone in need of our service, plus information and referrals to appropriate services, and act as a link between youth on the streets and community resources. They appear to be very sensitive to the risks related to injecting drugs, including infectious diseases, abscesses, endocarditis, “cotton fever" and blood poisoning, and do what is within their means to assist youth (and indeed others as well, when they encounter them) in getting necessary medical care.

Street Reach workers go out on foot patrol, with supplies in their back packs: condoms, juice snacks, sometimes hot drinks. Most of the workers are trained volunteers recruited from other social service agencies in the community. This guarantees that workers will come with some professional experience and provides the opportunity for Street Reach and partnering community agencies to share knowledge and expertise and break down barriers caused by prejudgment and mis-information about the clients. As in most outreach services, however, hours are limited because funds are limited.

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I have found it difficult to write this piece. I am feeling deeply sad. It is not just St. John’s, though it is a big part of it. People who use drugs whom I met here - and I am talking mostly about people who participated in the focus group (perhaps out of turn, because I do not yet have the transcript of it) experience so many barriers and so few supports that it is heartbreaking. If there is a particular nemesis, it is healthcare workers - especially doctors - who disdain them, humiliate them, devalue them as human beings through their behaviour toward them ... and I could go on about this. The result is that, by and large, people who use drugs do not seek medical help when it would be useful to them, unless they are in the direst need, because they cannot abide the pain inflicted on them by healthcare workers, real or anticipated. As well, many internalise this disrespect and come to believe that they are indeed worthless. Mind, it is not all doctors or all nurses who are “bad”, and not all of them are “bad” all the time. That is probably irrelevant, however. The impact is what matters. The damage done in the name of health care is palpable.

Despite the good work we saw being done here, and the good people doing it, it was a dispiriting way to end this coast-to-coast tour of Canada. I felt I had been thrown back in time to the days before harm reduction became legitimate - and there is no doubt that it is. A time warp? Yes and no. “Yes”, from the vantage point of cities like Montreal, Toronto and Vancouver - our big three. “No”, from the reality of this particular “ rest of Canada”.

There is only a scant difference between the status quo in St. John’s and that in many other locations in Canada. Unlike in the largest cities, where politicians, health departments and citizens are finally giving harm reduction something a little better than a quarter of a chance, in smaller cities and in rural areas the struggle to bring about necessary change in thinking and service provision is still in its early stages, not well understood and very scary, so entrenched are we as a country in old ways (whether they work or not) and in our stigmatisation of people who use illicit drugs.

That said, there are brave and selfless people doing outstanding work all over the country, some of the best I’ve ever seen anywhere in the world, against some of the strongest odds. They include people from all professions, as well as from the ranks of people who use drugs. They are under-supported and un-sung.

It is our hope that we can use the information that we gathered on this journey from Whitehorse to St John’s to increase the appreciation of the legitimate needs of people who use drugs and of the programs and workers dedicated to addressing them, in the face of the conscious lack of understanding of these needs and the deliberate dismissal of the approach that works best to help them - namely harm reduction - by our federal government in particular (since this is a national project) and to find a way to ensure that the voices of the experts - including those who have drug-use experience - are heard and respected.

- Walter