Leaving for Change

My name is Martin LaBrie, and I am a palliative care physician as well as an HIV treating physician living in Calgary, Alberta. I will be leaving January 10, 2010 to travel to Burkina Faso in western Africa as part of a project developed thorugh the Canadian Medical Foundation that is intended to enhance the capacity to provide palliative and end-of-life care for people living with HIV. I will be working with l'association Solidarité et entraide mutuel au Sahel (SEMUS) in Yako, Burkina Faso for the next three weeks.

The Canadian Medical Foundation (CMF) has partnered with Leave for Change (L4C) to deliver our international volunteer program. The program enables volunteers to participate in a two- to four-week volunteer assignment in a developing country. L4C is a component of the Uniterra Program, Canada’s largest international volunteer cooperation program, funded in part by the Canadian International Development Agency (CIDA) and implemented jointly by World University Service Canada (WUSC) and the Centre for International Studies and Cooperation (CECI).
In January 2010, the CMF is supporting six physician volunteers to go to Malawi and Burkina Faso to provide volunteer services in the area of palliative care as it relates to HIV/AIDS. More details regarding the project, the physicians who will be volunteering in Africa, and the Canadial Medical Foundation can be found at their website, www.medicalfoundation.ca.

Through this blog I intend to keep a record of my role in the project. I became involved with caring for individuals living with HIV early in my medical career. In 1983 I started a practice in family medicine in Calgary with a focus on palliative care in the home setting. The first diagnosed case of AIDS in Calgary was diagnosed that year, about four years after it was first described in the U.S. I saw my first patient living with HIV in 1985, and for the next decade I was involved in the care of very many individuals who were living and dying of AIDS. It was an extremely difficult time for me but those people taught me a great deal about living with a life-limiting illness. HIV disease is unpredictable, protracted, and affects every organ in the body. My palliative care experience to that point had primarily involved treating people with various forms of cancer. Cancer usually follows a fairly predictable course when it cannot be cured, with gradual progression leading to death that can be forseen weeks or even months in advance. The goal of palliative care was to ensure that pain and suffering were managed as well as possible during this disease trajectory. AIDS changed all that - now people were living for years with few or no symptoms, waiting for the ticking time bomb in their bodies to go off. When they did become ill, they often would manifest several medical conditions at the same time. Often we would expect people to be close to death, then see them recover dramatically, although temporarily. What impressed me most about these people was the sense of survivorship. At the time, these individuals were primarily young, previously healthy men who had not been contemplating end of life issues. The focus was on using every possible means to stay healthy for as long as possible, and to live each day. No one could tell these people to sit around and wait to die. It was a lesson that I took to the care of all the people I worked with who were confronting advancing disease, focusing on hope and life worth living no matter what was happening to them.

In 1996 everything changed with the development of effective treatments for HIV. We were now able to supress the growth of the virus, allowing the immune system to heal in most cases and preventing progression of immune system damage in those who were still not yet injured by the virus. It was a dramatic time, and at the time I likened what I was witnessing to people being released from a concentration camp, going from thin and weak to healthy and robust over a matter of weeks. Since then I have continued to be involved in HIV treatment for those who have the ability to adhere to complex treatment regimen and close clinical follow up. Palliative care in my world now involves individuals who are unable to access treatment because of other determinants of health such as chronic homelessness, Hepatitis C co-infection, addictions, mental illnesses, and other conditions that tend to marginalize some of us in our society.

Going to Burkina Faso means going back to the old era of HIV treatment. Burkina Faso has just under 15 million people. Almost 50% of the population lives on less than $1US per day, and most live on subsistence agriculture. Infrastructure for health care delivery is very limited, with very few doctors or nurses. The incidence of HIV infection is estimated to be between 5 and 10% of the population, and 8000 HIV-related deaths occur each year. This is in addition to the many other health issues such as tuberculosis, malaria, typhoid fever that people have to deal with. Health care has been a priority for the government of the nation, and the goal is to achieve universal access to HIV treatment. The country has extremely limited resources, however, and only a few thousand individuals have access to any HIV drugs.

I am very anxious at the prospect of trying to help people deal with a complex illness with very few tools available. My role will be to assess how care providers have confronted this problem to date, and advise regarding ways to enhance their capacity. I am certain, however, that I will be spending most of my time learning from caregivers who have had to make do with very little, yet still are responding to the needs of those in the community who are suffering. Maybe what I learn can be translated in to a better response from the disadvantaged individuals suffering from HIV in my own community. I hope that we all can learn together.