Architecture, Anthropology and Social Acceptance

A Downtown Eastside church expresses support for the local supervised injection site, whose operation was challenged by the federal government.

For over two decades, architect Sean McEwen and medical anthropologist Dan Small have been involved in designing and advocating for vulnerable populations in Vancouver’s Downtown Eastside—including North America’s first supervised injection site. Here’s the story of their endeavours, in their own words.

The architect and the anthropologist

Sean McEwen: I first met the principals of the Portland Hotel Society about 25 years ago, when I was working as an affordable housing activist in Vancouver. I was really struck by the social-serving activists who worked with the Portland, and began to collaborate with them on a number of projects. Over the years, they asked me to be the architect on such wonderful projects as the supervised injection site, the Interurban arts centre on the Downtown Eastside, a bank for low-income folks, social enterprises like East Van Roasters, and an urban farm.

Dan Small: Medical anthropologists, like other anthropologists, study culture, but they focus on culture in healthcare. My particular interest is the lived experience of healthcare and illness. To borrow a phrase from another medical anthropologist, Byron Good, while a physician might look at a patient as a site for disease, an anthropologist sees them as a site for story.

An anthro-architectural approach

DS: Stories give us a sense of profound experiences in people’s lives. This is a key part of the anthro-architectural approach that Sean and I have been working together on. It focuses on people’s experiences, their stories, the sense of meaning they derive from their community and their lives.

SM: As an architect, my work assists in explaining these stories and visualizing how they might manifest in real-world buildings and tenant improvements. I see my role as an advocacy planner—a community-based designer who takes the time to hear the stories. It’s a role that also incorporates the input of institutional stakeholders, and negotiates a path with the requirements of the regulatory system. As an architect-advocate, I try to defend and implement community aspirations, which can often be at odds with the status quo.

“Four Blocks of Hell”

DS: The work that Sean and I do takes place within the Downtown Eastside. It’s a place that’s been characterized by the media as dangerous, sick, mean, falling to pieces. The Vancouver Sun described the downtown east side as “Four Blocks of Hell.” These narratives reflect how the community is perceived, and also affect architects as they’re trying to get work finished.

Brazilian anthropologist João Biehl coined the term “zone of abandonment,” to describe areas where we have essentially sequestered people away, along with the social issues they represent. Our work tries to transform the Downtown Eastside from a “zone of abandonment” to a “zone of acceptance.” We want to create places that include people and welcome them back in the human family.

Zones of acceptance can take many forms—in healthcare, housing, support services or social enterprise. If you’re not allowed to have pets or shopping carts in a homeless shelter, that’s a barrier that’s put in place by a system. If we remove that rule, we’ve lowered the threshold for entering the shelter, and thereby reached a target group which was excluded. The ultimate result is to create a stronger zone of acceptance.

The Portland Hotel Society, which operates housing including the Pennsylvania Hotel, has long been involved in advocating for vulnerable populations on the Downtown Eastside.

The Portland Hotel Society

DS: In the 90s, I began working with the Portland Hotel, a single room occupancy (SRO) hotel in the downtown east side. It was used by a group of people who have a wide variety of healthcare needs: HIV, hepatitis, ongoing drug addiction.

At that time, these people were dramatically excluded from all walks of life: restaurants, primary healthcare, policy, social housing, dentistry, employment. One of the great thinkers in stigma, Irving Goffman,
described people who are stigmatized as being “not quite human”— they have a socially tarnished identity. Other thinkers, such as the psychiatrist Arthur Kleinman, describes a process whereby people are perceived as having “earned” their illness and lot in life. If someone tells you they have been diagnosed with lung cancer, the first question people ask is: “were you a smoker?” This digs at the idea of earned illnesses.

The related idea of sequestering comes from social scientist Anthony Giddens, who describes the way we hide away things that we’re afraid of in life, “sequestering” them, such as mental illness and criminality. I argue that many of the people we’ve created services for, on the Downtown Eastside, are treated as socially constructed lepers.

At the Portland Hotel, we developed a no-eviction policy. At the time, you could not receive funding to provide housing for active drug users. The Portland said, “let’s make it a rule that housing is sacrosanct, and you can’t be kicked out of this housing even if you are someone with an active addiction.” This was very astonishingly controversial. It was considered to be a kind of programmatic witchcraft.

The Portland became a founding ground for “housing first” policies. After the hotel was renovated into The Pennsylvania, it was also the birthplace of the first needle exchange located inside a housing facility, and had the first low-threshold methadone program.

An early floor plan for InSite included a supervised smoking room for clients who inhale rather than injecting drugs, but that use was not supported by decision-makers. The space became a staff office.

North America’s first safe injection facility

DS: The Portland’s supervised injection facility, today co-managed by the Vancouver Coastal Health Authority, is perhaps one of the most controversial pieces of cultural real estate in North America. (Despite the overdose epidemic on the continent, the United States still does not have a single officially sanctioned supervised injection facility; Canada now has 40.) Its main goal was to reach people who were using drugs on the hungry side of town, in the alleys and SROs. Those people were in need of interventions to just keep them alive—to reduce fatal overdoses and the spread of HIV and hepatitis. This was the primary biomedical outcome of the program. But it also had more referrals to detox and treatment than any other addiction program. Moreover, people that were referred by the injection facility were more likely to complete their treatment.

SM: Among the first ideas for the supervised injection site was that it would incorporate a facility we called “detox on demand.” From time to time, people who are involved in addictions feel like their lifestyle is not right: they know that they’re putting themselves in personal danger. And at those times they feel an impetus to try and turn things around. But the regular healthcare system entails referrals and waiting time, which can be a big impediment to an addicted person who wants to make changes in their life. At the safe injection site, when an addict makes it clear that they want to try and kick their habit, there is a facility located in the same building for them to access right away.

I began working with Dan and other folks at the Portland and in the community to put these needs down on paper. I put together a design proposal that we showed to various regulatory bodies and politicians. The mayor at the time, Larry Campbell, made a public commitment to see the facility opened within a six-month time period. There was a push to fast-track design, approvals, and construction to meet the promised timeline.

Rival narratives needed to be negotiated to make for a successful project. For example, we were establishing the safe injection site in an older building on Hastings Street that had a development permit requirement for retail continuity of storefronts. So we decided to make it look like the coffee shop that was there in the past.

As well, part of the design agenda was that we wanted to create a home-like atmosphere. We wanted to make sure that people felt welcome. We created an interior with appropriate lighting and residential-type flooring. Nothing was very costly, but we wanted to make sure people felt comfortable inside the space.

When the facility opened, there were some folks in the health services and regulatory end that felt that the finished product was too good for addicts. There was a concern that the lighting was reminiscent of a higher-end interior. Similarly, we had a donation of a cappuccino machine, so that we could demonstrate that part of the facility was a place to sit and have a coffee. This was deemed to be showing the wrong kind of image.

DS: The regulator and some of the funders made us remove the cappuccino machine and cover the floor, which was a sheet vinyl product that looked like a wood floor, and ultimately balked at the overhead lighting.

SM: They said that the concern was one of cost, so I said I’d pay for the lighting fixtures. And that seemed to solve the problem.

DS: These kinds of ideas were very powerful, and they still are very powerful today. There’s a petition being organized against supervised injection sites in Ontario. We need to be aware of the wider cultural narrative at play when we’re trying to design these innovations.

A sketch of the InterUrban Gallery shows the idea of using a streetcar as a stage during a temporary closure of Carrall Street.

The Interurban Arts Centre

SM: The Portland was also looking at providing ongoing community renewal through support for the arts. They supported murals and local photography exhibitions in the past. They thought there should be an art gallery and studio space that would be a centre for local folks to expand their talents.

We looked at a number of different sites around Carrall and Hastings Streets—ground zero of Vancouver’s Downtown Eastside. Finally, the Portland got a lease for one of the oldest brick buildings in the city. It was once a grocery store run by one of Vancouver’s first mayors. When we got it, the ground floor had been a warren of little retail shops. We cleared it out and created an open and airy gallery, with a strong relationship to Pioneer Square and Pigeon Park across the street. It’s now home to various arts groups, including First Nations carvers.

This corner was famous in Vancouver’s early days as the centre of the Interurban Streetcar network. As part of the heritage renewal of the area, we wanted to recreate a streetcar and use it as a street performance venue. We developed the two-storey brick building with full-height rail shed doors. We have a bed inside the building waiting to house an Interurban car replica that we can use as a performance venue, wheeling it out onto Carrall Street. All of these various initiatives aim to build local pride, giving Downtown Eastsiders a sense of possibility for community expression, and supporting their artistic endeavours.

A preliminary sketch of Pigeon Park Savings captures the welcoming, inclusive atmosphere envisaged for the community bank.

Pigeon Park Savings

SM: One of the basic obstacles to feeling part of society is when people have difficulty making the simplest financial transactions at a bank.
In the Downtown Eastside, most of the major banks closed their branches over the years. People had to rely on payday loan places and other usurious institutions for simple financial services.

The Portland wanted to fight this financial exclusion by creating a low-threshold bank, where the tellers would be familiar with the kinds of social issues and hardships faced by local residents, and could act as advisors. The bank also provides for some kind of personal identification for these folks, who oftentimes have trouble getting a simple ID card.

East Van Roasters

SM: The Portland was also involved in social enterprises. East Van Roasters is a heritage interior near that corner of Carrall and Hastings. It allowed women that had been marginalized, that were working in the sex trade and suffering from drug addiction, to develop new skill sets.

The enterprise is very successful today. It is employing a number of these women and giving them a sense of purpose and dignity, in quite beautiful surroundings that are welcoming to the public and to the local community, including fellow addicts—people working to make a better life.

DS: We often think of vocation as something that is more than just a job. Sometimes we think that low-income communities don’t need this sense of vocation—but perhaps they might need it even more. This facility, which is a bean-to-bar chocolate shop, has women recovering from addictions who can become chocolatiers, and go from one end of their experience of detox, on the upper floor of the project, to the ground floor of the building, where they can make award-winning chocolate.

A concept drawing for the Woodward’s site helped stakeholders to visualize the development of market-rate and subsidized housing on this prominent block.

Woodward’s Concept Development

SM: Another part of the advocacy I’ve been involved with at the Portland is providing conceptual drawings. These are tools that the community can use to talk about their needs with other jurisdictions and levels of government.

Twenty years ago, there had been a years-long planning process around the Woodward’s building in downtown Vancouver. Once the department store closed down, a first proposal was to use the whole of the existing building for market and non-market housing. The developer pulled out, and there was a vacuum with a lot of uncertainly around what would happen next with this important building site.

I was asked by the Portland to try and re-imagine what the area would look like with an adaptive reuse of the department store,
while incorporating high-density and high-rise residential development that would help pay for a large number of social housing units. I wasn’t involved past the initial ideas for the site. Eventually the project was developed and completed wonderfully well by Henriquez Partners,
to the benefit of the community.

Narrative competence

DS: It’s possible to have technical competence and also narrative or cultural competence. Beyond having technical skills as an architect, you can also develop skills in uncovering implicit and explicit values, to see how these drive narrative plots with respect to how we develop services—or don’t—within communities.

Anthro-architecture, first and foremost, wants to uncover these implicit and explicit values to see how culture shapes our public understanding of projects, communities and groups of people. To some extent, rather than looking at problematic target groups, we focus on the problems that institutions, organizations, and professionals might put in place themselves. To borrow an idea from another academic, psychiatrist Laurence Kirmayer, rather than looking for “sin” in individuals, we’re looking for “sin” in systems.

SM: We’re trying to describe a realm of possibilities for the future. There’s a quote by Oscar Wilde: “Nature, no less than Life, is an imitation of Art.” People didn’t really see the atmospheric effects of the River Thames until an artist painted it. Similarly, the architect can assist with the visualization of how to improve things in local communities, and help with pointing in the direction to create social improvements.

This article is based on a presentation delivered at the RAIC Conference this summer.

Sean McEwen is a Vancouver-based architect. Dan Small is a medical anthropologist at the University of British Columbia.