12:02:26 Why don't we get started, and we might have some more people joining us as we move along.
12:02:32 My name is Rebecca Penn, and 
12:02:40 I'm the project manager for the National safer supply and community practice.
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12:03:01 I'd like to just start off with some housekeeping things as people are joining us. We will be iterate these in the chat.
12:03:10 And then I'd like to do an acknowledgement of our colonial past and history and present, and then do a little introduction to this about the community of practice in this talk, and then pass it over to our speaker today.
12:03:25 Nancy Rai.
12:03:28 So, we are recording this event, and we will be sharing it on our website, and also in our Google Drive.
12:03:38 If you are having technical difficulties, please log out and rejoin we're it's really difficult for us to provide any technical support during the during the actual webinar.
12:03:52 I'm really happy to say that we do have French language interpretation.
12:03:58 We are the way we are doing that I'm going to let Gabrielle explain Gabrielle villain wave is is here to do the to do the interpretation.
12:04:11 We there's some conflict between providing closed captioning.
12:04:15 So we've come up with a solution for today. We're trying to find an ongoing better ongoing solution, but our temporary fix for today is to have the trend, the French translation happening on a Google Doc.
12:04:30 The link to that Google Doc is in the chat. Gabrielle Would you like to explain that in French. Absolutely. Yeah.
12:04:38 Thank you, Rebecca.
12:05:32 Okay, so we're all we are joined we have, how many participants, do we have now Robin 137 people here from across Canada, and I'm actually located in Mexico right now.
12:05:46 And so, I do want to acknowledge that we are all people who are living on stolen indigenous lands. And we're here in different capacities as as colonizers settlers.
12:06:00 as new people from across across the world.
12:06:04 And we're coming here today from different places across Turtle Island and and where people who live on treaty lands and unseeded territories. We work in a sector, whose goal was to adjust social harms and we must recognize that the production of these
12:06:19 harms.
12:06:23 Is it is it comes from the history of colonialism and its engineering practices institutions and ways of thinking, as well as other additional systems of oppression and violence colonialism is with us today.
12:06:40 And part of the work that we're doing, and the work that we must continue to do is to to work in ways that reshape these institutions and practices that have caused harm.
12:06:51 We need to be focusing on repairing harms and preventing future harms and work towards a more inclusive and just future.
12:07:10 So a little bit about the community of practice.
12:07:13 We started informally, just over a year ago as a group in Ontario, but in it but this year we received funding from Health Canada, and from the substance use and addictions program.
12:07:28 Our goal is to support the scale of of safer supplied programs to capacity building and knowledge exchange excuse my cat, and the focus of our community of practice is a medical model of safer supply and what does that mean that means that we're looking
12:07:46 at a model that is prescribed prescribed through our medical health providers through prescriptions and but we do focus on a medical model that is delivered from harm reduction in public health approach.
12:08:02 And we also support on going advocacy for non medical models and decriminalization that we offer is, we offer lots of different resources and activities and events.
12:08:17 We're going to be launching a prescriber consult line. Within the near future workshops consultations and support knowledge exchange events like this, working groups and network of supportive interdisciplinary providers and people who use drugs and stakeholders
12:08:36 in the community.
12:08:38 So, we're starting today this is our launch of our community of practice, really.
12:08:45 We're here to introduce you to the community of practice, and our team of knowledge providers administrators and myself, and. So why have we chosen to do a talk.
12:09:02 That's not about safer supplies specifically. Why are we talking about medical violence and anti oppression. And we chose to ask, non key to do this presentation for us today on medical violence and and and to building an anti oppressive practice, because
12:09:20 it really, we wanted to start off with really presenting what our values and approach to this work is to really situated in a particular in a particular way.
12:09:33 We really wanted to highlight what our guiding principles and values are.
12:09:39 What kind of approach to a medical model, we are supporting and promoting. And that is an approach that's based in harm reduction.
12:09:49 Equity inclusion social justice dignity and hope.
12:09:53 We also felt that this really demonstrates the possibilities of safer supply programs and prescribing.
12:10:02 This is safer supply comes from people who use drugs, it was a call made by people who use drugs and.
12:10:10 And this medical model.
12:10:13 We know that people who use drugs have experienced barriers to care. And, and a lot of stigmatization discrimination and violence within our healthcare and social care settings.
12:10:27 And so, there's this possibility and non keys presentation is challenging us to take up this possibility of transforming the delivery of healthcare and social service care.
12:10:41 It's also an opportunity to reconfigure the relationships between people who use drugs as patients clients and and health and social care providers.
12:10:54 So looking at trying to repair those harms and established and respectful, trusting collaborative collaborative relationships, and ultimately I just want to
12:11:07 drugs
12:11:12 to working with people, and is the on a continuum of care.
12:11:18 And we also need additional options, more entry points into care. And we also need non medical models and safer supply. So with that I'd like to turn it over to to knock a to introduce yourself please monkey.
12:11:42 Thank you.
12:11:43 Thanks so much, Rebecca for inviting me for this conversation and for kind of laying out the preemptive to what the conversation will be about.
12:11:53 I'm assuming we have folks here from all across so called Canada and the other assumption I'm making is that people who are here right now are likely folks who are either interested in or already working insane for supply program so just wanted to flag
12:12:06 but that's who I'm assuming the audience is. I'm just going to share screen here
12:12:15 we go
12:12:22 over here. Are you able to see that. Okay.
12:12:25 Perfect.
12:12:27 Okay.
12:12:41 So I wanted to just start by introducing myself thanks Rebecca for the introduction as well.
12:12:36 I'm a family physician I work out of the park to Queen West Community Health Center safer food supply program is short for SOS here.
12:12:46 You can reach out to me on twitter at that handle you can also connect with me afterwards by email, I'm happy to share that in the chat leader.
12:12:55 And what I'm hoping that we can talk about today is recognize the importance of safer supply in the current context, while collectively being able to critique and demand better of all of us in terms of how we provide for supply and some of the common
12:13:14 traps that I find myself in when prescribing this hybrid medicalized model of something that really shouldn't be rooted in.
12:13:23 In an issue of justice and policy. So, that will make sense. So I just wanted to start by separating myself I appreciate for Rebecca, and the organizers for Daniel and acknowledgement.
12:13:35 I think, important for me to just kind of acknowledge where I sit within the current relationship to the land that I'm on.
12:13:43 So I'm a migrant settler, I come from an area in the world called push me which is in between India, China and Baka son and my family particularly comes from the area that's currently militarily occupied by India.
12:13:58 And so the reason why I share that is just because conversations around land compensation and resource extraction and militarization have been something that I had heard from childhood until present day.
12:14:11 But it was important for me as someone who moved to Canada at the age of 10 to realize how I now had shifted in the spectrum of that equation of who had power and who didn't as a settler here on these territories.
12:14:24 And so, you know, I think a lot of people say like the land it doesn't itself need to be acknowledged the land knows who it is the stewards and the indigenous nations who have been, who have had sort of stewardship and jurisdiction over these territories
12:14:39 know who they are. So, my point for doing the land acknowledgement is not just to recognize ongoing indigenous presence and and fight against the eraser then indigenous nations experience, but part of my rationale for doing the Atlanta acknowledgement
12:14:54 is to recognize that I can't struggle for the self determination and sovereignty of all Kashmiris without actively supporting indigenous sovereignty movements here and that includes all movements for land back across so called candidate as well, and encourage
12:15:10 you if you're not familiar with the territories that you're on and if they are unseated or if there are treaty signed to them encourage you to look online and to learn more about that, and beyond the acknowledgement piece to really work towards figure
12:15:23 out what your relationship is to the land that's continuing to support care for house all of us in the current moment.
12:15:31 out what your relationship is to the land that's continuing to support care for how's all of us in the current moment. So I'm going to try this I'm going to see if it works. I'm hoping everyone has access to the bar at the top of their zoom where you can click on
12:15:41 annotate.
12:15:43 Maybe Rebecca you can let me know if people have access to that or not.
12:15:53 This I'm not sure. I'm just looking for it there. And some folks can try so the, the, the goal is if you click on annotate at the top there.
12:15:59 You should be able to get access to something called draw or text but draw or stamp work well or you can get like a checkmark or an X or heart star whatever you'd like.
12:16:10 Question mark.
12:16:11 And I'm holding meditate is available during webinars I think just during meetings. Ah, ok.
12:16:19 We will pivot them and try something else.
12:16:22 So I guess what I will leave you with is in your for your own self kind of see where you would fall it's always interesting for me to kind of see where people put themselves around the spectrum.
12:16:33 So this first question is safer supply programs are an exception to oppressive health care practices, and if some folks feel comfortable sharing in the chat if they agree with that or don't agree, you know, either strongly disagree or strongly agree,
12:16:46 feel free to do that, or for your own mental Mark kind of see how where you feel on that spectrum, do you really feel like do you know do you strongly agree that Microsoft my programs are an exception to oppressive healthcare practice or not.
12:17:01 And I'll keep an eye on the chat if people do submit anything.
12:17:06 Oh yeah, there's some submissions coming through.
12:17:09 Okay.
12:17:16 Perfect.
12:17:18 Perfect. Okay.
12:17:21 Perfect. Pam glad this is what folks are saying so a lot of disagrees.
12:17:28 And hopefully everyone can read some of the comments because I think they're really important.
12:17:32 So some things are you know tending towards strongly disagree unless drug users are running the space and a compassion club model with anti oppressive practices.
12:17:41 If they're happening within the medical system and they're not outside of the institutionalized violence of the medical industrial complex, not the exception.
12:17:49 Perfect. Okay, next question.
12:17:53 So say for supply programs do not replicate or amplify power and privilege as it exists in society so I think based on people's responses already I'm going to assume that a lot of people will let me reread it for myself so it was of my programs do not
12:18:08 replicate so a lot of people will disagree.
12:18:13 so a lot of people will disagree. Great. Perfect.
12:18:15 I think there's a Yeah, thank you thank you for engaging with the chat even though annotate doesn't work.
12:18:22 Perfect. Okay. And then this one is more of an inter personal or an internal question for everyone who's attending.
12:18:29 So the reason why I'm asking this question is, can you gauge so some people have a really good skill at this and others haven't developed this this is a practice just like anything else.
12:18:38 Do you know when you may have interacted with someone that made them feel dehumanized marginalized or excluded because of your actions or inactions and this can be verbal actions, physical whatever that might be.
12:18:53 Okay, sometimes, not always.
12:18:56 Okay. Sometimes, perfect.
12:19:01 Yeah.
12:19:03 Yeah, and I echo what a lot of others are saying, oftentimes, this is something that will hit me at the end of the day of like, Oh, I remember that person.
12:19:12 I caught them rolling their eyes when I said that ridiculously stupid thing. I knew I shouldn't have said, or sometimes you can feel it in the moment when someone kind of shifted away from you and starts kind of becoming a bit more guarded because you
12:19:24 clearly said something that communicates a lot to them in terms of what you understand or don't understand about their lived experiences.
12:19:33 Okay. Perfect, thank you for engaging with that one.
12:19:36 Okay.
12:19:37 This is more just like kind of a pulse check for me for the crowd that's here.
12:19:44 How do folks feel about this one, I have a good understanding of how structural violence and oppression exists within the healthcare system.
12:20:00 Perfect.
12:20:03 Okay, great. Thank you everyone.
12:20:06 Okay.
12:20:14 Perfect.
12:20:14 Yeah, some folks are saying, as a patient or not as a provider.
12:20:17 And I think I would echo that your, your knowledge of it and your understanding of it is likely a lot deeper and more embodied than those of us who have gone through so called professionalize training.
12:20:31 Perfect.
12:20:32 Okay.
12:20:35 So I wanted to, I apologize for someone who's seen me present before because I feel like I end up talking about this tree almost every time.
12:20:43 But I wanted to talk about this tree so the reason why I'm talking about it is, this is a little bit towards the any providers or clinicians anyone trained in so called professionalized health care practices here.
12:20:56 You'll find that the branches of this tree are labeled what they call the social determinants of health and the labeling of this and the reason why I share this is because this is often how people in different education particularly healthcare, education
12:21:12 are taught about issues of social justice, and I don't know if I can even stretch to say that but this is often the rhetoric that's us so people are taught that race and poverty and someone's income and unemployment status or access to food or not is
12:21:29 often what's linked to these downstream what we would call health consequences that a lot of us are seeing as clinicians in our day to day practices.
12:21:38 Neil plastic essentially just means cancerous simple way so cancer and and and infectious diseases.
12:21:46 And then you'll see here that when we talk about the social determinants of health they're talking about housing, they're not talking about the fact that there are a lot of people who live in really large housing that exceeds the material needs, they're
12:22:01 talking about gender, they're not necessarily talking about hetero patriarchy they're talking about race, not actually racism, they might talk about work environment but they're not actually talking about the inherent exploitive nature of our economic
12:22:14 system in terms of capitalism.
12:22:17 Same with disability, you know, as if this is an inherent thing, and so oftentimes when we're being taught about the social trends of health. It's done so from this idea that you know clinicians and future providers need to learn about the so called other
12:22:33 vulnerable at risk communities.
12:22:36 And it's done without actually ever having, you know, I think, maybe a homie grant statements that ever, but it's done, predominantly in a way where they're not talking about power and they're definitely not talking about history so they might talk about,
12:22:50 you know, this is our housing crisis right now there's not many people are experiencing, or how many people are in housed in the city of Toronto. They're not going to talk about what historically that has looked like what has been the historical processes
12:23:03 of settler colonialism that have led to displacement.
12:23:06 What are the historical relationships between capitalism and neoliberalism, you know, current stages of capitalism and the impact that that's had on housing, and the housing market.
12:23:17 So there's often a very a historical understanding of it and then there's often a very a political and particularly a lack of power conversation so about that individual who's at risk versus all the individuals that make up systems that put that person
12:23:32 at risk.
12:23:34 And so when I was going through my medical training, this was really really clear to me I would stand out every time we were getting this teaching, and at the same time.
12:23:43 Prior to coming into medical school I had somewhat of the foundation of the fact that there are much larger structures that was much larger roots at the root of the issue.
12:23:51 And we're often not talking about them. And through my residency projects so when I was in in school still ahead wanted to really work on the cognitive dissonance I was experiencing as someone who was being taught a certain thing and seeing the exact
12:24:05 separate thing being practice within a clinical setting. And I wanted to look to see if there was any literature out there that actually looked at the relationship between these roots.
12:24:14 And so here we're talking about the soil the foundation of our country of Canada rooted in the enslavement of black people, and the extraction of not just resources in the land but also water and people, as well as settler colonialism and capitalism which
12:24:33 went, hand in hand.
12:24:35 And so within the roots that, you know, we've created these structures of hierarchy within society which allows for ongoing domination and ongoing marginalization and very clearly found there was actually a lot of literature out there that made the links
12:24:49 between these routes, and what we'd call these downstream health consequences, but not so surprisingly, it was very strategic and it continues to be really strategic by the structures and the powers that be, that we don't talk about these routes because
12:25:03 when we don't talk about them. We just allow the system to continue working itself, we allow the so called social terms of health to continue producing downstream health consequences, which all of us as clinicians are then paid to take care of and support
12:25:19 clients through. And that can continue to happen when we just keep the roots completely ignored in the process.
12:25:27 So before going further I just want to make sure we're all on the same page when we say the word oppression because I know you know the title of the talk has anti oppression and and I just want to make sure that we're all have a similar understanding
12:25:40 of what we mean when we say oppression so I'm hoping folks in the chat may be able to type in what their understanding of oppression is it can be a few words, it can be multiple sentences.
12:25:52 Totally.
12:25:53 Yes, please feel free to screenshot graphics, and we'll share the link as well it's available online.
12:26:03 authoring. Yep.
12:26:06 Any other like, you know, control of a certain group of people by a dominant group. Perfect.
12:26:15 Thank you so yeah structural systemic institutionalized domination of groups who are socially marginalized are forced out.
12:26:27 Yeah.
12:26:29 exclusion based on social identities and unjust exercise with power thanks Kelly. Perfect. Okay so
12:26:38 yeah the us and them approach which is a bit of a divide and conquer strategy which will definitely yeah we'll definitely talk about as well thanks not.
12:26:45 So, really, broadly speaking oppression, like many have already put into the chat.
12:26:51 You know it's when one particular social group, or multiple groups dominate or disempower marginalized or silence or subordinate another group for their own benefit.
12:27:01 So there is an exploitation relationship when it comes to oppression. You are gaining something by subordinating marginalizing silencing or disempowering someone else.
12:27:14 It's often an unjust exercise of power like others have shared, and it can happen through many different means it's not just a physical, I'm harming you I'm going to take something from you and gain wealth from it.
12:27:26 It can also be psychological, it can be from a social threat framework, it can be cultural it can be economic etc. And whether the dominant group acknowledges it or not.
12:27:38 I think it's important to just highlight that oppression is often happening because of an explicit ideology of superiority. And by that I mean, people are, you know, to themselves whether they will admit it or not.
12:27:52 So this is where the like unconscious or implicit bias conversations come in which I don't really engage them because I think it's more recognition of it or not, outwardly.
12:28:05 But I think people are coming from, and practicing and engaging in oppressive behavior, whether it's at an institutional level or an individual level, because they think they know better, or because they think they are better or because they think they
12:28:17 they have something that might be better and you can understand how those of us who are trained within professionalized programs are essentially trained in order to oppress right we are trained to say that you have now gone through X and Y degree, you
12:28:33 have gotten access to x and y knowledge that other people don't have, and therefore you have something greater. And that gets extrapolated to a lot of us, who then inherit the Savior mentality.
12:28:45 It's not just that we have more knowledge, it's that because we have more knowledge we are somehow superior and therefore can inflict or force people into doing, etc, whatever we want them to.
12:28:57 And as others mentioned, we are, you know, oppression is occurring at the individual level and it's also the most definitely occurring at the system's level.
12:29:06 And so when we go back to this treaty and what that looks like.
12:29:10 I think I've spoken to this already but at a systems level, what the soil of this tree is doing the very structures that allow for Canada to exist in its current formation is in order to enact control, and to extract an exploit and wealth and resources,
12:29:29 whichever way they can. And then they built these hierarchies inherent to the soil, the roots are built in order to have people, you know, in order to kind of utilize a divide and conquer strategy.
12:29:41 So those who are, you know, in half more proximity to power will do what they can in order to gain some of the resources and wealth and control that others have while further marginalizing others who are been lower on the social stratification based on
12:29:57 these fruits. And so here we're talking about transphobia we're talking about system or Nativity racism able ism header patriarchy and imperialism at a global level, even though we won't be talking about the global relationship around the drug war today.
12:30:13 And just wanting to highlight since we're talking about the war on drugs we're talking about safer supply programs.
12:30:19 When we look at the ways that the health care system treats people who have been deemed by others to have quote unquote problematic substance use so this may be others are are making an assumption that the way someone is using substances is more harmful
12:30:32 harmful to them than not, or it's more harmful to others around them than not, or that it's more harmful to society because that person is that not engaging and the capitalist system and you know they can't extract wealth, out of their labor.
12:30:48 What we find repeatedly over and over again and this includes through our drug policy is a degree of disposability, so if we can't have you absorbed within our system in order to exploit you through that, then we will criminalize you and incarcerate and
12:31:01 that can include incarceration within prisons within police as long as within healthcare settings.
12:31:09 Because if we can't extract from you within the mainstream system, then we're going to try to erase you but ensure that we can still make a lot of money out of you.
12:31:18 So if we think about the prison industrial complex and the amount of money and wealth that's created and generated for people who are within institutions, particularly prisons.
12:31:30 You can see how the control and wealth extraction and exploitation continues even when people are in prison.
12:31:38 The other point that I'll just make here is just that, you know, we've continued to use our drug policies in order to enact this vicious vicious cycle of violence and it's very kind of urine Christian idea, you're a Christian idea of if we just, you know,
12:31:55 because substance use and substance use in a way that's being problematic by the society we live in is an issue of individual quote unquote feeling. We will punish people we will make people hit rock bottom which is often the language you'll hear, including
12:32:10 and clinical offices.
12:32:12 in clinical offices. But if we push people into feeling bad enough, we will somehow get them to change their mind. And so, again, recognizing, it's just fulfilling this prophecy that the system has created in order to continue to maintain itself.
12:32:27 Okay. What I was really interested in and what I'm hoping to share with you is oftentimes we'll talk about the roots of the tree, as if, you know, recognizing that the roots of this tree definitely exist within our so called prison justice system, where
12:32:42 they may exist within education, but I find within healthcare settings it's often seen as you know healthcare spaces are ambivalent, this is where people who are altruistic will come in, in order to provide care for other people out of the goodness of
12:32:58 their hearts etc etc.
12:33:00 without really thinking about how the roots of this tree have been deeply embedded in the history of our medical system across North America. And so this is why I wanted to share a few examples with you today.
12:33:15 And I'm flagging it as a content morning So, particularly for those of you who may belong to the communities of people that we're talking about through these examples, please feel free to step away and do what you need to do with maybe for the next, I
12:33:27 would say, 15 minutes or so.
12:33:30 say, 15 minutes or so. And for those of us who may not necessarily belong to communities and particularly I'm talking about black indigenous other racialized communities, queer and trans people through these examples.
12:33:42 So if we are not necessarily belonging to the communities and you're experiencing a lot of discomfort. While we go through these examples, I encourage you to try to stay with us as much as you can, because I do think that there's a lot of power and discomfort.
12:33:55 And I think in order for any of us to shift and grow we have to feel discomfort within our bodies in order for us to actually have an embodied understanding of what it is we're trying to then dismantle and change to create something better out of.
12:34:10 So hopefully that makes sense. So recognizing that discomfort is not the same thing as safety and trying to stay with us if what you're feeling is uncomfortable, not unsafe.
12:34:21 Okay.
12:34:24 Um, does anyone recognize who this might be.
12:34:31 Let's see if anyone in the chat does.
12:34:34 Tommy Douglas Yes, I've just noticed the more depending on the age of the craft.
12:34:40 Because I have done this a little extra to medical students who are younger, they don't necessarily recognize who this is, which does make me feel older, but I'm glad others are able to recognize it this is Tommy Douglas, you know, father of Medicare,
12:34:55 etc etc. I'm not sure how many of us for those of us who have gone through professionalized training actually learned about Tommy Douglas his work particularly around eugenics.
12:35:09 And so when I say that what I'm talking about is in 1933, Tommy Douglas published his master's paper he graduated at that time.
12:35:18 And his master's paper was titled The problems of the sub, sub normal family, I believe, and essentially he looked at what he proposed as eugenics solutions such as segregation and sterilization to limit the spread of quote unquote some humans who he
12:35:44 as women who engage in sex work people with disabilities people belonging to the LGBT community and of course indigenous people. And, you know if this was just one person's masters paper.
12:35:48 That's okay. And let's see what how he shifts because later in his career he does actually apologize for the work that he did, but the same year that he published his master's paper was also the same year that Alberta, had no sorry DC actually passed
12:36:05 their Sexual Sterilization Act here I'll show you the first page of the Act from Alberta and a couple of years before then, in 1928, Alberta had passed their Sexual Sterilization Act and In brief, then we'll go into a lot of detail.
12:36:21 What I will say is that this act involved a psychiatrist, a judge and a social worker who made up what they called the board of eugenics, and they oversaw the mass sterilization programs, and so called residential schools, as well as in quote unquote
12:36:36 Indian only hospitals, as well as other spaces within their provinces similar work happened in DC, and these acts remained in place until the 1960s, so not that long ago.
12:36:48 And then, I encourage people to read this book by Karen stone was published in 2015 and Karen still talks here about how the targeting of indigenous people continues well into the 21st century, and this book was published in 2015 and So up until that
12:37:04 point she had studied the 1970s and found that there had been over 580 sterilizations of Indigenous women that had taken place in federal hospitals across Ontario and so that includes hospitals in places like new factory and so look out where a lot of
12:37:20 us actually go into our training and present day as well.
12:37:27 Okay.
12:37:29 How many people have heard of the term Drake domain yeah
12:37:36 area. Yes, okay.
12:37:39 Yeah, so no car right. Okay, good won't go into too much detail.
12:37:44 But for those who haven't heard of the term drip Domenico, this was one of the earlier diagnoses in the medical establishment medical system in Canada at sorry not in Canada, all across North America.
12:37:57 And here, this was coined by Samuel Cartwright who was a surgeon and he published this in the New Orleans medical and surgical journal in 1851.
12:38:08 And here essentially what he was describing as a new diagnosis that he's found.
12:38:13 Mind you, he was also someone who had enslaved black people who he was, exploiting their labor from, and was a yeah ran a plantation, and in his paper he talked about how enslaved by people had who were trying to attempt to escape from slavery had what
12:38:34 he termed a medical disorder, which he called Romania, and he said that with proper medical advice strictly followed the troublesome practice that so many enslaved black people have I'm running away could almost entirely be prevented.
12:38:49 He put out prescriptions for the so called disorder with which he included things like you have to whip the devil out of them as a preventative measure, and he also suggested the removal of people's large toes in order to make running a physical impossibility
12:39:04 as a preventative measure, as well.
12:39:07 And so, you know, this is the 1980s and people in the early 1990s, and sometimes people will say to me, Well, monkey that was early times. This isn't the stuff that continues into current day, but we know that anti black racism particularly within medical
12:39:40 establishment has continued and remains pervasive and to present day. This here is a photo from a commercial Dinah psychiatric journal and here, this is where in the 1960s, when a lot of black power movement were on the rise, psychiatry has decided to
12:39:41 come up with a new diagnosis called the reactive psychosis, other term for it was called the protest psychosis, and what they said this was, and I'll quote one of the articles here, where they said a black youth who was diagnosed with psychosis was someone
12:39:56 who was influenced by social pressures, such as the civil rights movement. And as someone who is guided in content by African sub cultural ideologies and colored by a denial of Caucasian values and hostility there to encourage you to read a book by Jonathan
12:40:14 messy called protest psychosis house gets any became a black disease. This book was published in 2011, I believe.
12:40:22 And here, Jonathan metal, really traces how this new psychotic illness that was developed in the 1960s was later were replaced with a rise and the diagnosis of schizophrenia among African American men in particular to use in the US.
12:40:37 And this year is the commercial that I was talking about this was published in 1974 and the archives of general psychiatry and here they're showing you, someone who was quote unquote meant to be assaulted and belligerent, it's a commercial for Haldol
12:40:50 which is an anti psychotic to try to suppress their aggression towards the healthcare system, and also towards society and the book is called I'll put it in the chat.
12:41:02 It's called the protest psychosis, how schizophrenia became a black disease.
12:41:10 See if I can get in there.
12:41:13 All right.
12:41:16 No, the other thing that I just wanted to bring up here is, you know, we often look towards people like Harry slinger and the Nixon government for their, You know creation of the war on drugs, but I just wanted to highlight, you know, renowned Canadian
12:41:35 Canadian feminist judge, Emily Murphy, and I'm not sure how many people have heard, or have read the book that she published in 1922 called the Black Candle.
12:41:47 And the reason why I wanted to share this book and encourage you to read or listen to this CNBC interview. But the reason I wanted to share it is because right prior to that in 1988 when the first opium Act came into being came into being in Canada as
12:41:59 a result of anti Chinese Zena phobic riots and Vancouver won't go into details but encourage you to read it, there's a lot of documentation written about this.
12:42:08 And then, you know, a couple of a couple of decades later in 1922.
12:42:13 Emily Murphy publishes this book, and the kind of premise of this book is that people so racialized people around the world have created a conspiracy to and they banded together to try to correct the purity of the white race with the help of drugs and
12:42:29 essentially that's really what she's promoting and what she's promoting is that black and other non black racialized people should be deported out of Canada in order to prevent, you know, an order to prevent the intermingling and the lack of purity of
12:42:44 a white race from being able to continue its project of settler colonialism, and a lot of historians actually account to her publication of this book to the expansion of our drug laws in 1923 were heroin coding and cannabis were added, because she focused
12:43:02 a lot on heroin particularly cannabis in her book, as the drug that was being used by racialized people to corrupt again the purity of the white race.
12:43:12 So, I leave that to you just so that we don't continue to just look south of the border to find origins of the racist foreign drugs they have their ample examples and all of our drug history here and in Canada.
12:43:25 I will share this book by Gary get is largely because I wanted to flag, you know, we're talking about apologizing people.
12:43:35 As a result of issues of justice. And, you know, how is that related to the health care system in Canada. I would encourage you to read this book because I find one of the things that really stood out for me was, Gary get his talks about how, as you know,
12:43:50 new settlements expanded in Canada as as settler colonial was expanding and more land was being stolen the, quote unquote, Indian agent who was within these communities was often also the same person as the local physician or health care person that was
12:44:09 meant to provide care for the settlers who were around. And these people actually had the authority which continues in our public health last today, to be able to incarcerate anyone that they deemed would be a threat to the white settlers who were expanding
12:44:23 and stealing territory.
12:44:26 And, you know, we recognize how get us really talks about how the health care system particularly clinicians who had the power to be able to detain any indigenous person that they thought was a threat.
12:44:38 And so they would use things like you know risk of TV or risk of other infectious communicable diseases as to why they're detaining the person but they didn't have to actually have proof and why they were actually detaining them are not in the so called
12:44:50 In the so called any normally hospitals, and they talk about how the health care system really enforce what they call Tara Nellis right this idea that land is quote unquote I'm barren because it's not habituated by white Christians, and therefore for
12:45:05 the taking.
12:45:05 By the crown.
12:45:07 And so in order to actually have the land quote unquote be barren indigenous people were actually literally removed from it through the work of physicians in incarcerating them because of a threat of infectious risk to the white settlers who are coming.
12:45:22 So leave that example there, who time. Okay. I'll go through these briefly I imagine many have heard of some of these experiments and studies already but if you haven't, please feel free to check out the link they're all available online.
12:45:39 But the bottom here is a medical instrument, but all of us still use if you're ever in the or. This is a instrument that's called the sim speculum, and it's coined after Miriam Sims, who was one of the, what we would call the father of modern gynecology
12:45:55 and Miriam sins actually developed the speculum and became so famous in part because of the research he did on enslaved black women who, who were under his control, and he provided surgical, he operated and did a lot of experimental surgery is particularly
12:46:13 around Bagnall visualize on enslaved black women without giving them any anesthesia, because again this assumption that, quote unquote, black people feel less pain or are not you know not needing and a car or any pain treatment Well, he was doing these
12:46:29 experimental procedures. At the same time as he was doing them. He was then perfecting those surgeries and then doing them on white women and people would vaginas and would often offered them access to pain treatment in order to ensure that they were
12:46:42 to the process and the legacy continues today there's a lot of particularly black feminist organizing and resistance to really take down his statues because they exist all over North America as well.
12:46:55 And then the surgery. This article here by Kelly Hoffman and colleagues I was published in 2016, really looks at the fact that it's not because you know clinical black people have other coexisting comorbidities like poverty or other reasons as to why
12:47:12 they get less pain treatment because that was their justification that because black people are more likely to be poor in the US, or more likely have history of substance use issues etc etc.
12:47:23 That's why they don't get opioids for their pain treatment when they come to emerge and emergencies.
12:47:28 And then they found when they actually did studies with medical students and residents, that the rationale rooted into all of it wasn't just these, you know, social realities, but it was also the fact that majority of the white medical students and residents
12:47:43 actually believed in a lot of the, the, you know, pseudoscience and fake science that was created in order to justify slavery. So things like black people have shorter nerve endings have thicker skin, etc etc.
12:47:57 So a lot of people in present day, continue to believe that as clinicians and, you know, consciously or subconsciously This is also part of what what actually deters them from prescribing appropriate pain management, when people are being seen.
12:48:13 And then of course we know that the dehumanization of people, and, you know, seeing people is less than full human, and therefore harming them continues until present day.
12:48:24 I was really surprised I hadn't heard about Stephanie, Warner until earlier, until late last year, when a colleague of mine Matt Johnson had actually done a presentation with us and Stephanie was someone who was waiting in an ER at the trauma General
12:48:39 Hospital, just off the street from where I work in clinic. Last year was ended up being restrained by a hospital security guards and killed and in the process of the treatment security officers were seeing to actually move the cameras away.
12:48:54 And so there's no account of what they actually did to her.
12:48:58 And people talked about the fact that she was waiting there patiently but this was someone who had been identified as someone who was experiencing homelessness and was someone who was using substances and, you know, recognizing all the reasons why the
12:49:10 security personnel and health care workers around them.
12:49:14 Not intervening felt that they could actually physically dehumanize restrain, and kill this woman without any consequences and that continues to be the case of corner team her death on camera with the legal language was, but it was not deemed a homicide.
12:49:31 Okay. Why am I sharing all of this with you. So, part of the reason why I wanted to just share all of this was that in the report that I had written which I encourage you to read it goes through these and a lot more detail.
12:49:44 Really when I say medical violence, what I'm trying to summarize is that the roots of the tree that we've been talking about.
12:49:52 Continue to show up in lots of explicit and implicit ways within clinical practices, and some of the more structural ways that they continue to show up, is through forced you know attempted genocide so eugenics which continues in in much more subtle ways
12:50:07 in present day through medical experimentation and through dehumanization, and through medical issues of social injustice and denying that structural violence actually exists, and we can talk about how this occurs, particularly against people who use
12:50:25 drugs for the whole rest of the time, we could, but instead I'll just encourage you to check out this resource if you haven't imagined many of you here today already have.
12:50:34 But if you haven't encouraged you to listen to crack down, especially their episode on methadone and their most recent episode on Suboxone to try to think about how these different ways that medical violence continue to show up, or explicitly coming up
12:50:47 over and over again. So, over and over again against people who use drugs and particularly drugs that have been criminalized.
12:50:56 Okay.
12:50:58 So, part of the reason for why I'm really sharing, any of this is because I think the fact remains it's not just that we may hold consciously or subconsciously may think negatively or unfairly about other people.
12:51:11 It's the fact that those of us working within the healthcare system actually have institutional backing and political power to act in oppressive ways, without limited public knowledge, let alone scrutiny, a consequence for accountability.
12:51:25 And so, hopefully this quote kind of rings true for a lot of people and helps you reflect it also Google and find the entire speech that Stokely Carmichael made in the 1960s.
12:51:38 It's a really important read.
12:51:44 So, here's some of my thoughts of what I continue to think about and continue to shift in terms of what to do from here right, understanding that medical violence exists, understanding that the roots of the tree are deeply embedded within all of our institutions
12:52:02 and society, including the healthcare system. And where do we go from there. I think importantly for me this quote from Octavia Butler has always been really helpful.
12:52:13 Where you know here, she says, all that you touch you change all that you change changes you and I think for me the reason why I share this quote is that because we know oppression manifests itself from the internalized all the way to the interpersonal
12:52:26 institutional and societal level.
12:52:28 I think it's important and I think it behooves us to recognize that when whenever we're engaging and resisting medical violence, we have to do that at all four levels simultaneously.
12:52:39 And that might shift based on our own personal skill levels and what brings us joy and what we like to do, but I think it's important to recognize that we can't just critically think internally amongst ourselves or with just the handful of people who
12:52:51 are close to us, without engaging in radical change making work at a societal level. And we also can't just focus on external you know societal level changes without ensuring that we ourselves are also changing and growing in the process.
12:53:08 And at the interpersonal and if they internalize level, what's been really important that I brought up discomfort before is this idea of really embracing the discomfort and dissolving guilt, because I do find guilt is a really self serving emotion, very
12:53:22 common one, all of us experience it all the time. Usually when critiques are brought forward with the healthcare system majority of us and including a lot of providers and clinicians, our gut reaction is to be defensive and to experience, you know, be
12:53:37 defensive because we're trying to get dissolve our guilt and try to deal with it. But instead I'm really hoping that we're able to actually answer that question, I had asked in the beginning in terms of practicing the skills that we need in order to know
12:53:49 when the assumptions that we hold the attitudes that we have and the ways that we are behaving may actually indeed be marginalizing excluding or dehumanizing someone else and you know oftentimes it was called self reflexivity when we're talking about
12:54:02 education in the healthcare system. But I would say, for me, you know, when we talk about self reflexivity it's this idea of having to do the work to really process through to try to break down our own understanding and think about our privileges, but
12:54:16 my main thing really to contribute to that is that we can't do this in isolation, we can't do this work in terms of gauging our skill level around picking up the ways that we made to humanize other people and an internal and interpersonal level without
12:54:30 actually talking with other people and being open and critically looking at the way that we have structured, our communities or clinics, our offices, etc.
12:54:41 And I think part of this for me also means looking at the language that we use. And I think that that's important to always I think,
12:54:52 Oh, I appreciate that. Yeah. Guilt is an obstacle to taking responsibility, and taking responsibility is a prerequisite for change.
12:55:00 And I really often like to like break down the word responsibility for me responsibility is response and ability. So what do we have the ability to be able to respond to.
12:55:10 And we have to commit to actually responding. And when if our abilities shift our responsibility shifts alongside that too.
12:55:17 So thank you to the person who went there in the chat cameras like oh yeah so language languages is incredibly important.
12:55:26 And I think part of the reflection and the reflexivity piece is also really thinking about who stories are actually listening to, who are the people who are actually coming in and feeling comfortable seeing you in your practices, who's actually missing
12:55:39 who's getting policed whose histories are surviving I think these are really really important things to think about when we're practicing on a day to day basis.
12:55:47 And oftentimes, part of the guilt can also be coming up with these justifications that you know, I don't have time My hands are tied the structures that are the way they are like that and I think really part of the the embracing the discomfort piece is
12:56:02 actually working towards figuring out where that initial reaction of my hands are tied I can't do anything about this comes from, and working to actually challenge that amongst ourselves as well, in order for us to not actually be gatekeepers to institutions
12:56:17 and services and health knowledge and care, but instead actually be care workers, and I really like this quote from Sophia Bartlett where because Allison Baker had posted about how you know love when people talk about barriers to treatment as if many
12:56:34 services themselves aren't their own deterrent. Not all help is helpful, and some help, is hell. And I think that's, I think all of us can probably think about a lot of people who have shared that with us or people here who have obviously experienced
12:56:49 that life.
12:56:51 And so we're here to talk about you know my favorite is people who talk about hard to reach patients, how about we flip that around what about hard to reach doctors are hard to reach services or services with crappy barriers and restrictions on access
12:57:05 or doctors with city, attitudes, which again I think brings up to really shifting the conversation around reflection.
12:57:13 When we're having these conversations about times when we have harmed other people at the clinical level like up the interpersonal level within our clinics, I think for me, what's been really helpful as a framework is really understanding that my role
12:57:26 there is a practice healthcare is an act of solidarity, not charity. And when I say solidarity I don't mean just experiencing sympathy for other people I mean genuinely showing up as someone who is invested in dismantling the institutions and the power
12:57:40 and resources that they hoard and moving them towards those who are most at harm's way from structural violence in our society. And this quote here by Monica to lead hopefully you can read it.
12:57:53 I think for me, this is the essence of safer supply, in terms of why I'm doing safer supply. I do not think say for supplies where the liberation is at, particularly in its medicalized model that many of us are practicing in.
12:58:05 I solely really practicing for supply and because trying to support people and actually staying alive, and not just staying alive but support people in being able to organize with others around them and get access to power and resources away from institutions
12:58:22 that are continuing to harm them.
12:58:24 So hopefully that resonates or makes sense.
12:58:29 I'm gonna skip some of this for sake of time so we have lots of times for conversations.
12:58:35 I wanted to just talk at the institutional level, about why I think our history doesn't have to be a legacy and I think the only way that that can be true.
12:58:45 So when I'm talking about history I'm talking about all of those examples of medical violence that I went through.
12:58:50 That is the legacy we're inherently, but it doesn't have to continue to be. And I think this is where organizing ourselves within our workplaces and also outside of our workplaces because there are going to be inherent limitations to what we can do within
12:59:04 them is really important, and I share the eight white identities framework from Barner has because, you know, these are action. This is so that you can use this on whiteness you can also use this on lots of other forms of oppression.
12:59:18 But here, these are all actionable items. All of us exist and one of these places one way or another. Either we are actually holding on to our premise ideologies, or we're starting to get to the place where we're being critical of the dominant oppressive
12:59:35 ideology, whether it's whiteness or whether it's something else, or we're starting to shift beyond being critical towards becoming traders and I think people often will police how people engage in resistance I think it's really important for us to actually
12:59:50 engage in ways that works for the communities around us.
12:59:54 And actually work towards becoming, not just traders but moving from being traders to our institutions towards actually being abolitionists so working towards dismantling the ways that we structure our clinics ways we structure our practices.
13:00:08 Our goal should be working ourselves out of our current role, and out of our current jobs, if our jobs are reliant on making money off of the way structural violence harms people on a grand scale.
13:00:21 And when I say that a lot of people are like, ah, but I love being a doctor I love being a nurse practitioner I love doing this. I don't think there will ever be a place where your role, and the care work that we can provide is not going to be necessary.
13:00:35 I think the differences. I would love to support people with, you know, potentially, I was gonna say high blood pressure, but often environmental racism and so many other factors also lead to high blood pressure, but you know I would love to support people
13:00:47 people in doing preventative care and doing their Pap test, you know, supporting them and seeing if they develop diabetes or not, as opposed to continually trying to support them through for issues that are really really rooted and issues of justice that
13:01:02 we as a society and as a community need to dismantle.
13:01:06 Hopefully that makes sense.
13:01:08 Okay, um, in terms of a societal level so this is a piece that I was saying, I think, we can't just do this work into personally or within our clinical spaces, we have to engage more broadly with the ways that grassroots movements for justice are demanding
13:01:24 change to happen we have to support and uplift struggles for indigenous sovereignty and black liberation.
13:01:32 In particular, as well. And I think for me what that means when I'm as a clinician as someone who's operating as to ensure that the work that I'm doing actually centers the margins, because everything in healthcare is very much rooted in proximity to
13:01:45 those who have power and, you know, so for example, we'll get a new technology made and healthcare, some new screening test or X ray machine or whatever, and then usually it's followed up by 10 years of research as to why X and Y marginalized groups can
13:02:01 access that new technology or new fair be or whatever has been created. And if we actually flip that completely and actually Center, the perspectives and experiences and solutions coming out of those who are most pushed to margins of power within our
13:02:16 society, a framework, brought to us by black feminists like bell hooks and as well as Third World feminist like gender Monte here.
13:02:25 I think you can think about how then if our solutions are coming from those who are most pushed to the margins, then the solutions that we create will inevitably also support others who are then closer proximity to power.
13:02:38 An example of this is how the healthcare system responded to rise an overdose deaths by curtailing high dose opioid prescriptions on the odd formulary.
13:02:49 And so we can't prescribe high dose fentanyl patches we can't prescribe high dose injectable hydromorphone because this was the healthcare systems we are responding to their own sense of obligation without actually asking those who are most at risk of
13:03:04 the war on drugs and most at harmed by the war on drugs around with the solutions could be.
13:03:11 Okay, I definitely wouldn't want anyone to walk away from today with thinking that that medical violence has, you know, continue to happen without any resistance to it.
13:03:23 I think it's really important to acknowledge that communities who have borne the brunt of medical violence, have always been at the forefront of resisting it and have been often criminalized as a result of resisting it, and that continues until present
13:03:38 day.
13:03:39 And, and that oftentimes the communities who are making engaging in this resistance work, have not just improve the health broadly, at a community level for the communities that they were fighting for, but have also improved the health for many others,
13:03:54 and so example of here is a photo of the Black Panthers doing their sickle cell training program. And in the 1970s, the Black Panthers I think the estimates are somewhere about 10s of thousands of children and people were were actually screened by the
13:04:09 Panthers nationwide, and it changed the Nixon government at the time to pledge millions of dollars into sickle cell, diagnosis, and it created the sickle cell disease Association of America as we know it today.
13:04:23 You know, there's lots of critiques on how, why Nixon did that I think part of the reason for for actually putting a lot of that funding towards that goes all disease.
13:04:31 At that time, was to actually try to strip away power from the Panthers who were such a threat to the nation state.
13:04:37 But that's a conversation for another time in terms of how resistance struggles are co opted by dominant institutions, including safer supply progress, which we could talk about here is a photo from the Young Lords.
13:04:52 The Young Lords was a grassroots organization made up of Puerto Rican migrants. I listened to a podcast recently and I was blown away that the Young Lords were actually people who were aged 13 to 18 predominantly, which I just, like, incredible in terms
13:05:07 of the work that they were able to do within their communities. And here is a poster because Young Lords decided to take over Lincoln hospital after they found out that children who were being admitted for different issues were coming out of the hospital
13:05:21 with lead poisoning because of how poor the facility was.
13:05:25 And so, and this was Lincoln hospitals, you know, major hospital serving the South Bronx in East Harlem in New York where a lot of the Lord's also lived an organized.
13:05:33 And so they decided to take over the building they had, you know, a 200 healthcare workers who were in the eMERGE actually stayed with them in the occupation.
13:05:41 And these were some of the demands that they were asking for I'm not sure if you're able to to see them here, you can definitely read a lot more about them.
13:05:48 But included things like you know minimum wage for all workers childcare center.
13:05:54 Support for treatments like nada, which is a, you know, an ear acupuncture protocol for people who are going through opiate withdrawal, which was something that the Young Lords actually pushed forward to try to bring into the health care system in the
13:06:08 Bronx at the time as well.
13:06:10 And then here is an example of act up, you know, here's organizers, so this is aids coalition to unleash power organized a lot and pushed for access to ARV says we currently know them.
13:06:24 This is them actually doing a dying outside the FDA and this action amongst many others actually pushed the FDA to release a lot of the new drugs that they had been working on into the market so that the early days of AIDS medication called AZT wasn't
13:06:37 the only option that people had available to them when they were dying of HIV. And of course we have frameworks of compassionate.
13:06:46 Compassion clubs where people with HIV started coming together lumping medications from each other when people were in their loved ones were passing away in order to also provide mutual aid and support for one another example is that a lot of people who
13:07:00 use drugs and harm reduction activists also utilize to come up with creative solutions and present day.
13:07:07 Here's an example of moss park a lot of harm reduction workers here in the city but I'm in in Toronto, taking up tents.
13:07:14 In, in a park where there's a high overdose rate in the city. And this was done because the, the delay a bureaucratic delay around funding for the first three surprise consumptions science was continuing to happen and people were dying of overdoses accelerated
13:07:30 rate as they have been for quite some time now and directing these tents and actually operating it for as long as they did in itself and it was you know a powerful experience where people who use drugs got to build their power collectively, but at the
13:07:44 same time, they also push the province shame the province into really releasing the funds that the three agencies needed to actually enact the first section overdose prevention sites.
13:07:55 We've got saved supply concept documents coming out of Capone Academy Association and people who use drugs, see a number of the members here in the chat.
13:08:03 And so here's people who use drugs actually coming up with ideas and solutions and high address the war on drugs, and it, you know influence influencing many of us, including myself, this came out in February 2019 which is the same one that I started
13:08:18 prescribing safer supply, and then more recent action by Dolph the drug users Liberation Front and Vancouver, where they're really challenging, what it means to actually have access to say supply that is not a medical eyes model, their demands include
13:08:34 having accessible legal framework that de criminalizes licenses funds and provides facilities for, for people to have spaces for heroin, cocaine and methamphetamine compassion clubs.
13:08:47 And for the government to immediately fund programs for safe and accessible supplies of all drugs, including cocaine and heroin and crystal meth by directly listening to user groups and people who use drugs and adding these drugs to the formulary for
13:09:00 allowing drug users to actually create their own roots have access, and they've had some incredible actions where they've actually handed out tested, drugs, through collaboration with band do, and many other organizations as well.
13:09:15 So, point really is oftentimes we will ask like, what do I do at a societal level, just important to remember that communities who are resisting at the front lines of resisting the war on drugs that are coming up with solutions have always been coming
13:09:28 solutions. So the question for ourselves is really thinking about what your skill set is in terms of how you can remediate those skills or knowledge back towards the grassroots communities who are engaging and resistance on the front lines.
13:09:43 And, you know, sometimes I share the example of the Young Lords stealing an X ray TV van because they weren't doing TV screening for the community members, where they lived.
13:09:52 And so I always think about, well, who was the person who was the X ray technician that taught the Young Lords how to actually run the machine, and how can we be that person like what are the skills tangibly that we have as clinical providers to be able
13:10:05 to bring that into the hands of communities for resisting, because ultimately we need to be able to support self determination, which I think is a necessary prerequisite to towards health and full healing and collective liberation.
13:10:22 And ultimately, final, final message really is, if critical reflection, we need to be able to critically reflect, often do that with each other. And we can't just stop at the reflection and the I'm learning and learning we have to actually engage an informed
13:10:36 collective action, we have to make mistakes. We have to learn from those mistakes we have to shift our strategies that we have to try, you know, 100 different things.
13:10:47 And that doesn't mean you as an individual needs to try 100 different things we need to support all of us and engaging in ways that makes sense for us and that brings us a lot of joint and restoration in the process as well.
13:10:58 And that's what's really needed in order to build actual social change. So, I'll leave it at that.
13:11:06 Any questions, and I can stop share screen.
13:11:12 So I can see all your faces.
13:11:19 I think I see a hand.
13:11:23 Thank you. Would you like people to use the question and answer just in the chat what's easiest for you. And we're watching chats good yeah whenever. Okay.
13:11:31 Great. Thanks.
13:11:38 Thank you for your kind messages everyone I'll share the link so everyone has access to it as well.
13:11:45 I know Rebecca you're going to probably be doing some kind of evaluation I'm sure my managers would also want me to do that but I will leave it to you to do the evaluation pieces, it will will share them with your donkey.
13:12:02 What if it is okay, I'd like to just do a really quick poll.
13:12:07 That is partly for our funders, also the car reach right now. And so while I do that people can have a look at.
13:12:17 Think of some questions or discussion points that you'd like,
13:12:22 like to discuss with everyone,
13:12:26 Because I think it is a really thought provoking presentation and.
13:12:32 And we can also have.
13:12:35 Have some more talk like in the future about this, I think this isn't. this is ongoing work as you said, monkey and we need to keep this stuff on the agenda, all the time which is why we've started the national community practices started with, with this
13:12:49 presentation with monkey.
13:12:57 Yeah, no, I'm happy to answer any questions that come up for folks and share thoughts because I do think that we're constantly in a contradiction, for those of us who are working and say for supply programs I think especially as many of us get health
13:13:13 Canada funding I, I've been reflecting a lot about how power constantly re organizes itself to retain power. And so, when governments are giving, you know, a handful of funding to see for supply programs in the process.
13:13:30 They're also absolving themselves of actually working towards abolition and D funding and decreasing decriminalization, as well as regularization and legalization of drugs.
13:13:43 And so, you know, part of that is why I think for those of us who are working in safer supply programs, it's such a important responsibility for us to actually continue working alongside people who use drugs and grassroots organizations and actually demanding
13:13:57 for full decriminalization and legalization, as well as abolition of prisons and police, as some fundamental necessary changes in order to actually address the overdose crisis.
13:14:20 It's really important.
13:14:21 There is a question here from.
13:14:37 Sorry I'm interrupting your poll.
13:14:41 Okay.
13:14:45 Um, I'm just looking at there's, there's so many wonderful comments and thanking thanking you for this presentation donkey.
13:14:54 Okay, there is a comment here from Malika Sharma monkey. Can you comment on how to push this critical understanding of medical violence in places that have been structured to be removed from community like hospitals in patient care.
13:15:10 Often the biggest and actress and violence.
13:15:13 Thanks.
13:15:14 Yeah, thanks for that tough question Monica,
13:15:20 I think.
13:15:22 So I I'm always of the opinion. So oftentimes people will say like what do you work in the system to work outside of the system and I, I definitely feel like, for those of us who are in these institutions where a lot of powers hoarded and particularly
13:15:37 in hospitals where clients who are coming in who are being hospitalized are also at their most exploitable right like they're constantly being exploited they're being poked they're being woken up at any hour of the day, their humanity is not actually
13:15:52 part of the conversation is very much this transactional delivery of health care if I can call it care, and not to say that incredible clinicians like you who is the person who asked the question, don't exist within those spaces but I think this is where
13:16:07 having conversations with your colleagues and building relationships in smaller groups of people to build that critical analysis together is going to be so so important, because I think you have to be a little bit covert before you can actually get your
13:16:22 entire institution to shift and you have to build alliances with a lot of people who you may expect to be aligned or others who may not, but really finding those people through all the nooks and crannies of your hospitals in order to come up with all
13:16:38 the strategic ways that you can to push leadership within these institutions to do the bare minimum, but also remember that changes from the top down, aren't going to be sustainable if the actual people carrying out the care work the healthcare delivery
13:16:54 are not actually aligned with what the changes are meant to be. So you could have a surprise consumption site.
13:17:01 And people coming in, and people could then just be treated like absolute shit, and it's not going to buy the actual people who are physically in the subways consumption side delivering that care or checking people in, and it's not going to actually meet
13:17:16 meet the purpose of what the organization was trying to do so I think it has to be a bit of this two prong approach where you kind of build the critical consciousness of colleagues around you through every in any way that you can while continuing to then
13:17:30 you know in all your directions that you have access to push for larger changes at the top.
13:17:35 Hopefully, that works.
13:17:40 And definitely I think organize with people outside of your institution. I think it's. This is where the being traders and working towards being abolitionists really comes in like leak things to people outside like give people who are resisting your institutions,
13:17:53 the knowledge and the resources and the information they need in order to put the pressure on externally which you yourself can't do because of the, the, you know implications of that might have for your livelihood.
13:18:05 And so be strategic in that, you know, don't publicize it, I can say it in this presentation, but I think that is actually a really important skill that we should all have how do we actually support genuinely support the leaking of information and resources
13:18:21 and skills towards communities.
13:18:39 Yeah, Allison asked a good question. I don't know how much time we have I'm assuming we have to 130.
13:18:45 So Rebecca if you're okay with that I can respond to that.
13:18:49 Yeah.
13:18:50 So, since 2008, I've done a lot of workshops to try to change the oppressive discourse yet I see time and time again. Participants hundred percent agree on the concept, yet in practice continue to press and stigmatized people.
13:19:01 Do you feel that at some point there has to be some type of accountability as opposed to education. Yeah hundred percent I oftentimes, and when people think about accountability they're thinking punishment.
13:19:12 But I think it's important to separate those out. I think accountability should be unnecessary part.
13:19:19 And I think there's a very limited lack of accountability within our healthcare and social institutions and I think we can't do this work without actually building strong accountability processes because you and I could have this conversation, all day
13:19:35 long.
13:19:36 I could actually go and treat someone like absolute crap in our clinical appointment, and no one will actually have knowledge of that.
13:19:44 And this is also part of why I think being in a safe resupply program one of my responsibilities has also been to ensure that the clients I'm working with do get access to organizing with each other, obviously coven has really disrupted that but you know
13:19:58 having drop ins where clients are talking with themselves having advisory committees where the prescribers are not actually present for all of the conversations, so that people can can actually strategize and build conversations together and build structures
13:20:11 of accountability that will actually work as opposed to just slapping an idea of accountability of the institution things is enough to.
13:20:21 There's a question in the q amp a.
13:20:24 How can we create a culture within our workplaces, that welcomes disruptors and people who speak out against power hoarding and medical teams person feels like I'm risking my job labeling myself as insubordinate my advocate in a way.
13:20:37 Yeah.
13:20:40 Yeah, this is a tough question. I I'm lucky in that I work within an institution where I at least know that my executive director is open, and fully knowledgeable about who I am as a person before I was hired.
13:20:57 And so I it's hard for me to answer this because I, you know, I, I will risk a lot of things and one of the responses I've had from my leadership is that part of hiring you also means that we have to be open and willing to shift because I know that this
13:21:12 is going to be a challenging relationship one way or another. And I think that's actually really helpful with, you know, both people who admire each other but also can acknowledge that.
13:21:20 But if there's going to be challenged there's going to be conflict and we have to work through it.
13:21:25 If you are not in that situation, I think you do have to be very strategic, you have to be mindful of how you're organizing meetings where you're organizing meetings how you're working with your colleagues.
13:21:38 And you have to. Yeah, you have to be a just a bit more strategic in terms of the ways that you're asking for change whether within your institution or externally.
13:21:46 So similar to I think what I was saying to Monica.
13:21:49 So just depending on how open the leadership is of where you're working will depend on how you would, I think utilize different tactics to address it.
13:21:59 Hopefully that answers.
13:22:01 There's another one from the q amp a prescription based models of safe supply transfer the risk to prescribers and away from government and regulators, how can we advocate with regulatory colleges to become part of the solution instead of hoarding power
13:22:15 over prescribers.
13:22:16 Yeah, that's a good. That's a good question. I think for me.
13:22:23 Yeah, I think this is where it's been interesting to see how the regulatory colleges have responded to say for supply because I don't think any of us who were prescribing anticipated for example the CPS over to come out, acknowledging that for supplies
13:22:39 happening and here's the parameters with which we hope you do. And I think when that shifted, there was a little bit of a, you know, yes, it's helpful for those of us who are prescribing to not feel like we're going to be constantly on edge of having
13:22:52 our licenses being taken away, but I think there was also a little bit of this absolving themselves of responsibility, that's happening, also at the government level.
13:23:02 And I think part of the pushing of that is to continue to focus on a broader societal level changes because I genuinely think our regulatory bodies are going to be the last places where change happens.
13:23:17 Yeah, others are responding to it and so oftentimes people will say you know like we need to really struggle to make the change happen I think I'm of the mind that we need to actually find other people who are more aligned to us at a broader societal
13:23:30 level and work towards increasing our overall collective power, as opposed to going to those who are going to be the most in opposition to what we want to do, and wasting a lot of our time and resources and trying to shift them.
13:23:44 And I think hopefully that helps with the work that you're, you're doing.
13:23:50 And I think yeah bill, they will definitely need external pressure from many directions, not just from prescribers, but I think this is where we need to have policy level shifts that are governmental and institutional levels.
13:24:08 I often share like the spectrum of allies framework, which has been really helpful in organizing for me as well, to try to think about who are your direct opponents versus who are who could be allies and somewhat allies and really nurturing, those who
13:24:25 are more aligned
13:24:29 folks can that's helpful.
13:24:38 Any other thoughts or questions.
13:24:51 I mean I also say this with the, the grain of salt is like this is my.
13:25:06 theories and practices out there and so I think doing the work and actually learning about them is also really important for those of us who are engaged in not just providing clinical care and, but also engaged as political actors in the world, but hopefully
13:25:22 some of these resources are helpful for you.
13:25:31 Thank you, let me say, deep deep thank you for this presentation, and for starting us off.
13:25:38 In such a great way for this national community of practice.
13:25:44 If there's any other questions for a non key or comments that you'd like to make in the chat. That's great.
13:25:51 I did see a hand up from Emma.
13:25:55 I'm just not sure
13:25:59 if they were able to ask the question.
13:26:05 And yeah, thank you.
13:26:11 Gabrielle for. Yeah, they've been translating and really really appreciative.
13:26:13 Okay, thanks.
13:26:17 I'm just gonna share my screen to tell you a little bit about what's coming up.
13:26:24 So we would like to invite you to check out our new websites.
13:26:30 And if you are currently a member of the community of practice, we would like to ask you to register on our website. So, we have you registered as a member, and we'll make sure that you get to continue to receive the information and access to resources,
13:26:50 and all of that. If you're not a member we would love to have you join us.
13:26:56 There is, again, you just go to our website and there's a join page there so you just joined there. We're also now, Twitter, Instagram and Facebook. So you can look for information from us there as well.
13:27:13 So you can look for information from us there as well. So we have some upcoming public events, and then we have some upcoming members only events, and some resources that we're going to soon be making available to our members.
13:27:24 So public events we've got Corey Ranger who's an RN at the Victoria safer program in Victoria BC.
13:27:41 Corey is going to do a presentation about safety supply one on one, and will be sort of providing a bit of a background instituting safer supply including the medical models its limitations and such.
13:27:46 Within the current discussion around safer supply. So that's happening next Thursday from 12 to one hope you can join us, please do register in advance to register you can also find all these links on our website.
13:28:01 And then November 8 Corey Ranger and a key among are going to do a talk about emotional harm reduction.
13:28:11 And that is happening from one to 2:30am, Eastern, it should be Eastern Daylight Time will be that by that.
13:28:19 And then on November 25 Julia cola will be presenting the lead the major community health centers safer opioid supply program evaluation.
13:28:30 And that again is 12 to 130.
13:28:34 And in terms of member only events and resources, as I say, you do need to register to be to be able to access these things. We have a prescriber panel that's going to be happening December 16 and talking more about these tensions that arise for prescribers
13:28:53 trying to offer safer supply from a harm reduction approach, but also working from amount of within the medical model.
13:29:02 We are going to be launching a prescriber consult line within the next couple of weeks.
13:29:08 So stay tuned for more information about that if you are somebody who describes saber supply.
13:29:14 You do need to be a member of the community of practice. And then you also need to register, as, as someone who can participate in the consulate line.
13:29:24 We have more information for that coming out, just feel free to reach out to us. And then we are in the, in the process of organizing some rules specific workshops around say for supply.
13:29:36 So that's coming in January, we've started some working groups on talks on topics such as diversion.
13:29:42 Securing access to pharmaceutical alternative, or just pharmaceuticals rather employing people with lived experience. And then we also offer consultation and support so we've had some workshops on funding applications and provided some assistance with
13:30:00 funding applications as well as connecting people and talking about program development policy development that sort of thing.
13:30:08 So, yeah, hope you'll join us you can contact us through the website and get information there.
13:30:15 But on behalf of the team the organizing team or the secret the national senior supply community of practice to.
13:30:23 I'd like to my big big thanks to Nokia and Gabrielle.
13:30:29 And to all of you for joining us today.