Nandi Ishikawa

NASW-HI Practitioner of the Year Acceptance Speech at Café Julia

March 1, 2019

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Thank you to my colleagues Leilani Maxera, Dr. Christiana Wang, Laleh Kazemahvazi, and Sophiya Singh at Hawaii Health and Harm Reduction Center for nominating me for this award. And thank you to the NASW board of directors for selecting me as practitioner of the year. Thank you to my mom and dad, Iris and Calvin, and to my sister Heidi for encouraging me through the years and supporting me in my education and career. Thank you to my husband Craig and daughter Caylee for being my light at the end of the day to show me my path that I feel I must continue for as long as I can.

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There is a Japanese expression that manifests my deep gratitude to my family: okagesamade, or “thanks to your shadow.” I stand before all of you tonight because of the love and guidance that they provide.

 

When I graduated from Maryknoll High School at the tail end of the last century—has it really been that long?—I entered the University of Hawaii as an education major. My grandmother Shizuko’s stroke changed that. A social worker was a steady and vital presence for my mother to help ensure that my grandmother’s basic needs were taken care of. When my grandmother’s condition got to the point where long-term care was needed, a social worker was there the help make the necessary arrangements. A caring professional presence made a great difference, even for a family like mine that had resources. During my MSW studies at UH and my time with the Department of Education, my first impulse was to work in the school setting with students. After that I decided to move from government to the non-profit sector, and I am happy to have found my professional home with others who are dedicated to serving those with acute needs.

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I am truly humbled to receive this award. And I am deeply honored to celebrate with each one of you here tonight the truly noble, selfless, and under-appreciated work that social workers engage in. Responding to the urgent human needs before us is no small task. In many ways, social workers are ground-level practitioners of compassion in a society and larger world where judgment, material wealth, and social status prevail over other human qualities. The judgment of society falls especially hard on those who don’t have wealth or social status.

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As the author Pema Chodron once observed, “Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.” Jack Kornfield adds, “Compassion does not mean immersing ourselves in the suffering of others to the point of anguish. Compassion is the tender readiness of the heart to respond to one’s own or another’s pain without despair, resentment, or aversion. It is the wish to dissipate suffering.” 

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To be fully present for our clients, our colleagues, and those we love, we must remember to take good care of ourselves. Every human being faces illness. How can we best be present for ourselves when we are sick? How can we best be present for others when they are sick? Every human being faces death. How can we best be present for others when they are dying? How can we best be present for our own death? These are difficult but essential questions. As social workers in the field we continually cultivate the courage and tenacity to address them, even if there is no sure answer.

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This award reflects what Hawaii Health and Harm Reduction Center does every day for those communities without voices and for those people that are challenged with stigma and shame.  I am only as good as my team—and my team is amazing. 

We are out on the streets of Chinatown daily making sure people have access to clean needles. We have medical case managers and patient navigators helping people with HIV and hepatitis C live a healthy life with access to medications and social services. We have a nurse practitioner on the streets of Chinatown providing wound care services to reduce emergency room admissions for our houseless community and a clinic providing care to our high-risk communities.

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Who are we as an organization? We are younger, older, and middle-aged. We are male, female, and transgender. We are straight, gay, and otherwise. Some of us use substances; some of us are in recovery. Some of us are living with HIV or other chronic conditions. Some of us have been to jail and prison. Our family heritage traces back to faraway places – Nepal, Persia, Japan, Vietnam, Thailand, and Michigan – and to the beautiful landscape that surrounds us right here.

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Our work is intentionally strengthened by this radical inclusion. As former Waikiki resident Maya Angelou once wrote, “Diversity makes for a rich tapestry. We must understand that all the threads of the tapestry are equal in value, no matter their color; equal in importance no matter their texture.”

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How do we do our work? Our baseline is to treat every human being that we encounter with dignity and respect. We don’t turn away people because of their substance use or their mental health status. We don’t turn away people because they lack shelter. We don’t turn people away because they have been in jail or prison or are on probation or parole. We meet people where they’re at so that we can find the best way to link them with the care they need.

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The most basic shorthand for “harm reduction” is to “meet people where they’re at” so that they can take measures to reduce health risks to them and those around them. The harm reduction approach holds human suffering with a tender heart, with the understanding the those with substance use and mental health issues have often endured a good deal of trauma from various sources. Harm reduction is an open hand and not a closed fist. In a world where cocksure certainty is glorified and idealized, an open hand is a radical gesture.

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Harm reduction also meets imperfect systems where they’re at. The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The provision of health care in this country is not quite that, to say the least—especially for those who are living with behavioral health issues.

While we support measures like pre-arrest diversion and treatment access through the court system, the continued criminalization of substance use, mental health, and housing instability is far-removed from the pursuit of individual and social health.

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Meeting the system where it’s at—and working with the conditions that we are presented with—doesn’t mean that we can’t do better as a society. Physical, mental, and social well-being are not advanced through handcuffs or a jail cell. We cannot allow ourselves to habitually accept what is currently offered by prevailing structures of power as satisfactory.

In some quarters where very important decisions are made, incarceration is viewed as a treatment opportunity. Many providers across the nation have made peace with this viewpoint, one that belies the stark realities that we encounter.

Evidence-based, low-threshold treatment on demand for those who request it will not become a reality unless those of us who are in the field lend our voices to the public discussion.

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If we don’t have the capacity or resolve to be an advocate for systemic change, then let’s find ways to support those who are speaking uncomfortable truths to power and offering a vision for a more rational, just, and humane society.

I am so proud to work for an organization that doesn’t turn away from challenges but instead looks for opportunities to engage individuals who need attention and care with compassion, respect, and patience.

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Thanks again to the NASW Hawaii chapter, my Hawaii Health and Harm Reduction ohana, and my family.

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Okagesamade.