Harm reduction programs like needle exchange programs or medically supervised injection sites aim to a) respond to the addiction health issues of those who are dependent on injection drugs, and b) respond to the broader public health impact of addiction on a community such as a high amount of drug overdose or the transmission of infectious disease through the sharing of infected needles. These harm reduction programs are having an impact, but some have questioned whether such programs inappropriately cooperate with drug abuse. Our two guests today will offer us insight into that question and the impactful experience of two such harm reduction programs at Providence Health Care in Vancouver, British Columbia, Canada.

Our guests in this episode include:

• Scott Harrison, Director for Urban Health, Indigenous Health, Substance Use, Maternity and Neonatal Intensive Care at Providence Health Care
• Christopher DeBono, Vice President of Mission, People and Ethics also at Providence Health Care

This episode was recorded on January 23, 2020

Additional resources relating to or referenced in this episode:

• Assessing the Ethical Issues in “Safe Injection” Sites by Carol Bayley, and Fr. Charles Bouchard
• Catholic Ethicists on HIV/AIDS Prevention, by James Keenan
• Catholic Participation in Needle- and Syringe-Exchange Programs for Injection-Drug Users: An Ethical Analysis, by Daniel Sulmasy
• Safe Injection Sites: A Moral Reflection, by Steven Bozza and Jeffrey Berger

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Street Medicine is local and international. In this second episode on Street Medicine we hear about health care leaders in Portland, Oregon responding to the needs in their community. The challenge? Nationally, Oregon has the fourth highest rate of homelessness and the second highest rate of families without shelter. In recent years Portland’s chronic homelessness has increased at twice the national rate. The homeless population is growing older, more disabled, and is on the streets for longer periods of time. The homeless in any community face stigma, social isolation, and loss of relationships. They suffer a disproportionate burden of illness and premature death. The life expectancy of a homeless person is 47 years.  The healthcare leaders collaborating in the Portland Street Medicine program are working to shape a different future.

Our guests in this episode include:

• Dr. Dan Bissell, emergency physician and co-founder and executive director of Portland Street Medicine
• Drew Grabham, social worker and board member of Portland Street Medicine

This episode was recorded on April 10, 2020

Resources referenced in this episode:

• Portland Street Medicine

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COVID19 has caused all of us to prepare and it has also demanded something from us. We hear many stories of the technical and resource preparation. In this episode we speak with three physicians from California and Washington state about their preparation and what it has demanded from them. We hear people in frontier territory wanting to offer their best. Some might even call this the crafting of virtue.
Our guests in this episode include:

• Dr. Bethany Kapp, dual boarded in Emergency Medicine and Palliative Medicine, CHI Franciscan, Tacoma, WA
• Dr. Mojdeh Talebian, pulmonologist and ICU physician, System Medical Director Critical Care, Director ICU & Pulmonary Services, Sequoia Hospital Redwood City, CA
• Dr. Anita Chandrasena, pulmonologist, Chief Medical Officer, Northern California Division-Bay Area, CommonSpirit Health, Redwood City, CA

Three physicians, responding to COVID19… and diving deep.

This episode was recorded on April 1st, 2020

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We hear many stories these days about immigration. Certainly, healthcare workers see undocumented individuals in Emergency Rooms or clinics. What is that experience like of being undocumented and needing healthcare? What would be helpful for clinicians to know? Does healthcare ethics have something to say on this topic? Today we hear from two healthcare leaders on these issues. One, who was an undocumented person and who later became a physician in the United States, and the other is the healthcare leader who supported her journey.

Our guests in this episode include:

• Mark G. Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics and also Director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University, Chicago
• Dr Johana Mejias-Beck, internal medicine pediatrics specialist, currently at the University of Missouri, Kansas…and one of the first undocumented students to attend the first medical school in the country to accept applicants with DACA status.

Additional resources relating to or referenced in this episode:

• Limbo Really Exists: Undocumented Youth at Risk, Mark Kuczewski, Johana Mejias-Beck, Amy Blair, and Matthew Fitz
• Treating Fear: Sanctuary Doctoring, Loyola University Chicago – Neiswanger Institute 

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Health disparities and health outcomes for African Americans, is egregious… A 2019 report identified that African American Adults, compared to non-Hispanic white adults, are:

• 44% More likely to die from stroke
• 20% more likely to have asthma
• 40% more likely to die from breast cancer
• 25% more likely to die from heart disease
• 52% more likely to die from cervical cancer
• 23% more likely to be obese
• 72% more likely to be diabetic

Regarding pain medication, a 2019 published article offered that the pain of African Americans is systematically under-diagnosed and under-treated

Our guests today will offer stories and discuss insights on end of life care in the African American community. Our guests in this episode include:

• Patrick Smith, professor at the Duke Divinity School and associate faculty with the Trent Center for Bioethics, Humanities, and History of Medicine at Duke University School of Medicine.
• Dr Farr Curlin, Josiah C. Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine, and Co-Director of the Theology Medicine, and Culture Initiative at Duke Divinity School.
• Claretta Dupree, Chair of the Academy of Fellows at the Center for Bioethics and Human Dignity at Trinity International University, Deerfield, Illinois.

Additional resources relating to or referenced in this episode:

• Center for Practical Bioethics, Richard Payne, MD
• Palliative Care in the African American Community
• Perceptual Contributions to Racial Bias in Pain Recognition
• Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites

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