Thursday, May 11, 2006
Needle Exchange
"Now I am a LONG way from home." I thought I as strained against steep grade of the hill; the ever-present pull of gravity. Michelle and I were walking down from Nob Hill, a relatively rich neighborhood in SF, to the Tenderloin: the city's most crime ridden and impoverished. Yesterday--Wednesday--was my first time at the Needle exchange. I'd been threatening to observe this most controversial and necessary of humanitarian projects first hand, to see if I might want to volunteer there. I finially tagged a long with Michelle.
Michelle is a very attractive East Bay native with whom I work. With long blond-red hair, a confident stride and darlingly feminine eyes, she easily caught the attention of the groups of loitering black men. Michelle has been walk through this neighborhood for years, showing up on Wednesdays to help the city's large population of intravenous drug users by exchanging their dirty needles for HIV, Hepatitis B/C free ones. "A noble effort." I thought when I first heard Michelle talking about it.
There are few neighborhoods that I've not explored in SF, one of them--up until Wednesday, at least--is the Tenderloin. I'm not at all sure why it was dubbed with such an ironic name, but that is apparently what stuck. The irony of its name is that the Tenderloin is the worst part of the city. To quote some stand-up by Dave Chapelle, "There ain't nothin' tender about that place!"
The civic center and city hall are both proximate to this area, as is a stretch of Market street. Just North is Nob hill: one of the more prosperous parts of SF; just east, the financial district. This kind of rich-abutting-poor geography is the norm through this City of San Francisco. In a way it was the same in Central Maine. My guess is that it is the same in both rural and urban areas of this country, the exception being large suburban areas that can afford to hedge out all the poorer folks by making housing and transportation services too expensive.
I was nervous. There is no other way I can describe it, although I would like lie and say that I was calm and had not been envisioning some crazed IV drug user, enlivened with withdrawal and jealous of my privileged life, stabling me in the neck with dirty needles and saying, "Welcome to my world, bitch!". Hmmm... I believe that would be rather unfair, though, as it would've given me all the disease and none of the high. Plus, right now I doubt I've got more capital than the collection bottles in his shopping cart.
Anyway, I was nervous. These are dangerous people, I'd been thought. My nerves were solely based on all my pre-exposure to IV drug users which is consists of watching images of these unholy and fallen souls on a cathode ray tube.
Shelly and I arrived at TARC (Tenderlion AIDS Resource Center) where the other volunteers and staff had already setup. The setup was totally not what I expected, well at least the layout and size of area it occupied. What I was expecting with this: a gymnasium full of crackheads with a sprinkling of suites (the dark CEO with a DARK secret). I envisioned tables of needles and other associated paraphernalia, and the jonzing masses would be grabbing what they wanted in a big free-for-all intravenous extravaganza. The needle exchange actaully looks like this: A old store front--about 8ft by 20ft--with plate glass windows (not bullet proof). Just through the door, to the left, there is a regular size desk upon which lay a variety of fliers, forms and pens. At the back along the wall on a long bar are bins containing different sized syringes, cookers, tourniquets, packets of vitamin C powder, sterile water. Thats it. Simple and--I'll explain why--effective.
The exchange is open for two hours on Sunday and Wednesday. IV drug users line up outside and are let in three at a time. The fill out a form on the desk, return there dirty needles to the bio-buckets and receive packs of 10 syringes at the back. Here are the rules of the exchange: if they bring none back we give them 1 packet of 10 syringes; if they bring back 10, we give them 20; after that we match whatever number they return. All the works that one would need to shoot up cleanly and safely.
What is the point of this program? Who are these individuals that use and vail themselves of this service? Why propagate drug habits of these individuals?
Before I answer these questions in my own manner, I would like to submit a small piece of advice I was given by a co-worker on the subject of the needle exchange and how it will reflect on my person during reviews by medical schools. Specifically, I was told to not bring up the fact that I volunteered at the needle exchange while being considered for some of the more "conservative" schools of medicine. This will surely reflect poorly on me and ultimately jeopardize my admission to many med schools. If this is indeed so, and my participation at the needle exchange does result in my rejection from a great many schools, then so be it. I believe the needle exchange is a more than necessary program and no amount of ignorance or prejudice is going to keep me from including this experience, for it is in large part WHY I want to be a doctor.
Which brings me to the purpose of this program. The benefits of needle exchange are clear if one educates themselves about IV drug use, looking past the obvious social and legal taboos and concentrate on the mechanics. Intravenous drug users must do just that: use their drugs by putting them directly into the bloodstream, into the veins. To be sure they've hit a vein they must aspirate or draw up blood. Before the prominence of disposable needles through needle exchange, they were a commodity and, because of needle scarcity, people would share them (still do). This mechanism of drug use and the affected mind of the addict (one who is prone to poor decision making) sums to very high risk for contraction disease.
But why should normal people care? Why would someone living in the Occasionally
Michelle is a very attractive East Bay native with whom I work. With long blond-red hair, a confident stride and darlingly feminine eyes, she easily caught the attention of the groups of loitering black men. Michelle has been walk through this neighborhood for years, showing up on Wednesdays to help the city's large population of intravenous drug users by exchanging their dirty needles for HIV, Hepatitis B/C free ones. "A noble effort." I thought when I first heard Michelle talking about it.
There are few neighborhoods that I've not explored in SF, one of them--up until Wednesday, at least--is the Tenderloin. I'm not at all sure why it was dubbed with such an ironic name, but that is apparently what stuck. The irony of its name is that the Tenderloin is the worst part of the city. To quote some stand-up by Dave Chapelle, "There ain't nothin' tender about that place!"
The civic center and city hall are both proximate to this area, as is a stretch of Market street. Just North is Nob hill: one of the more prosperous parts of SF; just east, the financial district. This kind of rich-abutting-poor geography is the norm through this City of San Francisco. In a way it was the same in Central Maine. My guess is that it is the same in both rural and urban areas of this country, the exception being large suburban areas that can afford to hedge out all the poorer folks by making housing and transportation services too expensive.
I was nervous. There is no other way I can describe it, although I would like lie and say that I was calm and had not been envisioning some crazed IV drug user, enlivened with withdrawal and jealous of my privileged life, stabling me in the neck with dirty needles and saying, "Welcome to my world, bitch!". Hmmm... I believe that would be rather unfair, though, as it would've given me all the disease and none of the high. Plus, right now I doubt I've got more capital than the collection bottles in his shopping cart.
Anyway, I was nervous. These are dangerous people, I'd been thought. My nerves were solely based on all my pre-exposure to IV drug users which is consists of watching images of these unholy and fallen souls on a cathode ray tube.
Shelly and I arrived at TARC (Tenderlion AIDS Resource Center) where the other volunteers and staff had already setup. The setup was totally not what I expected, well at least the layout and size of area it occupied. What I was expecting with this: a gymnasium full of crackheads with a sprinkling of suites (the dark CEO with a DARK secret). I envisioned tables of needles and other associated paraphernalia, and the jonzing masses would be grabbing what they wanted in a big free-for-all intravenous extravaganza. The needle exchange actaully looks like this: A old store front--about 8ft by 20ft--with plate glass windows (not bullet proof). Just through the door, to the left, there is a regular size desk upon which lay a variety of fliers, forms and pens. At the back along the wall on a long bar are bins containing different sized syringes, cookers, tourniquets, packets of vitamin C powder, sterile water. Thats it. Simple and--I'll explain why--effective.
The exchange is open for two hours on Sunday and Wednesday. IV drug users line up outside and are let in three at a time. The fill out a form on the desk, return there dirty needles to the bio-buckets and receive packs of 10 syringes at the back. Here are the rules of the exchange: if they bring none back we give them 1 packet of 10 syringes; if they bring back 10, we give them 20; after that we match whatever number they return. All the works that one would need to shoot up cleanly and safely.
What is the point of this program? Who are these individuals that use and vail themselves of this service? Why propagate drug habits of these individuals?
Before I answer these questions in my own manner, I would like to submit a small piece of advice I was given by a co-worker on the subject of the needle exchange and how it will reflect on my person during reviews by medical schools. Specifically, I was told to not bring up the fact that I volunteered at the needle exchange while being considered for some of the more "conservative" schools of medicine. This will surely reflect poorly on me and ultimately jeopardize my admission to many med schools. If this is indeed so, and my participation at the needle exchange does result in my rejection from a great many schools, then so be it. I believe the needle exchange is a more than necessary program and no amount of ignorance or prejudice is going to keep me from including this experience, for it is in large part WHY I want to be a doctor.
Which brings me to the purpose of this program. The benefits of needle exchange are clear if one educates themselves about IV drug use, looking past the obvious social and legal taboos and concentrate on the mechanics. Intravenous drug users must do just that: use their drugs by putting them directly into the bloodstream, into the veins. To be sure they've hit a vein they must aspirate or draw up blood. Before the prominence of disposable needles through needle exchange, they were a commodity and, because of needle scarcity, people would share them (still do). This mechanism of drug use and the affected mind of the addict (one who is prone to poor decision making) sums to very high risk for contraction disease.
But why should normal people care? Why would someone living in the Occasionally
