Registed Nurses' Association of Ontario

Being in the right place at the right time doing the right thing

It all started in November 2016. After years of advocating for harm reduction as expert advisor for the Canadian Association of Nurses in HIV/AIDS Care and running the Coalition of Nurses for Supervised Injection Services, I found myself in Vancouver's Downtown Eastside neighbourhood volunteering at Canada's first pop-up overdose prevention site.

For months, I had been following the overdose crisis unfolding across the country and paying close attention to the situation in B.C. The provincial government there had declared a public health emergency in April 2016, but the situation was not improving on the ground.

"The provincial government there had declared a public health emergency in April 2016, but the situation was not improving on the ground."

In fact, it was getting worse every month. By September, 622 British Colombians had died of overdose. Facing a humanitarian crisis, along came harm reduction activists and pioneers Sarah Blyth, Ann Livingston and Chris Ewart. Together, they launched Overdose Prevention Society and opened two pop-up overdose prevention sites in the Downtown Eastside.

I arrived in Vancouver on Nov. 26 and went to the pop-up site to meet Ann. She explained how everything worked and gave me a walking tour of the site, which consisted of two tents, a portable toilet, harm reduction supplies, tables and chairs.The next day, I met Sarah at the local street market and she explained how the site had come together, how fundraising was organized, and the challenges faced on the ground.

I spent the next two days working alongside outstanding and compassionate peer volunteers, most of whom were working 12-hour shifts outdoors with a very basic set-up. Little did I know at the time, but this profound experience would lead me to become a core organizer for the pop-up overdose prevention site in my hometown of Ottawa nine months later.

Energy was high in Ottawa's Raphael Brunet Park when the overdose prevention site opened on Aug. 25, 2017. The need in the community was pressing, but we were up for the challenge, and determined to make a difference no matter what. We set up tents to open at 6 p.m. every evening and took them down at 9 p.m. each night. The first nights were all about establishing our service and building trust. It worked. On average, we saw about 40 visits per night. During our busiest week, that average climbed to 76 visits a night.

When guests arrived at the site, they were welcomed by volunteers at the main table where they could take harm reduction supplies, snacks, drinks, and sometimes clothing. If they wanted to use at our site, they could do so in either the safer inhalation tent or the injection tent. The safer inhalation tent was primarily for stimulant use and was monitored by one volunteer. The injection tent was primarily – but not exclusively – for opiates and was staffed with a three-person team trained to provide overdose first aid.

"Our success relied on our volunteer team's blend of expertise."

Our success relied on our volunteer team's blend of expertise. Peers with lived experience, nurses, harm reduction workers, social workers, and social justice advocates all worked together. Our success also relied on the fact that we operated outside the system to meet people who use drugs where they were at, both literally and figuratively. We worked in an outdoor public space, directly in the community.

“To connect on neutral grounds” is how Bobby puts it. He and I became partners right from the get-go. His lived experience, connections in the community, and street knowledge just clicked with my pre-hospital, acute care and harm reduction background. Together, we established a standard for the injection tent based on respect, compassion, engagement, and being peer-centered. Our nurse volunteers were held to the same standard. In that tent, the goal was not to evaluate, plan, teach, or counsel. The goal was to take a step back and be present. The goal was to make people feel comfortable to use the way they would normally. When interventions were needed to prevent or manage an overdose, we kept the best interests of the person in mind. Sometimes, that meant monitoring the person more closely, rather than acting too quickly.

I describe my experiences as a nurse volunteer at the overdose prevention site as "being in the right place at the right time doing the right thing." And that's exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about.

Marilou Gagnon, RN, PhD is an associate professor at the University of Ottawa's school of nursing and will soon join the school of nursing at the University of Victoria. She is the president of the Harm Reduction Nurses Association, co-president of the Nursing Observatory, and editor of the Radical Nurse.

Read more about Marilou Gagnon in the RN profile from the September/October 2017 edition of Registered Nurse Journal.