CREDIT: Ian Lindsay, Vancouver Sun Darlene Rowley has spent time on the street and is now in the detox program at the Harbour Light facility. Unfortunately, she will have no home when her treatment ends.

CREDIT: Ian Lindsay, Vancouver Sun Nancy McConnell (left) is manager and Amber LaPorte is a social worker at the Salvation Army's Harbour Light complex.

Second of three parts

By her second week at the Salvation Army's Harbour Light detox centre, Darlene Rowley had enough strength to keep her eyelids open, walk without shuffling and speak without straining for each word.

It was a vast improvement over her first week in the Downtown Eastside detox facility, when every movement seemed a struggle for the engaging woman.

Rowley, 43, has been addicted to drugs on and off for many years. She's hoping to get straight this time.

"I've reached bottom. I've been through drug psychosis -- I have thought that people wanted to kill me."

But the odds are likely stacked against her. Again.

Stan Karbowiak, a social worker who is Harbour Light's acting human resources administrator, has compiled statistics showing that across B.C., only 30 per cent of detox/recovery beds are available to women.

"Where the rest of the women go is back to the streets," said Karbowiak, a social worker for 16 years, most of them in the Downtown Eastside. "The women have nowhere to go, shelters are full, centres are full."

With an estimated 7,000 addicts in the Downtown Eastside, the Vancouver Coastal Health Authority funds 18 residential detox beds for women, 41 for men and 22 for youth, as well as a variety of outpatient programs.

Women who make it into detox don't fare nearly as well as men, Karbowiak said.

From 2005 through 2007, 5,100 people came through Harbour Light detox. Of the 3,500 male clients, 33 per cent went back to using, compared to 64 per cent of the 1,600 female clients relapsing.

The reason for this, Karbowiak's statistics suggest, is that it is four times harder for women leaving detox to get into a recovery/treatment centre anywhere in B.C. So there is a devastating pattern of women relapsing and going through detox multiple times.

Rowley has been one of them. This is her fourth time through Harbour Light. She has also been through treatment programs. She has had some periods of sobriety, but ultimately relapsed each time.

She had a lousy childhood, she said, scarred by physical abuse and substance abuse. She went to foster care. She has a Grade 7 education. Although well-spoken and street-smart, she has "never read a book in my life."

She got married, had a daughter and worked in the office of a trucking company in Toronto. But it was when she moved to B.C. about 10 years ago that things got out of control.

"I was fine. [But] it was really an issue when I came to Vancouver. [The drugs] were available. It was the amount I was using."

She lost custody of her daughter. She met a new boyfriend, and was soon selling sex to make ends meet.

"I had to support his habit and my habit and pay the rent and the bills," she said. "Somebody had to pay for the dope."

She has been diagnosed with acute bipolar disorder in a complicated combination with illegal drugs that she says the health system is ill equipped to handle.

"There needs to be more treatment, there needs to be more doctors, there needs to be more therapists and they need to work hand-in-hand together," she said.

Rowley waited three days to get into Harbour Light, which is too long, advocates say, because action needs to be taken as soon as addicts decide they want help.

Harbour Light says the average wait to get into its facility is four to five days, while Vancouver Coastal Health -- which funds the detox beds -- says the wait to get into detox generally fluctuates from a low of one day to a high of five days, depending on the demand.

Critics also lament the system's dearth of stabilization beds, places to stay between detox and the several-week-wait to enter a treatment centre. They argue the wait is too long for some of the system's most difficult clients to go home and be expected to stay clean until a space is available.

Rowley is staying in one of four stabilization beds for women at Harbour Light, beds that now have no funding.

While detox was covered by her B.C. CareCard, payment for her stabilization bed is taken directly out of Rowley's disability cheques. It means she can't cover the rent on her Surrey apartment, so she must give up her place, and will have no home when her treatment ends.

After being told by Vancouver Coastal Health there was no additional budget money, Harbour Light's manager of addiction services, Nancy McConnell said: "I got angry. I didn't care anymore."

McConnell found space for the unfunded stabilization beds by clearing out a small office and putting two sets of bunkbeds in it.

(By comparison, Harbour Light has 10 funded stabilization beds for men. It has 23 detox beds for men, and only six for women.)

McConnell said she has space in another area of the centre for more stabilization beds for women -- if she can get the funding.

Heather Hay, director of addictions, HIV/AIDS, and aboriginal services for Vancouver Coastal Health, argued improvements have been made for the 16,000 residents of the Downtown Eastside since a decade ago, when there was a "public health emergency" in the area.

However, she agreed that 2,100 people in the neighbourhood who typically have mental illnesses and addictions, do need more resources. Of those, about 250 are extreme cases.

In a frank interview, Hay acknowledged there is a need for more detox beds for women. "We need to fill that gap," she said.

When asked if the province has been lobbied for more money for detox, she replied that addiction treatment overall needs more funding.

Hay said the four stabilization beds at Harbour Light are clearly filling a need for women -- many of them dually diagnosed -- who need somewhere to go after detox and before getting into treatment.

"In a small way, the four beds the Sally Ann has put in there is filling the gap for these women," Hay said.

However, she said it wasn't in the health authority's mandate to fund the beds, and noted there is only so much money to fund the health care system.

Hay said a new 100-bed mental health and addictions facility promised last week by the province may be a place where some of the women can go while waiting for treatment-centre spots.

She said the Burnaby facility is also intended to assist the 250 or so of the most severe cases in the Downtown Eastside who lead "chaotic" lives.

How people will be sent to the Burnaby facility is still being worked out, but it will likely be through medical referrals and the criminal justice system.

"I think we all understand this client group ... has been underserved for a long time," Hay said.

Karbowiak is buoyed by the potential for the new 100-bed centre, which he said could have a big impact on the Downtown Eastside. If it takes the most extreme cases off the streets, then other detox services could be made available for more moderate addicts.

The first 30 beds are expected to be open this summer, and the remaining 70 by the end of the year.

Vancouver police, in a scathing report released earlier this month, said few medical facilities can deal with both addiction and mental-health issues, and that police have been forced to arrest people with a dual diagnosis because there is nowhere for them to go besides jail.

In a recent tour through the back alleys and decrepit rooming houses of the Downtown Eastside, Const. Stuart Black pointed out homeless people with severe addictions and said there aren't medical services to help them.

"You get released from detox with nowhere to go, no place to stay," said Black.

Hay remains positive about the improvements that have been made so far in the Downtown Eastside, such as lower HIV rates, fewer overdose deaths, good immunization percentages, and the number of people using the Insite facility to inject drugs safely and to try to get clean.

From October 2007 to January 2008, she said 115 clients have stayed in Insite's upstairs detox beds and another 58 have used its stabilization beds.

But Gloria Kieler, a pastor who funds her own mission on East Hastings, argues the detox beds at Insite are only for intravenous drug users, and they represent only 30 per cent of the addicts in the Downtown Eastside.

Kieler says she has been fighting for 15 years for more detox facilities in the neighbourhood, and has detoxed addicts in her own cramped living quarters in the back of her mission.

"I've detoxed people here for years because they had nowhere to go. ... I keep saying I'll never do it again. It's hard on your space," said Kieler, 65, a retired teacher.

Among the people she has taken in off the street was Sereena Abotsway, one of the six sex-trade workers Robert (Willie) Pickton has been convicted of killing.

She believes the Downtown Eastside has deteriorated so badly that "someone needs to charge the provincial government with negligence."

Amber Laporte, a Harbour Light social worker, says helping female addicts get treatment is key to getting them off the streets and away from predators like Pickton, who is accused of killing a total of 26 sex-trade workers from the area.

"Pickton is not the only one. We think because he's gone, the problem is solved. It isn't."

Carol Keewatin, 55, who has been addicted to drugs on and off for 40 years, entered Harbour Light to begin detox Jan. 14. Her five-foot-nine frame weighed just 100 pounds after many hard years of Downtown Eastside living.

"I was just a walking bone rack. I'm at that point I needed a change. I was just sick and tired of chasing garbage," Keewatin said, shortly after she was admitted.

"I was so sick from not looking after my body. I hadn't eaten properly, I hadn't slept properly."

Through her troubled years, she has experienced homelessness, violence in the sex trade and losing friends who ended up on a police poster of women who disappeared from the Downtown Eastside.

She was ordered into detox by the courts, not for the first time. Another failure meant going back to jail.

"I thought I could straighten out if I wanted to. Today I see a whole different view of it," said Keewatin. "It's so hard to walk through the detox doors again. I couldn't bring myself into an AA meeting. It's hard to face the reality of it. I'm an [addict]."

She said detox is a struggle every minute, and the first few days are hell.

In the past she detoxed herself while in jail, but this experience was more difficult because it was tougher to come off crack, which she considers a stronger, more mind-altering drug. After detoxing, she waited in Harbour Light's unfunded stabilization room for several weeks before getting into a treatment centre Feb. 5.

Before she left Harbour Light, Keewatin said she knew she is one of the lucky ones because she got help when she needed it.

"There's not enough facilities. ... Look at how many beds they have here for men, and not for women," she said, then flashed a look of determination. "I want my sobriety back. I know I can get my sobriety back."

lculbert@png.canwest.com/

- Thursday: Keewatin may be in recovery, but her two daughters are still living dangerous lives in the Downtown Eastside. What does the future hold for them, and for the troubled neighbourhood?