Pauline

We are learning more about God’s will to heal through the teachings of Keith Moore who gives a very strong Biblical teaching on why we know that it is God’s will for us to be healed today. This is transforming some of the way we understand and apply the word of God.  It’s really about being “doers of the word and not hearers only” in showing us what it means to put Scriptures about healing into practice in our daily lives. If you want to learn more or to pray with us through this teaching series, you can find it on http://moorelifeministries.com/mlmindex.php where you click “free downloads” then scroll the page down to select “2002 – God’s Will to Heal.” The basic question is: Whose report are you going to believe? Our final hope is in Christ.

As we recover from the shock of the decision to end chemo, we will continue to put these Scriptural principles into practice. For those of you who believe that it is God’s will to heal, we particularly value your on-going prayers to combat the evils of this disease. As we are learning to become more specific in our prayers and thankful for the healing God has given, we have seen specific answers. So we ask you to join us in prayer as the Lord leads you, but here are a few examples of specific things you could pray for:

*for side effects of chemo to rapidly leave my body–for example pray for the return of normal saliva functioning

*to balance rest and activity

*that Ron and I would know how to encourage one another and to seek outside help when we should

*that Monday’s blood tests would show an  improvement in my red blood count and a drop in the tumor markers. I had a blood transfusion yesterday and Monday have blood tests to see if more needed.

*for increased understanding and alertness to practice what we are learning in the word of God about healing

Since then I have struggled with medical care regarding the best approach to pain management for me. I was not prepared to endure a worsening of gut management (i.e. constipation) for some relief of back pain. Last week at the pain clinic they brought in a palliative care doctor who did have a solution. What a relief! What an answer to prayer too.

This meant agreeing to become a part of the local “Palliative Care” Programme. That required some emotional adjustment-and a reminder that “Palliative Care” does not equal “Terminal Care”. In return I get close management of my pain medication by a visiting doctor, and other in-home services. Another bonus is fewer 40 minute trips to the Surrey Cancer Clinic, which are tiring for me, and time consuming for Ron.

On a happier note, our eldest great-grand-daughter turned 3 years old last week. Over the next few weeks I expect visits from the rest of my siblings. My niece from Campbell River is here helping/visiting. My youngest brother arrives this week with his family. I get to meet my 3+ month old niece for the first time.

My next oncologist appointment is 5 May; I may have more to report afterward.

We continue to pray for the healing God intends for me in this process.

I see my oncologist on the 9th so should have another update shortly after that on how we are doing.

Pauline & Ron

We begin with a plenary panel session: PHAC Status Reports overview (Public Health Agency of Canada).  This report will soon be on their website: www.phac-aspc.gc.ca but unfortunately I couldn’t read the print on the electronic screen which gave the actual eventual link.  This was a look at findings from 2002-2008.  Several people reported on their sector of engagement during this session.

1. The federal programme “Leading Together” covered that period and has been renewed for the coming year.  It was a federal initiative for 8 population groups, who overlap each other as well and attempted to answer the questions, “What is the status of HIV/AIDS in this population?” and “What factors impact this population?”  At the end of 2005 there were about 58,000 people known to have HIV/AIDS in Canada, representing a 16% growth factor from 2002.  PHAs are found in the following groups:
   1. MSM (Men having Sex with Men)                   51%
   2. IDU (Injecting Drug Users)                              17%
   3. Heterosexual                                                   27%
   4. MSM & IDU risk factors together                   3%
   5. Other                                                               2%
2. Ontario is the only province with a known strategy for reaching specific target populations listed above, for enhancing capacity, reducing barriers addressing cultural issues, risk-taking and prevention.
   Saskatchewan has the highest numbers of new cases diagnosed, especially among women; this has implications also for the number of infants born to HIV+ mothers who are not on anti-retroviral therapy (ART or ARVT).  This appears to be due to a higher incidence of IDU. There have not yet been any studies specifically looking at Métis populations, if I understood correctly.
3. Factors influencing the status of those with HIV are co-infection factors: high incidences of HCV, STIs (Sexually Transmitted Infections), mental health status, age of onset of IDU, cocaine use, needle sharing and/or frequency of injection. Anecdotal remarks at the conference indicated that “rock” smoking is almost universal among the HIV+ heterosexual population leading to impaired judgment and thus greater risk-taking.
4. PHAC studies are moving from just looking at individuals to gathering community-based data.
5. Terry Howard reported on the Prison Outreach Programme for BC and Federal Prisons in BC/ACAP (AIDS Community Action Programme – part of PHAC). First it is hard to get funding for any prison outreach outside of federal prisons. Terry visits as many as he can; aided by his most faithful volunteer, an 83 year-old woman. They have created an “Entry to Exit” programme which continuously follows HIV positive inmates through their entire incarceration for ART and other needs, averaging 50 member clients monthly. It is noted that the only people followed are those who self-identify as HIV+ (gathered from voluntary testing in prison). Stepping forward with their HIV status exposes prisoners to great risk of violence. About 1.9% of male prisoners and 5% of female prisoners are confirmed as HIV+ but numbers must be a great deal higher. There are great unmet needs within the prison systems.
6. Positive Women’s Network (PWN) www.pwn.bc.ca (or pwn@pwn.bc.ca) is very active with support from ACAP. The report focused on the role of “Wellness Retreats” offered for member women, but that they could only handle 50% of the applicants due to funding and the need to keep the group size below 30 participants for healthy group dynamics. Of those attending, 35% are Aboriginal women. During the comments & question period following, one Aboriginal participant spoke from the heart about her appreciation for her male, HIV positive partner who has stayed with her since she was diagnosed some years ago.  She spoke of the pain that she could attend such events that helped her, but that there was no funding available for her partner, and how isolated he felt without opportunities to meet others in “sero-discordant” relationships.  Others spoke up and reinforced this.  This same woman shared some of her personal story with me on Day 1 and took my contact details.
7. Over lunch I met with a refugee woman from the same table who is part of the PWN and who has been instrumental in helping form a separate but related group for local African-Canadian women PHAs. I gave her my contact details but did not ask for hers as she expressed many safety concerns including a fear that her status and whereabouts could become known to others of her ethnic background.

The rest of the day was divided into 2 tracks and I chose the Aboriginal track.

1. We started with more reports from PHAC with more details specific to the Aboriginal population and more voice from those who themselves are Aboriginal. A recurring theme is the need for “decolonization” which appears to embrace both helping Aboriginals understand how the dominant culture (and especially the abuses of the 20^th Century residential schools, but not limited to that) has interrupted the grasp of various Aboriginal World Views and to re-introduce Aboriginal Peoples to their cultural/World View heritages; it also aims to help non-Aboriginal people working with that population to examine where their own cultural constructs are in conflict with Aboriginal culture(s).  This is presented as something that needs to be continuous and on-going.
2. I learned of the Canadian Aboriginal AIDS Network (CAAN) and brought home 6 or 7 print items and a CD to share with TFN &/or anyone else interested in learning more of the resources available.  Additionally several ASOs presented case studies which also reinforced the need to present ideas in the manner that the culture understood (such as “around the kitchen table” discussions and how to present them so that people would come rather than be offended).
3. The nurse (DL) in charge of the Vancouver Native Health Society (a comprehensive clinic) not only presented but also took the floor during discussion times speaking with great passion.  DL then apologized for her “passion”.  Later I spoke with her; we have met at a few CANAC (Canadian Association of Nurses in AIDS Care) conferences & suggested that she should never apologize for her passion when it came from her compassion for people.  We discussed possible reasons why people fear passion & then I said, “You work all the time with people with maladaptive coping methods…” and she burst out laughing.  Our “clients are not the only ones whose responses are “maladaptive”!
4. It was wonderful to be among people who truly care about people affected/infected/at risk for HIV/AIDS. Yes, some may have had a personal agenda, but the perception of pain and caring was very evident.

I came home from the conference a bit early, missing the closing remarks.  As I watched the evening news, the focus was on the “bringing home of the Olympic Flame” (arriving the following morning to Victoria).  The need for Aboriginal people to have a sense of place in society was reinforced when Larry Nahani of the Squamish nation (interviewed on CTV by Sarah Galashan). Larry Nahani oversees the war canoe that would be used in the ceremonies the following day and said, “Every time I step into this canoe I am very proud.  You know it does a lot for me.  It’s a lot of healing this canoe does for our people.”[1] The need for healing to be found from within the cultural world view was emphasized many times from participants.

How many of us know well enough how our cultural constraints impede us from seeing what empty traditions in our cultures are?  How equipped are we to come alongside others in their traditions to encourage exploration of ways to keep what is good and yet not settle for less than God’s best?  This is compounded by a long history/memory of damage done in the name of Christ.  Do we repent from the heart for this?

All in all, I am very glad that I was encouraged to represent SIM at this conference and learned much.

Respectfully submitted:
Pauline Clarke, RN, M.S. HIV/AIDS Education Consultant, SIM-BC.

The conference opens with an acknowledgement of the traditional heirs of the “Territory” (very common here in BC when holding public meetings).  A local Aboriginal Elder attends and welcomes us, followed by a blessing on each of us.

The stage is set for the conference: the plenary session exposes us to the enormity of mental health issues compounding the lives of those at risk for/infected by/affected by HIV/AIDS.

Carlene Dingwall is one of the first speakers, from the Provincial Health Services Authority (PHSA). Part of her report included this data:

Current prevalence rates indicate that 1 in 5 Canadians experience a mental health disorder over the course of their lifetime. Data gathered for this report indicates that 4 in 5 British Columbians living with HIV/AIDS and accessing services from an ASO (AIDS Service Organization) experience a mental health disorder. This means that 80% of people living with HIV are impacted by mental health conditions and illnesses at some point. These disorders encompass the entire range of mental illness; including depression, post traumatic stress disorder, substance misuse, bipolar disorder, psychosis, schizophrenia and so on. It is important to note that these conditions are frequently undiagnosed and untreated. Despite the high prevalence rates of mental health conditions among persons living with HIV, only 10.7% have been able to access formal mental health supports. This is in contrast to a 40% access estimate for those who have mental health conditions but are not living with HIV. Thus mental health conditions affect people living with HIV at 4 times the rate of the Canadian adult population and yet they access mental health support services at 1/4 of the rate of the “average Canadian”(www.psha.ca – Mental Health and HIV Strategic Action Report).

In addition to this data, I learned that many coping with HIV/AIDS &/or the Hepatitis C virus (HCV) also cope with multiple mental health challenges.  Most men in ASO programmes reported depression as the major issue they faced; by contrast the majority of women in the programmes who reported post traumatic stress disorder (PTSD).  It was also pointed out that using the term “mental illness” created un-necessary barriers to care. Whereas speaking of mental health issues more accurately reflected normal responses to the very stressful state of life that most people were dealing with, as multiple challenges that would impact anyone’s mental health: infection, illness, homelessness, violence, poverty, separation from family members, unresolved grief, addiction and many other issues.

Later on, in another session, I learned that many who are refugees &/or new immigrants to Canada also face many of these issues. In spite of my expectation that immigrants from countries where HIV/AIDS is endemic had likely brought their HIV infection with them, I was informed (by a BC-Center for Disease Control staff member) that this was often not the case; instead, the isolation and poverty faced by many led to high risk behaviour and subsequent HIV infection.  I learned that those from endemic countries only represent about 8% of Canada’s population of persons living with HIV/AIDS (PLWHAs).  Aboriginal peoples who represent 3.8% of Canadian population make up about 9% of those newly diagnosed with HIV/AIDS in 2007 and 7% of PLWHAs overall in Canada at end of 2007, thus being greatly over-represented in the total picture of PLWHAs in Canada.[1]

In the afternoon I was introduced to a panel on a variety of approaches to do outreach to the intravenous drug using (IDU) communities in BC, followed by an update from CATIE about new resources and links through their federal agency based in Toronto.  The main things I take away from that are:

1. • Harm reduction programmes are consistent with public health measures and they have very positive outcomes.
   • CATIE now will deal with not only HIV/AIDS related issues but also become a clearing house for anything helpful related to HCV.

CATIE is developing case studies on “Models of Front-Line Service Providers” (&/or practices) and using this terminology rather than what is more commonly known to me: models of “best practice”.