Fighting for Space Read online

  “The hotel of last resort,” Evans says with fondness for the term. “We accommodated people, no matter who they were.”

  Mark Townsend reappeared in Evans’s life in the summer of 1991, just a few months after she started at the Portland. He travelled to Vancouver for what he still insists was just a vacation.

  “It’s very hard to get a commitment out of me,” Townsend says. “I was just visiting Liz for fun.” He stayed at the house Evans had just moved into and shared with a rotating cast of roommates. It straddled the eastern edge of the Downtown Eastside and the more residential neighbourhood of Strathcona. One evening, Townsend went for a walk to buy milk. That was his first visit to the Downtown Eastside. “I thought, ‘Shit, what the hell is this?’” he recalls. Townsend likens it to apartheid South Africa—a situation so obviously and fundamentally wrong that there was no way one could witness it without taking further action.

  A few days later, Townsend returned to the neighbourhood to visit Evans at work and take her out for a cup of tea. While he was waiting for her in the lobby of the hotel, a pipe sprung a leak, so Townsend offered a hand and patched it up. Later that month, a maintenance worker that DERA had assigned to the Portland decided that he’d had enough of the hotel’s unique tenant population. His resignation was symptomatic of a growing problem between the Portland and its parent organization. But it worked out for Townsend, who became the hotel’s new handyman.

  In addition to maintenance, Townsend quietly began implementing programs that he hoped would alleviate what he viewed as harms inflicted on tenants by the criminalization of their drug addictions. Among the first of these was a needle-distribution program that they ran at the hotel’s front desk.

  In the Downtown Eastside in the early 1990s, even a used needle could go for a dollar or two. “There was a guy on the corner selling needles for five dollars,” Townsend recalls. The government of the day and its nonprofit partners insisted that clean needles would be distributed only on a one-for-one exchange for used needles. That sort of policy was about to contribute to an explosion of AIDS in Vancouver. But for many years the dominant logic among health-care providers stated that uninhibited needle distribution would encourage drug use and spread disease. (One-for-one requirements still exist today across much of the United States. In some jurisdictions, needle exchange remains completely illegal.)

  “I thought, what is this needle-exchange crap that we’re doing?” Townsend recalls. “So immediately, we got needles in the building. But that was horrifically politically complicated, because that was seen as a bad thing that encouraged drug use.”

  In the late 1980s, before anyone in Vancouver had heard the term harm reduction, a recovering addict named John Turvey began walking the Downtown Eastside’s back alleys, handing out packaged syringes from a backpack he carried. Soon enough, he turned those walks into a registered nonprofit that became the neighbourhood’s distribution system for clean syringes. Turvey called it the Downtown Eastside Youth Activities Society, or DEYAS. Today, dozens of sites across Vancouver offer clean needles free of charge and with no exchange requirement and no questions asked. But Lou Demerais, the executive director of another nonprofit called the Vancouver Native Health Society and an old friend of Turvey’s, recounts how risky the idea was back then.

  “I was sitting here in my office working on some other issue and John phoned me and said, ‘Guess what I’ve done?’ And I said, ‘You’ve what!?’” Demerais recounts. “It scared the living hell out of some of us. It was against the law. But then you started thinking, ‘Well, who gives a shit about the law? The law doesn’t give much of a shit about us or our folks.’ So when I calmed down, I thought about it and realized, you know, that’s probably what we need as much as anything else. But it had shock value.”

  Demerais emphasizes the impact that the arrival of injection cocaine had on the Downtown Eastside beginning in the 1980s, around the same time that he connected with Turvey. He explains that while a heroin addict can get by on three or four injections a day, a cocaine addict might require a dozen or more. That meant a lot more needles were needed, and since clean gear was so hard to come by in those days, it meant a lot more people sharing needles.

  “When injectable cocaine hit the streets, the [HIV/AIDS] numbers began to spike,” Demerais says. “What we found among our people down here was that it genuinely took about a year and half from the time that they knew that they were [HIV] positive until they passed away. Often it was about six months. Six months. So it was happening very fast.”

  When the AIDS virus hit Vancouver’s injection-drug user community, it spread like wildfire. A 1996 BC government report drew specific attention to this group, noting that in 1989, forty people who identified as intravenous drug users were diagnosed with HIV in BC. Five years later, in 1994, that number was 198.

  “Of the 688 people who first tested positive in 1995,” the report continues, “333—about one a day—cited injection drug use among their personal risk behaviours.”14 The vast majority of IV-drug users diagnosed with HIV then were not distributed across the province but were living in one neighbourhood consisting of less than twenty square blocks.

  DEYAS’s pioneering work in harm reduction and specifically needle exchange is worthy of incredible praise but also fair criticism. A lack of clean supplies for intravenous drug use had brought a tide of hepatitis C to the Downtown Eastside. HIV and AIDS followed shortly after. Turvey was the first person to insist that the best way to combat the spread of those diseases in the Downtown Eastside was to make clean needles more readily available. But DEYAS kept a tight bottleneck on the supply of needles from the time it initiated its programs in 1988 right through to the early 2000s.

  A DEYAS pamphlet from 1996 makes clear how difficult it was for a drug user to find a clean rig: “All trading is done on a point for point basis,” it begins. “You can get no more than one needle at any time if you don’t have any to trade. We do not issue needles to non-users. Clients not registered with the Exchange will be asked to confirm IV drug use by showing tracks [track marks] to the Exchange worker, or to the STD nurse.”

  Dr John Blatherwick was head of the regional health authority at the time and the man who ultimately oversaw the restrictions under which DEYAS operated. He recalls that authorities had to overcome successive learning curves, first within the health-care community and then in political circles. “A small group of activists got their own needle exchange going before any funding was available—they got private funding for it. I marvelled at what they were able to do,” Blatherwick says. “The activism came first, and it was John Turvey and [the activists like him] who paved the way.”

  Soon enough, there was an understanding among health-care workers that exchange requirements limited those programs’ ability to minimize the spread of disease. But health care for drug users was a highly politicized area. “You had to sell it to the politicians,” Blatherwick says. “And we sold it to the politicians on the basis of a needle exchange. In other words, if we were putting 10,000 needles into the Downtown Eastside, we were taking 10,000 needles out. If you had told them we’re going to put 10,000 needles in and maybe get 2,000 out, they probably would have said, ‘No, the citizens of Vancouver won’t support that.’”

  Townsend had other ideas. Over the course of their first year at the hotel, it became obvious to him and Evans that prohibition-style drug laws were inflicting as much pain on their tenants as the drugs themselves. The criminalization of addiction—a condition that was just beginning to be understood as a disease—was inflicting tangible harms on the Portland’s tenants. They began to attempt to reduce those harms.

  Townsend especially was highly critical of DEYAS’s limited needle-exchange programs. At the front desk of the Portland, he began doing needle distribution. When they could get away with it, if someone at the hotel needed a clean needle to inject drugs, they were going to get one. A few years before the term began appearing at drug-policy conferences in North
America, the Portland Hotel was doing harm reduction. Townsend says they simply acknowledged that their tenants were using drugs and so they tried to take away a few of the risks.

  At first, even the residents didn’t know how to react. “I remember the very first time someone overdosed in the building, there wasn’t a sense that they could tell us,” Evans recalls. “They would almost rather have died because they were so scared of being caught and getting evicted.”

  The biggest mistake that an intravenous drug user can make is to use alone, behind closed doors. When Evans arrived at the Portland, that was the norm. People were afraid that if anyone in any sort of position of authority saw that they were using drugs, they would be evicted, so they were injecting drugs in their rooms with the doors closed. “That reflected the level of fear and anxiety and criminalization and dehumanization that was the norm … in the community,” says Evans.

  “Building trust and changing that space from a criminalized space to a human space was really complicated,” she remembers. “It first meant that you had to explain to people that you weren’t judging who they were in the world, that you didn’t actually give a shit about their drug use, and that you just wanted to be there for them.”

  Slowly the Portland’s tenants began to leave their doors open a crack when they injected drugs. It became a subtle signal, letting people know that there was somebody inside that room who was using heroin or cocaine and that it wouldn’t be a bad idea if somebody poked their head in and checked on them every so often. “It was interesting watching how the culture inside the building shifted to one where people actually started to trust the staff and ask us to come and help them,” Evans says.

  Tenants began to feel comfortable shouting down to the front desk when somebody overdosed. “Then we would run up to the rooms and resuscitate people,” Evans says. It happened so often that she quickly lost count of the number of lives she saved performing CPR in the Portland’s tiny rooms.

  The year that Evans and Townsend arrived in the Downtown Eastside, 1991, was also the start of the province’s epidemic of drug-overdose deaths. In 1989, sixty-four people across the province died of an illicit-drug overdose. There were eighty deaths in 1990, 117 in 1991, 162 in 1992, and then 354 in 1993.15 A vastly disproportionate number of them were in Vancouver, in the Downtown Eastside.

  “If I walked down Hastings, it was not uncommon for me to stop and have to do CPR once or twice on my way to work,” Evans recalls. “Those were the days I would be puking because I was so stressed out. I used to walk into a room [in the hotel] and literally find two people down at the same time and be running from one body to the next trying to resuscitate two people and screaming, trying to get an ambulance. It was terrible and awful and sad. And it was stressful.”

  But for tenants who moved into the Portland that year, it was the exact opposite.

  Today Stephanie Blais lives a stable life. She has a mental-health diagnosis, but not obviously so. Her speech pattern is somewhat irregular and her body language is slightly over-animated. In 1992, however, Blais was what service providers called a “million-dollar woman.” That is, she was so well-known by police and ambulance services, interacting with them so regularly and spending so much time in emergency rooms, that it was estimated she singlehandedly cost the government hundreds of thousands of dollars every year.

  “My mental-health diagnosis was very disruptive,” Blais says, explaining that she was diagnosed with borderline personality disorder and emotional dysregulation disorder. “For about a year, I ended up calling ambulances almost every day and going to the hospital,” she explains. “I’d overdose and self-harm. Not overdose on heroin or whatever—I never got into any of the actual drugs—I’d overdose on Tylenol or on antihistamines or whatever.”

  Almost daily 9-1-1 calls meant there wasn’t a hotel in Vancouver that let Blais keep a room for very long. “I was living in a single-room occupancy suite just up on Granville Street, near Davie,” Blais says. “But my mental-health diagnosis was very disruptive. So I got kicked out of the hotel and had to go stay at Lookout’s emergency shelter for a bit.” Essentially living on the streets of the Downtown Eastside, Blais’ mental-health case worker suggested she try to get a room at the Portland Hotel. A few weeks passed, but she never got around to it. Then, one sunny afternoon, she was sitting on a bench in Pigeon Park.

  “People kept coming up and asking me if I wanted to buy weed. I didn’t know what people meant by up or down,” she says, referring to dealer slang for cocaine and heroin. “I was like, ‘Oh, well, I guess it’s up.’”

  While sitting on that bench, Blais eventually noticed the Portland Hotel just across the street. She walked over there, found Townsend at the front desk, and asked if she could have a room.

  “I moved into the Portland Hotel on Wednesday, June 17, 1992, at four o’clock in the afternoon,” Blais says. “Mark had dreadlocks! And he told me I could have a cat,” she continues. “I didn’t have a cat. But if I wanted one, I could get one.”

  Blais had met Liz Evans two years earlier, when she was still working as a nurse at the emergency psychiatry and assessment unit at Vancouver General Hospital. “She got to meet me when I wasn’t doing very well,” Blais says. But she proudly adds that encounter means that she was one of the first people Evans met in Vancouver, even before Townsend had arrived.

  Blais remembers how Evans and the Portland’s small staff helped her understand herself better and the problems her behaviour created by giving her more responsibility over her own life.

  “The way they helped me get out of that pattern is, if I overdosed or hurt myself, the staff wouldn’t call an ambulance for me unless it was a definite emergency,” she says. “So if I wanted an ambulance but I was still alive and breathing, then I could call it myself.” Blais explains how this made her feel a new sense of personal responsibility. At the same time, she realized that she no longer had to live in constant fear of a potential eviction notice. An enormous source of relentless stress was removed from her life.

  “It was them just letting me do what I needed to do,” she says. “I started wanting to do well again, to open doors again.”

  While Evans and Townsend struggled through their first year at the Portland, Kerstin Stuerzbecher, a young nurse, was employed at a Vancouver group home for troubled teenagers. It was difficult work. The kids were there because they had been abused by their parents or forced from their family’s home by other difficult circumstances. They were angry, some had serious mental-health issues, and many were violent. During an average day at work, Stuerzbecher would be cursed at, spat on, and punched or kicked by the young people for whom she was trying to provide care.

  Stuerzbecher was born in Canada but spent her formative years in Hamburg, Germany, where her parents are from. After she completed high school there, she returned to Canada on her own and settled in Vancouver.

  In December 1991, Stuerzbecher and her boyfriend, Kevin Grand, accompanied another couple who lived in their building to a Christmas party. It was the first of what turned into an annual gathering that Evans and Townsend hosted for the next twenty years.

  Evans laughs when she remembers meeting Stuerzbecher. “She was very severe-looking, very German, with short hair, wearing a leather jacket and looking very alternative, punky, and scary,” Evans says. “I was terrified of her. And Mark, of course, right away, was like, ‘You should work with us!’”

  There were about twenty people at the party that night, but Evans, Townsend, Stuerzbecher, and Grand spent most of the evening with each other at the kitchen table talking about social justice and their shared distaste for the cold nature of clinical health care. It took Stuerzbecher several months to decide to quit her job and take the position that Townsend had offered her at the Portland, but it was immediately clear that they all had a lot in common.

  “Working in that home for teenagers and working more in an institutional-type setting just was not my cup of tea,” Stuerzbecher says. “
Some of the aggression and violence that we were experiencing was as a result of the restrictions that we put on people’s lives, and fundamentally I did not agree with that. That evening, Mark and Liz had already convinced me that, politically and in our hearts, we believed the same things.”

  Stuerzbecher also had some experience with the sort of overdose crisis that was then just beginning in Vancouver. “In the ’70s, heroin hit Germany quite bad, and a lot of kids died,” she says. “At the main train station in West Berlin all these street kids congregated and were shooting up and dying. So people in Germany, people I knew, died.”

  In 1981, the German filmmaker Uli Edel made a gritty picture about the city’s heroin scene that gained cult status, due in part to a supporting role played by David Bowie. In Christiane F. – Wir Kinder vom Bahnhof Zoo (Christiane F. – We Children from Bahnhof Zoo), a thirteen-year-old girl is drawn into an underground drug culture that revolves around a subway station. Townsend had seen the film and taken an interest in German cinema. He and Stuerzbecher bonded over conversations about their shared interest in such films and their growing disdain for accepted norms in mental-health care of the time.

  In the decades before Evans, Townsend, and Stuerzbecher moved to Vancouver, jurisdictions across North America drastically cut services for the mentally ill. That left police and prisons as the first points of interaction many vulnerable people had with the state. Researchers at the University of Chicago compared America’s prison population to that of mental hospitals. They found that since the 1970s, the rate of the former has quadrupled while the rate of the latter has fallen three-fold, to close to zero.16 A graph tracking the sizes of the two groups over seventy years consists of squiggly lines that form an X. It suggests that the US literally transferred the people who it once housed in hospitals and health-care facilities into correctional institutions. Left to pick up the pieces of BC’s mental-health-care system were nonprofit organizations and people like Evans and the team she was putting together in the Downtown Eastside.