Full Circle

Becky Shorrock, an out reach nurse employed by the Sunset Family Health Team in Kenora, and I, as consultant psychiatrist to the Kenora Association for Community Living in Kenora Ontario, presented at the U of Toronto Annual Conference on Indigenous Health last week. We reviewed lessons we have learned supporting homeless, traumatized, self -medicating Indigenous adults during the COVID pandemic. Kenneth Jackson , author of Death As Expected Inside a Child Welfare System where 102 Indigenous Kids died over 5 years Jackson,Kenneth, Aug 2108) travelled to Kenora in September, 2020.As an APTN investigative reporter and producer of the APTN political affairs' show Nation to Nation, he hoped to give a voice to the homeless individuals living there, many of whom are survivors of the Ontario child welfare system.

Becky is a founding member of Compassionate Kenora, a grass roots- driven, not for profit organization founded in Kenora Ontario in August 2019 to address hate messages being posted on social media platforms in Kenora .Compassionate Kenora has recently opened a store front on Main St in Kenora, which is culturally safe and provides primary care to individuals uncomfortable in more traditional primary care settings. Many clients are known to be self -medicating with narcotics and crystal methamphetamine after being apprehended in childhood, displaced from their Treaty 3 communities to southern and central Ontario, only to be traumatized again there. As they age out of this system, many return to Northwestern Ontario with uncompleted high school credits, no money or personal or vocational goals, and undiagnosed and untreated Post Traumatic Stress Disorders (PTSDS) and Complex PTSD.

Becky, Jen Carlson, also a nurse at the Sunset Family Health Team and Dr. Jonny Grek, a family physician in Kenora , are passionately committed to the principles of Harm Reduction, while supporting traumatized individuals self-medicating with narcotics and crystal meth amphetamine , as am I . They hold space for individuals, walking alongside those they support , without judgment, without attachment to outcome, honoring the need for transparency, the development of trust and the need for time to allow healing journeys to begin and progress. To do so they bring a trauma-informed lens to their work, as well as an acknowledgment of the need to be aware of social injustices -that systemic racism exits in the courts and prisons of Ontario (please read McDonald, Nancy,Feb 18, 2016 Canadas Prisons are becoming the New Residential School schools, MacLean's Magazine) and the "system of care " offered by Children's Aid Societies in Ontario ( Please read "Interrupted Childhoods Over-representation of Indigenous and Black Children in the Ontario Welfare System,Ontario Human Rights Commission, 2016).

They and I, are not Indigenous. We therefore practice cultural humility, an open awareness of the colonized stereotypes and biases we bring to our work and a commitment to combine Western and Indigenous world views in the healing practices we all to well offer .They actively participate in Ojibway healing ceremonies to better honor the elements of Indigenous healing practices the Residential School system was designed to destroy. They know of intergenerational trauma all to well . Becky and Jen work part- time at the Kenora Jail, an institution where I have provided psychiatric assessments for many years - where prescriptions for mental illnesses are not typically filled on release, where there is no smoking cessation therapy or needle exchange programs , where gang affiliation holds promise to Ojibway young adults who have been alienated from self, family community and spirituality. They and I have watched as individuals with severe addictions and mental illness are segregated in cells not fit for humans .( please read Report and Recommendations on Homelessness in Kenora, Ontario Human Rights Commission, Sept 17, 2019).

These three compassionately connected souls traveled to the East side of Vancouver to visit Insite, the first Safe Consumption site in Canada. They walked through a site established in 2003, which has been used by 75,000 individuals 3.5 million times as the Supreme Court of Canada,over an eight year process , unanimously voted to uphold the rights of citizens of Canada to receive treatment in a facility that has never been the site of a death due to overdose.( Please watch Dr. Mark Tyndell The Harm Reduction Model of Drug Addiction, TED Talk,April 18, 2018 and Johann Hari Everything you know about Addiction is Wrong,TED Talk, July 9, 2015.) .They are realistic about the possibility of such a option being funded in Kenora, particularly during the COVID pandemic So instead , they created a non-profit organization appropriately called Compassionate Kenora. Several thousand concerned citizens of Kenora subsequently pooled resources, time, energy and passion to create a store front site offering a culturally safe space to the disenfranchised homeless citizens of their town. They established a clinic offering primary care to individuals uncomfortable in traditional medical settings as well as walk-in appointments, food , shelter, showers, hope and faith. In Novembers 202, Dr. Grek assessed 119 individuals . Becky and Jen assessed 168 individuals and 1035 visit were offered to individuals seeking systems navigation, social connection, workshops and volunteering Dr. Grek and I are informed by a paper created by the medical consultants to the BC Centre of Substance use, "Risk Mitigation in the Context of Dual Public Health Emergencies" ( BC Centre on Substances Use www.bccsu.ca/covid-19).This document was designed to give clinical guidance to health care providers to address the need for safe supplies of drugs during the COVID-19 pandemic, recognizing that border closures have resulted in a increasingly toxic and adulterated street drug supplies; thereby resulting in a marked increase in deaths secondary to overdoses. We have used medical marihuana to treat symptoms of narcotic withdrawal and have preliminary experience prescribing ADHD stimulants ( Adderall XR and Dexedrine XR ) to reduce cravings for crystal methamphetamine. This is not for the faint of heart, but while we wait for the "evidence " we are committed to proceeding with compassion.

And then, shortly after Becky and I present Lessons learned about Harm Reduction in Northwestern Ontario, at the University Of Toronto's Annual Conference on Indigenous Health, Compassionate Kenora is served an eviction notice effective Dec 31st,2020

Is there racism on the streets of Northwestern Ontario ? Yes ! ( Please read Gerry McNeilly Dec 2018,Independent Police Review Director- Broken Trust-Indigenous People and the Thunder Bay Police Force) Still not courageous enough to agree?-read Tanya Talaga, Seven Fallen Feathers racism , Death And Hard truths in a Northern City, Sept 2107, and All my Relations Finding a Path Forward,Oct 2018.

What to do next ? We welcome suggestions.

Dr. Bob King MD FRCPC