Photovoice: Un/safety in clinic spaces
Photovoice is a participatory, arts-based research method and a community tool to illuminate sites of social tension and action.
We engaged & compensated 14 participants from marginalized genders to take photos of safe and unsafe spaces in the 3 VCH DTES Primary Care CHCs (Downtown, Heatley & Pender). The focus was predominantly on the waiting room spaces, but extended to all clinic spaces, and participants’ additional frequented spaces.
Our Peer Advisory Circle took photos and we present their more representative photos below. These are followed by major themes that came out of the larger photo debrief discussion with all available participants (8). These themes are: Seven Sacred Teachings, harm reduction, bathrooms, seating, gates/doors, reception, security, community strengths, signage, plant/flowers, clinic rooms, & art.
Peer Antonette highlights her experiences engaging in this process, safety in the clinic and how that can change over time, and delights us with her poetry:
Kat, Blackfoot
It’s just one tree sitting there. I have had dreams of this one tree. And, I don’t know why, I don’t understand why I have dreams of this one tree. It doesn’t matter how it loks, its just this one tree on a hill or on a side soewhere or in the Rockies somewhere. The one tree, I don’t know, but it always makes me feel safe every time I think about it or go to it. In my dreams or if I am feeling stressed out or something, then I will close my eyes and go to it.
This is my peer group, this is the only peer group that I have ever been to, but this is my peer group, the only one that I want to go to. It’s my group, it has the flowers, it has the tables, it has someone sitting there who is going to eat and it has other people sitting there talking. And I like that, it makes me want to cry. It’s a nice feeling, something that I am going to miss. Cause I don’t think that we should take that away.
Laural
It’s like the doors of perception, behind where the light is shining, you’ll find love.
The whole angels thing. Angels are here. Some of the staff are somewhat angelic to work here.
Hard to capture what I wanted to capture.
Just how grimy it was.
I’d say that a Kits Clinic wouldn’t look this way, so why is it ok for here?
That relates to respect.
Maybe you live up to your surroundings?
Tara
I don’t like that room at all.
Because of the needles and all. It needs more artwork or some kind of calming music. So you don’t pay attention to - cause I always go like this when they are taking blood. I just don’t like needles.
At the site of a needle, I want to throw up.
That’s why they need something to distract.
There’s a lot of posters of blood work, of how much blood work they are going to take out. You know, the tubes.
Even when they have the gloves out, you see it, you smell it. Just the thought about it. Cause I used to give myself a shot. Methotrexate shot by myself for a couple of years or so, before i started coming in to get it. I do not like that medication at all.
I think that some people are nodding off, cause they don’t have a place to live and so, this is a safe place and some people fall asleep. I was homeless. We were homeless before but we moved here and we were homeless when we were teenagers, older teenagers and I was going to work at ___ cafe, where HAVE cafe is and I was working there, but we were homeless, so I was up all night. We had no place to go, you know its like you need a place to just sit there.
Harm reduction cart
Because it’s so nice and colourful.
You don’t see the needles at all, but people know where they are.
I feel safe with that one. This one I feel safe because it is opened up, you can see the people, the receptionists. Compared to here, you have to lean over or talk in the little things when they are just right there. When [Pender] it’s just open.
I chose the harm reduction, but I like it because it opened up the bathroom area where you wash your hands and all that. The Heatley, I like their bathroom, how they have it all set up it’s so bright around that area where you can not see sometimes in that area where the lights are so low. […My daughter, I] go to the bathroom with her. This one, I could just sit there and she’s right there. So it’s nice and bright.
Antonette, hybrid
I love the mirror because it’s there. And you’ve got the handwashing thing, soap, water, clean. Touch up your make up, your lips. I like mirrors. You see everything that’s going on.
Empty clinic with a sign out front. Looks safe when it’s empty. Less people the safer it feels. I’m not in there, so I’m ok. A lot more inviting with less people in it. It’s intimidating, who’s in the waiting room.
Wisdom, courage & love. We should always carry that with us, the love and the courage. I hope find the wisdom that you are looking for there to answer your concerns.
This one of course also has the escape route, the bike. If you knew how to ride the motorbike you would feel a lot more safe. Gate indicates change, moving from one space to another, move from danger to safety, or safety to danger. A gate of new opportunity, gate of discovery, makes you feel safe inside. You can keep the cold, cruel world at bay, if you are inside the gate, and the security guard to watch. The security guard makes me feel safe, makes my bike feel safe.
Annie, Nuxalk Nation
When I phoned, nobody answered.
I come down here and they’re all talking about what they’re gonna be doing when they’re off. Maybe an hour before closing down. They’re standing in a group of four, maybe five talking about their home life. I had to stand there for five minutes before someone even noticed me, a couple of times. Didn’t want to be rude, but still.
They don’t seem to give you a choice. If it’s womxn’s night, I’ve tried to make an appointment during the day if it’s important. “Oh it’s womxn’s night tonight, come tonight.” All the regulars that go and they don’t want to leave. When I finally get to see her, like two minutes in ther, she’s saying “okay, time to go.” I’m not very happy about that.
You don’t see us once in a while? We come and we try and make an appointment at the front.
I took a picture of a tv because that is what I do everyday when I am at home or at the clinic, it takes my mind off of waiting and being bored and stuff.
I feel comfortable and safe doing that.
It was nice to watch it without having to read the lips. You’re not guessing what the movie is about.
Here they don’t turn the volume on. Cause the security doesn’t like it on.
Clinic Support Attendants (CSAs)
[The CSA] walks you out….gives you the biggest smile.
I feel more safe with the gates, cause there’s a guy outside when we went to Heatley and he was giving ladies problems. And then [CSA] he went outside and got the guy to move away, so they make me feel safe.
Bigger group themes
Harm Reduction
> I felt safe outside there.
> If [children] grow up around it, it ceases to be “other".” A kid might say “oh, mommy what’s that?” and mom can explain.
> That’s when I was ten years sober. I didn’t want to come out that day.
> Yes it’s safety, supervised safety.
Harm reduction being out in the open. I think all drugs should be legalized, decriminalized & free. Those companies are making so much, they should be providing them.
If children grow up around it, it ceases to be traumatizing.
People could be discrete [if it was legal]. It’s the stigma of using that causes people to just get it in them and make a mess. People are dying just because of the secrecy, people’s attitudes, the way they’ve been brought up to think about it, it’s all unhealthy. It’s unsafe. And then the whole incarceration system that goes with it. Unnecessary.
Bathrooms
> They didn’t look clean. I want to walk into a bathroom and it looks clean…at least half clean. Like, I can sit down on it.
> I really hated that when that guy came into the bathroom. I didn’t like that. you’re in the bathroom and they open the door, It shoulodn’t be a guy in there, that’s really upsetting.
I don’t like how that happened. Sometimes that’s how we got dates whether you really wanted them. And, if he’s security, why is he like that. It’s not nice. They should have women going in there.
I didn’t even finish going to the bathroom.
> Yeah it’s so much harassment right now. I’ve had nothing but problems going to the bathroom anywhere lately.
> I’ve actually asked for accompaniment to go to the washroom now.
Waiting Room
Safety from violence
> I think we need to help people be safe here.
> He got my cigarettes. Stole them.
Someone pulled a scarf right off my neck one day cause they were too cold. Pulled a scarf right off my neck going out the door here.
> [Security] is cranky, if [security] doesn’t like you, [security will] put you down.
Seating
> Um i don’t know, I just find that they are just, not comfortable.
> I thought that they were nice and clean, just like the safe injection picture that I took. They were nice and clean.
> It’s intimidating who’s in the waiting room. The chairs too close. I would not have a place to sit.
Gates
> The gates are safety from violence.
> i don’t like the gates because I have gotten stuck on both sides and not been able to get out. That’s my main thing of feeling scared, feeling like I can’t get out. And, I feel like I’m being stuck or pushed back or something. These gates represent that. I can’t, I can’t, its just too much for me.
> I seen the gates all over and oh god. you felt like you were in jail again, get arrested again or I why should go to the Dr.? I scared to go because it’s like a jail. The bars and that aren’t welcoming at all.
The Seven Sacred Teachings
> I took them because some of the words that were on the signs, I thought, made me feel comfortable…Wisdom and Respect.
> I think that’s what kept me alive is um seeing the strength and Wisdom and respect. Seeing those words, at different places… on the counter at the social workers office I used to read it and put one on each of my shoes and I’d always watch on my feet… those signs and affirmations that were a comfort. Helped keep me safe.
> So it take a long time for me to trust.
Strengths:
East Van Community Pride
[I like this art] cause it has east van on it. And it has the hand sanitizer beside it. I don’t know, it just reminds me of east van - community pride.
Spirit, resilience, belonging
This is the themes, last year’s themes at the Hope and Shadows. Spirit and resilience, belonging was this year and I made both of these, actually.
Good times
I had some fun times chasing the dragon there ‘cause I can’t shoot needles anymore. I felt safe outside there, sunny days, everyone is there having a good time and chasing the dragon.
2SLGBTQIIA+ inclusive art & symbols
Maps of Indigenous territories & Indigenous art
Plants & flowers
And it would be nice to see some plants in doctor’s offices. And flowers.