TEDMED 2017
Chera Kowalski: The critical role librarians play in the opioid crisis
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Public libraries have always been about more than just books -- and their mission of community support has taken on new urgency during the current opioid epidemic. After witnessing overdoses at her library in Philadelphia, Chera Kowalski learned how to administer naloxone, a drug that reverses the effects of narcotics, and she's put it to use to save patrons' lives. In this personal talk, she shares the day-to-day reality of life on the frontline of the opioid crisis and advocates for each of us to find new ways to keep our communities safe and healthy.
Chera Kowalski - Librarian
Chera Kowalski is championing the transformation of her library into a safe, responsive space for the community it serves. Full bio
Chera Kowalski is championing the transformation of her library into a safe, responsive space for the community it serves. Full bio
Double-click the English transcript below to play the video.
00:12
When you walk into your
neighborhood public library,
neighborhood public library,
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you expect the librarian
to help you find your next favorite book
to help you find your next favorite book
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or some accurate information
on a topic at interest.
on a topic at interest.
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00:22
You don't probably expect the librarian
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to come running out from behind
the reference desk with Narcan,
the reference desk with Narcan,
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ready to revive someone
overdosing on heroin or fentanyl.
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
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.
to kids and teens even.
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But what we think of as community support
takes on new urgency
takes on new urgency
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when you're in the middle
of an opioid and overdose crisis.
of an opioid and overdose crisis.
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I work at the McPherson Square Library
of the Free Library of Philadelphia.
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,
communities in Philadelphia,
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with a long history of being isolated
from resources and opportunity.
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.
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
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
in direct contact
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with the drug trade
and use on a daily basis.
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:
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,
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.
on our property and throughout the park.
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02:07
And it is normal for kids
to come into the library
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,
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.
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,
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.
to sensationalize Kensington.
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I'm sharing this because
this is the reality of a community
this is the reality of a community
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that is constantly striving
to move forward,
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.
employment and more.
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And this is also what it's like
when the drug trade and use
when the drug trade and use
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affects every aspect
of life in the neighborhood.
of life in the neighborhood.
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And the opioid epidemic
has only amplified that stress.
has only amplified that stress.
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When I was hired
by the Free Library in 2013,
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
to grow up in an environment
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where substance use disorder
shapes the everyday,
shapes the everyday,
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and I wanted to use
those personal experiences
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.
grow in Kensington.
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Like many other communities,
we were just not prepared.
we were just not prepared.
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We began to take notice
of IDs we were seeing:
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
Ohio, South Carolina, Alabama
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coming to Philadelphia for cheap heroin.
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04:00
People began to linger longer
and longer in our public restroom,
and longer in our public restroom,
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causing us to pay
more attention to the restroom
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.
to use drugs just purchased.
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One day our toilet clogged
so badly in the restroom,
so badly in the restroom,
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we were forced to close
our library for two days
our library for two days
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because the culprit of the clog
was discarded needles.
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,
container for the restroom,
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and after that,
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the library administration
quickly approved installing one
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.
in the park for days, weeks.
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You could walk outside
on a sunny, warm day
on a sunny, warm day
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to find multiple groups of people
in various states of intoxication
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
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.
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
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.
overdose and die came close.
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One overdose in particular
occurred after school,
occurred after school,
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so the library was full of kids,
noise and commotion.
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.
from inside the public restroom.
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When we opened the door,
we found a man on the floor, unresponsive.
we found a man on the floor, unresponsive.
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He was pulled out
in plain sight of everyone --
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,
and teens downstairs,
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somebody went to flag down
the ambulance in the park.
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.
it was all we could do.
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So we waited and we watched
this man lose air --
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,
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.
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.
of naloxone through injection.
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And I remember he jolted
like he was electrocuted,
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,
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.
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.
that reminded me so well of my childhood.
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Before I was born,
both of my parents began using heroin.
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 --
the weight of their secret --
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the weight of our secret kept so much
so-called "normal" out of our lives.
so-called "normal" out of our lives.
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Every time we'd be dropped off
at our grandparent's house,
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.
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,
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 --
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.
are trying to score drugs.
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There was so little I could do
to control what was going on around me,
to control what was going on around me,
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that that feeling of helplessness
was overwhelming.
was overwhelming.
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08:09
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,
I started smoking,
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which shortly after led to my own
experiences with drugs and alcohol.
experiences with drugs and alcohol.
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I convinced myself that my parents' past
would be my future.
would be my future.
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But eventually both of my parents
entered recovery
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,
for me and my siblings,
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and it was those personal experiences
that brought me to McPherson.
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
of that feeling of helplessness
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and finding ways
to be supportive to others.
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,
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.
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.
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
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.
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.
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.
and barely breathing.
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Her friend was frantically
slapping her in the face
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,
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,
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
of what just happened
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because I never thought
I'd be saving anybody's life ever,
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,
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
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
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
in crisis before this
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for reasons that are endemic
and intertwined,
and intertwined,
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and anyone familiar
with the neighborhood can think of why:
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,
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.
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.
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
with the resources we have
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and we will continue to provide
whatever help we can
whatever help we can
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in hopes of keeping our community
safe and healthy
safe and healthy
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because public libraries
have always been more than just books.
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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ABOUT THE SPEAKER
Chera Kowalski - LibrarianChera Kowalski is championing the transformation of her library into a safe, responsive space for the community it serves.
Why you should listen
Chera Kowalski is revolutionizing the way public resources are meeting the needs of the communities they serve. As the Adult Teen Librarian at the Free Library of Philadelphia’s McPherson Square Branch, this often means saving lives.
After witnessing drug overdoses firsthand at her library and the nearby park, Kowalski volunteered to receive training in overdose defense through Prevention Point Philadelphia and now advocates for training for other librarians and community members to learn how to administer naloxone -- a life-saving drug that reverses the effects of opioids -- to people in distress. Motivated by her personal experiences as the daughter of parents who have maintained recovery from opioid use, Kowalski is transforming her library into a safe, responsive space for her community that is able to help people with whatever they need in a supportive, judgment-free way. Kowalski is a graduate of Temple University's College of Liberal Arts and the University of Illinois School of Information Sciences.
Chera Kowalski | Speaker | TED.com