I learned about the video above from the HIV course I’m taking at UBC (IHHS 402).
The video is of our former Canadian Minister of Health (and current Minister of other portfolios), Tony Clement, talking about InSite at the 2008 International AIDS Conference. InSite is a centre on E. Hastings where addicts can come with their drugs to a place with nurse supervision, clean needles and other drug use equipment, and non-judgmental support. It has treated over 1000 overdoses (and prevented deaths), it has encouraged more members of the community into detox programs (there is a detox centre upstairs called OnSite), and there are dozens of peer-reviewed scientific articles supporting its necessity and success (I suggest starting with a search on “Insite” or “harm reduction” on pubmed.com or Google Scholar). InSite is based on a model of harm reduction, which is about reducing the harmful consequences associated with recreational drug use, but that is not what this post is about. I could comment on how both the BC Supreme Court and the BC Court of Appeals both supported the continued operation of InSite but the federal government still intends to use taxpayers’ money to appeal to the Supreme Court of Canada, but that is not what this post is about, either (but I invite you to read about it).
In the video above, Mr. Clement loses some cool near the end, concerned that someone will put this video on YouTube (he was right to think that someone would). I could write about how I believe he is misinformed about some of the issues surrounding harm reduction, such as his belief that harm reduction is akin to palliative (end-of-life) care, but that is not what this post is about. I could describe how I think Mr. Clement’s views on harm reduction may be due to the misunderstanding that addiction is a choice rather than a mental illness (and often a manifestation of a long history of psychological isolation, neglect and/or abuse), but that is not what this post is about, either.
Those who know me would know that I would do anything to avoid confrontation, and this post touches on a controversial topic much more than I am usually comfortable with, but that is what this blog post is about. This HIV course has taught me enough to make me speak up, and I think that is what all university courses should strive to do with their students.
University courses are not just supposed to educate, they are supposed to bring awareness of subjects so that we, as students, can be inspired to take that knowledge and change the world with it.
University courses should tell us about issues in the world that make us excited, angry, depressed, and frustrated so that we are motivated to do something with our bountiful knowledge. We are privileged to be able to go to university, and I think we have an obligation to take our position of privilege and do something with it. We may run into walls or even run the wrong way for a little while when we’re impassioned and on fire, but I think that is what we are supposed to do, at least when we are just starting out.
I wanted to share the following journal entry for my HIV course, because writing this was when I realized how this course has changed my life.
“As I reflect on my progress through this course, I realize that my first week was about being overwhelmed with information and feeling powerless. My second week was about realizing that education equals power to make important changes. And this week, my third week, has been about passion.
This course is really more of a journey than a course.
Going to the Eastside Pharmacy was life-changing. Never have I thought that I would be interested in working at a pharmacy, but that was because I never visited a pharmacy that was so integrated into the community. By integrated, I mean that members of the community literally cannot survive without the pharmacy. Every staff member knows every client by name and knows exactly what each client wants. Alex, the owner, happily gives out timbits when they’re available, and he fed me a delicious lunch even though I should be paying for their food to thank them for the amazing knowledge and experiences bestowed upon me. I learned more there about the harsh realities facing members of the community than at any other placement, and it may have been because the clients there were willing to divulge stories of their lives to the pharmacy staff the way they would unload on family members or close friends. Alex lets women sleep in his pharmacy because he knows that they need their rest during the day if they are to be able to protect themselves at night. What other pharmacy would do that? What other pharmacy would console, hug, and then personally make an appointment for a patient at a clinic that doesn’t make appointments just so the patient could deal with her anxiety? What other pharmacy would urge their patients on the streets to go home when it’s late and waive drug dispensing fees for them when necessary? When we heard that a woman died after being beat up by her pimp, the staff members mourned the passing like they would a dear friend. Eastside Pharmacy does all of this because these individuals are not their clients or patients, but their extended family. The staff members work there at lightning pace because they know their family members cannot stand to wait too long. They are all grateful to be able to work there and make a difference for their extended family. I may be wrong, but I think very few pharmacies in the world are this valuable to their community. I am thankful to have been able to have been part of such a cornerstone for the community, even just for one day.
At Eastside, a client told a pharmacist that another pharmacy in the DTES was offering to “lend” $20 a day for methadone clients. I did not fully understand the ramifications until it was explained to me… Since methadone is the prescribed substance (often mixed with Tang orange juice!) most often used as part of heroin replacement therapy, the government offers extra money incentive to pharmacies that will accept methadone prescriptions, for fear that not enough pharmacies are willing to serve drug addicts. The problem with this incentive is that it allows for criminals to take advantage of the system. Pharmacies that “lend” $20 a day to methadone clients are essentially drug dealers that want to make the extra money from the government and will bribe clients to go to them. Furthermore, these pharmacies are legally obligated to watch their clients consume the methadone to ensure that they are getting the medicine they need and not selling the substance outside, but the drug-dealing pharmacies often do not care whether the clients use the methadone or not. Learning about such criminal activity makes me angry, not just because they are stealing tax payers’ money, but because they are ruining people’s lives. When you have a pharmacy that is out to make money rather than care for their patients, you mess with the community’s lives, and that is not ohkay. It is infuriating, and learning about this crime was one strong reason for why I have decided to pursue lifelong work in public policy.
The other bit of inspiration that has led me to wanting to dedicate part of my life to health policy came from Thomas Kerr. When he explained how the RCMP repeatedly paid researchers to try to overturn evidence for harm reduction, how the government used their influence and power to discourage and ban funding for harm reduction, and how the former Minister of Health Tony Clement completely misunderstood what harm reduction is all about, I realized that scientists need more people on the inside of government and policy making to help translate fact into policy. I do not really believe that government officials would intentionally deny scientific fact – they are simply at the mercy of public opinion and the media. They need experts who can help them understand the scientific evidence for important matters like harm reduction (and climate change) and how policies need to change, but they also need these same experts to work with them to develop a strategy on how to educate the public and garner popular support for these controversial decisions. This is a niche that I believe needs to be filled, and it is a niche that I think I belong in.
I have looked up McGill’s Health Policy Fellowship program, and I will be finding out more information about how I could possibly integrate an education in public policy into my MD-PhD.
So you see, this week to me has been about passion. Passion to not let this course just be like any other course. Passion to take what I have learned and do something important with it. Passion to take action, get out there, and make a change.”