interviews
An Introduction to Care | Part Two
by Dr. Kali Cyrus
February 13, 2020
Dr. Kali Cyrus is our February co-editor. This is part two of our conversation.
There is a lot of off the clock work happening, and out of pocket spending. So much of the care falls on staff after hours.
I would call it the out of pocket / out of office hours commitment. In terms of the costs to me, if I happen to be a doctor who gets bothered, a doctor who works in the public system, what ends up happening is most of my time is not actually spent treating the person's mental and physical health. It's mostly spent trying to figure out case management issues.
If we know this person doesn't have any food at home and they need to be taking their meds with food, or this person doesn't actually have a primary care doctor and they're smoking half as many cigarettes, which is usually the case, or their blood pressure is 200 over 120, or they keep getting hospitalized for medical reasons, if they're in a house dealing with trapping every night, they can't get sleep, it worsens their depression, and they're in a crisis and calling the cops, I can't do my job.
It isn’t really monetary, but as a team, we spend most of our time trying to figure out how can we get this person food when they may not be eligible to get free food from the state district, how can we actually try to get this drug dealer to forgive a debt – which is like, how can we do that?
What we end up doing instead of focusing on what kind of medications can I give you, or how can I meet with you on a weekly basis and talk through what you need to change, what is a path to recovery, is trying to manage the social stressors. It more so impacts social workers or people who've gone to school who want to be therapists, they end up being case workers. They end up doing these kinds of things, you can talk to them and use your therapeutic knowledge in that way, but it's a very different job that requires a lot more patience because you're dealing with systems that are so non functioning.
It's like going to the post office every day and getting in line for eight hours.
It's essentially what that part of the job has become. I think the other end of it, if you think about teachers who end up spending their money to buy supplies, that type of stuff, I don't necessarily end up in that position because I'm the physician. That's something a lot of us have very strict boundaries about. If I have a patient asking me for food, I'm at a clinic or I'm at their house, I'm not going to. No one would expect me to go run to the grocery store. That's going to fall on my staff. If my staff goes to see them three times a week, they're the ones who are going to get asked for money three times a week.
Think about people who work in group homes, where you have mental health patients with people who have other physical or mental disabilities, staffed by people who are not necessarily nurses. One, you're not making a lot of money and you're supposed to be in house with them all day, those are the clients saying, "I need a cigarette, I need a cigarette" when they've already used up all their cigarette money. But if they're going to flip, they're going to punch you in the face because they have a psychotic illness and they don't have the insight into knowing that you can't just give them cigarettes, cigarettes, cigarettes – they'll go buy them cigarettes if that's the thing that's going to keep calm.
Thinking through the costs in that way, is something I've learned from, and the way I've tried to help my staff out is however I can apply to services for them. I have some people in D.C., once I find out that they're at an age where they could potentially qualify from a home health aid, I apply to everything. I try to get them meals on wheels. I try to get them this thing, that thing. Many of them have been denied in the past, maybe they haven't really tried, or maybe they aren't eligible, but the main way is to try to get them as many services as possible, which then leads to complicating the treatment because you have four or five different agencies involved, and you're trying to figure out who's doing what, which is a different problem, but a better problem to have.
For the most part, the out of the pocket comes from my case workers. You end up spending a lot of money to help the system function to help your patient.
What needs to happen for these systems to work more cohesively?
I think about it as large group solutions and smaller more immediate solutions. In terms of the large overall solutions, I think crisis, I think crisis settings. I really believe in the urgent care system. If you're having a crisis right now people come to the ER and there's no beds to send them to. No long term hospital spaces. Not everybody needs to be in the hospital for seven days a week, 24/7 to be monitored.
We can move them to this middle unit where they can be kept safe for a little while. Some of them just need to get through the weekend. Observation units that aren't hooked up to all the expensive hospital bays are really great places, and then a lot of people can go home after that. They might not need the five days, they just need a couple of days. And I've found that that's a good workaround of not having inpatient beds.
I've also found that outpatient urgent care settings are good. It's a nine to five clinic, with staff, social workers, usually one physician, some peers. You can walk in off the street. It's an outpatient model, imagine how much money you save in that.
You can deal with the multitude of crises by having some place where you know you can go that's not waiting in the ER for eight hours.
In terms of the large system, it's groups. If you're not going to magically be able to reimburse every psychiatrist or every outpatient, why don't you have more groups of people, who once they leave the hospital just need something from six to nine. Think about AA in terms of mental health treatment, they need other people who are going through the same things they are that are staffed by social workers or staffed by psychiatrists who can provide ongoing care for them, in a model that's in a community center somewhere. That's not expensive and something the state can pay for.
Imagine the quality of what you could have at that time. It's not one reimbursable, so it's not there. Obviously the other individual level solution, you need a meals on wheels program or functioning transportation to help people get to appointments. You could even put a psychiatrist or psychologist in primary care offices.
My simple answer is how do you incorporate mental health players in these spaces? Making sure you at least know there are places that you can go. That takes investing in social services not just mental health centers. It's investing in the community itself.
interviews
Anti-Colonial Science & The Ubiquity of Plastic
by Max Liboiron
December 18, 2019
This interview with Dr. Max Liboiron was conducted and condensed by frank news. It took place December 4, 2018.
I'm Dr. Max Liboiron. I often introduce myself in Michif. So, I say, Taanishi. Max Liboiron dishinihkaashoon. Lac la biche, Treaty 6, d’oshchiin. Mtis naasyoon, niiya ni. Which means my name is Max Liboiron. I'm from Northern Alberta, treaty six territory, where I'm part of Mtis Nation, and I now live and work in Newfoundland and Labrador in Northeastern Canada.
I'm an environmental scientist and we do anti-colonial, feminist science – which means we draw a lot from the insights of the social sciences and also different traditional teachings and law, to inform our scientific practices. So that they are anti-colonial. So they are feminist. So that they do deal with questions of equity, questions of justice, questions of humility, and do work in a good way, as opposed to just an efficient way or a fact-y way.
Science, and research in general, has long played a role in colonial entitlement to land, both in proving that people deserve to be dispossessed in being the reason for research – we need to research tropical diseases so we can better settle in this tropical place, not our environment. Or, how do we patent different botanies? A lot of those legacies have stayed in science and aren't usually noticed anymore.
They used to be fairly contested, especially when science was trying to move into new places or when race was being scientized. But now people seem to have forgotten about that legacy. So our task at CLEAR, my lab, is to first of all recognize how science is already colonial, and then number two, work very hard to do the practices of science in ways that do not reproduce entitlement to land or universalism, which is actually just self portraiture of Europeans usually. The idea of mastery over nature, or that nature is a resource for use.
Every moment of science has these sort of legacies. There's lots and lots and lots of room for doing anti-colonial science and feminist science. Those are different things, but they're related in that they both find that science isn't neutral. It is deeply political.
The presentation of your research, visually, is patient, subtle, pretty – completely different from the majority of images I see related to plastics research. Can you talk about the work you’re doing right now?
I'll start with the premise of that, which is that we, I think, look at plastic very differently than a lot of the dominant discourses. Like you said, a lot of the dominant discourse about plastic is that plastic is inherently bad, and it's a bastard child of industrialization, and it needs to be eradicated, and illegalized, and banned, and exorcized.
But also plastic is our kin, it's our relation. It's from ancestors – organic ancestors from a long time ago. And if you neglect your relations to that, then you're bad kin. Even when plastic is misbehaving, which means it's being bad kin, you can still do good kinship with bad kin. And you know this. You have an asshole uncle somewhere. He might be bad kin but you still call him on his birthday, or bail him out of jail depending on what kind of bad kin he is. The same thing is true of plastics. I spend a lot of time with plastics. I do a lot of care work for plastics. I make sure that they are cleaned properly and I look at them a long time, and when I look at them, and I look at them in aggregate, I learn things about where they've been, and how they might have got there, and what their journeys might have been like, and where they might be going, because they're going to go for a long time.
We hang out together a lot, and they have a lot to teach us. Trying to ostracize them as the only sort of relation you can get, misses a lot of teachings that they have for us and also a lot of the respect. Because they are made of the earth. They've been pulverized in various ways so that they're not very earthy anymore, but you still have to respect that.
There's a tension with that in that the research that I do is mostly ingestion studies. Animals that have eaten plastics. Mostly what we focus on are animals that people, especially in Newfoundland & Labrador, use for food, depend on for food. For cultural sustenance, for nutritional sustenance, for economic sustenance. So the contamination of that food web is a form of colonialism. It's based on the idea that land is pollutable in the first place, that it is an okay place to put wastes. And magically, not magically, it's through different power structures, those tend to accumulate in rural, Indigenous, northern communities, which are never the places that benefit from plastic production. Almost never, but pretty much never.
At the moment, we’re doing some ducks, cod, seal, some geese. We get them mostly from hunters and fishers. We have a rule in the lab, all of our samples have to be eaten because what we test is food. We don't test oceans or some abstract fish, we work on food sovereignty. That means we sample food.
Are you consuming it?
Often.
Is that difficulte after seeing what's inside of it?
No. It's delicious. In the area we're researching, we do find plastic, but we also find them in smaller numbers than we find them in other places. Up in the north, we're fluent in things like the breast milk debate. In the 90's there were these big debates where scientists found really high PCBs in breast milk, and there was this huge protracted debate as to whether or not mothers could be considered abusive for feeding their kids that breast milk. A lot of stigmatization, ostracization, really screwed up relations within science. It turns out after multiple years, scientists decided, and medical practitioners decided, that actually, it's better to feed your kids contaminated breast milk than it is to feed them formula for their entire lives.
That being said, we have some of the least contaminated food in the world at this moment. Maybe not going to stay that way, but we consistently find lower ingestion rates in say, cod or ducks, than in other places. Part of that is the water that surrounds the province that I work in comes from the Arctic. There are certainly plastics in the Arctic, and that number is increasing, but it's not like the Gulf Stream which is filthy, where a lot of people get their fish.
What state is the plastic in when you find it in animals?
The vast majority of what we find are microplastics, smaller than five millimeters, that are fragmented from larger things. You can't usually tell what they're from. Most people don't eat the guts of animals, so we don't usually ingest those plastics. There are some exceptions. People here eat seal intestine, and if you eat the fish called capelin or sardines, you eat the entire animal.
The concern that we have is that we know plastics absorb oily chemicals. Like when you have your tupperware that's stained orange from your chile or your curry, that's because plastics is really good at sucking in oily chemicals. If you want to wash that orange color out, which is really hard, you would put it in hot, abrasic, acidic conditions, like a stomach.
My dogs eat plastic everyday and there's no crisis of the dog species. Most dogs eat plastic.
The albatross on Midway Island, Chris Jordan's photographs, drive me crazy because those birds did not die of plastics. In fact, albatross are one of the only marine bird species in the world that is increasing in population and range. They are the healthiest bird species literally in the world. Albatross die a lot because they're what's called an R-species. They live a really long time and have a baby every year, and the vast majority of those babies die. While those babies are dying and starving, they eat a lot of things that aren't food, including plastics. When you find an albatross that's dead with plastics in its belly, the incorrect assumption is that it died because of plastics, not because it was dying and thus ate plastics.
That’s a revelation & also cause for pause about what we’re panicking about.
I think we need to be concerned, but differently than we're currently concerned.
Right.
We're really concerned about objects that are plastics, and that is a concern. But more concerning are all the chemicals that originate in plastics and get absorbed by plastics, many of whom are built by the same industry. The petrochemical industry makes plastics, makes gas, makes plasticizers, makes fragrances, makes flame retardants. Those are the same companies. Those are the same set of products. And the plastic parts are like the vehicles or the vectors, and that's not great, especially because it assumes disposability and therefore access to land, which is a form of colonialism, to dispose of. But the health concern is really these chemicals.
Are you optimistic about the future of plastics? In our ability to innovate, or participate in change?
No, because I don't believe in end of pipe solutions. At all. And that's because I fully understand the scale of plastics. It's like trying to bail out a boat, but you haven't plugged the hole that's sinking the boat.
How about if we stop top of pipe? How about if we stop the production of disposable and ubiquitous plastics? People like GAIA, or Break Free From Plastics, which are these large coalitions that not coincidentally are global coalitions with a lot of people from the global south in them, those are the groups that are like, screw your end of pipe, because they're the end of the pipe. They're where American corporations are building their incinerators. They’re where the people are shipping their recycling to. And they're like no, these solutions clearly don't work. They just defer and shuffle the problem.
What you need to do is stop the pipe. That's what I believe in. This isn't a technological problem, this is a problem rooted in colonialism that assumes you get access to other people's land for your solutions, whether it's storing your pollution or your recycling or whatever. I'm really interested in things like China's recycling ban, which ripped a hole in the world's recycling program because the entire world's recycling programs depended on the idea that things went away, and away was China.
People are looking for other ways. They're like oh, let’s ship our recycling to other places in Southeast Asia. Oh, Vietnam. And you're like, no, no. China taught us something, folks. What it taught you was you're going to run out of aways, and your aways are going to get tired of you, and folks in Malaysia right now are fighting, fighting, fighting not to be the next away. That's colonialism. That's just waste colonialism. That's just the newest frontier in waste colonialism.
If I'm going to put my optimism somewhere and my change making somewhere, it's in that. It's in people being like no, I'm not going to be your away. Go find your own god damn away. Once we run out of that, or once we take ownership of that – when I say we, I mean industrialized nations mostly. I don't believe in most narratives of “we” because they make it sound like consumers can do something. If you live in Newfoundland, even if you live in other places, there's one fucking store. There's no such thing as consumerism or consumer choice. Reuse is already to the nines because there aren't a lot of resources. So all of the...banning straws? There are no straws.
The straw thing put me over the edge!
A lot of the common discourses make zero sense in the north. It's a handy barometer when someone's like, this is a solution! And you just sort of look around and you say no, not possible. Moving on. Really helps you scale and prioritize the types of things that might work.
What is the alternative to our dependency on mass produced plastics?
The alternatives would mostly come from industry. The number one product category for plastics is packaging. It's not more than half, but it's the largest chunk. Most of that packaging has been necessary only since the 50's. That's living memory. We could circulate goods in ways we remember from living memory differently than totally packaged in plastic. Yeah. They circulate differently. They don't circulate as far. It just means you have different distribution systems. The problem is that oil has just reinvested in plastics big time. Eight months ago they invested more money than they put in the last few years into new plastic production. So that's their call, right?
Why are they re-upping their investment?
I don't know. There was no discussion of why this, like why plastics? I do know, and I have studied historically the reason that plastics and plastic packaging in particular is so attractive to industry is because it is so cheap and it is so easy to turn a profit off of. Part of that is disposability. The fact that you don't have to be responsible for the end of life of your product. Some other country, someone else's land takes care of that for you. It's a huge cost savings compared to other things that are possible.
That's deeply upsetting.
It is. That's why any conversation about plastic, if it also doesn't talk about power, it's missed the boat. If it talks about individual agency and consumers, and it talks about empowerment but not power, it's actually missed the entire structure of plastic production and pollution.
Do you think large government policy can be effective in altering our use of plastic?
Yeah. If government stops subsidizing oil. I look for these things that are not the expected things, like China saying no. Or someone being like, no more corn. No more subsidizing corn for alternative plastic stocks, which makes plastic just like plastic. These unexpected things, because plastic is so dependent on these really extensive networks. Transportation, extraction, production, disposability.
Are more people understanding the relationship and connectedness between plastic and industry?
I don't know about more people, but I do think that key people do. Some of these international global coalitions, get it. A few key scientists get it. The Story of Stuff pretty much gets it. GAIA gets it. Teen Vogue gets it! These folks who have moved away from the end of pipeline story and the recycling story and the five small steps story, and have considered or deeply know power structures. That's increasing, a lot.
I've been working on plastic pollution since before it was cool, and the story has shifted significantly. The recycling and five small things continues to proliferate on its little treadmill, but there's now a lot more variety than there ever has before, especially as people are like holy shit, car tires. Holy shit, clothes. Holy shit. Those are things where you can’t just make a little shift because of their massive infrastructural ubiquity. People are starting to understand scale. Key people are starting to understand scale. Yeah. So that's nice.
How do you work to eliminate plastics but also acknowledge those who will likely become more disenfranchised by a rising cost of plastic, primarily medical items, that are dependent on plastics?
I work with folks who are at the periphery who aren't getting benefits. People who hunt and fish and need that food for all sorts of reasons. The thing is, if you think about anyone who needs plastic medical equipment – medical waste is different than packaging waste. I don't want a pacemaker that's not plastic. First of all, it's not possible. Second of all, I want my fucking pacemaker. But the thing is, there's ways to do that that is not about mass production, that is not about releasing and patenting and circulating chemicals that haven't been tested properly.
The problem isn't plastics. There are natural plastics. There are polymers that decay.
That's the problem. This idea that you either have to ban it all or take it all, you're like no. Those are not the only two things available. And I know this because I live in the fucking north. Concepts of ubiquity don't really work here. The all or nothing doesn't work in a lot of places, and that's obvious.
What would a local plastic economy look like? Huh. No one’s ever asked that question really. If you had to own the plastics, own the extraction of those plastics, own the chemicals that go in the plastics and the extraction of those chemicals, I bet your plastics would look a lot different. I bet you wouldn't have packaging. I bet you wouldn't have BPA. I bet you'd just move to something else half the time. And I bet you'd have plastic pacemakers.