2018 Week 3: Healthcare and Health Policy

picture of Ananya Sarkar CIIPANANYA SARKAR | CHASE BREXTON POWER PROJECT

The highlight of my third week would have to be National HIV Testing Day on Wednesday at the YNot Lot. We had music, free food, free rapid HIV testing and trainings where people could become naloxone trained to prevent overdoses.

Many individuals were apprehensive about getting screened for HIV and one of the many questions I was asked was whether the test was invasive. When they heard that we needed some blood, many of them left. Despite the fact that there were Chase Brexton signs all over the lot, I was also asked if the tester was from Hopkins. Hopkins has had a controversial relationship with the Baltimore community, and it is still evident today in individuals’ distrust of invasive medical tests.

One individual in particular came up to me and mentioned that they were HIV+ and were not interested in getting tested. I told them that I was glad that they knew their status and offered some of our food. They then proceeded to ask me about my religious beliefs and I informed them that I was not interested in sharing that information. This individual continued to pester me and other community members by saying that Chase Brexton was taking their blood to clone individuals. As weird and funny as the situation was in the moment, I wondered what we could do to change these perspectives that may be prevalent throughout the community.

Overall, National HIV testing day was a success, as we served over 150 individuals and tested over 25 people! I met many wonderful individuals who were so thankful that we were offering these services and expressed interest in coming to Chase Brexton in the future.

 

picture of Reah Vasilakopoulos CIIPREAH VASILAKOPOULOS | BALTIMORE HARM REDUCTION COALITION

I knew this week would be very busy, given that 3 of 5 weekdays revolved around the Maryland Harm Reduction Pre-Conference and Summit. I was incredibly excited and fortunate to be there, meeting so many different people who cared about harm reduction and incorporated it into their lives, profession, or both. Whether I was learning about how to center people who use drugs in the management of organizations providing services for them, or what harm reduction for people who do sex work can look like, I saw so many exciting paths for future work, for my own future. Meeting other people who love harm reduction practices like I do made my inner desire to continue doing this work even stronger. I came out of the Summit feeling validated in many of my future hopes.

But, I also came out of it feeling frustrated in some ways. I had a few experiences at the Summit, while helping out with Narcan trainings for the Maryland Department of Health (MDOH), which showed me that the framework of racial equity and understanding of racial injustice at BHRC is not taken up by everyone in the harm reduction world.

At BHRC, we really work to center racial equity in everything we do. Racial injustice and systemic racism undeniably contribute to stigmatization, lacking access to treatment, and changing public response. There is clear difference in the response to opioid overdose in our country: people of color have been incarcerated for substance use (including opioids) for decades, but treatment and sympathy was offered for opioid use once white people became the mainstream focus of the crisis.

First, I was speaking to the MDOH employee who had been training people all day at the Summit. She opened the pamphlet that she used for visualization and covered the symptoms of opioid overdose with me. I read “blue fingertips and/or lips.” Blue? I had been trained to include blue or gray in my Narcan trainings, understanding that people with darker skin do not reflect blue tinges but instead look gray or ashen. Training people to solely look for blue fingertips centers opioid overdose once again around white people. I spoke to her, asking if she could make edits to include this in her future materials. She was receptive and said yes, but following it made a side comment about how many different people review their pamphlets. To me, it just sounded like it was reviewed by many different white people.

Later on, another person I was training alongside made a racist “joke” at the expense of a colleague I had met a few days prior. I was immediately pulled into training someone after I heard her “joke”, and chose to not pause that training to call her out on her racism. I considered that we would have had a much longer conversation that was better suited for a private setting. Since we were the only two tabling at that time, we would’ve not been able to meet the training needs of the other Summit attendees. But I didn’t get to say anything to her privately before she left. They say you pick and choose your battles. Thinking back now, I am afraid that I chose wrong. Moving forward, I want and need to choose right.

 

picture of James Yu CIIPJAMES YU | KESWICK MULTICARE CENTER

After the third week I feel that I have settled into my role very well and I understand what is expected of me and where I can help out. The uncertainty that I once felt being a new intern entering an unfamiliar field of work is now gone. I can act independently and not have to have to constantly ask my supervisor how to perform certain tasks. This means I can comfortably take initiative and help out when I see that a staff member is overwhelmed with completing their tasks while also tending to the needs of all the residents. It really is a rewarding experience when a resident or their family thanks you for simply caring enough to check up on them or to say hi in the morning. I love working at Keswick and I have met a lot of amazing people who have helped me along the way.

My supervisor has been a huge helping hand and a role model for me. He is a social work designee and acts as my mentor and trainer. Even when I first met him, I instantly felt at ease interacting with him and that I could ask him any questions I had. He taught me enough to lay a good foundation for the work I had ahead of me but he did not hold my hand and lead me through everything. He let me learn by making my own mistakes, allowing me to grow into my role and develop my own unique style of social work while also making sure I provide the proper services that the residents need. He is incredibly friendly and just has a certain je ne sais quoi when he interacts with residents and staff that endears him to everyone he meets. Every morning he comes in with a jovial air and never hesitates to brighten up other people’s days. Hopefully I can emulate his qualities and improve everyone’s lives like he does.

 

picture of Christina Ambrosino CIIPCHRISTINA AMBROSINO | CHARM CITY CARE CONNECTION

This past Thursday was the Maryland Harm Reduction Summit at Martin’s West conference center. Charm City Care Connection had been attending the BRIDGES Coalition meetings to help organize for a mock safe consumption site outside of the conference. The safe consumption site would display photos from other safe consumption spaces around the world and allow visitors to give their feedback about what a safe consumption space would ideally look like in Maryland. The basic setup of such a space includes materials to make drug use, especially drug injections, more hygienic and more informed (through the use of fentanyl test strips, for example). Within the spaces are also often designated areas for drug delivery and comfortable places to rest while the drug takes its effect. If a person appears to be struggling to breathe – a key sign of opioid overdose – or showing any other alarming signs, one of the medical professionals at the site would step in. Around the world, there are over 100 safe consumption spaces worldwide. There have been millions of injections at these sites and but zero deaths have been caused by overdoses. Drug use doesn’t have to be risky – safe consumption spaces exemplify the harm reduction approach in relation to recreational drug use and addiction. People who came out of the conference building to see the mock safe consumption space in the 90 degree heat were likely a self-selecting group of people who were already interested in harm reduction. Still, it was wonderful to see peoples’ positive, supportive, and constructive reactions to the mock safe consumption space. We had a space for people to write their own feedback about what a safe consumption space in the Baltimore community would ideally look like and why they support harm reduction. Reah, the intern for Baltimore Harm Reduction Coalition, displayed some of these truly powerful messages on her social media. I think it’s so important that we continue to spread the word about safe consumption spaces and normalize this idea that has the potential to save so many lives.

 

picture of Luke Bonanni CIIPLUKE BONANNI | SHEPHERD’S CLINIC

Now that I have completed my third week at Shepherd’s Clinic, I can say that I have comfortably integrated into the culture at the clinic. I know most of the regular staff by their first name now and have no problem cracking jokes with them. I’m especially glad that I have gotten to know our nursing coordinator a bit better as the weeks have progressed. Initially, I thought she was overly strict with clinic policies, but as time has gone on I have come to realize how vital she is to the functioning of the clinic, and how much she actually cares about every patient that walks through the front door. She has been at the clinic for years, and I have been told that if she were to leave the clinic would not be able to function. I have come to realize that what I perceived as strictness is actually just a result of her caring about our patients. All of the doctors at the clinic volunteer their time to provide medical care for free, and most appointments occur every 30 minutes, so time is a valuable asset at the clinic. When a patient arrives 25 minutes late for a 30-minute appointment, the doctor is obviously unable to see this patient since they are preparing for the next one to arrive in 5 minutes. Because of this patient’s lateness, 30 minutes of a doctor’s volunteered time is wasted, and when some appointments can cost $400 at regular clinics, this is a big deal. Our next available appointment is usually 3 or 4 weeks away, so appointments are in high demand. Thus, I have learned that when the nurse coordinator is strict about clinic policies, she is strict not out of a love for rules or for wanting to make things difficult for patients, but because she wants the clinic to be as effective as possible and to help as many patients as we can.

 

picture of Valeria Hernandez Munoz CIIPVALERIA HERNANDEZ MUNOZ | ESPERANZA CENTER

There is no “busiest day” in the clinic. The number of patients varies so much that we can be understaffed one Friday and twiddling our thumbs the next. On sunny days, families will brave the heat and we’ll run out of kid-sized chairs. On rainy days, field workers will be glad they don’t have to miss a day of work to come see a health provider. Indeed, absence excuse letters don’t always cut it, and some patients would rather get fired than speak out through a process that might make their immigration status more visible. This week, a father of two brought his girls and his medical bills: “I can no longer afford my meds since I had a seizure at work and got fired for it.”

Their fear is not unfounded.

Some days the waiting room will be empty, and we’ll later hear that there was a deportation. Seeing this happen once in only three weeks of the internship was one time too many. People lock themselves up at home and children may or may not go to school. The morale drops.

On Wednesday, I went to a rally against family separation and other ICE practices. The people most affected by such practices weren’t there, staying in the relative safety of their homes. Rallies like this depend on allies that don’t fear the cops containing us, the cameras ready to make our faces public, and the helicopter floating above us. “What has the city done for immigrants?” yelled one of the speakers, “nothing!” It’s easy to forget that Baltimore is not a sanctuary city.

Many visited the office this week. Catholic Charities’ help at the border was praised in the news and the possibility of more funding was discussed. “When unaccompanied minors became a national issue we saw funding like never before,” recounted our manager. “No one cares about adults.”

In my time in the US I have thought a lot about what it takes for people to wake up. The children were being caged because their parents started being prosecuted, but “no one cares about adults”. Children’s innocence and lack of control over their situation is more visible, and I wonder how we can bring adults’ to light too.

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