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Controversy surrounding the future of Insite, the Downtown Eastside facility that offers supervised injection for drug users, has sparked renewed interest in the West End's Dr. Peter Centre, Canada's only HIV/AIDS health program and care residence that also includes an in-house safe-injection service. Compared to the lingering debate surrounding the Supreme Court ruling in late May granting Insite's continued operation as a dedicated safe-injection site, life at the Dr. Peter Centre has retained its relative calm. While Insite tenuously operates under an exemption of federal drug law, the Dr. Peter Centre never needed such an exemption, according to the centre's executive director, Maxine Davis.
“We decided to not pursue requesting a Section 56 exemption approach that Insite is using, because the Section 56 exemption, we felt, our nurses were not contravening,” Davis says, with regard to introducing the safe-injection program at the centre six years ago, a year before Insite opened its doors in 2003. “[The nurses] were doing everything reasonably possible to not contravene that act, and, therefore, that Section 56 exemption was not required.”
That's because the Dr. Peter Centre's safe-injection room (called the ‘harm reduction room') is part of a larger spectrum of care under the ‘comfort care' model developed by Dr. Peter Jepson-Young, a B.C. doctor famous for publicly documenting his battle with AIDS in the early 1990s. The Dr. Peter Centre was named for him. “That supervised-injection service is just a very small part of what we do in a greater health-care context,” says Davis.
The centre, located in a contemporary four-storey building behind St. Paul's Hospital, at Comox and Thurlow, features a day health program and a 24-hour care residence for people with HIV/AIDS. The main and second floors service members in the day health program, which includes 300 participants who can access daily meal service, music and art therapy, computers, laundry facilities, showers, and the harm-reduction room. The third and fourth floors house those in the 24-hour resident care program, who are also able to use safe-injection services without using the harm reduction room. Services are provided using Dr. Peter's comfort care objectives, which focus on respecting individual dignities while recognizing a broad spectrum of health and quality-of-life issues — a model that aims to push out the despair, isolation and fear experienced by many HIV/AIDS sufferers.
“In our residence, the vast majority of the people who live there have an intersect of HIV, mental illness, addiction,” says Davis. “In the residence, the nurses meet their obligations by providing [safe-injection] service in a person's private room. And, indeed, if you look at the [College of Registered Nurses of British Columbia] ruling, those are obligations for registered nurses throughout the province.”
Registered nurses were the first to suggest the provision of safe-injection services at the Dr. Peter Centre. “The nurses came to me and said, ‘Maxine, we think what we are doing is unethical. We are giving people clean needles and sending them outside to inject,'” recalls Davis. “Because of that, they risk overdosing and dying, and what we observe as nurses is preventable infections: They rush their injections outside in bushes, they don't want to be embarrassed by people seeing them, they come back into the centre with ripped veins and skin, and they end up with infections that are preventable and they end up in hospital. As nurses, we find that unacceptable when we know what we can do to prevent that.”
Davis added that the single biggest contributing factor to the risk of death by overdose is injecting alone.
Davis and the nurses presented the issue to the College of Registered Nurses of British Columbia, whose practice standards are regulated by the Health Professions Act. The College ruled that it was in the scope of nursing practice to supervise injections for the purposes of preventing illness and promoting health. “From a federal/criminal law perspective — the Canadian Drug and Substances Act, the nurses were not contravening that act,” says Davis. “They were never touching, injecting, or providing the drugs.”
Despite the harm-reduction approach being chastised in many communities, Davis maintains that West End neighbours have welcomed the Dr. Peter Centre's programming with open arms. “When we started the [safe-injection] service in 2002, we were public about it,” Davis says. “It was not our intention to hide what we were doing, and we also wanted to make sure that our clients didn't feel that they were in a situation that everyone else didn't know what they were doing. I was really impressed by both the neighbourhood and by the public response. I had people call me and convey to me how much they respected the position the organization's taken.”
In an organization in which 15 per cent of funding comes from donor revenue, Davis was careful to keep all donors informed of the centre's news. She recalls worrying about potential negative reactions when the harm-reduction room was introduced, but was pleasantly surprised to discover an influx of support. “I never had one donor call me to say, ‘Forget it, I'm not supporting you anymore.' Indeed, it was the opposite,” says Davis. “We had people calling and saying, ‘We really admire the decision you've made.'”
The recent Insite ruling gives Davis hope that the Dr. Peter model can gain momentum in other communities. “I feel that the [Insite] court decision validates the approach that the Dr. Peter Centre is taking,” she says. “I feel that it opens the door for other communities to take a similar approach as the Dr. Peter Centre is taking. One of the comments Judge Pitfield made [in the Insite judgment] was that there is no question that death and disease is reduced as a result of people having supervision of qualified health-care professionals.”
Car-share program makes City staff greener
Staff at City Hall will soon have another reason to leave their cars at home, following a city council vote last week to contract the Co-operative Auto Network (CAN) to provide cars and vans for City of Vancouver business. “This move has been just a great validation for everything we do,” says Tracey Axelsson, who started the car-sharing network 12 years ago.
The Co-operative Auto Network, which launched with two cars in the West End, has expanded to a fleet of 225 cars covering nine Metro Vancouver regions. To date, CAN has a little over 4,300 members, a number which is expected to double by 2010.
The new contract with City staff takes its cue from similar programs in Portland, Philadelphia, and Berkeley, California, all of which have car-sharing programs for their city's employees. It's part of a strategy to reduce greenhouse gas emissions and support increased car sharing in the community, according to Sean Pander, the City of Vancouver's climate protection program manager. “We found that one of the main reasons people drive to work was they said, ‘I need a vehicle to do my job,'” says Pander. The number of City staff who drive to work is fairly low — about 38 per cent — so introducing a car-sharing program is expected to be a smooth transition.
Under the new car-sharing program, which is set to begin this summer, a fleet of CAN cars, located in the City Hall parkade, will be available to City staff for daytime business. The cars will be moved out of the parkade and onto the neighbouring Cambie-area streets for easier public access on evenings and weekends.
Axelsson hopes the CAN contract will pave the way for more work-related car-sharing in Vancouver. “It's time. We've proved that this works, we've proved it saves money, we've even proved that people lose weight [through the program],” she says. “It really is just so great to have this vote of confidence from the City.”
West End gets behind walkway enhancement plan
The walkway behind King George Secondary School, at the corner of Denman and Barclay, is frequented daily by West End residents of all stripes, but neighbours call it a dead zone because it lacks a certain je ne sais quoi that would help bring people together. That's all about to change, with a little help from more than a few groups of friends.
The West End Residents Association (WERA) is spearheading a walkway revitalization project from King George Secondary up to Barclay Square, a public undertaking that will bring together high school students, seniors, members of the mental-health community, and neighbourhood groups to breathe new life into a walkway currently bordered by scant patches of grass. The plan is to re-introduce native plant species to the area and install community-made public art, creating much-needed public space — and community engagement —that is increasingly hard to find in the city.
“This walkway is such a natural gathering place,” says Aaron Jasper, director of WERA. “Right now it's a bit of a dead zone, but if you think big and imagine what it could be, this could be a really beautiful, natural gathering area. It's bringing people together who may not, in normal circumstances, come together, building up relationships, breaking down some barriers.”
The eclectic mix of community groups backing the project sets the scene for continued diversity down the road. Ellen Silvergieter, director of advocacy services at St. Paul's Anglican Church, is thrilled that the project welcomes community members otherwise pushed out to the margins of society. “I work mostly with people in poverty,” she says. “There's very little opportunity for them to do anything like this, be able to get involved. They're often pushed out by other people. They're not welcomed into doing things.”
For King George Secondary chef and professional cooking teacher Patricia Gonsalves, the walkway project is just what her students need to make connections between their community and what they learn in school. “I can't stress how perfect this is,” she says. “Kids tend to get disconnected from what's going on around them, and the environment around them as well. The best part about this project to me is that this is going to cover a broad spectrum of classes — there's art class, science, chemistry, history, cooking.”
The public-art installation will be led by an as-yet-undetermined local artist; mosaic artist Glen Anderson has thrown his hat in the ring to be part of it. Regardless of who's chosen to be the lead artist on the project, Anderson hopes that the installation will build a legacy for King George students. “It's a kind of community-connective device, which then has reverberations down the years as people meet friends in a context that they wouldn't normally have done,” he says. “Over years and different phases, students can instruct these [art] techniques to subsequent [generations of students], and then they can continue this... It's an ongoing legacy over time.”
In addition to installing public art in the walkway, the project also aims to bring people back to their roots — literally. “This particular laneway is appealing because it is the opportunity to connect kids again with nature,” says Jarrid Jenkins, public programs manager for the Stanley Park Ecology Society. “It fit our mandate really well to be able to be involved in a project that helps to combine or create an opportunity for nature and community to interact and to help each other grow.”
WERA and the West End Integrated Neighbourhood Network (WEIN) are now hard at work in getting the project off the ground. “What happens from now on is we're going to start talking to the community at large and find out how they can get involved,” says WEIN chair Andrew Pilliar.
Pilliar and Jasper will lead a public meeting about the walkway revitalization project on Tuesday, June 24, from 7-9 p.m. at the West End Community Centre (870 Denman). For more information, contact Aaron Jasper at aaron_jasper@hotmail.com or 604 669-3131. 
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