Harm Reduction Providers Navigate Grief While Helping Others
By Luke Schmaltz, Editor, VOICES Newsletter
“There is no grief like the grief that does not speak.” – Henry Wadsworth Longfellow
Across Massachusetts, direct service providers are working to combat the devastation caused by substance use disorder (SUD). As they provide counseling, peer support, and harm reduction resources to local residents, they often face circumstances which can take an emotional toll. This month, two professionals working on the front lines of the opioid crisis share stories of their vocational roles, their personal losses, and how they deal with grief while helping others.
A Challenging Vocation
Cara Moser is the Harm Reduction Program Manager for Tapestry Health in Greenfield, Massachusetts. Although she is fairly new to her position (eight months), she is no stranger to working in healthcare. Previously, she was the facility administrator at a family medical practice. This sector of care, however, presents a different set of challenges. Daily meetings, outreach assignments, testing, ordering of inventory, administering of vaccines, and distribution of supplies to the public can be demanding from a technical standpoint. “We keep ourselves pretty busy,” she says.
Moser goes on to explain that she discovered an unexpected advantage to working in harm reduction. “I find I get really close to some people and I am not being triggered as much as I thought I would.” She then pivots and drops a bombshell: “I am happier working among people who are using drugs because I can help them like I couldn’t help my daughter,” she says.
One of Moser’s three daughters, Eliza, overdosed in October of 2018 after being in recovery for a year. “It was a nightmare, still is,” she begins. “She ended up using [substances] on her birthday because she had lost a pregnancy. None of us knew she had relapsed. One of her sisters heard her come in that morning and just went back to sleep – thinking everything was OK. Then, her younger brother, who was 14 at the time, got back from a short day at school and he found her. They were so close, the two of them,” she explains.
One Day at a Time
Currently, Moser’s family is managing the grief from the loss of Eliza through various avenues. “We’ve tried therapy and one of them does extremely well with it,” she begins. “But my son is not particularly interested in doing that no matter how hard I try to convince him to find somebody to talk to.”
Moser points out that there are signs of hope, however. “I think he is finally starting to be able to do some real grieving, but up until now he’s just been so traumatized. Here it is, four years out, and we’re all still stunned and sad, crying every day, you know?”
The Power of Action
On a personal level, Moser practices self-care by excelling at her chosen profession. “This work, it really helps keep me going,” she says. “I’ve seen people become trusting of myself and the staff and we are building these relationships. We see people moving on to find housing and to get the medical treatment they need – especially for wound care. We are able to connect them with doctors who are drug-friendly and user-friendly. So, that gives me a lot of happiness, I feel happy about that,” she explains.
In her free time, Moser continues to assuage her grief by seeking the fulfillment of helping others. “I also do advocacy for safe consumption sites,” she says. “I’ve been doing that since the day Eliza died.”
Along with colleagues, Moser is currently working with Safehouse in Philadelphia to support their efforts to promote safe consumption and harm reduction. The group is called Friends of Safehouse. “We’ve been doing protests and trying to educate people because Philly is devastated by the opioid epidemic,” Moser says. “I would like to ask people to consider advocacy as a way to grieve.”
Overall, Moser acknowledges the power of grief and, while it has inspired her to make the world a better place, it may not be moving on from her life anytime soon. “I spend a lot of time grieving and crying endlessly,” she says. “I don’t know if I’ll ever stop grieving. These are tears and they are powerful. I like remembering how much she [Eliza] touched me.”
An Outreach Veteran
Nellie Maldonado is an Assistant to Harm Reduction Programming for Tapestry Health. She recently celebrated her 30-year anniversary of working in community outreach, having started in October of 1992 as a bilingual counselor.
Maldonado comes from a family of seven children. When she was five years old, her sister, who was 13, began using. Years later after they lost contact, she passed away from HIV. The sister, who was the oldest of the siblings, struggled with substance use and there was little information available at the time on how to help her. “They would move her around, lock her up, or send her away,” Maldonado explains.
The circumstances were characterized by a lack of acknowledgement and communication. “I’ve learned that these are conversations we need to have,” Maldonado says. “These discussions need to happen in schools, in churches, at jobs, and in homes – the places they are not happening. We need to work at this as a society because these conversations [about SUD] are still very taboo.”
The Call to Serve
Eventually, Maldonado became impassioned about helping people in her community who are struggling with substance use and other issues. Today, the growing numbers of overdose casualties are making the work she does increasingly important, especially with a condition such as SUD which carries a significant stigma. “It’s hard to provide services to your loved ones, especially in the Latino community,” she begins. “This disease does not discriminate.”
Maldonado’s work frequently places bereaved people in her midst, and she explains how important it is to have empathy. “You meet people who have lost loved ones. When a person has lost another to SUD, it is important to give them a space to talk,” she says.
Dealing with Loss
Recently, a volunteer at her facility passed away from substance-use-related causes. “It’s tough to lose someone,” Maldonado begins. “There’s anger and confusion and it just feels so heavy. It makes us question our roles. Since we help other people all the time, why couldn’t we help him?” Regardless, she subscribes to the power of communication and openness. “It is important to not avoid talking about it. There’s no shame in talking about it. I still start crying – it’s only been a month,” she says.
Maldonado offers sound advice when it comes to counseling someone who is grieving, placing primary emphasis on the importance of sincerity. “Don’t ask the question if you don’t have time to listen,” she begins. “You don’t want to start a conversation and then have to go all of a sudden. That’s when the person will need to let everything out. When people are sharing their feelings, be sure to tell them that it’s OK,” she explains.
On a personal level, Maldonado subscribes to a self-tailored coping system for dealing with grief. “I’m still learning,” she begins. “When you’re a caregiver, you lose people you care about. I will take a couple days off, work from home, use my faith, my church, and my family. Sometimes, I’ll look something up in the Bible, listen to soft music, or simply just talk about it,” she says.