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Risk, Citizenship, and Public Discourse: Coeval Dialogues on War and Health in Vancouver's Downtown Eastside 1

2006; Taylor & Francis; Volume: 25; Issue: 4 Linguagem: Inglês

10.1080/01459740601021160

1545-5882

Leslie Robertson,

Gender, Security, and Conflict

Abstract This article is about September 11, 2001, and its narrated effects on the lives of nine street-involved women in Vancouver's Downtown Eastside. I outline the locations from which they spoke about war and health: as consumers and economic agents whose bodies are linked to transnational economic processes; as residents in a local community of shared knowledge and practices; and as marginalized citizens of a nation-state. I hope to emphasize the value of engaging research subjects in coeval dialogues that work against essentializing, state-sanctioned discourses narrated in the context of armed conflict and a public health crisis. To women drug users in Vancouver's Downtown Eastside, the “War against Terror” evokes particular sites of knowledge: the body, the local community, and transnational processes. Their repertoires of war stimulate questions about citizenship and perceptions of risk, challenging dominating medical and political discourses that tend to temporally and spatially localize their engagement with the world. Keywords: coevalnesscitizenshipconspiracy narrativesdrug economydrug historiesdrug puritypublic discourserepresentationtransnational forms of riskwomen drug users Notes 1. This work was strengthened through the process of critical peer review and an encouraging dialogue with Stacy Pigg, the editor of Medical Anthropology. Dara Culhane, Julie Cruikshank, and Denielle Elliott read earlier drafts and generously offered conversation and critical comments. 2. Our scholarly products are, of course, not immune to this critique. A good deal of current work debates the contributions that ethnographic and qualitative methodologies make to public health initiatives. I ask for consideration of the ways in which our tightly fashioned conceptual analyses also constitute a kind of erasure of research subjects dictated by discursive rules that shape the specialized products of academic labour circulating well beyond our subjects' views. 3. This occurred largely through VANDU (Vancouver Area Network of Drug Users). 4. The Health and Home Research Project: A Housing Community for Downtown Eastside Women was funded by the Social Sciences and Humanities Research Council of Canada, Strategic Theme—Society, Culture and the Health of Canadians, Grant #828–1999–1046. Dr. Dara Culhane was the principal investigator. 5. An interdisciplinary team of faculty, graduate students, and community-based researchers worked with over 100 women over the course of two years. The research model involved working with “community-based researchers” (CBRs) who were/are residents of the DTES. These women trained academic researchers in relevant community protocols around recruitment and honoraria, appropriate questions, anonymity, and issues of legality. In turn, academic researchers trained CBRs in research processes, including ethics, forms of documentation, interviewing techniques, and analysis of data. Researchers scheduled monthly interviews with particular women in order to understand their perspectives on the shifting relationship between health and housing. Each participant received an honorarium of CDN$15. 6. Official state narratives mark women who not only bear the weight of the label of “addict” but who also experience the perceived loss of cultural authenticity that follows from the appellation “urban Indian” (see Peters 1998 Peters , Evelyn 1998 Subversive Spaces: First Nations Women and the City . Environment and Planning D: Society and Space 16 : 665 – 685 . [CSA] [CROSSREF] [Crossref], [Web of Science ®] , [Google Scholar]), which has long been associated with substance abuse, sexual promiscuity, and assimilation. In the classificatory categories of biomedicine, Aboriginality is high risk (Craib et al. 2003 Craib , Kevin , Patricia Spittal , Evan Wood , Nancy La Liberte , Robert Hogg , and Kathy Li , Katherine Heath , Mark Tyndall , Michael O'Shaughnessy , and Martin Schechter 2003 Risk Factors for Elevated HIV Incidence among Aboriginal Injection Drug Users in Vancouver . Canadian Medical Association Journal 168 ( 1 ): 1 – 6 . [CSA] [Google Scholar]). 7. They narrate histories of mobility and shifting financial strategies; several spoke about their solid work histories in trade and service industries. Turnings towards long-term drug use were often precipitated by the experienced grief of multiple losses in the form of failed relationships, deaths, and/or the lost custody of their own children (see Roberts 1999 Roberts , Carol 1999 Drug Use among Inner-City African American Women: The Process of Managing Loss . Qualitative Health Research 9 ( 5 ): 620 – 638 . [INFOTRIEVE] [CSA] [CROSSREF] [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Sometimes, it was the excitement of a life at the edge, or fast money, that drew them into long-term drug use. 8. “Survival sex” is the current term used by the women with whom I worked. It comes from advocates and activists in the Downtown Eastside who want to draw attention to the labour of impoverished, drug addicted women who work on the street, where they receive less pay and often endure more dangerous working conditions than do those women working through brothels or escort agencies. 9. In Canada, the Opium Act, 1908, and the Patent Medicines Act both served to limit the import and use of opium and morphine to medical practitioners. Rather than address the issue of addiction to opiates, the Opium Act was more closely associated with Canada's immigration policy and the deportation of Chinese workers. It was not until an amendment in the form of the Opium and Drug Act, 1925, that the prescription of opiates was prohibited for the relief of addiction in Canada (Ogborne, Smart, and Rush 1998 Ogborne , Alan , Reginald Smart , and Brian Rush 1998 The Treatment of Drug-Related Problems in Canada: Controlling, Caring and Curing . In Drug Treatment Systems in an International Perspective: Drugs, Demons and Delinquents . H. Klingemann and G. Hunt , eds. Pp. 2030 . Thousand Oaks : Sage .[Crossref] , [Google Scholar]:21). 10. Dara Culhane, personal communication, May 22, 2005. 11. Women's social taxonomies were grounded in social hierarchies within the “micro-risk environment,” which includes: roles in the drug economy, adherence to street mores, and drug of choice (Moore 2004 Moore , David 2004 Governing Street-Based Injecting Drug Users: A Critique of Heroin Overdose Prevention in Australia . Social Science and Medicine 59 ( 7 ): 1547 – 1557 . [INFOTRIEVE] [CSA] [CROSSREF] [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]:1551). They portrayed different user groups through a moral discourse on ethical (read economic) behavior. In the local hierarchy of heroin and cocaine users, crack cocaine occupied the lowest, least predictable, and least respectable niche. According to drug users from all groups, alcoholics are entirely “other,” and people who consume rice wine are further stigmatized. 12. VANDU's narrated history pinpoints the arrival of “ready-rock” in 1997, when “crack cocaine became available, cheap, pure…before this, smokers cooked their own rock” (Livingston 2004 Livingston , Ann 2004 Responding to A Cocaine Epidemic: What You Can Learn from Us . Second National Conference on Injecting Drug Use , Leeds , UK . Available online at . [Google Scholar]). 13. Since the 1980s, 69 women are officially listed as missing from the Downtown Eastside. The women are known drug users who have had some involvement in the sex trade. Families and advocates of/for the women charge that police largely ignored the disappearances and further stigmatized the missing women. In 2002, a pig farmer from an outlying district of Vancouver was arrested, and, in 2005, he was charged with 22 counts of murder. The trial is expected to begin in late 2006. 14. After Pearl Harbor was bombed, the Canadian state classified Japanese Canadians as “enemy aliens.” They lost their property and their livelihoods; they were stripped of their citizenship, deported, and/or detained in camps away from the coast. In pre-Second World War Vancouver, “Japantown” was located in the Downtown Eastside. 15. For the most part, women who participated in this research did not focus on “race” as a primary social category among users. Their taxonomies of difference were based on economic roles, adherence to street mores, and, drug of choice. Women did, however, racialize those who wield power in the drug economy: street-level dealers and people who participate in organized crime networks. 16. RCMP officials state that the use and production of methamphetamine is on the rise in Canada (U.S. Department of State 2001), and medical authorities have linked intravenous use of the stimulant to HIV transmission. 17. “One to two tonnes of heroin are required annually to meet the demand of Canada's estimated 25,000 to 40,000 heroin users.” and “fifteen to twenty-four tonnes of cocaine enter Canada each year” (U.S. Department of State 2002 U.S. Department of State 2002 International Narcotics Control Strategy Report 2001. Bureau for International Narcotics and Law Enforcement Affairs . [Google Scholar]). 18. According to VANDU, since 1996 there are few heroin users in Vancouver who do not use heroin and cocaine in a “speedball” (Livingston 2004 Livingston , Ann 2004 Responding to A Cocaine Epidemic: What You Can Learn from Us . Second National Conference on Injecting Drug Use , Leeds , UK . Available online at . [Google Scholar]). According to an epidemiological account released in 2001, there were “significant decreases in the reported use” of cocaine, heroin, and speedballs between 1996 and 2000; however, “weekly use of crack…has more than doubled” (McLean 2001 McLean , Mark 2001 Vancouver Drug Use Epidemiology. Vancouver and BC Site Report for the Canadian Community Epidemiology Network on Drug Use. Available at . [Google Scholar]). 19. More often than not, people like Alex are branded as “non-compliant” patients. In the biomedical language of risk, women are more likely to leave the hospital against medical advice—LHAMA. Those with weak support networks, unstable housing situations, and recent injection drug use are particularly “at risk” (Anis et al. 2001 Anis , Aslam , A. Chan , D. Guh , H. Sun , Martin Schechter , and Michael O'Shaughnessy 2001 Risk of Discharge from Hospital against Medical Advice and the Relationship to Social Supports and Housing Status . In Canadian Association for HIV Research 10th Annual Conference on HIV/AIDS Research (Abstract 465P) . Toronto, May 31 to June 3, 2001 . [Google Scholar]). 20. The Coalition of Progressive Electors [COPE] won the election. Larry Campbell, the former mayor of Vancouver, is an ex-coroner who worked for several years in the Downtown Eastside. He sometimes writes scripts for the dramatic television series Da Vinci's Inquest, a gritty, inner-city cop and coroner show set in the neighborhood that depicts drug users and sex trade workers within the context of unfolding policy debates. 21. A community activist noted that, of the 1,300 subjects working with VIDUS in 2000, 68 percent of them lived outside the DTES (Cameron 2000 Cameron , Sandy 2000 Look beyond the Skid Row Image . Canadian Medical Association Journal 162 ( 2 ): Letters . [CSA] [Google Scholar]). Many women noted the superior quality of drugs outside of their neighborhood.