The critical role librarians play in the opioid crisis | Chera Kowalski

46,619 views ・ 2018-06-26

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When you walk into your neighborhood public library,
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you expect the librarian to help you find your next favorite book
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or some accurate information on a topic at interest.
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You don't probably expect the librarian
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to come running out from behind the reference desk with Narcan,
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ready to revive someone overdosing on heroin or fentanyl.
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But this is happening at some libraries.
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Public libraries have always been about community support
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with all kinds of services and programs
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from assisting with job seeking efforts
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to locating resources for voter rights
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to providing free meals to kids and teens even.
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But what we think of as community support takes on new urgency
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when you're in the middle of an opioid and overdose crisis.
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I work at the McPherson Square Library of the Free Library of Philadelphia.
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It's located in Kensington,
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one of the lowest income communities in Philadelphia,
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with a long history of being isolated from resources and opportunity.
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And because of that,
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it has been the center to the city's drug trade and drug use for decades.
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And so inside the neighborhood,
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our library is nestled inside of a park,
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which has unfortunately garnered a reputation
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for being a place to find and use drugs,
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especially heroin,
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out in the open,
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putting us and the community in direct contact
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with the drug trade and use on a daily basis.
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And so inside the library,
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it is routine to see people visibly intoxicated on opioids:
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eyes closing, body swaying slowly.
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It is routine for me to ask them if they are OK,
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but at the same time remind them
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if they can't keep their eyes open,
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they have to go.
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It is routine for our volunteer, Teddy,
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to pick up dozens of discarded needles on our property and throughout the park.
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And it is normal for kids to come into the library
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to tell me or our guard, Sterling,
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that someone is outside using,
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which typically means finding someone injecting on our front steps,
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benches
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or near the building,
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then asking them to move along because kids see them.
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And it is normal for the community
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to see people in various states of intoxication and withdrawal,
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to see people buying and selling,
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and to see people act and react violently.
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I'm not sharing this to sensationalize Kensington.
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I'm sharing this because this is the reality of a community
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that is constantly striving to move forward,
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but due to factors like structural racism,
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urban segregation,
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the cyclical nature of poverty,
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of trauma --
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the community has inequitable access
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to education, health care, employment and more.
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And this is also what it's like when the drug trade and use
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affects every aspect of life in the neighborhood.
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And the opioid epidemic has only amplified that stress.
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When I was hired by the Free Library in 2013,
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I specifically chose to work at McPherson
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because I understand what it's like to grow up in an environment
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where substance use disorder shapes the everyday,
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and I wanted to use those personal experiences
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as a guide for my work.
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But before I get to that,
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I want to share what it was like
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to witness this epidemic grow in Kensington.
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Like many other communities, we were just not prepared.
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We began to take notice of IDs we were seeing:
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addresses from nearby and upstate counties
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and then slowly out-of-state ones.
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People from Arkansas, Ohio, South Carolina, Alabama
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coming to Philadelphia for cheap heroin.
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People began to linger longer and longer in our public restroom,
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causing us to pay more attention to the restroom
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than to our daily responsibilities
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because it was an accessible place to use drugs just purchased.
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One day our toilet clogged so badly in the restroom,
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we were forced to close our library for two days
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because the culprit of the clog was discarded needles.
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For a while prior to that incident,
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we had been asking for a sharps container for the restroom,
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and after that,
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the library administration quickly approved installing one
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along with hiring bathroom monitors.
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And as the weather warmed,
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we struggled to respond.
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People began camping out in the park for days, weeks.
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You could walk outside on a sunny, warm day
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to find multiple groups of people in various states of intoxication
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and children playing in between them.
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The amount of needles collected by Teddy on a monthly basis skyrocketed
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from 100 to 300 to 500 to 800,
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to over 1,000,
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with many found on our front steps and the playground.
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Then there were the overdoses.
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So many occurred outside in the park,
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some inside the library.
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Sterling, our guard, would spend his time walking in and out of the building
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and throughout the park,
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constantly making sure everyone was safe,
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because at times,
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our fear of having someone overdose and die came close.
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One overdose in particular occurred after school,
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so the library was full of kids, noise and commotion.
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And in all of that,
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we heard the thud from inside the public restroom.
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When we opened the door, we found a man on the floor, unresponsive.
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He was pulled out in plain sight of everyone --
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kids, teens, adults, families.
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Someone on staff called 911,
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someone else escorted the kids and teens downstairs,
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somebody went to flag down the ambulance in the park.
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And the rest of us --
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we just waited.
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This had become our overdose drill
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because at the time, it was all we could do.
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So we waited and we watched this man lose air --
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seize up.
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He was dying.
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I don't know how many of you have witnessed an overdose on opioids,
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but it's horrific
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because you know the gasping for air,
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the loss of color in someone's face,
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is a timer running down on the chances of this person surviving.
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But luckily for this man,
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the ambulance arrived
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and he received a dose of naloxone through injection.
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And I remember he jolted like he was electrocuted,
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and he pulled the needle out,
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and he told the paramedics to back off.
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And then he stood up, and he walked out.
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And we --
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we went back to work
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because people were still asking for time on the computers,
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kids still needed help with their homework
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and this was our job --
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our purpose.
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I think that incident stays with me because of the waiting.
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It made me feel helpless.
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And it was that feeling of helplessness that reminded me so well of my childhood.
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Before I was born, both of my parents began using heroin.
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It made our lives chaotic and unstable:
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promises being made and constantly broken,
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their fighting, the weight of their secret --
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the weight of our secret kept so much so-called "normal" out of our lives.
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Every time we'd be dropped off at our grandparent's house,
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I'd be stuck on the thought that I was never going to see them again.
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Every time we'd be left in a car, at a house, at a store,
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I'd cry.
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And every time I saw those El tracks --
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the same ones I take to work now to McPherson --
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from the backseat of a car,
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I'd be angry,
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because even kids know
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when their parents are trying to score drugs.
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There was so little I could do to control what was going on around me,
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that that feeling of helplessness was overwhelming.
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I struggled in school, struggled to read,
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I was prone to anger and depression.
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When I was 11 years old, I started smoking,
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which shortly after led to my own experiences with drugs and alcohol.
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I convinced myself that my parents' past would be my future.
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But eventually both of my parents entered recovery
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and maintained recovery from opioid use.
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And their strength and their commitment
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provided support and stability for me and my siblings,
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and it was those personal experiences that brought me to McPherson.
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Choosing to be a librarian
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and choosing to be at McPherson
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was me letting go of that feeling of helplessness
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and finding ways to be supportive to others.
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And one way to provide support
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was learning how to administer Narcan.
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Public libraries respond to the needs of their communities,
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and not knowing how to utilize Narcan
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was a disservice to the needs of our community.
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We were on the frontlines
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and desperately needed access to this lifesaving tool.
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So finally in late February of 2017,
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after much advocating,
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we finally received training from Prevention Point Philadelphia
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and about a month of so later,
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I utilized Narcan for the first time to save someone's life.
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It was after school again,
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and Teddy came into the library
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and said someone was overdosing on a front bench.
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Someone on staff called 911 again,
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and I grabbed the Narcan kit.
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The woman was barely in her 20s and barely breathing.
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Her friend was frantically slapping her in the face
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in hopes of reviving her.
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I administered the Narcan nasally,
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and thankfully she came to.
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But before the ambulance arrived,
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she and her friend ran off.
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And when I finally turned around,
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I saw the kids --
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kids that come into the library on a daily basis,
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some that I have known for years --
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standing on the steps of the building.
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They saw everything.
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And they didn't seem like they were visibly upset or in shock,
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and so I walked into the building,
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right into our workroom, and I cried.
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I cried partly from the shock of what just happened
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because I never thought I'd be saving anybody's life ever,
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but I mostly cried because of the kids.
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This is their normal.
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This is the community's normal.
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This is a catastrophic normal,
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and in that moment,
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I was forced to confront once again that this should never be normal,
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and as with my childhood,
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when you're in it, you just accept it.
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The opioid epidemic is not just about those living
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with opioid use disorder
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because the reach of the epidemic goes well beyond those living with this
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and their families.
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It impacts the entire community.
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Kensington was a community in crisis before this
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for reasons that are endemic and intertwined,
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and anyone familiar with the neighborhood can think of why:
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racial disparities,
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failure of local and federal government to properly fund schools,
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lack of economic opportunity.
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And what we're trying to do at McPherson
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is find ways to support this community out of crisis.
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And perhaps now, because of the epidemic,
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more people are paying attention to Kensington.
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But regardless of that,
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at McPherson,
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we will continue to do what we can with the resources we have
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and we will continue to provide whatever help we can
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in hopes of keeping our community safe and healthy
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because public libraries have always been more than just books.
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We are physical shelter,
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a classroom,
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a safe haven,
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a lunch room,
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a resource hub
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and yes,
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even a lifeline.
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Thank you.
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(Applause)
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