Decolonizing Care

Decolonizing Care

Justin Maxon, 2024 Winner

"Decolonizing Care" is a long-term project that examines the systemic failures in care for treating fentanyl and the impact on one family (the Surbers) in a rural indigenous community, the Hoopa Valley Reservation. The project explores the historical post-conflict factors that have led to the health and human services failures in addressing this epidemic. The completed work will include non-fiction narratives written by Judy Surber to build a series of policy recommendations to improve treatment access, enhance family support, and address the stigma surrounding addiction, particularly in indigenous communities.

The kids and I are at the beach in Crescent City. Ever since the kids got placed in foster care, two and a half hours away from their home, I go over every other weekend to visit them.  One of their favorite places to spend time is at the beach.  They have been in the foster system for the past ten months, and it is taking a toll on the kids and me.  When it is time for me to leave, there are a lot of tears and emotional meltdowns.  I treasure every second with them. (Caption by Judy Surber)

****** is weighing out some fentanyl to sell. He supports his habit by selling small amounts. He often travels to San Francisco to buy it cheaper, so he makes something when he sells it in Hoopa. (Caption by Judy Surber)

I’m combing my hair in the morning, doing my daily routine.  It’s my time to reflect. (Caption by Judy Surber)

I am checking on Roger. He had significant infections going on, all too common in substance use, and was having issues with pain and walking that day. No matter how old my kids are, I will always worry when they are sick and care for them when they are not well. (Caption by Judy Surber)

Trinity River at the end of winter and the start of spring when it’s still high. (Caption by Judy Surber)

Kinsinta’s 6th birthday.  This was the first time the kids had seen their parents in several months.  It was an emotional day, filled with loneliness for their parents but excitement to have them there and for the birthday party.  At this time, the children are still living in Crescent City, and the parents are living in Eureka, homeless at this time. Although they have been promised consistent visits with their children, this has not happened since they are clean. (Caption by Judy Surber)

Kinsinta bowling at her 6th Birthday party.  This is two and ½ months after the kids were removed and put into the foster care system.  Kinsinta is the Hoopa word for “sugar or sweet,” she fits her name.  She is my pretty, pretty princess. (Caption by Judy Surber)

Cory’s 8th grade graduation picture with his best friends. Full of hope and promise in this picture, but by the following year, he was expelled from school, started using Oxycontin, and never had a high school graduation. One of his best friends and cousins, on the far right, was killed in a work accident at the age of 26. (Caption by Judy Surber)

Shed outside. It was a smokehouse. It’s no longer used. I wouldn't say I like it. (Caption by Judy Surber)

Roger and Ethel are talking to friends. They were on the lookout for fentanyl that day because the Valley was dry with several big drug busts. (Caption by Judy Surber)

Some of Cory’s many trophies.  He could have been a contender.  This picture makes me emotional and sad. My son was such a good athlete and competitor.  Now, he’s living homeless in the SF Tenderloin and around the Santa Rosa area.  I haven’t seen him for almost five months and worry about him every second of the day. (Caption by Judy Surber)

Sign placed downtown by Behavioral Health.  Posts the number to call for suicide prevention and where to receive services. (Caption by Judy Surber)

The Trinity River in the early morning. (Caption by Judy Surber)

Typical morning. My 86-year-old mom and I are drinking coffee and watching the morning news. I feel grateful and fortunate to have this strong woman in my life. She is a fantastic person, a tribal storyteller, and the one person who understands and loves my kids as much as I do. (Caption by Judy Surber)

Burning brush outside the house. (Caption by Judy Surber)

Roger is having a bad day, struggling for many reasons. I am so relieved that he is in recovery and doing well now. No more of the daily hustle to get through the day. (Caption by Judy Surber)

A weird message someone wrote on Cory’s window when he was still living at home. (Caption by Judy Surber)

A burned-up truck, on the road to the river, behind our house. A man who was using drugs burned his vehicle. He was later found dead in the Trinity River, with signs of suicide. (Caption by Judy Surber)

Bella, my 14-year-old granddaughter, shortly after she returned to California from a treatment center. The first treatment center she was in was in Colorado.  After approximately four months, she was moved to a native-based treatment center in Utah.  She returned to Hoopa in June of this year. She’s doing very well, and I’m so happy to have her back home.  Although there was an adjustment period when she first returned, she quickly settled in and is doing great now. (Caption by Judy Surber)

Tribal workers, cleaning and taking care of the tribal cemetery. This is where my husband, brother, grandparents, and most of my family are buried, so I appreciate the upkeep the tribal workers do to keep the cemetery looking nice. (Caption by Judy Surber)

Me. I was working in my little garden.  I love working and relaxing in my garden. Although small, it produced a lot of tomatoes, lemon cucumbers, green beans, and squash. (Caption by Judy Surber)

A recreational field in Hoopa is getting water in summer to keep it alive. The park in Hoopa is one of the only recreational sites in the area. (Caption by Judy Surber)

My only daughter and youngest, Megan, my stylist, is French braiding my hair.  We have gone through hell and back together, and she is always by my side, one of my strongest supporters who keeps me going.  Although she hates the addiction, she loves her brothers fiercely and is loyal to them always.  She is a great mother and aunty to all her nieces and nephews. ‘She was a daddy’s girl and feels his loss daily. (Caption by Judy Surber)

I am looking out my office window, thinking deeply about multiple things simultaneously. (Caption by Judy Surber)

I was walking on the beach north of Crescent City.  On my bi-weekly visits to my grandchildren, we must devise things to do besides sitting in a motel room.  The kids love the ocean, and it is calming for all of us. (Caption by Judy Surber)

Photographer's Statement: 

The Hoopa Valley Reservation is in far northern California, within Humboldt County. Fentanyl abuse has exploded in the Valley, leaving families like the Surber's shattered. The local tribal clinic, K'ima:w Medical Center, has flooded the Valley with Narcan. The Hoopa Tribal Police report three to four opioid overdoses daily, with the ambulance service witnessing a 53% spike in overdose calls. Humboldt County has the highest leading "Deaths by Despair" in California.

The Surber family has been at the front lines of the fentanyl epidemic. Judy said that at one point in the last few years, every person living in her house was using opioids: her two adult sons (Roger and Cory), her granddaughter of 13 (Bella), and her late husband (Gordon), who passed away of COPD in 2019. In addition to her first-hand experience with the epidemic, Judy is also the Medication-Assisted-Treatment Manager (MAT) for K'ima:w, serving over 50 patients dealing with fentanyl substance abuse disorders.

A series of gaps in care within Hoopa further exacerbated the epidemic. 1) The only two Indian Health Services (IHS) sites in California deny many youths, saying they need higher levels of care. Often, Native youth do not have the resources to be placed in higher-level care institutions, so they sit in a holding pattern for months, waiting for care. 2) Children are not eligible to take Suboxone until they reach the age of 16. 3) Suboxone (the drug prescribed for withdrawal) often does not work for users with a high tolerance. The most effective treatment is methadone, and even at its highest dose, it often does not last the whole day. 4) Most rural areas do not have a methadone clinic. Patients in Hoopa must get up at 5 am to travel by van daily to the nearest clinic (3.5 hours roundtrip). 5) Hospitals, doctors' offices, and dentists discriminate against people with substance abuse disorders and even more so for Indigenous patients. 6) Concurrently, there has been a significant increase in Indian Child Welfare cases where children are being removed from their homes and placed in the foster system, which directly correlates to parents with SUD (substance use disorder).  7) For Indigenous families, navigating how to best care for family members with a substance use disorder must reconcile with the consequences of a "tough love" approach. Tough love, compounded by a history of colonization, can perpetuate harm to Native families.

Colonization is synonymous with genocide for indigenous people. Its practices included war, widespread massacres, displacement, forced labor, forcible removal of children from their parents, residential schools, environmental destruction, the spread of deadly diseases, assimilation, and almost complete extermination of Indigenous social, cultural, and spiritual practices. Colonization altered societies, displaced populations, and led to long-term changes in cultural and social structures within Indigenous communities throughout the US. We are living in a post-conflict world for Indigenous people all over the United States.


Justin Maxon
Justin Maxon's picture

Justin Maxon is an award-winning photographer and socially engaged artist who uses his experience in recovery to deconstruct the societal stigma surrounding substance abuse. He grew up on the Hoopa Valley Reservation in Northern California and has been friends with the Surber family for over eight years. He is a faculty member in the Art Department at Cal Poly Humboldt. His socially engaged projects have been funded by organizations such as National Geographic, the California Arts Council, the Center for Photographic Art, CENTER Santa Fe, and the Magnum Foundation. He has received numerous awards for his photography and video projects, including two 1st place awards from World Press Photo, the Aaron Siskind Foundation Fellowship, and the Alexia Foundation for World Peace Professional Grant. He has worked on stories for publications such as TIME, Rolling Stone, the New Yorker, Mother Jones, and NPR.