WHAT'S AN AMERICAN DOING IN ROTTERDAM

working as her own country forbids

Synn Stern moved to Rotterdam after 8 years working in health education on the streets of New York and finds a safer, friendlier place to work

At a conference in Liverpool - the First International Conference on Drug-related Harm - I met, fell in love with, and without much delay moved in with, a Dutch man. What did I leave behind? Underpaid outreach workers. Poorly subsidised family planning clinics. A volunteer job with an outreach team where I had to carry photo ID, and statements from each of the police precincts I entered declaring my presence in the strolls and dealing zones strictly on the up-and-up, and requesting that - in the event that I should be arrested I be released upon presenting copies of the same. A severe nursing shortage. Meanwhile HIV was spreading like brushfire, the wait for emergency hospital beds growing from hours to days; methadone programmes and shelters were becoming crowded beyond capacity with waiting lists that were months long; and crack was continually flooding the strolls with untrained desperate amateurs responsible for an across-the-city drop in the prices sex workers were able to charge - NYC forbade the sale, supply, exchange or prescription of injecting equipment. An outreach programme in Brooklyn had the portion of their funding that went into the provision of bleach kits to sterilise needles withdrawn. And while it was perhaps okay to show somebody how to use bleach to sterilise his or her injecting equipment (I had to get a prescription to carry a demonstration model and even then the majority of my colleagues were chary of touching it), it was absolutely not okay to show somebody how to use his or her injecting equipment either less harmfully or more effectively. Escort services were free to solicit both customers and staff, but suggesting to a client that he or she had enough looks and confidence to get hired by one, and by doing so would find a safer, more lucrative work environment was equated with pimping - should the client be under age this carried even more serious charges. And helping clients learn to screen potential customers, or service them in ways that did not put either party at risk, was considered as aiding and abetting prostitution.

Forbidden to work as a health educator in the way that I saw the role defined, and constantly looking over my shoulder for fear that, by providing the necessary education and counselling despite the laws, I would sabotage programme funding, myself or my employer, I spent eight uneasy, angry years doing health education on NYC streets.

When I arrived in Rotterdam, all cold and confused and not just a little frightened, neither my impressive stack of reference letters nor my sweetheart's lists of contacts were enough to get me a job. I wanted one. I wanted very much to work in a setting where I could legally give drug injectors needles, where I could legally counsel sex workers on safer, faster, easier ways to work. But first I had to learn Dutch.

What did I do? I went to a language school, where in an early lesson on opposites - big/little, black/white, friend/enemy - 'the Germans' were given as an example of the latter. I had an unsuccessful interview or two. I purchased hypodermic syringes in pharmacies until the thrill wore off. I indulged my fascination with the Pauluskerk: a cafe sort of spot, in a church basement, which provides a well-lit, well-equipped and staffed room where people can inject or smoke. I visited several drop-in centres including the Keetje Tippel: a programme that serves the same population of drug-using street sex workers as mine in the Bronx, but which with its furnished living-room, its working shower, its storage areas, doctor's office, and kitchen, is so vastly different from our little van and garbage-bagged supplies - was almost dreamland. I was fascinated to see well groomed, well-fed users with their well-cared-for pets; to visit users' homes and find rugs, electronic equipment, furniture, working refrigerators containing food. Because there's only one legal stroll, street sex workers in all their various forms and flavours work side-by-side: straight women and addicted ones, adults and teens, trans-sexuals and transvestites, pregnant women and dominatrixes; and charges are based more on time and location, than on the service. The typical tensions between the groups exist, but it's a small stroll (in the same way it's a small country) and everybody works together with Rotterdam sex workers exhibiting more flexibility in the sex industry (from phone sex to street to club and back again) than their NYC counterpart. Dictionary in hand, I puzzled through the various magazines designed to provide information, health advice and safety tips relevant to drug users. For the first time since my youth, I saw 'For Rent' signs in apartment windows. I entered bathrooms in public buildings without having to obtain a key or permission. I discovered toilets in snackbars and take-out stands, and in all but the touristy ones across the open square from the Pauluskerk, I was not required to make a purchase in order to use them. I kept looking for, and not finding, the tent villages, cardboard box houses and campsites of the publicly homeless.

When I finally found the homeless population I was looking for, it was in the public library, where being dishevelled and obviously homeless is apparently not a criterion upon which one might be denied admission; where the spacious, accessible toilet's only drawback is the anti-injecting 'blue light' which makes it hard to determine if one has properly wiped. Absent were the young men, blotched purple with Kaposi's sarcoma, and with the slight but riveting bulge a Hickman catheter makes under a button down shirt, the noticeably swollen lymph glands dotting gaunt bodies, the white goo of thrush in the comer of a mouth, and the wealth of AlDS-related art. advertising, services so common to NYC.

I watched two men approach other johns' cars, to urge them to use condoms. I got paid to teach the members of an outreach team (the project where I am currently employed) to prepare drug suspensions and solutions safely, and to deliver a no-risk, painless, bruise free, intravenous injection. I was approached by the local department of health (the GG & D) to train the staff of a variety of Rotterdam drug treatment programmes in counselling female sex workers - in how to be a decent sex worker if you want to know the truth and, finding the training a success, they decided to make a sex workers' advice booklet from my notes. Sure, take-out meals, aspirin and rubbing alcohol cost a fortune, but tampons were cheap and I could afford to buy myself health insurance.

What can you expect when you get here. Drug users, drug transactions and drug talk share basic similarities everywhere I've been in the world so far. If you recognise it on your own turf, you'll recognise it here, with the difference that the scene in Rotterdam is softer, smaller, friendlier than NYC's certainly, and probably also wherever you are from. But it's also different enough here to make many of the basic assumptions that framed the way I'd become accustomed to totally out of place. Unlike Grand Central Station in New York, at Rotterdam's Centraal Station drug dealers are more aggressive, less selective and more vocal than panhandlers. Crack's popularity has made the sight of somebody, maybe several somebodies, pulling on a stem a common one in NYC. Here, where people make their own crack in a time and detail laborious effort, it is not uncommon to see people doing this in the open. Cocaine, addiction, craving and misery are just that. But the psychosis, aggression, rampant sexuality and sociopathic depravity, attributed by the US media first to PCP and then to crack, is so significantly less evident here that many of the users I spoke to expressed disbelief and disappointment that they'd already been making and using this superpotent 'new' drug they'd heard so much about.

In NYC, where using drugs and selling sex are criminalised and stigmatised activities and where this translates into making purely 'being' a drug user and/or a sex worker a criminal offence, a new client who volunteers his or her real name and age is risking just as much, and giving the same size gift as I did in handing them sterile needles. The fact that needle sales, distribution and exchange are legal here has played a huge role in the relatively good physical appearance, general health and low HIV seroprevalence of Rotterdam's injectors. But it also takes provision of sterile injecting equipment and injecting advice out of the realm of the political, and places it back into regular old social work.

Here the subway works on a sort of honour system: listed prices already contain sales tax; as the majority of service providers receive a salary and do not depend on this as income, tipping is not expected. If you have a job, you get health insurance; if you don't have a job, you get health insurance, and even illegals have (some) access to legal and medical social service. AIDS knowledge and AIDS care here have not progressed much beyond what was known in NYC in 1985, but the availability of medical services also limits the availability of drugs on the street to psychoactive ones - beyond the three basic powders, this is limited to a few benzodiazepines and barbiturates. The antibiotics and AIDS medications offered by street dealers in NYC are only to be found on prescription in Rotterdam. Nor is the exotic world of drug-related slang a characteristic of this drug scene. My impressive lexicon of drug terminology serves me no purpose here, and there's no need to build another. One can hear more argot for sex organs, sex acts and money than for drugs, drug users or drug use. \ Existing drug slang is minimal, and borrows heavily t from American terminology. Daily life provides exercise enough so fat people are as rare a sight as gym-membership cards. The average diet is good enough to make vitamin popping a behaviour of only the faddish or the j under-nourished lower class. Children, dogs, and occasionally adults, are offered free tastes of sausage, cheese and cookies at their respective shops. Drug dealing occurs by and large indoors. Shop clerks often permit customers to taste the cheese, nuts, salami, olives, candy or powder drugs before buying, and should one fail to be satisfied with a particular product, it can be returned and replaced.

Don't expect bagels, Hagen Daas or pizza by the slice, but if you want to try your hand at street health education, I couldn't think of a softer, safer, friendlier place to work.