Health care and Police

Flash from the future in 2021! As usual, any time I read back over one of these older posts, I notice things that I didn't quite get right, or where my understanding has really changed over time. The blog is called "learning to nurse" and not "being an accomplished nursing expert" for a reason, I guess!

Anyway - I may at some point come back to this post and run some edits. This post has more writing, fewer pictures, and even less of a coherent thesis than any ones before it... I also *REALLY* don't do justice to the concept and history of harm reduction... But, swallowing my pride (and a healthy dose of shame) I'm leaving this all as is for now: trusting folks to overlook my naivety (literally, if necessary), and thanking everyone for bearing with this learning nurse.

------- LMac, March 2021

In the last few weeks a couple of different things have come through my email inbox/facebook feeds/general awareness around policing and health/health care. I'm going to share some thoughts and articles below.

First off, one article by social justice activist and pediatric emerg physician Samir Shaheer-Hussein, a person who I admire so much for his down-to-earth demeanor and dedicated work on what I would consider some of the most important grassroots political campaigns in Montreal in the last 15 years. At a time when anti-Black police violence is getting a lot of attention in the U.S., he looks at how police violence against racialized people, and particularly youth can be understood as a public health issue for communities in the Canadian state context.

"When Will Police Stop Killing our Youth?" Huffington Post online, Jan 5, 2016

drawn image, black/white/purple: portrait of Anas Bennis, 25 years old. Killed by Montreal Police in Côte-des-Neiges in 2005

Secondly, this thing has been happening in Toronto that just confounds me. A local organization that employs harm-reduction outreach workers started doing a "pilot project" with the Toronto Police.

I'm going to back it up for people who aren't familiar with what it is that harm-reduction workers do in this city. I'm not an expert myself, here, but I think I can explain a little bit without misrepresenting too much.

Harm-reduction outreach workers are people who, among other things, go around distributing safer injection kits, and who aim to build, for lack of a better term, "caring" and/or "therapeutic" relationships with people using drugs and/or living in poverty/on the street/in precarious situations, etc. By using a harm reduction approach to building these relationships (non-judgement, seeing the person rather than their 'problems,' meeting the person where they're at) workers can become an important point of access for people who need various kinds of essential resources and services that they would otherwise have a really hard time getting or not be able to get at all (food, shelter, mobility devices, health care supplies and services, income support, legal services, etc etc etc).

Some of the workers are nurses, some have other kinds of backgrounds in organizing and supporting people and communities' health. This work requires a ton of specific knowledge and is highly skilled (though often not highly paid relative to other kinds of "professional" care work). Its effectiveness depends largely on how much trust workers are able to build with the people they are working with and for.

So. Along comes this "pilot project" that puts plainclothes police officers alongside harm-reduction outreach workers, without informing "clients" or the community in general about who they are and what their goals are. Can you see why this might create a problem? Might freak people out, and erode people's trust in the organization, its workers, and in street outreach workers generally (like, across organizations)? I sure can.

Anyway, this situation is still unfolding, and I, like most folks it seems, am in the process of learning what the hell is going on and why. Below I'm including a very general article from about a month ago when this issue first emerged in mainstream conversations:

"Drug harm reduction partnership with police irks Toronto outreach community" Metro News, Dec 28 2015.

Next is a very smart commentary from K. Lanktree about the mismatch of police and harm reduction, as it relates to the situation above:

K. Lanktree
"Police in Harm Reduction: A Recipe for Failure" Studio L, Dec 31, 2015

Finally, a blog post by community/health care worker Zoe Dodd that shares some of the details coming out of a public meeting with some representation from Toronto Police, John Howard Society and The Works, who are the three groups doing the "pilot project" together. This post contains some great analysis from the perspective of a community member and health/care worker as well as some details about how this project came into being, how it's funded, etc.:
                                                       
Zoe Dodd
"Reflections on Yesterday's Public Meeting and the Project - JHS, The Works - Toronto Police" Stark Reality (blog) Jan 9, 2016

Finally, a couple of my own words and more personal reflections:

I was in my first year of university in an intro political science class when I first encountered the definition of police as having a "monopoly on the legitimate use of violence" under the state system. As a white 18 year-old from a middle-class background, I was basically learning a concept that many people learn through experience at a much, much younger age and in far less safe, privileged environments. In any case, it might not have been 100% new information but it hit me hard with a new understanding in that moment (I could tell you the classroom I was in at the time and where I was sitting). I guess that's when I started to think more critically about the role of police in society, as necessarily agents of the state and as defenders of the status quo/social hierarchies.

In nursing school, the only time I can remember us talking about police/law enforcement was in the context of emergency mental health care, which kind of makes sense for reasons I'll hopefully make clear. A guest speaker whose name and role/job title I cannot remember for the life of me taught us about the "forms" used by law enforcement and medical institutions to legally detain people against their will under Ontario's Mental Health Act. (There's other legislation that relates to "treating" people medically without their consent/cooperation or against their will. But even without that piece, this is some heavy, complex stuff, legally and ethically. I'd encourage people to learn more about these things. I have some personal experiences with this system that I won't share for now.)

Anyway, the main thing I remember this guy saying was something to the effect of: "You (soon-to-be new nurses) must treat law enforcement like respected colleagues." The suggestion seemed to be that nurses (or new nurses?) are known for disrespecting cops, or treating them with hostility. I'm not sure how true this really is.

Now, I can understand that there are lots of situations in which, as a person providing/trying to provide health care to someone, it would be a wise and rational choice to treat a police officer with civility, assuming this is an option. I don't think this is the same thing as trusting them as a colleague, or even necessarily treating them as one.

The speaker's suggestion seemed to me to be that "we're all workers trying to do the same job", i.e. protecting a person's health and the safety/wellness of the people around them. I could think of some very hypothetical situations in which this could be true, I guess, and I'll let you decide for yourself if you think this is generally true after reading the articles and discussion posted above. I would just suggest that, however you go about considering this question, you think about your position and your privilege relative to police and the state justice system.

Anyway.

The whole thing made me start thinking about the role of police and law enforcement in health and health care more specifically. I don't have answers but this hasn't stopped me from asking questions.

Thoughts in progress. Thanks for reading this far. I welcome your good-faith reactions, feedback, criticisms, etc.


(here are the urls for the articles above in case the hyperlinks don't work for some people:)

http://www.huffingtonpost.ca/samir-shaheenhussain/police-killing-youth_b_8914048.html

http://www.metronews.ca/news/toronto/2015/12/27/harm-reduction-partnership-irks-community.html

http://www.studiolonline.net/blog/guest-post-police-in-harm-reduction-a-recipe-for-failure

http://zoedodd.blogspot.ca/2016/01/reflections-on-yesterdays-public.html

First Annual Learning to Nurse Holiday Newsletter

Dear care workers, care receivers, and everyone else –

(I’m mostly thinking of nurses of various stripes, attendants, PSWs, nannies, expert generalists in everyday care… but also others. Community health workers, therapists, friends and family, people who receive care episodically and/or regularly, weird docs, those who defy naming as carers or as workers… family and friends of the above, and anyone else reading)

Hi.

It’s been another year of this nurse’s learning, and another year of this blog being online, and so I thought I’d take a moment to put up some pictures and words and let you know that I’m thinking of you lately. A lot. Especially during this season of yuletide festivities/chaos and accompanying heavy (emotional) labour.

Since the last time we chatted through the Blogosphere, I graduated from school and got my nursing license. About a year ago I got a job in pediatric home care as a shift RN. Since then I’ve been working full-time night shifts pretty much without a break. Your sincere congratulations and your side-long looks of concern are anticipated and greatly appreciated. (Yes, I gained some new experience and paid off my student loan - with some help. Yes, I verged on losing my mind a couple of times. I’m fine just now, thank you.)

Now for my cute holiday annecdote:

The image I’m including for you here comes from the holiday card given to me by a young family I’ve been working for, 4-5 nights a week, for the last several months. Their baby ("Joey" or my “patient” or “client” properly speaking) has some health issues since birth but is now doing pretty great living and growing at home in his family’s care 99% of the time. My job, primarily, is to put a set of trained eyes and ears on this kid and to spell the parents off for a few hours so that they can (theoretically) sleep.

I say “theoretically” because they have another, older kid. And she, even more than her littler sibling, does not like to sleep at night. On a shift starting at 11pm and ending at 6am, it is not uncommon for me to see her as many as three or four times. Sometimes it’s for 5 minutes each time and sometimes it’s an hour. I’ve tried different strategies to get her to do the things that I think she should do (sleep: preferably at nighttime and in a bed,) and the things her parents want and need her to do (sleep; or at least not prevent them from sleeping). I’ve researched, I’ve tried to be consistent, and I’ve tried to systematically track my “successes”, but if there have been any so far it is not obvious to me. Ultimately: she is cute and sneaky, and I am a pushover for those things. For the last couple of months this child has been the most interesting, and definitely most challenging, part of my job.

Anyway, here is the card her parents gave me on Christmas morning:

 handwritten text reads: "Nurse Peents, thank you for taking such good care of baby Joey, and also treating Sammy like a little sister. Wishing you and your family a very Merry Christmas and a Happy New Year. Love, The Patient's Family, Dec 2015."  

(as always... names changed for privacy/confidentiality. including mine in this case - my clients do not call me "nurse Peents")

When I read this on my way home I was pretty tired and had a good laugh/cry. I was not expecting such a sweet, personal, and funny note.

I say funny because of the line about me "treating Sammy like a little sister". (Sammy is of course their older, rascally daughter.)

My immediate reaction was: “Holy Hannah! Is that really how I come off?! I was going for something closer to, like: kindly, respectful professional health care/respite provider.” Anyway, I guess you could say this was a moment of transference/countertransference made visible, if this language means something to you. (It means a little bit to me but I need to read more to really feel like I know what I’m talking about. We just got a whiff of Freud in undergrad.)

I think (now) what they probably meant was a few things: that I’ve become a fixture in their home, almost like another family member. And they see me treat their little girl with affection, and varying degrees of patience (somewhere between “some” and “really quite a lot” on a regular night.) But finally (and this is a huge part that makes me laugh/cry): they also see my complete lack of true parenting skills and experience. 

For them this is just a given. For me, it was a wake up call. I was thinking of myself, on some level, as a third parent. I’m not. I’ve never been a parent, I don’t have those skills, and also it’s not my role. This could be a nice time, maybe, to rethink what my role really is or could be.

For now I’ll only add that the implied “big sister” title is just as funny and touching to me since I grew up as an only child. They could have conceivably meant so many other things in this card: maybe they see me as their daughter, from a completely different cultural and ethnic background to both of them, who is somehow also around their same age and only comes to visit on weeknights. Or maybe they think that I treat their daughter "Sammy" as the “little sister” to the younger baby… or maybe they didn't mean anything at all. The readings are kind of endless. If you have a funnier one, let me know.

In the meantime, I hope you and/or the people you’re caring for are getting through the season with some kind of grace and comfort, and all of your most important parts intact.

Your with nursy/sisterly love,

Nurse Peents.

A Whiff of Freud Fine Body Mist

hypoallergenic and fragrance-free

“A perfect gift for that special nurse/nursing student in your life.”

also available in Yonic bottle design for a limited time only.
TM/(c) Nurse Peents, December 2015

- to the members of the Soul Retention Society, with fondness and gratitude from me