Space For Human Encounters In The Staffed Living Room?

Space for human encounters in the staffed living room?

The staffed living room was a place where the workers were not tied to dealing with and dispensing dangerous compounds. The living-room was a big open space with a staffed counter, couches, computer, tables surrounded by benches, a large TV and a mini kitchen area.

All the towns that purchased OST from this clinic stated in their agreements that hurt reduction OST need to not be exclusively about medication: they required that the clinic offered also some psychosocial treatment such as ‘psycho-education’, ‘psychosocial support’ or ‘an environment that allows peer assistance’. The presence of the staffed living room was linked to these goals. The director of the center, however, told the ethnographer that the living room was not truly a part of the official deal with the municipalities as they did not cover its running costs. The director described that the NGO that run the clinic has actually actioned in to fund the living room since it was thought that medication by itself was inadequate. There were a few regular activities for the clients in the living room (e.g. a music group and a patient committee) thanks to short-term task funding gotten for this function by the NGO.

Some patients never visited the living room; they just got their medication and left the center. It appeared that this was typically the case when a client tried to be drug-free and wished to prevent drug users. Most clients invested a long time in the living-room regularly while lots of utilized the space more or less everyday for a number of hours at a time. On a normal day, tens of clients spent time in the living-room chatting, consuming coffee, watching TV, running errands at the staffed counter, checking out newspapers etc.

According to the guidelines there had to be a minimum of 2 workers present in the living-room at all times. They guaranteed an open counter which appeared like a hotel reception desk. For the sake of security, one employee was not to be left alone behind the counter, which suggested that when there were only two employees they both stayed behind the counter. Clients might speak to the staff members, request suggestions or to make a medical professional’s consultation and they could make telephone call etc. In addition, the employees gave clean needles and syringes and guaranteed that the living-room remained peaceful. Using and selling of alcohol and drugs was prohibited while intoxication was tolerated. The example below depicts a normal scene at the staffed counter.

The living room is pretty complete and it’s quite loud by the counter where numerous patients hang out. A young blonde lady is asking worker 1 if she could see the doctor and have an authorized leave and take-away bottles for a few days as she feels very unhealthy and has a high temperature. Worker 1 hands her a thermometer and says that the center does not give sick leave unless one is hospitalised. Worker 1 continues that the lady needs to go to her own community health centre the next early morning as the center’s medical professional just manages issues straight connected to OST. The lady states: ‘I can not go to there in the morning as I need to come here every bloody early morning! Can I not have authorized leave to get to the health centre?’ She continues: ‘There is an issue with my arm, it’s extremely aching’. Worker 1 uses to have a look. An agitated older male client talk with Worker 2 about his medication: he is dissatisfied and loud. Worker 2 talks with the older man patiently. Two young male clients try to talk to worker 2 and they start yelling to be heard. They seem to need help with discovering a contact number and wish to make a phone call to a social employee with the center’s landline. Worker 2 attempts to maintain the conversation with the older man and raises his voice and asks the boys to wait. Elina, a young patient with whom I have actually talked several times, approaches the counter and says to me: ‘I wanted to speak with Pentti (Worker 2) about moving to rehabilitative OST however I don’t think that’s going to occur today’. I suggest that Elina waits a bit, possibly the counter will quiet down quickly. Elina says that she does not want all the other clients to know her organization and turns away from the counter. I pity Elina. Worker 1 states to the young blonde lady that the wound on her arm may be infected and she should go to the municipal mishaps and emergency situation center. A couple approaches the counter and they ask employee 1 when they can exchange clean syringes; they are in a rush and can not wait. Worker 1 asks to await their turn. The center’s phone rings for a long period of time, employee 1 apologises to the blonde lady with the contaminated wound and addresses the phone.

As the example portrays there was no personal privacy at the desk for discussing individual matters and the desk was routinely flooded by patients wanting something. Elina, whose objective is to stop using cannabis, lower her methadone dose, enter corrective OST and gradually surface with OST, quits even attempting to talk with the staff about how to proceed with her plan.

The clients often described the living-room employees behind the counter as ‘air traffic control service’. This metaphor in truth appropriately characterised the position and function the workers held in relation to the clients in the living-room: their main task was to keep an eye on patients’ comings and goings from a distance — simply as air traffic control service keeps track of aircrafts from the air traffic control tower. Further, much like air traffic control service, the workers attempted to avoid accidents between patients by actioning in if the patients got extremely spoken or started an argument. There were numerous occasions when I sat with a group of patients in the living room and one of them had an intense problem; for example, with their medication, health, financial resources or real estate. When I suggested that the individual would ask the employees behind the counter for advice, the patient’s response would be something like: ‘I won’t go to the air traffic control service! I do not understand them. They don’t even know my name! They don’t care, they’ll simply state ‘No other way’ to whatever I attempt to say!’ (Field notes, September 2013).

Neither ‘air traffic control’, namely confidential control from a range, nor the somewhat chaotic scene of one-to-one interactions at the living-room counter portrayed in Example 5 manifest the realisation of logic of care. The employees at the counter attempted to address the clients’ many needs however they had a great deal of clients to handle and no time at all or personal privacy for proper discussions, for instance. Again, the little number of employees made interaction between personnel and clients challenging as the workers were frequently overwhelmed with the a great deal of patients needing something. Simply put, there were not enough resources for a logic of care to be realised and the reasoning of austerity took control of. In this way, looking after methadone dominated what was going on in the living room, too. In our information, the reasoning of austerity seems to undoubtedly result in a lack of care, which evokes Biehl’s (2005, 2007) descriptions of ‘zones of abandonment’ where ‘the unwanted’ are delegated take care of themselves as best as they can.

The ethnographer witnessed lots of circumstances in the living room where some patients were attempting to help other clients with their issues, and a couple of clients had in reality attended a brief course on how to provide peer support. We recommend that also a new focus on peer assistance and self-help belongs of the logic of austerity. It can become a method of offering a minimum of some form of assistance when professional resources are limited. While peer assistance obviously has a lot of possible there is also a danger that, in resource-poor contexts, where many people have complex and persistent issues, the problem on the peers ends up being undue. In our information this was the case for Saara, who was dedicated to providing peer assistance to her fellow patients however became slowly overloaded by the intricate requirements of her peers combined with her own individual vulnerabilities.

A little after half-way into the 5 months of fieldwork there was one remarkable duration of practically one month when there were rather regularly more than 2 workers in the living room, and they systematically took turns to leave their position behind the counter. One and even two workers frequently rested on the living-room sofas or benches or stood in a corner talking with patients. This practice was initiated by one uncommonly proactive team member who constantly made complains and demands to her superiors that the living room required more staff to permit more interaction with clients and a possibility to help patients with their wide selection of issues. When the ethnographer asked several workers how they discovered this new system, they said that it clearly benefited the patients. The clients were eager to talk with the staff and more contact motivated closer and more relying on relationships, which implied that clients discovered it much easier to rely on the workers for assistance. When this particularly proactive member of personnel decided to move to another task, however, the brief explore more staff in the living room was quickly and silently forgotten. The number of personnel was minimized to 2 again, which manifests the victory of the logic Benefits Of Medical Marijuana’s Harvard austerity over the relational logic of care.