Scott Harrison pulls no punches when it comes to addressing how health care providers treat their HIV positive patients.
The president of the Canadian Association of Nurses in AIDS Care addressed an HIV workshop in North Battleford last week, saying, "We're all racist."
In Saskatchewan, 80 per cent of all new HIV cases are of self-reported First Nations and Métis heritage.
"We all judge," said Harrison. "We're human, that's what we do. The difference is being aware that those thoughts are coming through your mind."
From birth, the colour of our skin means something socially to us, he said, and racism is a problem if you're white.
"If we remain oblivious as to how this plays out in our health care interactions and social interactions we become paralyzed, we are not able to address it and move on."
Harrison is originally from the UK, and is of a Romany family. In his native country, his people were called gypsies, gypos or pikeys, and they were not considered white or part of the mainstream culture.
"Being in Canada was my first experience being white," he said.
"Moving to Canada and talking about indigenous health, it's like 'what's the white guy doing up there?' I'm thinking, 'what white guy?' So I have had this weird experience of being 'whitened,'" said Harrison.
Harrison is an experienced nurse, midwife, nurse practitioner and health care leader with a particular interest in vulnerable and marginalized communities, including people living with HIV/AIDS. He is currently the director of Urban Health and HIV/AIDS with Providence Health Care in Vancouver.
"As the white man, I get flack because I'm not expected to speak against and agitate in opposition to racism," Harrison told those attending the workshop sponsored by BTC Indian Health Services Inc., in partnership with Prairie North Health Region and Kanaweymik. "I'm not expected to sit up here and criticize the people in my profession. I'm expected to keep my mouth shut, be the nice nurse, be the good white guy, don't discuss these things."
Diane Knox of the Battlefords Sexual Health Clinic introduced Harrison, who attended the event for no fee or travel expenses. Having heard him speak at other events, she said, "He gives us a wake up call about our duty to provide care and how we sometimes discriminate not even knowing it."
Most people feel a little bit uncomfortable with what he shares from his experience, said Harrison.
"The icky stuff we are going to talk about is more around shame, how we use shame and how it affects the practices we do, particularly around HIV and aboriginal health."
He said, "One of the most powerful mechanisms we use to control our behaviour and the behaviour of others is shame," adding, "Shame is heavily laced in the nursing profession."
In western culture, he said, people are awarded power and authority largely by their education, their professional affiliation, where they work, who they are and what colour they are.
In "invisible backpacks," each person carries their experiences, beliefs, values and morals, he said. Those backpacks affect how people talk to each other, view each other and work with each other.
They also contain privilege, he said.
The dominant culture in Canada is the white, Christian, heterosexual culture.
"That's just how life is."
If you are in one of those three groups, he said, you automatically embody privilege, whether you are aware of it or not.
White privilege has been defined as being the unearned advantages of being white in a racially structured society, he said. It is characterized by institutional power and it is largely unacknowledged by most white individuals.
"If we are aware of it, we either deny or protect," he said, adding, "Unacknowledged privilege creates unconscious oppression."
However, he said having privilege doesn't mean one's biology is his or her destiny, or that everyone isn't oppressed in some way.
"The whole point of when we are working with vulnerable people is to reach inside and touch that part of ourselves that has experienced that oppression, has experienced feeling not perfect, or feeling angry."
Harrison ties it all together with how people avoid dealing with feelings of shame.
Shame, he said, is a very deeply set of emotions that start early in childhood. Everyone has experienced that sinking of the stomach, and the heat of the "warm wash of shame," a term coined by author Brené Brown, he said.
"We never want to experience our shame, so we stuff it down in many ways," said Harrison. "For some it's heroin, some it's a beer, some it's a banana nut muffin."
Other defence mechanisms see people trying to remove themselves from it, leading to blame, hatred, withdrawal, regret, self-loathing, disconnection, bigotry, racism, humiliation, fear, separation, anger, contempt and disgust.
Shame needs three things to survive - silence, secrecy and judgement - he said, using Canada's residential school history as an example.
"It still knocks me sideways when people say 'haven't they got over that yet?'" said Harrison, "and I get that a lot. And no, people haven't got over that yet because we have been silent, we have been secretive and delayed judgement."
The only thing shame can't bear is empathy, he said, but there is very little of it in health care. Training discourages empathy as unprofessional, so what patients get is sympathy, which disconnects the caregiver from the patient, he explained.
"Empathy is the whole thing about getting in a puddle with someone rather than standing on the sidelines."
The two most powerful words in empathy is saying "me too," he said.
"It's not unprofessional or inappropriate," he said, "It's telling your patient you also have been vulnerable, you also have showed up in the arena, you also have failed, and it's OK and that 'together we will get through this.'"
Harrison also said caregivers may disconnect from their patients and colleagues by striving for perfection.
"So she called the patient a bad name, she's rude to all the staff she works with, but you're telling her she's a great nurse because she can land an IV on the first go? No," said Harrison.
Another defence against shame is anger.
"This is the one men do really well," he said.
Another, he said, is to shame others to get the "warm spotlight of shame off me to someone else. This is where arguments come from."
The most insidious defence against shame is contempt, he said.
"The most poisonous, toxic body language you can ever do is roll your eyes at someone," he said.
"On the receiving end you feel small, you feel stupid, you feel discounted, your shame is triggered," said Harrison. "You then go into another one of these defences against shame, which is normally withdrawal."
Harrison underscored his feelings about eye rolling by saying, "If you are a health care provider and I ever see you doing it, you won't have eyes to roll."
Power is another defence mechanism that is "absolutely virulent" in health care, he said.
"We use power over each other as health care professionals and we use power over our patients, and then we deny that we do that."
Other hot buttons with Harrison were caregivers who are "too posh to wash," or "too cool for school," thereby not engaging in the process of care, disconnecting from their patients.
"Who of you wants our profession to look like this?" he asked the attendees. "It's starting to look like this, but we have time to turn it around."
In the larger context of Canadian culture, Harrison talked about dominant narratives, "the big stories that we tell ourselves and we all believe to be true."
He said, "Every Canada Day and Thanksgiving we dwell on the past even though we tell people from aboriginal communities they shouldn't dwell on the past we say their stories are irrelevant if it doesn't match what the dominant narrative is."
He said, "What's important to understand, particularly, as nurses is that our western concepts of civilization are subjective and pejorative. We use the term civilization in Canada to describe wealth and technological advantage. The irony is both wealth and technology are often used for very uncivilized ends and the concept is very pejorative when we apply it to our indigenous cultures."
He encouraged his audience to learn to see through a racial lens.
"Try to understand that different people see through different lenses. Educate yourself about those lenses."
He reminded them, "If you leave a racist comment unquestioned, if you leave an HIV stigma unquestioned, you are giving approval for it to be used again and again and again."
By standing up to the stigma, talking about it and removing the shame from it, health care providers can connect better with their patients, he said.
"Ultimately, what we are here for as nurses is to connect on a human level."
