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Entertainment

'Bevel Up'

Nettie Wild's new doc about nurses in the trenches.

By Dorothy Woodend 18 Apr 2008 | TheTyee.ca

Dorothy Woodend reviews films for The Tyee every other Friday.

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Scene from 'Bevel Up.'

The title of Nettie Wild's new documentary tells you a lot about the film itself. The term "bevel up" refers to the best way to inject drugs intravenously, with the bevel side of the needle pointed up, in order to take it a bit easier on your veins. This is a good summation of the film's intent: blunt, practical and trying to reduce the damage to people who are already dealing with enough problems.

Bevel Up: Drugs, Users & Outreach Nursing follows Vancouver's street nurses as they seek to provide health care to people who probably wouldn't or couldn't visit a clinic or a doctor. Sex workers, addicts, street kids and the mentally ill are their principal clients. The Street Nurses Program is a team of 12 nurses who visit not only Vancouver's Downtown Eastside, but also the far tonier sections of town such as Robson Street. They offer tests for HIV and syphilis, clean needles and crack pipe mouth pieces, along with basic human contact and conversation.

Dynamic duo

Bevel Up focuses mainly on nurses Caroline Brunt and Liz James, following along behind them as they venture into parts of Vancouver that might make tough men tremble. The ease with which these women navigate Vancouver's mean streets comes from years of hard-won experience.

At the beginning of her nursing career Caroline says, "I just didn't see people who used drugs as being human. I always thought I was a cut above them, I always thought I was a class above them. All it was essentially was that I didn't understand. . . . Over time, I realized that in order for me to be an effective nurse, I had to begin to go past the wall of drugs and connect with that individual and realize that they were like me."

Liz James had a similar experience in learning to deal with sex workers, until she says finally, "They're just people like you or I. They're like my sister or my brother." The daily reality of visiting skid row hotels is as much about building relationships with people, as it is about providing basic healthcare. Seeing and being seen, just "hanging out and being visible" as Caroline says, is as important as medical support.

Trust between the nurses and the people they care for has emerged slowly over time, and it was this level of trust that allowed the film to be made.

Vital teaching tool

Bevel Up is much more than a simple documentary. A co-production with the National Film Board, and the B.C. Centre for Disease Control, the film is a teaching tool for generations of future nurses, and as such, it address all aspects of providing care. The 45-minute documentary introduces many of the ancillary issues surrounding healthcare, not just the politics and legalities of drugs, but more critically, the ethics that inform policy, and directly affect how healthcare workers do their jobs.

The Bevel Up DVD contains more than four hours of additional material including interviews with therapists, lawyers, counsellors and many different types of nurses. Many of the topics broached in the individual chapters -- everything from dealing with addicts on hospital wards to how not to be charged with trafficking -- are related by different professionals, each with specific expertise in a certain area.

The issue of drugs is something that affects all levels of society and all parts of the province. Rural nurses, who service enormous areas of big old British Columbia, are often faced with challenges that are distinctly different from their urban counterparts. For example, how do you treat someone with addiction problems in a small town, where everyone knows them? Nurses who work on First Nations reservations, where abstinence-only drug programs are often the only thing available, struggle to put forth ideas about harm reduction.

Many of the teaching topics are aimed specifically at nurses who are just entering the profession, and the approach is always calm, measured, and deeply thoughtful. A case in point is Sarah Payne, senior practice leader for Fir Square Combined Care Unit at BC Women's Hospital, who talks about the critical importance of keeping addicted mothers and babies together. The efficacy of this policy is evidenced by the number of women who have come back and told her, "I'd be dead now if I hadn't been able to take my baby home with me." The "transformative power of birth," as Payne says, often gives women motivation to finally detox from drugs.

Grounded in real life

This is a narrative documentary about people actually putting theory into practice. One example is the story of Becky and Liz (mother and daughter addicts), who are living underneath a trailer. When Caroline Brunt seeks them out, having heard from another woman that Becky has suffered a stroke, the situation looks dire. Becky, a heroin user for decades, is suffering from pneumonia, and her daughter Liz is pregnant. As Caroline tries to find a place for the pair to stay, and organizes food, shelter and medicine, the small details of trying to treat people in a state of addiction become readily apparent. On their way to the clinic, Becky has to stop and fix. Caroline helps her out of the van, so that she can shoot up, and then they resume their trip. As Caroline later explains it's often better to let someone use drugs so they're more comfortable, and the threat of withdrawal is diminished.

The thing that is most striking about the film isn't the shots of individuals using drugs or the almost unbelievable conditions in which people can exist, it is the lack of judgment of others that the nurses bring to their jobs. The question of how to turn off your moralizing brain when you're working with people engaged in behaviour that is destructive, threatening or ugly is a difficult one. It often seems to come down to separating the person from the activity that they're engaged in. In one sequence, Caroline tests a man named Barry for HIV. "Barry is a drug dealer, so what?" she says.

Nursing as 'political act'

A Q&A will follow the film at the Vancity Theatre in Vancouver on April 26 and 27 at 7 p.m. Both screenings will feature a member of the street nurses' team, as well as director Wild. It promises to be a heated debate; even the press screening prompted something of a contretemps.

Which is only fitting since the politics of health care form a large component of the film. Simply eradicating drugs isn't possible. A more reasonable approach is to try and reduce the level of harm to people who use drugs and to society at large. Eugene Oscapella, lawyer for the Canadian Foundation for Drug Policy, who speaks about prohibition in the film says, "People will listen to nurses . . . . And if nurses come out and say 'look, the system is dysfunctional, the system is hurting people, the system is killing people,' I think the public is going to listen. Nurses have an extremely important role in this, they're the ones who deal with these people, they see the humanity that is being destroyed by our drug laws and policies."

"I think nursing is a very a political act," says street nurse Janine Stevenson. It is also, potentially, a revolutionary force that asks what kind of society do you really want to live in? How do you see past the surface of things and connect with the human behind the drugs, or the sex work, or the sickness? Or, for that matter, the skin colour, gender, age, or whatever thing that separates us from them, or you from me?

Go and watch the film and listen to nurses speak.

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