April 2021

Dutch Courage: How a studious outsider became the saviour of Sydney’s mean streets.

Q&A with Dr Ingrid van Beek

For more than 30 years Dr Ingrid van Beek AM has worked in harm reduction, including as Director of Kirketon Road Centre in Kings Cross, Sydney, until early 2017 and as the founding Medical Director of Sydney Medically Supervised Injecting Centre (the first of its kind in the English-speaking world) in 2000–08. In 2010 she was awarded membership of the Order of Australia for her contribution to improving the health of socially marginalised populations. Ingrid is a Conjoint Professor at the University of NSW Sydney’s Kirby Institute and chairs the National Centre for Clinical Research on Emerging Drugs.

You’re a physician, so were you born into a medical family in the leafy eastern suburbs of Sydney?

No. Quite the opposite. I was born to Dutch migrant parents who came to Australia in 1950 after the war with nothing, like many migrants at that time. My father worked as a tradesman, a fitter-welder, and my mother did home duties. I grew up in Wentworthville in Sydney’s western suburbs and I went to state schools – in fact, a pretty rough high school where I was quite frightened for my safety for many years. Someone like me who stood out a bit was certainly a target for the school’s bullies.

What was it that made you stand out?

Even though my parents were living in very modest circumstances, they had big plans for me and my brothers. It’s the migrant story. They invested heavily supporting us through our state school education and for me that included ballet, stage-acting and modelling as a child. These were not things that increased someone’s popularity at my school. And, yes, I did well at school – that in and of itself wasn’t something that made you popular, either.

I’ve later in life seen that those difficult years, even though I had good friends, taught me to cope with not being liked necessarily – which is not to say I don’t like being liked, but respect means a lot more to me.

My mother was particularly influential. She really pushed me forward with the idea that I just had to keep persevering and with time things would get better. She was right – certainly once I went to university. There it was the reverse where I was “the Westie”, unlike most who were from the leafy suburbs and the private schools, but in a way that was cooler than how I’d been perceived to be at school. I definitely didn’t need to make sure a friend went with me to the toilet block anymore.

It made me resilient and persevering and determined and I learned how to just soldier on. Maybe it also gave me some street smarts that I found useful particularly when it came to the injecting centre’s various battles.

I was born to Dutch migrant parents who came to Australia in 1950 after the war with nothing, like many migrants at that time.

My father was part of the Dutch resistance during World War II. He taught me about having the courage of your convictions… and that you have to stand up for what you believe in even if that involves some risk.

What inspired you to want to study medicine?

My background gave me a deep sense of social justice. I saw a lot of people living in that social milieu who didn’t have the support of their parents like I did, who were actually often quite bright but didn’t necessarily do well even if they did make it to university level, also because they didn’t usually have role models.

I had an older brother who’d already done medicine so there was in fact a doctor in the family before I started, immediately before me – six years ahead so he finished when I started. So right throughout my high school years I had him as a role model and that was in contrast to most of the other kids in our area at that time. To me medicine seemed like something that was practical and useful work, where good things could be done.

I had an acute sense of how people didn’t have equal opportunity. I suppose I caught that bug and it was nurtured by my parents, who were very political. My father was part of the Dutch resistance during World War II. He taught me about having the courage of your convictions even if contrary to the government of the day – the government of that day in the occupied Netherlands of course being the Nazi regime – and that you have to stand up for what you believe in even if that involves some risk. He came from a socialist youth background, was part of the early trade union movement, so I grew up handing out how-to-vote cards for Gough Whitlam’s “It’s Time” election. That was when I was starting high school, so I was politicised at a very early age and it all melded together.

As a medical student I was placed at St Vincent’s Hospital in Darlinghurst during the late 1970s. That was when there was an incredible escalation in barbiturate use, heroin use and injecting drug use.

How did you then direct your career towards public health?

As for choosing to work in public health, and in particular among drug users and sex workers in Kings Cross, as a medical student I was placed at St Vincent’s Hospital in Darlinghurst during the late 1970s. That was when there was an incredible escalation in barbiturate use, heroin use and injecting drug use. Overdose cases were coming in – many – every day and I saw those as a student and later on as an intern and medical resident there. There was a huge disaffection for drug users; they were treated very poorly, disrespectfully, in the emergency centre and on the wards. I could see that there was this huge need. There were no networks in place or community-based services to actually refer people to for any further care or assistance at that stage.

My junior medical training years there also happened to coincide with the AIDS epidemic and a whole shift in thinking. Instead of just sitting back and saying “Well, when you people want to change, maybe we’ll have an abstinence-based drug treatment program for you”, we were starting to reach out to people while they were drug using, not making judgements. And treating people respectfully – partly, I’d like to think, because we thought that was a better way to approach all people, but also for pragmatic reasons because it was quickly appreciated that this was the population that was potentially going to be the conduit for HIV to the broader community.

We had no choice but to reach out and make contact and try to find ways, acceptable ways, to reduce people’s risk behaviour to stop an explosive epidemic which had already well and truly established itself in that area.

You joined Kirketon Road Centre quite early, didn’t you?

Kirketon Road opened in 1987 – the final year of my MBA program.

Kings Cross was unique in Australia in that there was a substantial gay community in the Darlinghurst area with an HIV prevalence of about 30 per cent by the time we realised what was happening. Australia was historic in not having that move across to “injecting drug users”, as they were called then, because we were in time with a needle syringe program and with all sorts of other supports necessary to reduce risk behaviours.

My interest in social justice, graduating at that time, seeing a need for drug users, HIV turning up – it all converged and then I did a placement at Sydney Hospital during my MBA. I had switched away from surgery, which was my original idea, because I thought there was no real need for me as a surgeon. But I was pretty organised. I had re-organised the entire booking system of the cardiac surgery unit at St Vincent’s during my surgical term there, which they’d said couldn’t be done. And that made me think “Hey, maybe I’d be better working at population level, systems level”.

And then while I was at Sydney Hospital the medical superintendent there, Dr Vicki Pearson, was just about to become the first Director of the Kirketon Road Centre (KRC). She didn’t have a clinical background. I’d done my family planning course and she needed doctors with clinical skills. So I became the Wednesday doctor during the second and final year of my MBA. I really enjoyed the work – the integrated primary health care model. I was hooked.

Then, in late 1988, the Director took extended long-service leave and I stood in for her for four or five months. I was very lucky to be able to put my hand up to do what I thought was the job from heaven.

That was really when it took hold that I could see a vision for the service. It was very tiny in the beginning – it was really just a slightly specialised general practice with a social worker thrown in – but we were like this lovely little family of health workers committed to harm reduction.

I could certainly see at that early stage that the model had huge potential in that area, partly because, as I’d discovered while working just down the road at St Vincent’s, there was a dearth of services in the area. You would have thought that if you were going to have a government-funded sexual health service – I mean, HIV wasn’t the first sexually transmitted infection to come along – that you’d have located a clinic in Kings Cross, where there was a huge concentration of sex workers and their clients and young people and gay people and so on. Yet there was basically nothing there of that nature.

Kirketon Road had more of a sex worker health focus to start with but it quickly broadened its scope, starting the area’s first NSP in 1988 as injecting drug use was increasingly being recognised among its street-based clients, and hepatitis C not long after. In 1993 we also integrated a low-threshold methadone access program to ensure that those most at risk of blood-borne infections no longer had the greatest difficulty accessing this effective treatment modality.

‘K2’ – KRC’s satellite NSP set up in a shopfront on the main street of Kings Cross in 1996 – was what I often describe now as the “dress rehearsal” for the injecting centre.

What do you remember most about the initial days of Sydney Medically Supervised Injecting Centre – its establishment and then once it started operating in 2001?

‘K2’ – KRC’s satellite NSP set up in a shopfront on the main street of Kings Cross in 1996 – was what I often describe now as the “dress rehearsal” for the injecting centre: a big battle about the location and lots of community meetings. It was a new thing at that time to find myself in community meetings being called all sorts of things by some of the burghers of Kings Cross.

Those earlier years helped me during our establishment of Sydney Medically Supervised Injecting Centre (MSIC) from the point of view of learning not to overreact, not to take any abuse too personally and not to crumple in a heap – but instead to continue to calmly and respectfully explain the reasons the area needed what was being proposed, trusting that right would win out in the end. And it did. Random polling showed we had high levels of local community support for this new service and the injecting centre later on.

When we started NSP in 1988, the community wasn’t at all mobilised in relation to objecting to them; they didn’t really know what they were. We were also very lucky not to have social media back in those days, so people were much less able to organise their opposition compared to now.

You were the lonely, one and only, medical director of an injecting room in Australia for quite a long time.

Yes, I was – for the first eight years.

We never dare call any health service “permanent” – they’re always “subject to ongoing reviews”.

So you saw it from the beginning until it was made permanent?

We never dare call any health service “permanent” – they’re always “subject to ongoing reviews”. But MSIC ceased being referred to as “a trial” when its enabling legislation was finally amended in the NSW Labor Government’s final days in late 2010.

I’d returned to being KRC’s full-time director by then. But, never one to waste an opportunity, I used my resignation from MSIC in 2008 to advocate for the lifting of its trial status, putting this firmly on the public agenda. That the tabloid press called it out as “a deliberate publicity stunt” is a badge of honour to me.

* Read part two of our conversation with Ingrid in the May edition of The Bulletin, when she shares her thoughts on NSPs and primary health care in Australia.

Inside story

In her book, ‘In the Eye of the Needle: Diary of a Medically Supervised Injecting Centre’ (published by Allen & Unwin in 2004), Dr Ingrid van Beek AM recounts the establishment phase and challenging early years of the facility’s operation in Sydney as experienced by its founding Medical Director. ‘In the Eye of the Needle’ is available in paperback and as an e-book.