Dealing needles

On the bathroom wall at the Seattle Needle Exchange, a single florescent light hummed and flickered. A bottle of moisturizing soap sat on the counter; a supply cabinet stocked with sterile needles and cotton balls sat across from the toilet. Taped to it was a piece of paper with a poem with no title or author:

"Dear God, so far today I've done all right. I haven't gossiped. I haven't lost my temper. I haven't lied or cheated. I haven't been greedy, grumpy, nasty, selfish or over-indulgent. I am thankful for that. But in a few minutes Lord, I'm going to get out of bed, and from then on I'm probably going to need a lot more help. Amen."

"I know this isn't the type of job for everybody, but there are survivors out here ... they need help," said Joe Tinsley, Seattle Public Health volunteer coordinator and education specialist.

Located a block away from the downtown Green Tortoise hostel in a Seattle neighborhood known for its population of transitory homeless and drug users, the needle exchange averages 200 to 300 visitors a day. For almost eight years, it has opened its doors from 1 to 5:30 p.m. every day except for Sunday. People can come to the exchange to trade in their used needles for clean ones and get a variety of drug paraphernalia such as tourniquets, cotton balls, heating supplies and paper clips. Doctors are on site twice a week to help with abscess care and screen for HIV, hepatitis A and B or Tuberculosis.

Run by the King County Department of Public Health, the needle exchange's mission is to reduce blood-borne diseases in the community, decrease the number of HIV infections, get drug users in treatment and provide a safe place to dispose of contaminated syringes. HIV infection rates have decreased 2 percent among drug users in Seattle this year, thanks to the program, said Tinsley.

"A lot of people support the program, but it's always controversial," said Tinsley. "In the summer, people walk by when the door is open and stick their head in. Some tourists that are visiting the market say, 'Cool, I've heard of this' and some say we're getting more people into drugs."

People started trying to open the locked doors at noon.

"We're not open for another hour, come back then," shouted Tinsley, his voice loud in the small room consisting of three chairs and a counter lined with supplies.

"Can anyone spare any change? He wants to buy a kitty," said the first client of the day, lisping slightly though her missing front tooth. She walked through the door with a limp. Her hair was stringy.

A little boy stood next to her, grasping a toy soldier. He watched as she deposited a bag full of needles in the drop box in exchange for clean ones with shaking hands, spotted with dark brown circles. The boy began to reach in the needle drop box. "Don't touch anything. Stay by me," she said, as she gathered the last of her materials. "Let's go."

In the building, there are a few small offices and a bathroom, which occasionally doubles as an operating room for cutting out abscess that are so infected they have to be treated immediately. Tinsley and Kyle Davidson, another Seattle Public Health employee, refer these clients to bigger hospitals such as Group Health or Harborview Medical Center -- but many users are wary of hospitals.

"A lot of these people are hesitant to get services in other places. Doctors and nurses will judge you once you've used injection drugs. It's often really subtle, but hurtful. It makes people not want to go back," said Davidson.

Tinsley greeted clients with a smile before handing them their needles. He asked some how their Thanksgivings were. A teenage girl with turquoise eye shadow stood by the drop box for almost 10 minutes, dropping needle after needle into the shoot.

"I'm surprised at how much stuff tiny purses can hold," Tinsley said, as she dropped the last needle, number 42, into the bucket. The container was empty at noon, but almost full to the top an hour later. The young woman put her new needles in her deceivingly small purse, pushing aside the Victoria's Secret catalog she also managed to fit in it. "Thank you, have a nice day," she said with a shy smile as she left, avoiding eye contact.

"I try to remember the little things about people. It's amazing how little gestures can open people up. A lot of times they're just not used to being treated like human beings," Tinsley said, who started with the Exchange as a volunteer eight years ago.

Among the seven needle exchange sites in King County, there are about 25 volunteers. They start out by bagging cotton balls in the back, and then slowly move to working the front counter. Tinsley tries his best to prepare them for the types of things they may see while working there.

"The most vividly traumatizing moment was when I was there to see an abscess cut out," said Ken Sutto, a volunteer of the program. "The smell was horrible, and the sound of the woman screaming ... it was intense."

A UW sophomore, Sutto got involved with the exchange through a service-learning component of an urban geography class he took as a freshman. The option the professor gave was either read a few books, or choose to volunteer at different outreach programs such as a women's shelter or food bank. Sutto and another classmate chose the needle exchange.

"It was out of my comfort zone. I'm from suburbia like a lot of kids I know," he explained. "We've all seen Trainspotting. I wanted to see if it was like that. I was voyeuristically intrigued."

Sutto is quick to point out the reality of injection drugs is nothing like he saw on the TV screen.

"A variety of people come in. It's not just your stereotypical homeless person in the back alley -- it's someone in that house over there. It's not just the Ave. rats, it's mothers, brothers, business men," he explained. "Times get hard, people get down, some feel drugs are their only option."

However, not everyone shares the same sentiment as the volunteers and Public Health workers about the nature of their work or the people they serve.

"A lot of people don't understand it and think we're encouraging people to use. One of my friends said, 'How could you help junkies?' without any knowledge of what we do" Sutto said. "People can be really naive and vindictive about it."

When Sutto's class ended, he continued to volunteer at both the downtown exchange and the location in Capital Hill.

"It sounds like such Disney crap, but I've learned not to judge as easily. People need to get with the world -- this is reality. It's taught me not to be a jerk," he said.

Sutto hopes someday to get a job with Public Health. At the same time, he points out it's not always easy to be confronted with reality.

"A couple times I have to step outside and sit out, have a cigarette," he said. "I go home sometimes and cry; I'm not going to lie."

Each year, the downtown clinic puts about 200 people into treatment. At $3,500 a person, "It's not cheap" said Larry Keil, who has worked with the program for seven years as the HIV prevention and education operations manager. There are around 500 people on the waiting list to receive treatment.

Pamphlets line the back walls with information on how to shoot up correctly, how to protect your mouth when using ("Meth and your mouth"), how to keep your veins healthy and where to go if you want to get help. Posters are hung on the remaining side wall that say "fix with a friend, don't shoot up alone."

Another poster has four pictures of the same needle before and after repeated use. A service worker is available twice a week to talk about treatment options.

"My ultimate goal is to stop the spread of HIV in this population and get people to think about changes they can make in their lives to get healthier," said Tinsley. "I just open doors. Some may not be ready. If I push too hard the door might close forever."

Tinsely and the other Public Health workers stress the importance of making each client feel comfortable.

"If you can get people to trust you, you can slowly figure out their situation and see if they're open to getting help," Tinsley said. "All it takes is just someone to listen."

Leaning against the counter, his arm brushing the sterile syringes in their protective sleeve, Tinsley tallied the number of needles deposited so far. Two men sat on the chairs discussing the books one was holding. A woman sat reading a newspaper as she waited for the doctor to test her for HIV.

"People are grateful we're here, they know we care about them and their health," said Tinsley. "That alone makes the job worthwhile."