Dr. Susan Ackland
The care and treatment of HIV affected patients has been large part of my work and life for much of my career. As a family practice and HIV physician working in inner city Vancouver, British Columbia, for the past fifteen years, I have worked primarily with patients who live with addiction issues, and experience a high incidence of HIV infection.
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.
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.
For more information about Vancouver HIV Doctors Overseas, email: sackland@shaw.ca