“Ugh… always lube everywhere,” I mutter under my breath as I lower and lift my sticky hands off my cars steering wheel. I’ve just finished the current cohort’s education session on HIV and hepatitis C at the local treatment center, and part of the education includes safer sex. Internal condoms (one of my favourite things to teach about) are well lubricated so the lube sticks around for a while if you’re not able to wash your hands right away… Just part of the job!
This would have happened sometime between 2013 and 2015 in the Rutland neighbourhood of Kelowna. I graduated with my Bachelor of Social Work degree from the University of British Columbia Okanagan in 2013 and got hired by my last practicum placement at Living Positive Resource Centre as an Education and Outreach Worker. I later received a Certificate in Harm Reduction from York University.
When the public thinks of social workers, many think of people working in the “child welfare” system. I’ve never had any interest in that work, and social work is so varied it has allowed me to experience many different roles with many different people. Most of the work has been in community-based non-profits doing direct work in healthcare navigation and support, poverty, disability, mental health, housing, and substance use, but I’ve also worked at health authorities as a Clinician and at a regional Coordinator level.
There has never been an “average day” because things can change based on what comes up. In one role I might take a Community Living BC client on a tour to look at Christmas lights, in another I might go to court or probation. Maybe I’m describing safer injection tips to someone having difficulty with their veins or driving someone to an appointment. You could find me facilitating guided meditation in early recovery groups or holding someone’s hand at the doctor while they got an abscess drained. In less direct service roles, I could be talking to the media or a group of coroners, presenting budget recommendations to the government, co-developing policies or planning programs and education. This is a broad field of work with constant learning, my favourite part of being a social worker.
In many roles, you have the privilege of walking alongside someone to reduce obstacles and provide support as they navigate through systems and aspects of their life. The person you work with is the key decision maker of the speed, direction, and destination of the work you do together because it is their life (caveat: legal situations). Advocating and working with others on system or service change is an important extension of this work so things are improved not just for one but for many.
The systems and services people have to deal with don’t come with a guide or map and carry risk of harm throughout. Stigma and structural violence can make accessing services challenging for folks which makes it less likely they’ll get the resources they need and want. Understandably, many people will say “f*** this” if the process is harmful or unnecessarily complicated.
Hepatitis C testing and treatment can be a tough system to navigate, although there have been improvements. Many of today’s struggles are the same as in 2013-15 when I was first doing direct hepatitis C support. Lack of affordable housing, poverty, rural/remote access, overwhelmed lab, and healthcare services, and stigma are ongoing, but now we have Direct-Acting Antivirals (DAAs). The most common treatment pre-2015 was pegylated interferon (once weekly injection) with ribavirin (a twice-daily pill), taken for 24-48 weeks. That’s a long treatment to adhere to! Successful treatment with sustained virologic response (SVR) or cure occurred for about 40% of patients with the most common virus type. Up to half of people on interferon treatment experienced terrible side effects that were compared to chemotherapy, and many would stop treatment.
A long testing and diagnosis process and treatment regimen with mediocre success rate and terrible side effects? It’s a tough sell, especially if you’re already dealing with multiple stressors and other chronic illnesses. This is one of those “f*** this” examples. People who did this challenging treatment have a unique experience that is worth learning about.
There is good news though: DAAs have very few side effects, an 8-12 week daily pill regimen, and a high SVR of at least 95%. Whoa, right? This makes it much easier technically for someone to be cured of hepatitis C, but as previously mentioned practically and logistically, accessing a diagnosis and treatment is still inaccessible for many people.
Social workers can play an important role in helping someone living with or being treated for hepatitis C. Here are some ways you may be able to do that:
- Find out about where you can access harm reduction supplies in your community. New, unused harm reduction supplies prevent transmission of hepatitis C, including reinfection.
- Learn about the importance of peer support for hepatitis C, find out if there is a group in your community or find one online for future referrals. Help 4 Hep peer helpline is a provincial support program that can be accessed by phone and text.
- Advocate for policy and program changes to better support social determinants of health and access to healthcare, especially for people who are most often excluded.
- Find out how much support they want and what they anticipate being challenging. Work together to address those challenges, for example:
- Support access to food programs: some medications need to be taken with food and our livers are happiest when we eat regularly.
- Support connection with positive family, friends, care providers for emotional or practical support and morale boosts.
- Discuss and plan for taking daily medication. Do they need an alarm clock or an alarm set up on their phone? Do they need to pick up their dose when they get their opioid agonist treatment (OAT)? Reminders by phone or during outreach? Find out what would be most helpful and support that.
- Discuss and plan for getting to appointments including lab work and specialists. In rural areas this may require some creativity. Explore possibilities for phone or video appointments when feasible, providing access to phone or computer if needed.
- If they aren’t on it already, consider applying to the Ministry of Social Development and Poverty Reduction for Persons with Disabilities benefits. Then you can apply for additional benefits like a high protein diet supplement or the Monthly Nutritional Supplement for vitamins and minerals. Registered Social Workers can complete Section 3 of the application (“health professional”, and can support and navigate the rest of the application process.
- Identify community organizations with peer and community workers who can provide support (some can be found here).
Gratitude to my educators, mentors, people with lived/living experience of STBBI and/or substance use, and for having the privilege of walking alongside so many in their lives. I still think of you and grieve or wonder how you’re doing.
Kate Fish (she/her) is a fat, chronically and mentally ill, queer person and a Registered Social Worker with a decade of experience in BC. She is a white settler that grew up in a fishing community off of Prince Rupert on Tsm’syen territory. Her mother has a long history as a pregnancy and sexual health nurse and her father was a fisherman. Kate currently lives on K’òmoks territory (Courtenay) on Vancouver Island with her partner, where she gardens, plays cozy computer games, cooks, and watches for seals at the beach. She is the Education Lead at the BC Hepatitis Network.
Are you a social worker, community worker or educator who wants to talk about hepatitis C, harm reduction, or this blog post? Connect with Kate at kate@bchep.org.
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