My name is Yanick. I work as a clinical coordinator
at the Dopamine clinic. I've been an outreach worker
on the street for 11 years, primarily in crack houses.
That's my background as a frontline worker.
The first thing about harm reduction is pragmatism.
People have used, are using and will continue to use drugs, so
they might as well be with us while they are using. Why not be by their side?
I think it's a privilege to be part of their ritual, of their intimacy.
The second thing about harm reduction is, of course, humanism.
It's about the relationship we have with people.
You don't have to come here, and
it's possible that your injection techniques
are not great, but while you are with us, we will go along with you,
and take the time. Perhaps the first time
your injection techniques are all wrong,
but that's your ritual. Over time, we will do prevention
by saying, "why don't you try this?", "how about doing it this way?" or
"try your other arm." As we build a relationship,
we will emphasize
harm reduction.
Everything about front-line work has to do with
relationships.
People have known us for a long time.
Our approach works for independent community organizations.
People trust us because we spend a lot of time
and share a lot of things with them.
It's through this relationship that we can convey prevention messages,
once we have built enough trust to establish a relationship.
This allows us to better direct and advise people. The nice thing about a SIS is that we have
a nurse with us every night from 8 pm until 1 in the morning,
7 days per week, 365 days per year.
This provides an entry point into the healthcare system for
people who have experienced failures in places like hospitals.
This is a different approach, and I think
it can rebuild their confidence to go to
a facility, to enter the healthcare system and to
take steps like getting a health card or getting
acces to hepatitis C treatment, methadone or suboxone,
etc.
The Lotus project is about a navigator. My colleague Magali accompanies
people, for example to receive their hepatitis C treatment.
The first step is to make a deal with family doctors to
take them on as patients. They are no longer just seen as a hepatitis C virus.
It becomes 360°. People experience a lot of things
when it comes to nutrition, to money, to
their love life and their social life.
We make sure the person keeps a
family doctor after the treatment and enters the healthcare system if he or she wants to.
The Lotus project also helps them get around.
We often take transportation for granted but it's not always the case.
The project pays for a bus pass so that people get around.
I think it also offers a $100 grocery voucher so that
they can feed themselves.
Magali goes with them to the doctor,
to get fibroscans done. She accompanies them pretty much everywhere.
On the other hand, street workers are also there
to support people in their efforts,
when it comes to their health but also as a whole.
Because we must look at people as a whole.
You can't just look at the virus, treat it and then say, "see ya!"
They deserve better because they give us a lot,
and we have to do the same. This is the best school of all.
It's about working with people and being with them
in a holistic way.
We've had supervised injection sites since June,
and we are quite happy and proud of it.
We are part of a regional system.
Dopamine is one of four supervised injection sites.
Legal technicalities often complicate the situation.
We aim to provide a low threshold and sometimes,
protocols focus too much
on drugs and not enough on users - that's my two cents.
There is a lot of nonsense
that we must get rid of over time, actually
we should do it as fast as possible.
For example, in supervised injection sites,
we have people who have bought drugs together and want to use together.
This is called a split dose. Our protocol forbids it because
it's considered trafficking, so we must send people outside to split their drugs.
But we have another protocol that forbids trafficking outside. You see the nonsense?
This is one of many examples.
This one is pretty obvious, but we must take another look at protocols.
At Dopamine, we have a code of conduct, a way of doing things, and it's all about
respect; of others, of the stakeholder, of the patient,
of the furniture, of the space.
Sometimes protocols get caught up in small details and it can
really put restrictions on us, but I believe in this new project.
It's only been around since June,
we haven't even gone through four seasons, and we
really want to work on these
legal issues that can
work against a low threshold approach.
I think we should allow split doses and let people test their drugs.
People can't even sniff their drugs before injecting them.
This needs to go too because it makes sense. We can't go backwards
in our prevention messages. We can't say test your drugs then
sniff them, but do it outside and come back. It makes no sense.
It's like going backwards. Assisted injection too, we must include people
who show up together and inject together.
I think this should be allowed.
It goes back to what I was saying at the beginning.
It's about being pragmatic. They are doing it anyway.
They might as well do it at Dopamine, where there is a nurse,
a worker, where we are present.
People are the starting point for our services.
We must start from their requests, their needs, what they tell us,
not the other way around. We shouldn't invent services to reach people.
We must listen to their needs and adapt services to their needs,
to their lifestyle.
And we must take our time, take the time
to build relationships. To spend time together, as one human being to another.
There's no need to rush. Actually, all we have to do is be there.
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