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Substance Abuse and Mental Health Services Administration
Exchanging Needles, Sharing Compassion
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Every night the Albuquerque Healthcare for the Homeless outreach van sets up shop in an empty parking lot. Outreach workers offer healthcare, food, clean needles, and kindness to those who knock on the door. The HRC’s Wendy Grace Evans describes an evening with the outreach van. She shares her reflections on addiction and loss, and how human connection and kindness can offer a path toward hope.
My three-year old daughter Lucinda had a direct line to God a few months before I got sober. In a moment of grace, she drew a picture of a woman falling on the end of a string from a mountain. Beneath her was the upturned cradle of a rainbow drawn in reverse. I had been falling for years. The woman in the drawing, she said, was me -  her mother. I framed the drawing and hung in it my bedroom. Now, Lucinda, who is one year older, points to the drawing and tells me, “That’s when you were in the shadows.” She has seen shadows and light and shows me compassion.

Last night, I spent time in the shadows of addiction and the light of compassion in a Healthcare for the Homeless (HCH) outreach van. I do not think of it as a van – I call it hope. Outreach is just one aspect of the work at Albuquerque HCH. The agency is the only health care organization in New Mexico that is exclusively dedicated to providing comprehensive healthcare and support services to people experiencing homelessness. Albuquerque HCH serves 7,500 men, women and children each year and works toward a world where there is no homelessness.

As a witness to the work of the Albuquerque HCH outreach team, I followed the large white van from the Albuquerque HCH clinic to the parking lot where the outreach team sets up every Tuesday night from 5 to 8 pm.

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It is raining. The city feels empty as Rebekah, a young outreach worker, parks the van in a parking lot. She tells me the team has collected 602,404 used needles in the last year and has distributed 687,240 clean ones. Within minutes of our arrival, people are knocking on the door looking for food, health services, a kind conversation, and a collection of clean supplies to reduce the risks of intravenous (IV) drug use.

The people who arrive at the van wear their exhaustion. The consequences of addiction are shown in lines on their lips; they are carried on the words they speak. I hang onto these words.

There is a knock on the door. Three women ask for food and hygiene kits. There is a second knock and a young girl enters, and light conversation follows. Ken McCullough, a volunteer outreach nurse for HCH, asks the young girl if she has been inoculated for Hepatitis A and B. Ken hands her clean needles and advises her to stay out of the rain. His concern for her well-being sits quietly between us on this rainy night. Ken works as a nurse at the University of New Mexico Trauma Surgical Burn Sub-Acute Care Unit and has been volunteering with HCH for the last ten years.

There is yet another knock on the door. Throughout the evening there will be a steady stream of people. An older woman enters and her eyes dart rapidly above hollow cheeks. She comes seeking help in obtaining a driver’s license.

“I got this income tax check for $2,000 two months ago and I can’t do a darn thing with it.”

Rebekah explains what she will need to do to start the process of hoop jumping to get an ID card. Rebekah offers to meet her the next day at the clinic to start the process. She is thankful and leaves quickly, like a hummingbird.

There is another knock on the door. A woman comes in and announces that she has 200 to 300 needles to turn in. She explains that they are all hers.

Often people will be part of what is called a secondary needle exchange. This means they will come to the outreach site with needles of their own as well as the needles of others who are reluctant to come. It takes a long time to build relationships and trust.

“My arms are looking really unhealthy, they have hard bumps on them. I guess I did some bad dope.” A petite woman in light blue shorts and a tank top extends her arms for Ken to examine. He gently touches the veins that protrude from her skin and considers whether she may be developing an abscess.

“Don’t tell me that,” she says, “My uncle just died of an abscess.”

The outreach workers decide that because her arms are not hot, it is not likely that she has an abscess. She explains that she has no feeling in her arms.

“My ex tried to cut my arms off. I have no feeling in my arms.” It has been a week since the hard lumps appeared. Her arms visibly upset her.

“It looks just awful,” she says, and then asks for condoms before she leaves with a bag of needles.

I talk to Ken. He is a bear of a man with kind eyes and an open heart. He wears his compassion comfortably and judges no one.

“I have really worked hard in my life to not be judgmental about anything that is not harmful to me. When you think you are better than someone else, that is the first step in losing your humanity.”

I want to hold his humanity in the cup of my hand. I want to examine it like a precious object, but it is free flowing and fills the van. I think about the normalization of desperation and loss. It becomes routine the further into addiction we go.

We talk about outreach. Ken believes effective outreach has everything to do with keeping people safe and meeting their immediate needs.

“It doesn’t have to be anything big. It doesn’t have to be packing a wound. It’s a big deal to me if it is one hundred degrees and you give someone a bottle of water, when a person can come in and feel that they are cared for.”

There is a lull in the stream of people and stories. The van is quiet and no one knocks on the door again for a while. I bear witness to silence after two hours of bearing witness to the exchange of compassion and needles. I think about the fact that I am one year sober tomorrow.

Ken’s thoughts about community stay with me as I leave. He feels that it is his responsibility to contribute to his community in any way that he can Ken believes that if one person in a community is not well, then the entire community is sick.

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