Dan Coulston – Activism

“It’s just what I did.”

Initially there weren’t really any resources available [for patients with HIV/AIDS]. If they were in the hospital, we had a couple of social workers who were very involved in their care. But other than just the standard community health, there really weren’t any specific resources. That’s what led to developing Spokane AIDS Network [SAN].

It was [Dr.] Jeff Collins, a resident—he was either a year or two behind me in the residency program—who also took an interest in HIV. [He] started getting involved with it because I was very overloaded with patients at that time. Plus, my other specialty of critical care kept me out of the office quite a bit. And then a social worker, I think it was Tom Crowe from Deaconess. I don’t know whose idea [SAN] was, but between us, [we] recognized there was a problem. So, the three of us got together and formed an organization [now SAN], and didn’t know what the hell we were doing, but made it happen.

You know, Jeff and I probably funded quite a bit of things for quite a while there. Certainly the at-risk community was in support and contributed what they could, but I don’t really think we had a lot of general support. It’s a long time ago and I don’t remember all the details. There were some grants we were trying to get, and donations, but mostly it was an at-risk community [that] was supporting SAN at that time, and I think probably Jeff and I.

[Before we formed SAN] there was no place for anybody to turn who had HIV. [The idea for SAN] was, at one point, to hopefully bring together the possibility of some case management so that patients knew what resources were there. It was about the time that the AIDS Omnibus Bill was coming into effect with the Evergreen project and EIP [Early Intervention Program] funding.[1] So, [it was ] a way of helping patients maneuver through that. That was very new.

I spent a fair amount of time in Olympia with that too, as well. It was far beyond what could happen in the office setting. I think it was the idea to bring some place where resources could be centralized for this unique problem. And then [we wanted to do] outreach to other organizations—whether that was the Gay Alliance, or Rainbow League, the food bank, or whatever it was—trying to at least bring people together so there is some sort of common grounds.

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HIV crossed all barriers. Between my street patients and my professionals who were involved and infected, there was a fair amount of at least extended family community support from there, as far as the organization. As far as getting traditional humanitarian organizations to take this as a cause, [they] were few and far between. We had some support from some of the social networks and clubs in those days, but there wasn’t a lot of support. Some of it got a little bit of a “I’m-wearing-the-scarlet-letter A” and a little militant. You know, it was a time of ACT UP.

[It was] a very vocal and very difficult time in Seattle, especially with ACT UP, trying to get legislative action—trying to get them to rein back just enough that we could actually get things through. I think that the Omnibus Bill was very unique in the United States. Putting together that package for HIV care and HIV recognition was something that was very unique. Nobody else was doing anything like that. There were so many warriors in that battle. I was one of too many to count—fighting to get rights and to get things moved through [the legislature]. The biggest fear was, “Is that the cost of care?” I mean, the cost of care, even before having HAART therapy, was incredibly expensive.[2] After HAART therapy it just escalated.

I was in Seattle on the average of once or twice a week, after work, at night, flying over there for late night meetings. Fortunately, all the meetings were organized around the airport, the hotels around there. [I had] first-hand knowledge of dealing with the representatives of ACT UP, and trying to fight through what we could really accomplish in the state. [Those efforts were] legislative, the protocols, and [dispelling] the fear, and getting people [on board—the idea] that anybody could take care of HIV in those days, that it’s not a specialized disease because there was no specialty to really treat. This is just internal medicine basically. Trying to get that out there to the public, specifically the health care professionals.

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I never thought about [where my commitment to critical care came from]. I don’t know. It’s what I did. It’s just what I did. Someone’s got to step forward and do it. So I just . . . was there.

[1]The AIDS Omnibus Act was passed by the Washington State Legislature in 1988. The Evergreen project refers to the Evergreen AIDS Foundation.

[2]Highly Active Antiretroviral Therapy.

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Source: Interview with Laura S. Hodgman on 10 July 2013.