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Evanna Brennan and Susan Giles: Bringing Action Based Care to Vancouver’s Downtown East Side
By Grace Jenkins
Home-care nurses Evanna Brennan and Susan Giles have been providing life-saving care to people living with HIV/AIDS and significant health issues in Vancouver’s Downtown East Side (DTES) since the 1980s. They saw the beginning of the HIV epidemic and witnessed the drug and overdose crisis develop into what it is today. Throughout it all, they have remained stalwart pillars care and compassion for Vancouver’s most vulnerable population.
The DTES, a neighborhood with disproportionally high levels of drug use, homelessness, poverty, crime, and mental illness, became their area of primary patient care and most urgent need. Complex health care problems began to ramp up in earnest in the eighties with an influx of hard drugs and the start of the HIV epidemic.
“Lucky or unlucky, we just happened to be there at the beginning,” says Evanna.
Adapting home-care nursing
Susan and Evanna recognized that typical home-care nursing methods did not fit this patient population, so they adapted the process to work in these circumstances. Their patients would not go to clinics, so they would track them down and bring care to them. Sometimes that meant asking someone’s drug dealer where to find them, or dressing a wound in a bar.
Before there were effective HIV treatments, they mostly provided palliative care, but palliative care looks different for someone who uses drugs. They learned how to provide care in that situation together with an outreach doctor, Susan Burgess, whom they continued to work with over the years. They also received support from the BC Centre for Excellence in HIV/AIDS and the Canadian Association of Nurses in AIDS Care.
An innovative model for nursing – Action Based Care
Susan and Evanna used their experience to develop an innovative model for nursing called Action Based Care. It is a holistic, relationship-based approach to medicine that incorporates harm-reduction principles. It is designed create access to care and meet patients where they are. A core part of their care, is respecting the patient’s autonomy and space.
“It’s that respect. The same way that you would want respect if a health person came into your home,” says Evanna. “That’s hard to do, when you know you can help them, or make life much easier for them. But it’s not what we’re asked to do by them.”
Action Based Care also involves putting aside any judgements or prejudices to focus on building care around what works best for the patient.
“It’s not easy to like people who use self-destructive things,” says Susan. “But you have to kind of accept that, or you’re always going to be in conflict over what you’re doing.”
They go above and beyond typical home-care nursing, including buying food and other supplies out of their own pockets. Filling those needs helps build the trust needed to get the nurses through the door, and the relationships that are a core facet of Action Based Care.
Susan and Evanna have fond memories of one of their patients, a woman with HIV who was twenty-two when she passed.
“She was easy to love. She really was easy to love,” says Evanna. In the end, she could not really eat, but she loved slurpies. Susan and Evanna would bring them to her. “I’m so glad we did that.”
Persevering through the years
The two retired from their positions with Vancouver Coastal Health in 2012, but continue to provide care as independent contractors. The DTES is an unsafe area, but people there are protective of Evanna and Susan. They stick out as nurses, and their patients - and their patient’s drug dealers - know who they are.
Their close partnership has been key to them being able to continue this work for so long. They originally went out as a pair for safety, but quickly realized the benefits of being able to combine their expertise to provided augmented patient care and support each other through chaotic situations.
Their compassion has also driven them to continue.
“If you’ve seen someone die of AIDS, you will do anything to get that person to be able to take the meds, to stop looking like a skeleton and being so sick,” says Susan. “And we had seen that, so it really spurred us on.”
The problems in the DTES have only grown more severe over the years. In one building they work in, nine people have overdosed in the last two months. Susan and Evanna used to go to every funeral. Today, they can’t keep up.
“I didn’t think it could get worse, but it is worse. The drugs are worse, the homelessness is worse, the street scene is more violent,” says Susan.
“And the overdoses are shocking,” says Evanna.
Contributing to nursing education
Susan and Evanna have shared the knowledge they have gained over the years, contributing significantly to nursing education in BC, Canada and beyond. They have taught nursing students from Canada, the US, Europe and Asia, and have presented at national and international conferences.
They want to continue to mentor other nurses and help influence the next generation. They hope that the documentary that covered them and their work, Angels on Call (2020), could be used as an educational tool and help spread the philosophy of Action Based Care.
Susan and Evanna have saved uncounted lives over the years by providing lifesaving medication and wound treatment to those who otherwise would have fallen through the cracks of the medical system. They have reduced harm and built relationships with some of Vancouver’s most vulnerable people.
The health care problems in the DTES do not have simple solutions, but in Susan and Evanna’s knowledgeable opinions, increasing housing, shelter beds, and access to mental health care, along with better long-term addiction treatment and recovery, could help alleviate some of them. They would also love to be able to break down the barrier of people being afraid to approach drug users and others who live in the DTES. They believe that only by knowing this population, like Susan and Evanna do, can we overcome the painful turbulence that exists in this community.