"It Didn't Go So"

"It didn't go so," she said under her breath. —Erna Brodber, Myal, p.84.

Peer Recovery Supports Training - 19 Oct 2017 20:28

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NEC's Technical Assistance Center is the best repository for peer recovery supports evidence base and technical assistance I know of. It is run by Oryx Coleman, who co-founded the Freedom Center in Massachusetts with Will Hall.

Good recorded webinars

IPS

eCPR

Open Dialogue

Other recovery tools

For more of my thoughts on how to teach recovery peer supports, see my blog post on Teaching Mental Health. - Comments: 0

Roles for providers in action medical support - 18 Dec 2016 06:31

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Medical providers who have not cross-trained as street medics are welcomed as an integral part of street medic mobilizations. It feels good to get out of the hospital or the clinic and work in the field, free for a moment from the encumbrances of paperwork, "cover your ass" medicine, and frustrating administrators. However, many other things are also different on the street. You don't have staff, advanced diagnostics, easy referrals, charts to give you baseline on patients, or a controlled working environment.

By working outside of medical institutions, each action medical worker becomes personally responsible for establishing and maintaining appropriate clinical boundaries in the street. How you carry your social authority may cause some people to cling to you and others to be afraid of you and refuse care. Working as part of an action medical mobilization requires an open mind, real humility, and a willingness to learn from anybody, admit what you don't know, be creative, and constantly improvise. And it can change your life.

A few roles have a particularly good "fit" with providers who have not cross-trained as street medics.

Buddy

You can plunge right into the fire and work in the field at actions, housing, or jail support as the buddy of a street medic. Don’t cheat yourself by buddying up with another medical provider; find a street medic who is not a medical provider. Your exchange with her in the street will be worth it. When choosing your buddy, get to know her and ask her questions before making a commitment. Ask when and where she was trained as a street medic, and if it was a 20 hour training. If she can't tell you, or didn't attend a 20+ hour training, she isn't a street medic. Find another buddy.

It is appropriate to ask a street medic for names and contact info of people she has worked with at past actions who can "vouch" for her as a medic. Feel free to ask, and to check in with those people and find out what they have to say about her. Ask her what actions she has worked at and what she thought of them. Ask what kind of risks she prefers to take at actions. Ask about her political philosophy. Ask if she holds any certifications or licenses in the medical field.1 Ask if she is an herbalist. You're looking for someone you can trust in the field, and someone you would like to work with. Some medics may not want to work with you if you do not have action medical-specific training. Among the many legitimate reasons for their preference might be their concern about your practical politics of informed consent or your skill in more highly fluid tactical situations. Don't be offended; be grateful your lack of affinity was discovered *before* you entered the field!

If you find someone you'd like to buddy with, encourage her to take point and to provide the majority of the care. Start practicing empowerment with your buddy! If she seems really inexperienced it's probably because she is. From your position as the "scene assessment" buddy, you can learn what your buddy knows and maintain the detachment to kindly help her grow in her confidence with assessment and care skills. Her bad health promotion judgment calls are learning opportunities for her and sometimes chances for you to kindly and respectfully help her learn. You will probably make bad tactical judgment calls, from which she can help you learn. You and your buddy can decide to switch roles in the course of care if she wants you to get hands-on with the patient or you need her to make judgment calls about your team's response to a rapidly developing environment. Debrief after every patient, and take the time to listen as well as to teach.

Clinician

Action first aid spaces and wellness centers are very different animals from most community clinics. They exist as an additional tier of care provided by action medical at an action, and do not replace existing community health services when those are needed. Patients who do not immediately need emergent care services offered by technical medicine use action wellness/first aid space to rest, get a higher level of patient care than can be provided in the street, get injuries documented, receive wellness services or nursing care, or consult with an herbalist or other clinician.

A common sight in action wellness/first aid spaces is "the drunk guy who face-planted." His friends flagged down a street medic and reported he stood up on a park bench and fell on his face. He's drunk so you can't really evaluate the cause of his altered mental status. No vomiting, no observed transient loss of consciousness, pupils equal, round and sluggish in response to light. The medics try to get the guy's friends to take him home and follow the guidelines on the head injury aftercare sheet, but they came all the way from Montreal and really want to be out in the streets. So the friends take him to the action wellness/first aid space. During his evaluation, he's meek and apologetic. Medics make him comfortable and let him sleep, herbalists brew up some tea, and a medic wakes him up every hour to check his pupils and look for late developing signs like raccoon eyes or Battle's sign. He feels better by the time his friends come back, and the medics send his friends home with clear instructions for using the head injury aftercare sheet.

Action wellness/first aid spaces don't see themselves as definitive care. In a pinch, they stretch their resources and pull off amazing feats with patients who absolutely refuse transfer to definitive care. But for everybody else, the clinic triages them into those who leave quick with or without a simple intervention, those who stick around for a while for assessment over time or rest, and those who leave quick in an ambulance or a car for the hospital. The action wellness/first aid space needs a good list of local low-cost and free health and social services to give patients who require definitive follow-up or services the action wellness/first aid space cannot provide.

There isn't a staff at the action wellness/first aid space to keep things running smoothly, just the volunteers scheduled during your shift, with whatever skills they have. They serve the patient, not the doctor. A street medic with experience in action wellness centers or action first aid spaces (and their buddy) should always be onsite to do clinic coordination or everything could fall apart. Jobs that need to be done include scheduling, constantly organizing and labeling supplies (and throwing out or hiding supplies that should not have been donated), cleaning up, and staffing the front desk. Some spaces include intake workers; in others, you do your own intake. People come in waves that depend on the action and mood in the street. Sometimes it's dead for three hours, then the space is suddenly swamped, right after the provider left from boredom.

Nurses and herbalists prove some of the best at intuitively understanding what is needed in action wellness/first aid spaces. The basics are two pillows and a blanket somewhere that is quiet, clean, accessible and feels friendly and safe enough for patients to relax; a box of correctly-sized exam gloves; and a caring, competent, sympathetic clinician. Everything else is extra.

Generating records for lawsuits and criminal defense

Patients sometimes want police-inflicted injuries documented for legal purposes. Common injuries include almost visibly imperceptible wrist abrasions or bruising combined with compression neuropathy of the superficial radial nerve caused by long custody in overtight handcuffs, or 30 cm wide contusions in lateral lumbar regions caused by blunt force trauma (usually from projectiles fired at fleeing protesters). Sites where requests for injury documentation are most common include at jail support (when support teams including medics, legal, and comfort maintain vigil outside holding facilities to receive released arrestees), in the action wellness/first aid space, and at housing sites. Street medics take photographic and written evidence of injuries and give these records to the patient. Reports written by anybody other than a medical provider are considered hearsay by judges, but usually a legal team can use them to build a case.

Medical providers have the authority to create official medical records which can be used as legal documents in court. The authority to create legal documentation of injuries can be a great asset to patients. In the United States, medical doctors and doctors of osteopathy are granted this right in all states. The ability of nurse practitioners to produce official medical records with the authority of legal documents in court is governed differently by each state's advanced practice nursing or advanced nursing practice laws. When producing medical records for patients, be sure to provide your business card or other contact information along with the record, so the patient can easily contact you and call you as a witness in court. Be aware that if they do initiate a lawsuit, it may be several years before you are called.

Medical records for hungerstrikers

Official medical records are also highly useful in support of hungerstrikes. Hungerstrikers use their own declining health as a bargaining chip, often when more moderate tactics have failed, and all they have left to bargain with is their own lives. Accurate, regular medical records collected every week (or more frequently during precipitous declines in health) can be given to the patient who may then share them with their support team in order to publicize their cause and their determination. Records may be used in court and you may be called as an expert witness if the court intervenes on the behalf of the hungerstrikers.

The role of a support medic during hungerstrikes is never to support the strikers' health — health support begins when strikers voluntarily break their fast and need info about a safe food reintroduction schedule, aftercare, and recovery support. Hungerstrikers' intent is to get as dangerously unhealthy as possible as quickly as possible and be as well-publicized in their campaign as possible so they can win as soon as possible. Lab reports on significant bloodwork interpreted by a sympathetic doctor on an evening news program can spark widespread concern and sway public opinion very quickly.

When hungerstrikers are incarcerated people (as they often are), you may use your social privilege to gain access to them and release the records to the support person(s) of their designation. In these situations, your special access allows you to be a valued advocate if they are being abused (ie. by forcefeeding orally or intravenously, which is rarely legal, by clandestine harassment or torture, or by inappropriate and life-threatening food reintroduction after a voluntary end to the fast).

Injury prevention

One of the greatest assets medical providers can bring to action medical mobilizations is wise and strategic use of medical authority and social position.

At a large Occupy Wall Street action in New York City, a street medic buddy team was evacuating a patient with a head injury and altered mental status using a chair carry. Their goal was to get the patient clear of the crowd and outside police lines where they could transfer care to EMS. They grabbed two medical doctors in white coats who were protesting with a group of doctors and asked the doctors to help them negotiate through an otherwise impassable situation. Doctors who look like what people expect a doctor to look like can flag a cab in situations when it will not stop for anyone else.

In an unusual situation at a large anti-globalization protest in Philadelphia, a paramedic was waiting for ambulance backup, kneeling in the street and immobilizing the head of a downed patient with cervical spine crepitus and mechanism of injury for a c-spine fracture. He used his paramedic medical rank (higher than first-responder and EMT-B trained police officers) to order an advancing line of heavily-armed riot police to turn down a side street and re-form behind him. The line of police complied.

Similarly, an outraged medical doctor who looks like a medical doctor can work magic in a civil disturbance at times when a medic who looks like an outraged protester would become an additional casualty. At the Miami Republican National Convention in 1972, the police raided the truck street medics were using as a mobile staging unit. The police dumped all the supplies on the ground and were tossing lit matches on the pile. In the pile were two full O2 cylinders, and surrounding it was a dense crowd. A nurse practitioner in the crowd (who looked like a protester) found her way to a nearby hotel lobby, grabbed a bystander who had the look of medical authority about him, dragged him outside, and showed him the situation. The presumed doctor quickly went from fighting her off to full-blown outrage at the dangerous situation the officers were actively creating in the midst of a dense crowd. He took his outrage directly to the most in-charge-looking officer, who curbed his little pyromaniacs before anything exploded.

Spend enough time in the streets, and you will get your own story of a daring rescue using nothing but your posture of authority and negotiating skills, your courtroom testimony that changed the whole tone of a trial, or your neatly placed phone call or email that defused a situation before it ever happened. It is magical to be able to put your authority on to challenge illegitimate authority, and take it off to work in a horizontal organizing structure or provide care to a person who is extremely skittish after being brutalized by another authority figure. Using your authority strategically is a way of providing care.

Legal notes

This document is about roles, but most medical providers come to this work anxious about legal liabilities. Insurers want to scare doctors into thinking volunteer care is legally risky even when it isn't, because insurers benefit financially when anxious doctors give them money. Thus if you search the literature, you'll find a weird clash of strongly-worded suggestions that volunteer providers carry malpractice insurance and strongly-worded reminders that malpractice suits are vanishingly rare when it comes to volunteer doctors.

Federal protections for physician volunteers:

  • Volunteer Protection Act (VPA) of 1997.
  • Federal Tort Claims Act's (FTCA) Medical Malpractice Program, as extended by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and further extended by the Patient Protection and Affordable Care Act.

State protections for physician volunteers:

  • Good samaritan laws are on the books in all states; they generally apply to emergencies if the emergency wasn't caused by the good samaritan, care wasn't grossly neglegent or reckless, and care was given with permission if possible.
  • Some states immunize medical volunteers via the same apparatus used to immunize state employees from liability (operates similarly to federal FTCA Medical Malpractice Program, and usually includes a state-administered defense fund).
  • Some states (eg Michigan) immunize all volunteers from suit, including volunteer health practitioners (with exceptions, like surgery).
  • Some states (eg Virginia, Connecticut) immunize volunteer health practitioners by allowing them to purchase malpractice insurance with premiums paid by the state's department of health.

These laws come out of a recognition that states have abandoned their responsibility to serve the health needs of their population, and the unrealistic hope that volunteerism can somehow fill the gap.

There are still three things of which you must beware:

  • Records you generate must stay with patients — HIPAA still applies and fines start at $10,000.
  • You lose your license by forgetting to renew it, not by fulfilling your oath outside of your institution.
  • Protests are places of intense ethical conflict — you must struggle to be relentlessly ethical, not because you fear lawyers, but because your soul demands it. - Comments: 0

On affinity group medic trainings - 29 Nov 2016 08:03

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Dave P and I taught an Affinity Group Medic (AGM) training in Atlanta as part of the convergence against the Klan last April. Hopefully these reflections will contribute to the larger conversation about trainings that's been happening among street medics over the last year or so.

What is an Affinity Group Medic?

The purpose of an AGM training, as I see it, is to promote the assembly of affinity groups. I would wager that self-organization into affinity groups does more to improve health and political power than any other intervention we make.

The way the training promotes self-organization is by promoting a circumscribed goal. The AGM doesn't attend to the health of strangers; only the health of friends. In order to be useful in an AGM role, she has to assemble an affinity group.

I believe that, unlike street medics, AGM is not a basic scope of practice. It is a role, like comms or police liaison. I teach that the only requirements to be an AGM are the desire to fill that role and the consent of the group. The AGM training may make one a better AGM, but is not a prerequisite for the role.

In an action, an affinity group has a goal. That goal might be to cut a fence, block a road, provide safer space, do clinical support, carry water, do media, be marshals, spiral dance, scout, drop a banner, make lots of noise, cook and serve food, do childcare, do jail support, or whatever. The AGM's job is to help them achieve that goal without injury or illness. It is a before, during, and after role.

What are the core skills?

During a human barometer, people arrange themselves from "strongly agree" to "strongly disagree" in response to the statement "People come to me for help." This identifies natural AGMs, and leads to good conversations, especially between the agreers and the disagreers, about things like referrals and healthy boundaries.

I see the core of the ideal AGM skillset to be SAMPLE and confidentiality. When I taught an AGM training in Ferguson, we spent a lot of time on confidentiality. Unfortunately we breezed by it in Atlanta. This is in contrast to what I see as the core of the street medic skillset: initial assessment and consent. The difference: AGMs care for friends; street medics care for strangers.

SAMPLE helps the AGM start health conversations, build trust, and assess risks faced by group members before the action. If the medic knows group members' allergies, medications, and past pertinent medical history in advance, she can better assist when group members are trying to balance personal needs with group actions. Confidentiality is the ethical response to the trust that affinity group members extend to their medic.

During the post-training evaluation, students said they liked

  • PEARL1 buddy check-in
  • SAMPLE
  • HALTS and "What did you do to take care of yourself today?"/"What do you need to do?"
  • Local resources: alternative to 911 mental health crisis line, peer support warmline, others.

I don't have the eval notes in front of me, but I remember people saying they had concrete situations in which they could immediately apply those assessments and resources.

A student raised how AGMs are prepared for acute first-aid, but recovery is a prolonged process. Some students wanted to improve their skillset for supporting post-action/post-crisis recovery. That stuff won't be included in the 6 or 8 hour AGM training as I teach it, but would be good to flesh out into a good-length training for the populations we serve.

The agenda for the 7-hour training in Atlanta

  • 2 hour health and safety (open to people who don't want to stay for the rest)
  • Affinity groups lecture, SAMPLE practice, and confidentiality discussion
  • Scene assessment and communicating about a scene practice sessions and debriefs
  • First aid lectures, demonstrations, and practice sessions (no initial assessment)
  • Lecture and discussion on local referral options.2

If we'd been able to do it on Thurs, the plan was to support AGMs in teaching the Health and Safety training Friday.

The 2 hour health and safety is is similar to this outline (which I use as a handout): Ferguson health promotion training outline. That whole training is fun and works well. Students do human barometers, paired buddy check-ins, eyeflushes, and a really fun "best-dressed protester" exercise.

The affinity groups lecture, SAMPLE practice, and confidentiality discussion used Sophia's SAMPLE training sheets

The scene assessment and communicating about a scene practice sessions and debriefs used Dick R's style of communicating about a scene: Scene safety training exercise) and a scene awareness exercise led by Dave P that I think I've seen Charles and Leah do in the past. Both exercises were hits.

For the first aid lectures, demonstrations, and practice sessions we worked through Colorado Street Medics' 2010 first aid zine,3 which all students got a copy of. We dumped fake blood on each other, students practiced gloving up, using roller gauze, walking assist, putting each other in shock position, etc. CSM's zine is pretty good because it has pictures. I'd like to start sending students to Where There Is No Doctor's new first aid chapter and Buttaravoli & Stair's Common Simple Emergencies on their phones during future trainings.4 I feel like otherwise they'll forget to look at it when they need it.5

There were no activities during the lecture and discussion on local referral options.

Four final comments

1. We should have integrated SAMPLE more deeply into scene assessment (give people cards with AMPs of their fictional affinity group before going outside for the exercise), first aid, and referral options. As it was we taught SAMPLE then never referred back to it.

2. Street medic trainings (because of the centrality of consent) provide lots of opportunity for practicing communication. AGMs don't need that much practice, but could use some. It should be adapted to mimic communication with someone the AGM knows.

3. We taught privacy circle but didn't emphasize how intensely a crowd mobs a casualty; wanting to help or protect the casualty, or just curious. I remembered this crowd behavior when, during the anti-Klan action, a person with a breathing difficulty was mobbed by a crowd (including two street medics who didn't recognize that a nurse was already on scene). The paramedics arrived promptly with oxygen, but that poor person needed space.

4. Scenarios adapted for caring for known friends instead of randos would be great.

Hope these reflections help someone :) - Comments: 0

SAMPLE training sheets - 30 Apr 2016 19:21

Tags: first-aid how-to protest training

I got these SAMPLE practice sheets from a training Sophia wrote for Chicago Action Medical around 2003ish. She may have gotten them from Black Cross Health Collective or may have written them herself. I love to use them for teaching students how to take a patient history. A fragment from one of my training outlines from 2013 is in this post below the practice sheets.

Besides seeing the utility of SAMPLE and learning the acronym, an objective I always have when teaching SAMPLE is to encourage students to suspend forming an opinion; to live in the question, not the answer.

Finally, I remind students to trust the people they help. Often this interview helps chronic illness sufferers or people with disabilities remember what they need to do. They are already the experts on their conditions! We assist them in locating the problem with SAMPLE. After they decide on an course of action, we may assist them in carrying out their plan.

In affinity group medic (AGM) trainings, I encourage students to talk with their affinity group members confidentially about members' allergies, medications, and past pertinant medical history before an action. This establishes knowledge that can help the AGM be a better wellness buddy, and also establishes trust. If you can keep group members' confidence before they're hurt, they'll trust you more later when they're hurt and scared.

Kaylee

S: Shortness of breath.
A: None.
M: Inhaler for asthma.
P: Diagnosed with asthma at age 15; no other medical problems.
L: Had nothing to eat today.
E: Running from cops; scared.

Jayne

S: Headache around eyes.
A: Sulfa drugs.
M: Takes birth control pills.
P: Got hit on head one week ago, had a wrist fracture one year ago.
L: Nothing to eat today; has been drinking coca cola and water and peeing "a lot."
E: Went out on blockade at 7 AM; slept 3 hours last night.

Malcolm

S: Nausea and diarrhea.
A: Milk, nuts.
M: Epinephrine for allergic reactions.
P: Nut allergic reaction about 6 months ago; had to go to hospital.
L: "Shitting every 15 minutes," has not vomited; ate big chicken dinner last night but nothing today.
E: Chicken dinner; just been hanging around convergence center all day.

Inara

S: "Sprained" wrist with pain (hurts to move it).
A: None.
M: None.
P: Broke same wrist in 1996.
L: Ate oatmeal and drank tea about 2 hours ago, went to toilet a few minutes ago.
E: Fell on wrist, running around in crowd.

Simon

S: Fell down, dizzy, feel hot.
A: Aspirin.
M: Seizure medications.
P: Seizures since age 23.
L: Ate breakfast today at 8 AM, lunch at noon, went to toilet an hour ago.
E: Stood in sun at rally for about 6 hours now.

River

S: Itching on abdominal area.
A: Hay fever.
M: Homeopathic pills for hay fever.
P: Skin condition "with a name I donÕt recall" that cleared up with medication in 2003.
L: Ate pie for breakfast, drank coffee and later tea.
E: Used special soap meant to take oil from skin as protection from tear gas.

Zoë

S: Drunk, dizzy, nauseous.
A: None.
M: "Just the whisky!"
P: "I drink all the time!"
L: 12 drinks in 3 hours, ate a pizza 2 hours ago, urinating constantly.
E: "Just felt like partying after the big riot."

Wash

S: Chest pain, with 'acidic' feeling.
A: None.
M: Rheumatoid arthritis medications.
P: "I have heartburn," denies history of heart problems.
L: "Deep fried Mars Bars" and a pizza for lunch today, no dinner yet, drinking water.
E: Ate about 60 minutes ago; no other events since then.

SAMPLE patient history

Refer students to SAMPLE on chart paper—students must see SAMPLE, not just hear it.

Facilitator says: Sometimes the SAMPLE history is over quickly. Sometimes it is a time consuming and detailed interview that begins in the first few moments of patient care and continues until you walk through the doors at the emergency room. Good SAMPLE histories can be disorderly and divergent. They go off on tangents. They explore deeper than the basic questions. They encourage the patient to talk and elaborate when the patient is able.

S: for Symptoms.
A: for Allergies.
M: for Medications.
P: for Past medical history.
L: for Last food and drink (and last shit and piss).1
E: for Events.

Facilitator says: Run through SAMPLE in your head every time you take a history to make sure you cover all your bases, even if you ask questions out of order. Memorize this acronym.

Trainers model SAMPLE and debrief

Facilitator says: Let's see what we can learn by taking a SAMPLE history.

3 students: volunteer. Each gets a Reader opened to Sophia's SAMPLE practice sheets. Each student gets to pick which patient they want to be without telling trainers.

Trainer buddy pair: interviews each student sequentially in front of class.2

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

Students model SAMPLE and debrief

6 more students: volunteer. They come up in front of the class in pairs and each of 3 students playing medics interviews each of 3 students playing Sophia's patients.

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

OPQRST pain history

You don't get much information by asking, "What are your symptoms?" There are lots of good questions for zooming in on the chief complaint. The most useful a string of letters from later in the alphabet.

O: for Onset.
P: for Provokes/Palliates.
Q: for Quality.
R: for Region/Radiates/Refers.
S: for Severity (1-10).
T: for change over Time. - Comments: 0

Scene safety training exercise - 30 Apr 2016 15:58

Tags: first-aid how-to protest training

This training exercise is based on the way that a long-time member of Chicago Action Medical mentors new medics when they buddy with him. As they walk around a protest, he asks questions like the ones below. One of his buddies suggested we drop most of our scene assessment lecture and replace it by assessing the actual scene (with some added imaginary elements) around the sketchy locations we hold trainings.

Actual scenes students have walked through at trainings I've led include loading docks, blind alleys, razor wire-topped fences, broken glass, no running water or handwashing stations, broken water filtration (contaminated water source), high-speed busy roads, dangerous banner drop locations, bus shelters, children and people with extremely limited moblity, and an approaching wildland fire. At several trainings, students used their breaks to control risks they had identified.

The below training text is from a 2013 training in the Piedra Wilderness Area of Colorado. It is not the whole Scene Assessment section, just the "good parts." Since 2013, I've used this exercise with modified questions in St Louis, Chicago, and Atlanta. It's always a hit!

Introduction to scene assessment

Facilitator says: Watch surroundings and communicate.

  • Look for danger.
  • Make the scene safer.
  • Be prepared for the scene to change.

Facilitator says: Scene assessment encompasses a lot of continuous observations:

  • Personal (Ethan’s here, he gets seizures).
  • Specific (the baby bloc pushing strollers is right next to the Commie bloc chanting about shooting Obama).
  • Big picture (open businesses, street grid, weather).

Facilitator says: Always assess scene and stay situationally aware—especially when things seem calm and no one is injured.

Practice communicating about a scene

Facilitator says: We’re going to practice doing scene assessment as medic affinity groups here at camp. An experienced medic will walk around camp with each group, and guide you to see the scene.

Proctors: identify selves.

Students: break into as many groups as there are proctors.

Facilitator says: before you head out, answer these questions:1

  • Who are the organizers and logistics people at this camp?
  • Is there cell reception in camp?
  • Who has a charged phone?
  • What is the local emergency number for medical/trauma emergencies? What resources exist for someone in camp who needs help with sexual/domestic violence, STI/blood-borne illness testing/treatment, mental health crisis, poisoning, or addictions recovery support?
  • If you call 911, what hospital will someone end up at?
  • What is our camp evacuation route?
  • How long would it take to evacuate one limping (assisted) or unresponsive (carried) person to a rendezvous point? All the way to definitive care?

Groups: Go assess the scene around the training location for 10 minutes. As they walk around, their proctor asks Dick Reilly-style questions like these:

  • Where are your exits?
  • Where are your treatment areas?
  • Where are the police?
  • Where are their bosses?
  • Where are the legal observers?
  • Where are children and elders?
  • Could the weather change?
  • Who is most at risk here and why?
  • What are the biggest dangers here and why?
    • What are choke points?
    • Obstacles for panicked crowd?
    • How can we calm crowd?
  • What is the state of food, water, and sanitation?
  • Where are alcohol and intoxication clustered?
  • Where can someone go to get away from all alcohol and intoxication all night?
  • Where can someone shelter-in-place out of weather?
  • How can someone leave camp to get care or go home?
  • If "…," then what would you do?2
  • If "…," who would you involve, where would you refer the person, or who could improve the situation?

Debrief

Facilitator asks: How did communicating about the scene as a group change your individual perception of it?

If your team sees injured protesters

Facilitator says: Look for danger/needs/resources. Stop to decide plan and activate back-up. Scene assessment continues while your buddy team:

  1. Exits the scene,
  2. Uses available resources to control scene (but does not assesspatient or provide care),
  3. Or controls scene, engages patient, prepares to do advocacy.

Calling 911 to activate EMS

  • Know location; In city: exact address if possible, at least cross streets. In backwoods: know name of your area, directions to road-accessible rendezvous point, nearest highway mile marker, GPS coordinates.
  • If you’re a medical professional, identify your title, cert or shield number for authority drag purposes (or choose to remain anonymous).
  • Say patient’s chief complaint (if known). Follow dispatcher’s lead. Stay on phone. Response time depends on 911 dispatcher’s assessment of urgency and availability of responders.

Scene control options

Get to a safer scene by foot, car, transit, cab, or ambulance

  • Get out of cold, rain, wind, or heat.
  • Help someone back up from a fight
  • Get to wellness center or hospital.

Stay put; make scene safer around you

  • Calm, comfort, reassure: Sometimes the scene is safe but the injured person is so hyped he doesn’t recognize it is safe.
  • De-escalate and redirect hostile/nosy bystanders: Use humor, give something to do, be polite, firm, and cheerful.
  • Create privacy circle. - Comments: 0

What Katrina taught me - 27 Aug 2015 18:09

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I wrote this two years ago for a Katrina anniversary event I agreed to speak at but couldn't attend.

Good evening everyone. Thank you to Nancy for inviting me to speak at this event. Unfortunately, a little disaster prevented me from attending. On my way back from training health workers in the Four Corners region of Colorado, the clutch gave out on my car. While I try to put together $900 to remedy this situation, I'm stranded far from home, far from this event and my job and everything I had hoped to do this weekend.

My little personal disaster is not a bad place to start thinking about what it means to weather a storm like Katrina's aftermath. The subjective experience of a catastrophe is in many ways like that of a million little disasters repeated across space and through time, with those who are vulnerable no different from those vulnerable outside of disaster.

I remember the emptiness of major streets in the Algiers neighborhood of New Orleans after the winds and rain of Katrina had been replaced with impossible stillness and impossible heat. I remember who stayed in my neighborhood: disabled residents and elderly residents and a few of their caregivers who could not bear to leave them — and a handful of neighborhood leaders who felt a responsibility to stay to ensure the survival of the neighborhood.

I remember the forces that wanted us gone: the cracker squads who declared "open season on niggers," the police who closed the parish border to blacks, trapping disaster survivors in, the 82nd Airborne and 1st Cav soldiers who evacuated the Fischer Housing Project a week after the storm as if it were an insurgent village on the border of Pakistan. The flying vees of unorganized New Orleans Police who kicked in doors and settled scores. The politicians who staged a land-grab, promising 80,000 property lots to developers, then had to ensure that 80,000 property owners remained displaced.

Most of all, I remember why a ragtag group of people who believed in the right of black communities to practice neighborhood self-defense established and developed the first civilian healthcare services in the city, a free clinic on the corner of Teche and Socrates streets in the Algiers neighborhood on the West Bank of New Orleans. I think those of us who nurtured the clinic through its first months had many different reasons why we did so, but we met on one.

The City of New Orleans was built by its residents. It is its residents. The world owes New Orleanians for the vibrant life they made from the scraps they've had to work with, the music and way of life that makes the world smile. The city could only be rebuilt by its residents. In the aftermath of the storm, its survivors and heroes faced dispossession, state terror, and casual murder. Those who wanted to stay might benefit from a health corps to attend to their medication refills, listen, and advocate for them as they strove to hold ground against dispossession and rebuild. We knew how to do health work.

Every day was like a year after Katrina. I don't talk too much about it anymore, because once I start it is hard to stop. Maybe you're lucky that I'm stranded with a broke down car in a national forest, because it means I can't overwhelm you with stories of the horror and the hope I lived through. Some day, if you see me, stop me on the street and ask about Katrina. For as long as you want, I'll tell stories that have come to define my life.

For now, I have three goals. I want you to imagine catastrophe in a way that makes it familiar, not foreign. I want you to know the degree to which disaster survivors rise to almost any occasion and totally outclass organized relief efforts. Finally I want you to know how even the organized relief I loved most suffered from a failure of the imagination. I will say this now, and again after I make those three points: in a catastrophe, our hope does not come from the hills, it comes from us.

To make the familiar foreign, I want you to imagine that your house burned down. No one died in the fire, thank God. You lost your essential documents, your mementos, your bank card, checkbook, medications, eyeglasses, food stamp card, phone — everything. The Red Cross puts your family up in a shelter for a while. Some of your family and friends help; some avoid you. You try to deal with your insurance and your financial institutions. Most of what you lost can never be replaced. Even years later, a certain pain and alertness remains.

Now imagine that your bank also burned down, and the local Red Cross. All the hotels, and all the pharmacies, all the grocery stores and food stamp offices burned too. Your psychiatrist's office burned, the emergency room burned, The Lighthouse for the Blind burned, and so did the homes of everyone you've ever known and everywhere you've ever been. Everywhere you could walk to is burnt to smoking ruin, but you can't even see to walk. What would you do?

I don't know you, but I'll wager money I know what you'd do. Within 24 hours someone would find you, and together, the two of you would find someone else to help. You'd help them dig through the wreckage of their home. You would canvass the neighborhood, meet neighbors you never knew you had, look for survivors. You would give away food you found and share information. You would begin to self-organize, prioritize, and surprise yourself with your collective ingenuity.

When the soldiers were sent in to New Orleans after Katrina, they were told to restore order, to establish a jail, to clear houses, to stop looting, and to fear disaster survivors. The guardsmen who stayed long enough to properly see for themselves, saw a New Orleans safer and more egalitarian than was imaginable, self-organized for survival, with bitter enemies working side-by side. In my neighborhood, when our detachment of guardsmen realized this, they knew they had been misled. By mid-September 2005, they began to ignore their orders and ask survivors how they could help.

It is harder to show the ecological toll of Katrina, because I don't know it well enough. I was inside a clinic for 18 hours a day, 7 days a week, so never saw the effects of the Murphy Oil Spill in St Bernard Parish, or the land loss in native communities of lower Lafourche and Terrebonne Parishes. I didn't get to see the massive hazardous waste dump in New Orleans East where a city's worth of building material was deposited. I wasn't with my cousin when she encountered a quarter million dumped refrigerators. The human toll — and human potential — that I saw from the clinic took all my attention. Our biggest environmental illnesses were a nonspecific rash and the Katrina Cough, a difficult-to-treat upper respiratory infection that everybody had for a while.

After Katrina, I saw only people, and the bonds between people. At first I saw people who lived on a fixed income and depended on medications to manage their asthma, blood pressure, diabetes, chronic pain, or schizophrenia. The storm came on the 29th, so their check was gone and so was their medication. Then I saw people who needed to talk through horrific experiences, terrible fears, and the impossible challenges ahead. Then I saw hundreds of Sewerage and Water Board workers who needed tetanus and hepatitis vaccines before they returned to work. I saw people who felt safer sitting in front of the clinic than in their homes because of the constant danger of state violence. I saw our clinic volunteers decompensating and finding no one who could understand the burdens they carried after all they had witnessed.

This brings me to our failure of imagination. Our little clinic, established by nonprofessional movement first-aiders and disaster survivors in a mosque, was for a year the busiest free clinic in the nation, ranked in the highest tier of clinical care. Thanks to volunteers and donations, we provided care at the lowest cost per patient. All very exciting.

However, in our exuberance, we replaced disaster survivors with out-of-state volunteers, dropped our initial model of being a medical support corps in order to emulate Federally Qualified Health Centers, and failed to provide adequate mental health support to our volunteers. The clinic did not close. It is still at 1401 Teche St, and still sees patients. It is a long-term commitment to the health of a black American neighborhood it joined in a time when the oldest and sickest stood their ground against a militarized land grab.

However, I also learned the toll that disaster takes on those that come from out of town, who leave their lives to spend months or years participating in relief and recovery as unpaid volunteers. New Orleans was a citywide support group for a while. Survivors were invited, but out-of-town responders were not.

After listening to hundreds of survival stories, becoming deeply involved in people's lives and struggles, and living under extreme state violence, responders found that their families and friends away from the disaster could not understand their struggles, and neither could disaster survivors. The toll that the clinic took on its volunteers was too heavy. We needed to understand our own vulnerability and collectively provide for our own recovery, and we did not.

The disaster of Katrina only began with the storm. It continues with the deadly depredations of real estate vultures. Their land grabs mete out more destruction than the flood could. Those who want to help may find it too difficult to do anything now, unlike in 2005 when it felt like we could do everything.

Whatever form your concern for affected family, friends, or strangers may take, remember who always does most of the relief work — devastated people who need something to do in times of crisis. Not the Guard, not the Red Cross, not even the little clinic I loved and helped to build.

In times of catastrophe, follow your gut. Your help will never come from the hills, only from you. Despite governments' proclivity for repressive violence and business's proclivity for anti-human opportunism, in times of crisis people self-organize and demonstrate a strength that could turn the world right-side up.

I am sorry I was not able to be here in person, but thank you for allowing me to share my experiences. - Comments: 0

Finding people arrested in Charlotte - 22 Aug 2015 17:36

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I recently had to find some people in the Charlotte-Mecklenburg, NC system. This post is a quick tutorial on how to find your people.

Finding Arrestees

If your friend was arrested in Charlotte, and you want to find out the charges and bond amount, see the Mecklenburg County Sheriff's Office Inmate Search page: http://www.mecksheriff.com/inmatesearch.asp

"Arrest inquiry" search info is updated shortly after the arrest, and includes charges and bond amount. "Inmate Inquiry" information is usually available within six hours of arrest, and includes the arrestee's Prisoner ID #, where the arrestee is being held, and (if you click the "view charges" button), the next hearing date.

Making Bail

If you go to a bail bondsman, you will be required to pay 10% of the bail amount, and someone with a job will have to "secure the bond," or sign that if the person does not show up for court, they will be on the hook for the rest of the bail amount.

If it says they're being held at MCJC (the central jail), you can wait for their release at 801 East Fourth Street, Charlotte, NC 28202.

Finding Court Dates

To find upcoming court dates in an ongoing case, check the North Carolina Court System calendar. You can enter a Citation Query by Defendant Name: http://www1.aoc.state.nc.us/www/calendars/CitationQueryByName.html

When entering someone's name in the NC Court citation query box, do not insert space between the last name and the first initial. For instance, to search me, type in "Keller,A" with no spaces. You will find the court date, county, courtroom, and session (morning is 9 am, afternoon is 1 pm). You'll also find the charges, and the name/agency/badge number of the arresting officer. - Comments: 0

Bad parents - 21 May 2015 15:31

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In the United States, many psych and substance abuse services have been pushed to become more trauma-informed as a result of the profoundly influential Adverse Childhood Experiences (ACE) study. Advocates push this discursive shift: do not ask "What is wrong?" Ask "What happened?"

In the midst of this discursive turmoil, tidy categories like "serious mental illness" leak and rupture and are called into question. I wonder about the usefulness of such categories and classifications. Do they allow more effective government of disabled personalities, or do they co-produce these personalities? Most likely, they accomplish many contradictory things at once.

First, a caveat: Mental illness is not a predictor of violence. It's a predictor of victimization. People diagnosed with mental illness are five times more likely to be murdered and significantly more likely to be assaulted, raped, mugged, and arrested than controls. They die 25 years earlier than people without psych diagnoses.1 Now, on to the show.

Foucault and his students looked into the discursive turmoil around a famous case of parricide 150 years ago, at the beginning of the construction of categories that trauma-informed critiques now challenge. That conversation is documented in the book I, Pierre Riviere, having slaughtered my mother, my sister, and my brother: A Case of Parricide in the 19th Century.2 The debate around modern Pierre Rivieres revolves around whether they are mentally ill, terrorists, or common criminals. The terms in 1835 were very different. By resurrecting the case of Riviere, Foucault showed how our categories are not eternal; how they have an outside.

More recently, Mark Ames covered Michael McLendon's 2009 workplace killing spree in Alabama, which included what Ames called a "mercy killing" of McLendon's mother and her dogs. Ames needs an editor, but his courageous take on parricide and workplace violence also seeks an outside to the classification of McLendon's character. By investigating the scene as well as the killer, Ames highlights the legitimate desperation caused by horrific everyday violence of chicken factory workplace conditions, routine wage theft, lack of legal recourse against local oligarchies, and the costs of municipal bankruptcy due to unpunished white-collar crime. This context clarifies the cognitive dissonance when someone — who believes that free, white, male, 21, and American entitles them to something — finds that they are in fact fungible. Is it serious mental illness? Terrorism? Common crime? Desperate, pointless guerrilla resistance by isolated individuals?

The conversation about adverse childhood experiences has begun, but the presence of routine social violence in lives like Riviere's and McLendon's curiously drops out of court, media, and scholarly narratives of massacre. When the righteous suffer, they can cling to stories like Job of the Bible, the Catholic saints, or Husayn ibn Ali, the grandson of Muhammad. But when those who were born unrighteous and will always be considered guilty suffer, attempt to resist, try to breathe, what is their narrative? That they had bad parents? - Comments: 0

Nursing apprenticeship - 28 Apr 2015 18:03

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Thank God for Mo

Mo saw me come down the road into the Western Shoshone prayer camp in southern Nevada. The incessant dusty spring wind cracked my lips. I was dejected and sore after walking the last eighteen miles of what began as a straightforward freight train ride from Cumberland, Maryland. Later, Mo told me she was about to tear me a new one for being a day and a half late, until she got a good look at me.

"Grace," Mo said soothingly, as she helped me out of my pack and shoes, "Soak your feet. You look like you've been through hell." She got me a cup of water to drink and poured hot water into a foot soak basin. "Rest yourself today; you're going to get a piece of my mind tomorrow."

I spent much of the year I turned twenty finding my way to Mo's field clinics and learning from her. Mo worked as an ER and ICU nurse in a small-town Montana hospital, but what she loved was home care, hospice, and running field clinics for people engaged in confrontational politics. She was a gentle, stable role model in my tumultuous life.

Mo and other health workers mentored me as I learned to organize and manage health workers, do basic assessment, care, and education for physical injuries, and provide individual and community care after sexual assault and mental health crisis. I learned by doing and reflecting. During an E. coli outbreak I learned basic epidemiological methods and aggressive rehydration. After a backcountry suicide I learned basic forensics and camp-wide trauma counseling. After a meningococcal meningitis death I learned to work with health departments to do contact tracing and multi-state health-messaging.

Mo has a humble, quiet determination to be a good nurse and to constantly teach non-professional health workers like me. There is something profoundly moral about her ability to accompany people through the turbulent waters of political upheaval and end-of-life care with her simple, practical toolbox: two pillows, a blanket, some water, and non-latex gloves.

Finding a scope of practice

In the late fall of the year I turned 20, I settled in the inner city of Pittsburgh. For ten months, I did free wound-care and lay social work for a small clientele of homeless white men who drank and black women who rented rooms in abandoned buildings around the projects. The next year I organized a neighborhood lay mental health and substance abuse support network. I identified natural caregivers and got us together for regular continuing education, peer support, and meals. The group continues to meet eleven years later. It never incorporated, professionalized, or had its direction set by funders.

In 2005 I worked with Mo again, in New Orleans, where we were among the organizers and founding staff of the city's first post-Katrina civilian health clinic. Called Common Ground Health Clinic, it is now a nine-year-old Federally Qualified Health Center. During our time there, it was the busiest free clinic in the United States (~22,000 patient visits logged in our first year), and was recognized for its high quality of care.

Mo and I guarded the centrality of health education, creative problem-solving, and home visits during our time at the clinic. We dispatched a volunteer carpenter to build a ramp and make other accessibility modifications to the home of a diabetic man who lost his second leg in the storm waters. We sent brown-bag lunches and cleaned the badly roach-infested home of a World War II veteran who lived across the street. We also visited him with oxygen and the clinic's albuterol nebulizer when his asthma required clinical management.

Enduring friendship

In the years since I left the clinic I continued to do health and mental health work inspired by Mo and other mentors. I have enjoyed a privileged freedom of spirit and a court-side seat to significant historical events, but I have also become frustrated by the small-scale, reactive, and difficult-to-replicate models for health work Mo and I helped propagate.

Mo now trains nurse aides in her valley in southwest Montana. We still talk regularly. How can we scale innovative health initiatives without abandoning people's priorities for those of funders? What makes some practices self-propagate while others die out? How could seeking better health save poor people money in the short-term and the long-term? How can health work strengthen political organization, challenge local inequities, and enter local traditions? These are some of the questions we are asking now. - Comments: 0

Defending our women - 05 Mar 2015 07:40

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I'd like to make an obscure, maybe even pedantic, point about the convergence of forces in the political battle over nondiscrimination ordinances in the city where I live. A recent civil rights proposal quickly became a clash of civilizations. At stake in the proposal was the grounds for civil rights lawsuits. At stake in the debate was a contest between the vulnerability of "wives and daughters" and the vulnerability of transgender women, in order to advance fundamental claims about the nature of gender and government.

The story of the battle over the proposal is narratively simple but discursively complex. I will tell the story first, then graze the surface of the story of warring discourses as I understand it.

Birth and death of an ordinance

The story of the proposal began in November of last year.1 A Human Rights Campaign member proposed adding marital status, familial status, sexual orientation, gender expression, and gender identity to the characteristics protected by city nondiscrimination ordinances. Charlotte is one of only three out of the 20 biggest cities in the US to not protect these categories. The proposed change would give lesbians grounds to sue if they were denied a room at a hotel, or gay men grounds to sue if a taxi wouldn't pick them up.

City council asked the city manager and the city attorney to look into the proposed changes. In February, the city attorney explained federal, state, and local legally protected characteristics to the council, explained the extant ordinance, and drafted the proposed changes. On Monday, the proposal was put to a vote and "the most controversial ordinance [city council] has considered in years" failed.

Mobilization

Prior to the city council meeting, people (many from outside Charlotte) sent almost 40,000 emails supporting or opposing the proposal. Almost 120 people delivered nearly four hours of passionate public comment. Hundreds more rallied in protests. A Charlotte Observer reporter tweeted, "Never seen a crowd like this at #cltcc [Charlotte city council] before." The battle became this week's top local news story.

The proposal was drafted as a shield for people who can litigate. Middle-class married couples with children would probably be its primary beneficiaries. Crystal Richardson, a Charlotte lesbian, told the council, "I stand before you as someone who can be thrown out of a Charlotte hotel for who I am." Edward Garrett said, "This is not a hypothetical debate. I have experienced discrimination because of my sexuality." The proposed changes would have given those two recourse. As you can imagine, their straightforward and reasonable testimony didn't capture any headlines.

They also weren't the subject of the vitriol of the organized opposition, who absurdly framed the debate as solely about whether the proposal would give transsexual women legal cover to sexually assault women and young girls in public restrooms.

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"Protecting our daughters is at stake," said Bryan Boyles. Chris Glenn said his 14 year old daughter will not use public restrooms out of fear of being molested. Hal Jordan said the city hasn't taken into account teens sneaking into women's restrooms pretending to be trans. A speaker showed a map of sexual offender homes and said restrooms will become fertile ground for molesters. Kim Moore said she was raped and can't believe she has to ask the city to protect her and all the women in Charlotte. Roberta Dunn of Mooresville told the council, "I'm a transgender woman, not a sexual predator."

By centering trans womens' bathroom use, the opposition baited supporters into publicly explaining gender theory instead of defending the bill on its own merits. Some supporters took the bait, and the culture war between two identarian conservatisms was publicly enacted. In the one camp, the head-of-household virtuously defended his women against predators; in the other, the educated expert virtuously defended oppressed trans women against bigots. Neither discourse defends anyone: they both serve to highlight the virtue and nobility of the defender, and his sovereignty over a territory constructed of identities. Your allegiance is determined by who you hate more: autocratic fathers or bureaucratic pedants.

Defending our women

The "defense of the feminine vulnerable" discourse has deep roots in this country, but reached a pinnacle in the Jim Crow era. In his hugely influential 1944 study An American Dilemma, Gunnar Myrdal wrote that sex was "the principle around which the whole structure of segregation of the Negroes — down to disenfranchisement and denial of equal opportunities in the labor market — is organized…. The Southern man on the street responds to any plea for social equality, 'Would you like to have your daughter marry a Negro?'" (p. 587). Myrdal argued that the popular argument against social equality of the races was based in white men's paternalism of white women's sex lives.2

By directing the powerful fear of rape onto their opponents, the "family values" patriots used the strategy that once justified de jure apartheid to great effect. Their use of the strategy was straightforward and unambiguous. A man's home is his kingdom (and cuius regio, eius religio); a man's wife, children, and employees are his property for him to dispose of as he likes; a man's right to defend himself and the property in his realm is absolute; and the federal government is a competing state. His hostility to LGBT claims to rights are as unrelated to rape as was white planters' hostility to the enfranchisement of slaves and women.3 His hostility is to federally-protected rights that diminish his authority.

How does the "defense of the feminine vulnerable" rhetoric drive current "social justice" discourse?

"A vast nonprofit industrial complex, and a class of professional 'community spokespeople,' has arisen over the last several decades to define the parameters of acceptable political action and debate. This politics of safety must continually project an image of powerlessness and keep communities of color, women, and queers 'protected.'" —Croatoan, Apr 20124

Unlike Richardson and Garrett, whose straightforward comments were about about desiring legal recourse for discrimination,5 Sam Spencer of Davidson lectured the council on concepts with no more relevance to the proposal than the family values patriots' rape fantasies:

"The idea of gender as a spectrum and non-binary is actually quite ancient at this point [but] it's new to many people — including many Charlotte City Council members. However, the scientific and social consensus is that biological sex may be between your legs, but gender is between your ears…. Trans folks suffer every day because of our society's legal and political framework."

Remembering martyrs6 and making your opponents feel stupid doesn't protect the people you claim to speak for. Those are strategies for bolstering the power and position of experts.7 I don't mean to pick on him personally, but Spencer's rhetoric says: it's all very complicated to you, but not to me, so hire me.

It's not about that

I appreciate the people who worked on the proposal to expand protected categories in Charlotte's city nondiscrimination ordinances, and I'm sorry their work got undercut by this vicious culture war. The changes should have been enacted 30 years ago. I'm sure this isn't the last we'll see of it.

My point is that the people crowing about bathroom molestations aren't talking about molestation. They're talking about an erosion of their sovereignty. Similarly, the people talking about gender as a spectrum aren't talking about transsexual women. They're talking about an extension of their own sovereignty. The former discourse is no more a solidarity with wives and daughters than the latter is a solidarity with trans women. In each case the object of false solidarity is used to advance the interests of their false defenders.

Yeah, so what?

If you've read this far, thanks. I made my obscure point. Why should you care? My guess is, because you care about yourself, your wife or daughter, or your trans woman friend, and I mischaracterized you because you actually want to help. Thanks, you're awesome. Don't look to me for all your answers, but here are some thoughts:

  • Emphasizing the vulnerability of women you love might make them feel more vulnerable, or might make other people see them as more vulnerable. That doesn't help.8
  • Highlighting your own virtue or what an expert you are doesn't help either.
  • Lecturing the general public about queer theory and making trans women more visible causes them to get harrassed more often.
  • Telling your daughter that there are molesters lurking in every restroom probably scares her.

Preventing molestation and rape of all women, and making life easier for trans women, starts from understanding the actual situations in which problems happen.

  • About 6% of men in their early 20s have already raped at least one woman. In the U.S., women are mostly raped by friends and family, mostly while under the influence of alcohol.9
  • Life is hard for trans women mostly because of issues with criminalization, housing, education, and employment, not pronouns or restrooms.

Most solutions happen in the context of relationships. People who help their friends navigate the difficulties of life aren't experts. They usually don't even know what they're doing, but they stick around long enough to learn.

It's not a bad time to be a friend. The circus this week has temporarily made entering a public restroom more stressful for most everyone who uses the ladies' room in Charlotte. Without real, dependable, friendships there is no foundation for freedom. - Comments: 0

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