Outreach Street Nurse Caroline Brunt (centre) journeys through a back lane with her nursing bag. Photo credits: Nettie Wild
Caroline Brunt, shown in the photo above, is part of a team of nurses who work on the streets of Vancouver’s Downtown Eastside. They take care of the health needs of homeless, addicted, and marginalized people -- on their own turf. This is not always the easiest, or cleanest environment to provide health care. Why do they do it? That’s a complex question for each of them personally. Obviously there is a need and the Vancouver Street nurse team of the BC Centre for Disease Control (BCCDC) has a mandate to provide health care to this community. As Outreach Street Nurse Liz James says: “We have built lots of fancy clinics but what do you do when the clients don’t come? How do we reach them? We have to go to them.”
I interviewed all the street nurses in the film, as well as others on the outreach team. They are unanimous in not wanting to end up as the heroes of this story.
So why did they make this film? Brunt describes the traditional medical model as to “cure and to fix. We are always right. Thank God for this population who are not bowing down to us.” Juanita Maginley, Program Manager, saw the opportunity to create something that really addressed the systemic barriers that exist when trying to reach this marginalized population. Brunt describes sitting down with fellow nurse Fiona Gold and saying, “If the skills we are learning are of any use, we need to educate the next generation and practicing nurses. This needs to be documented.” Two years, a bunch of fundraising, and an award-winning documentary crew later, Bevel Up came into the world.
The world that Bevel Up takes us into —the scene on the streets, alleys and hotels of this downtown Vancouver, BC, Canada neighborhood (very close to the soon-to-be 2010 Olympic Village)— can stretch the limits of tolerance and compassion. Yet this is the task: to provide non-judgmental, effective care. Humanizing those who are often stigmatized as less than human is the baseline of reducing harm. This is what Bevel Up in its multi-platform incarnation as a 45 minute documentary, as well as through it’s 3.5 hours of teaching chapters, interviews and topics, shows us. Directed by accomplished filmmaker Nettie Wild, Bevel Up, like it’s title, is gritty and poetic.
Says Bevel Up Project Coordinator Fiona Gold, “Harm reduction is about listening. It is about really trying to understanding where people 'are at' and then working with them to help them make their lives safer and healthier, step by step. Distributing condoms or clean needles to prevent HIV or Hepatitis C infection; providing a supervised injection site so people do not overdose alone in an alley; providing referrals to a detox facility or a drug treatment centre are all examples of harm reduction initiatives. Drug treatment can be seen as a continuum that spans harm reduction initiatives and abstinence. As health care workers we often see street drugs as the problem. We have to remember for the user they are often a solution. It’s not a question of enabling drug use – it’s a question of respectfully helping this individual to achieve optimum health. I feel as nurses, we have an ethical responsibility to reduce human suffering. And we are uniquely situated within the health care system to decrease the harms associated with drug use.”
As for Bevel Up, now in release for about a year, has it accomplished what it was created for? Originally meant to help shift practice within the health care system, several of the nurses I spoke to cited one specific simple yet profound change in practices based on a screening with emergency nurses at a local hospital. Now they give out antibiotics directly when needed by street-involved patients. Before they used to give prescriptions. In terms of reducing harms (and of course infections), this is a small step with huge impact.
Outreach Street Nurse Elaine Jones comments that mostly people’s response to the film has been overwhelmingly positive. She adds: “It’s a very intense film that really make them look at issues. And I think it has a lot of impact that way. Occasionally it makes people angry and that is very interesting, because that is where the challenges lie.” Elaine acknowledges that taking a harm reduction approach does make life harder for some health care providers, which is indicative of the system that as a whole needs transforming.
Says Brunt, “Even if one person treats someone a little different from seeing this, then we will have accomplished what we set out to do.”
