Canadian Physicians in Partnership in the Fight Against AIDS in Africa

On a daily basis I see the impact of HIV on my Canadian patients, but I have also been deeply aware of the devastating impact of HIV on the lives of individuals and indeed entire nations in other parts of the world. The HIV/AIDS pandemic is one of the most urgent health crises facing our world today.  Around the globe, an estimated 33.2 million people are living with HIV[1], and approximately 2.5 million people become newly infected each year.

I have always wanted to engage in international work, and recently, my experience as an HIV physician opened the door to this opportunity.  As with many other Canadians, this moment came in response to listening to Stephen Lewis, the former UN Special Envoy for AIDS in Africa. At the 2006 International AIDS Conference in Toronto, I listened to Stephen Lewis gave a passionate speech, challenging everyone in the audience:  “And what are you doing about AIDS in Africa?”  I felt that he was talking directly to me, and felt compelled to take action.  Many of my colleagues from Vancouver felt the same.

Together we formed an organization called Vancouver HIV Doctors Overseas, consisting of a group of HIV-experienced physicians who were committed to volunteering their services to address HIV/AIDS in Africa.

Sub-Saharan Africa is the most deeply HIV-affected region of the world, home to 68% of the world’s total population living with HIV.  In the heart of this region, the small, landlocked country of Lesotho is battling the HIV pandemic with determination and courage.  Lesotho has the third highest HIV prevalence rate in the world, with one in four adults (23%) between the ages of 15 to 49 infected with HIV.  The majority of these individuals are women.

The commitment and efforts of Canadian healthcare providers and organizations have resulted in a unique bond of partnership between Canada and Lesotho in working to address the issue of HIV/AIDS in Lesotho.  OHAfrica, a Canadian international AIDS service organization based in Toronto, has been working in Lesotho since 2004, assisting the Lesotho Ministry of Health in the launch and expansion of publicly funded HIV treatment and care services to the HIV-affected population.

Vancouver HIV Doctors Overseas is working in partnership with OHAfrica to provide HIV experienced physicians to work at one of Lesotho’s largest HIV treatment centres. Over the past year, physician volunteers from Vancouver, including myself, have been volunteering in monthly rotations at the Tšepong “Place of Hope” Clinic in Lesotho, supported by OHAfrica.

OHAfrica was founded in 2004 by the Ontario Hospital Association with funding from The Change Foundation, in response, once again, to an appeal by Stephen Lewis to Ontario hospitals to assist in the fight against AIDS in Africa.  A small team of Canadian and HIV experienced health care professionals, led by Dr. Philip Berger of St. Michael’s Hospital in Toronto, arrived in Lesotho on World AIDS Day, December 1st, 2004.  Working together with local Basotho health care workers, the OHAfrica team helped launch Lesotho’s first public HIV treatment centre, the Tšepong Clinic, which means “Place of Hope”.

When the OHAfrica team first arrived, there were less than 116 HIV positive patients[2] registered at the clinic.  By the end of March 2009, over 10,000 HIV positive patients had been registered, including 4,216 patients who are receiving anti-retroviral treatment.  Tšepong Clinic is a department of the Leribe District Hospital, and acts as the district referral centre for the entire district of Leribe, an area of Lesotho with a very high concentration of HIV infection.

click on any photo to view it full size

Over the past three years, OHAfrica’s work has expanded beyond Tšepong Clinic itself, to support the HIV training of nurses at community based primary health care centres throughout the Leribe District.  In addition to the patients registered at Tšepong, a further 17,000 HIV positive patients are registered at 20 community health centres, including 4,326 of whom are currently on anti-retroviral treatment.  All HIV treatment and care in Lesotho is provided free of cost, a crucial factor in a country where poverty and unemployment are a serious challenge to many.

My first experience volunteering in Lesotho was in 2007, as part of the Clinton Foundation HIV mentorship program, which several members of Vancouver HIV Doctors Overseas participated in.  This program changed directions at the end of 2007 and was no longer in need of physician volunteers.  As a result, our group developed a new partnership with OHAfrica, and we provide a rotation of 4-week physician volunteer placements to Tšepong Clinic on an ongoing basis.

The OHAfrica program model in Lesotho is something I find extremely appealing and motivating.  OHAfrica works in direct partnership with the local health system, providing a balance of concrete service delivery as well as training.  Lesotho has a shortage of local healthcare providers, and an extreme shortage of local physicians, and the support provided by volunteer and staff physicians by OHAfrica and other international organizations has a significant impact on the ability of the health system to cope with the patient load and ensure adequate care.  It’s a very satisfying experience to be able to treat patients directly in addition to providing mentoring and sharing expertise on HIV care.

The experience of working at Tšepong and the time I have spent in Lesotho has been an incredible opportunity.  In addition to my trip with the Clinton Foundation in 2007, since early 2008, I have been on two 1-month volunteer placements with OHAfrica, and I am planning a third trip in September 2009.  My experiences in Lesotho, and the relationships I formed with colleagues and patients at Tšepong, have provided me with a deeper perspective on life, and emphasized in a profound way how we have a responsibility to other people in the world.

It is a powerful experience to work with a team of individuals at Tšepong and OHAfrica who are interested in problem solving and working together to address issues big and small, all for the goal of improving patient care.  It is a privilege to get to know and to work closely with the dedicated team of Basotho staff at Tšepong.  Our job is to stand beside them, to lend a hand as needed, to share tools and experiences we have, and also to learn and to be respectful of the local context and experiences that we encounter.  This experience has been as much about learning as about giving.

click on any photo to view it full size

It is also humbling to see how patients in Lesotho cope with such grace and dignity with the challenges of life threatening illness and poverty.  The patients at Tšepong are average people from average families, taking care of their children, trying to make ends meet, and embracing life on a daily basis in the face of extreme challenge.  I was amazed at the commitment of Tšepong patients on anti-retroviral treatment.  There is a misconception in the West that HIV patients in developing countries will not stick to their drug regime.  They do not miss. There is great commitment, and great resilience.

In addition to the impact this work has had on me personally, it is inspiring and encouraging to see how extremely interested my Canadian patients are in the work I am doing in Lesotho, and how moved they are to respond. When I returned from Lesotho in November 2008, one of my methadone patients insisted on making a $200 donation to the OHAfrica program to support the HIV patients at Tšepong.  He could ill afford this, but he was insistent, and it demonstrates to me how strongly people feel connected to the struggles of other ordinary individuals and want to help, regardless of how geographically distant they are.

As a clinician there are moments of amazement and satisfaction as well as challenge and deep frustration.  At Tšepong Clinic, we see levels of HIV related illnesses that are extremely rare to encounter in practice in Canada.  At times there is little that can be done because patients have come too late, or there are not the resources available to provide the intensive care that could possibly make that difference and give someone a fighting chance. At other times, I have seen patients dealing with extreme infection or desperately short of breath, and thought, This person is not going to make it.  It is a joy to see them a week later at my consulting room door, walking without assistance, glowing with life, and excited about the transformation in their health as a result of the care and treatment they received at Tšepong.

It is a powerful and sobering experience to encounter intimately the impact of HIV on the lives of so many people, and it can be overwhelming not to be able to help everyone. However, when I focus on the bigger picture and look out into the patient waiting room and see the huge majority of patients thriving as a result of HIV drugs, that is profound.  These individuals have reclaimed their lives, and that is the most powerful message of all.

It is now my mission to talk about this program with everyone, and to let people in Canada know what’s going on in this small country, where some very positive things are happening to address HIV/AIDS.  My experiences working in Lesotho and with OHAfrica over the past year have made me feel that this is where my work is.

references

1. All statistics from the most recent UNAIDS Report on the Global AIDS Epidemic; most recent statistics are for the year ending 2007.  Source – UNAIDS website: http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
2. All OHAfrica and Tšepong Clinic statistics provided by OHAfrica and documented in OHAfrica bi-monthly reports to the Lesotho Ministry of Health.