Every city in Canada has a homeless community and some of them happen to have a drug addiction. There are people in society that will claim to be outstanding citizens but fail to acknowledge/contribute to helping that minority community. They sleep well at night, knowing that it’s not them seeking food and shelter or their next fix. When I moved to Vancouver six years ago, I’d never seen such a concentration of poverty and destitute than I did travelling to film school daily on a bus down E. Hastings. When I first realized the magnitude of the situation my next thought was, how did it get so bad and how long has this population felt invisible to the working class? I was immediately impacted by the size of the penurious community and what the city was doing to help. After all, when society looks at the impoverished, they tend to only see people addicted to drugs, sex trade workers and others with mental illness but they forget that they are also someone’s son, daughter, mother or father.
Being able to identify each individual as a human being first allows us to open the door to compassion and caring. Every person living on the streets has a story about how they got there. If we would only take a minute to listen and leave judgment to the pigeons we might learn something about them and their needs. For somebody to be rescued from homelessness and drug addiction requires many factors. The most important of all being the acknowledgment to want help. Whether or not they want help is ultimately their choice and their right. Having their basic rights recognized and receiving proper health care without judgment is the focus of the documentary, Bevel Up. It was created in 2007 by acclaimed filmmaker Nettie Wild (A Place Called Chiapas, KONELĪNE: our land beautiful) and the outreach nursing team from the BC Centre for Disease Control (BCCDC) and co-produced with the National Film Board of Canada (NFB). Bevel Up is designed to give students and instructors in the healthcare field access to the knowledge and experience of pioneering practitioners, as street nurses in Vancouver’s Downtown Eastside deliver nonjudgmental, compassionate and trauma-informed healthcare to people who use drugs.
This award-winning documentary and learning resource to help healthcare workers deliver compassionate care to people who use drugs, is available for the first time as free online harm-reduction content at NFB.ca. I had the distinct pleasure speaking with Caroline Brunt, an RN and former street nurse. Currently she is a Nurse Instructor with Vancouver Community College.
“How long have you been part of this program?”
“Currently I’m teaching at Vancouver College and that was when I was part of an outreach team. It was based at the BC Centre for Disease Control and we had a team of approx. 12 Registered Nurses and 2 Health Care Workers. Our goal was Sexual Transmitted Infections (STI’s) and Human Immunodeficiency Viruses (HIV) prevention. As you can understand when you step out into the downtown Eastside you come across a lot more than that.”
“Do you remember what your first day was like going out into the homeless community?”
“I learned so many things. Part of my impetus for coming and teaching is, I fundamentally believe that we have to understand ‘who’ we are delivering care to. There’s a lot more education in the schools of nursing today that really speaks to how we can deliver care to people that use drugs and work in the sex trade versus when I grew up in the early eighties from a London teaching hospital. The first day was scary and unfortunately I was raised through the lens of judgment; I had to unpackage that because there’s a standard of care and we have to deliver health care to all. I knew I needed to go through that vortex to get to the other side. I got shot down a lot of times within the first 6 moths because I wasn’t a good communicator. It was the best education I had in my whole life. The people who use drugs and the people that work in the sex trade, I believe helped me to become a better nurse.”
“In the documentary you are so familiar with many of the people using drugs and living on the streets. How long did it take to become familiar with them and win their trust?”
“Not very long. People are first. The old language of addicts and drug users, that’s out the window. You’re a person, you have a past, you have a present, you have a future and how can I help you right now? If I make that connection and if the trust, the compassion and the love are there, according to our standards of practice then the rest is gravy. If you trust me then you’re going to talk about your possible drug use or this or that. As with anything, it doesn’t matter if you’re in your living room talking to your kids, it’s the same language, the same acknowledgment; it’s the same respect. I think over time society has developed this ‘us versus them’ mentality. It’s not acceptable and we need to figure out how to better deliver health care and better educate people so that we are continuing to be compassionate, caring and loving. That’s the best care you can ever deliver to anyone.”
“Is this program still continuing?”
“At the center for disease control there is still a small team. I think since ‘harm reduction’ has become a household name in health, other health authorities have taken on the mantra and created what they feel is ‘outreach’ and that’s delivered across the province and country in different ways. When we were the only ones doing it many years ago, nurses from other provinces came to us asking how we do it, what they need to consider, how do we connect with people? That legacy has gone on in different formats depending on where you are. We’ve been to conferences and talked about what we were doing.”
“When did you get involved with the documentary?”
“We did a needs assessment across the country and asked universities and colleges across the country how much they were teaching; it was very little so that gave us the impetus to say, let’s put something together. What was only going to be a 45 minute documentary turned into 4 1/2 hours. There are chapters and topics behind the documentary with people in the documentary referencing the 45 min. segment of film. There’s a nurse aesthesis, there’s a nurse practice consultant and there are people in the film that use drugs, people that work in the sex trade that talk about what it’s like to be that person and what support they have/the challenges/the barriers, etc. It was many different people that made the DVD possible.”
“When you’re communicating with many of the individuals using drugs are you advocating for treatment?”
“Absolutely, but most people have to be ready and willing. I think we all have addictions, no matter what it is. None of us are immune; we all have family that could have alcohol, drugs, caffeine or other issues. Does it interfere with your health and when it does should you do something about it? Whose definition is that and what works for you? The philosophy of harm reduction is meeting the person where they’re at and what works for them right now. It could be that they may want to give up drugs and alcohol or other addictions they have, or it may not be. Are they safe in doing what they’re doing now? Is there a teachable moment? The other end of this is, you’re going from an abstinence to harm reduction to education to safety and then there’s treatment. Is it something you want to get off right now? Can we refer you, can we educate and can we get you into treatment? It depends where the persons at. It’s a conversation, if you gain trust with the person you can have.”
“Was this program government sponsored or city sponsored?”
“It was The BC Centre for Disease Control so they are a government health organization in British Columbia. The money comes through them.”
“I used to go past the heavily populated area of E. Vancouver on Hastings daily. Looking at the faces of the homeless population it struck me that they are someone’s brothers or sisters, sons, mothers and fathers. Considering your access to medicine, is there a treatment that doctors are working on that could remedy the affliction of addiction?”
“I really don’t know, I’m not really on that end of it so you’d have to ask somebody else because I’m on the treatment side. Providence Health at St. Pauls does a lot of that stuff with medications that they give. The Portland Hotel also does a lot of this, what you’re referring to. What Bevel Up was and still is and why it’s relevant today is that it really talks about the connection. You have to have a connection for anything to happen. It’s the connection and communication and the intricacy of that. As to whether you will seek treatment or you will stop or in a moment of wanting to continue to use and how can I do it safely? There are other treatments out there, such as opium replacement therapy and Kadian. We’ve advanced in so many ways but I think we still have to advance further. Personally, I believe we need to have a safe drug supply and regularization.”
“Do you know what kind of progress the city/government has made in providing a safe drug supply?”
“I think it might be a federal issue. It’s not Vancouver city council and I don’t think it’s provincial either. You’re talking about the drug policies we have right now that keep people where they’re at. We criminalize more than putting health care on the table but a lot of the budget goes toward the criminal component versus health. It’s a bigger issue and the reason Hastings is what it is. Vancouver is a port; there’s heroin, cocaine, there’s alcohol and bars. Over the years I think people migrated down there and hence that’s why it is today. Not every city is like that and when you’re looking at people with substance use and people that work in the sex trade, they’re in the community everywhere. I think what you’re seeing in the downtown eastside is the result of many systems not working to their full potential; we’ve failed some people. It’s complex.”
“Having been on the front lines, how do you make the government listen to inform them that more needs to be done?”
“Other than what people are doing already? I think our drug policies need to be changed. If people were given a safe supply of drugs then they wouldn’t be chasing the drug. It takes a whole system and an entire country as well as everyone behind each other in order to change that. This is at a federal level right now and the person to talk about that would be Donald McPhearson. He works for the Canadian Drug Policy Coalition Group and they do a lot of that work.”
“When you were working with the people using drugs, what did you find was the most frequently used drug?”
“Back then it would be heroin, but now it’s fentanyl. This is me hearing from people working down there and not talking to the person using the drug. For me, they’re the direct source and people who know. When I was out on the streets and talking to the people themselve’s, I’d ask them what the latest drug on the street was and how can we help you and what do you need? They are the best source.”
“What else would you like viewers to know about the documentary?”
“Bevel up was a beautiful marriage of art and science. When we made it we went across Canada, we went to conferences, we went to Hot Docs and we took it to communities. We created dialogue and we helped to get the community together to try to figure out what best to do. The solution has to come from the community as to what they need to do for themselves. What still exists and may still exist for awhile is, people within health have stigma and discrimination much like society toward people using drugs. Because of that, people who use drugs don’t access health.”
This documentary was an eye opener and provides hope for people that might find themselves addicted to drugs someday with no place to go and nowhere to turn. They have advocates looking out for them to ensure their health is maintained but more needs to be done and we could all pitch in more to eradicate the life and death struggle. My sister-inlaw was a bright vibrant mother and loving wife years ago. Her addiction to hard drugs changed the world she was familiar with and ultimately took her life. Her kids miss her daily and I know that none of us are impervious to addiction.
Please take 45 mins. to watch Bevel Up and contribute to a solution.
Photos courtesy of NFB and Nettie Wild.