MSF is doing more than
just emergency relief in Chad — their doctors
are also mentoring and training local healthcare
workers.
Photo credit: Dr Paul Nguyen |
HIV/AIDS patients' risk of death
is 43% lower if they're treated by a physician with
above-average experience treating the disease, according
to a new study. Unfortunately there's a dire shortage
of such physicians in Canada and in the third world.
To redress the situation Canadian AIDS specialists are
giving their time to act as mentors, sharing their knowledge
with colleagues both here and in developing countries.
Mentors' work educating other doctors
is one of two important components in improving the
quality of care provided to HIV-positive patients, alongside
actual experience treating those patients, says Dr Anita
Rachlis, medical director of the HIV Ambulatory Clinic
at Sunnybrook Health Sciences Centre in Toronto. "A
mentoring program can help provide support for people
to take on patients and therefore get that experience."
At last month's International AIDS
Conference in Toronto, Dr Rachlis presented the research
that showed a direct link between HIV/AIDS patient mortality
and physician experience. She believes the finding points
strongly to the value of primary care mentoring. If
a primary care physician has a mentor as a resource,
then that physician will feel more at ease taking on
more HIV-positive patients and will quickly acquire
that invaluable expertise him- or herself.
"It's time to look at funding for
mentoring of primary care physicians, both provincially
and nationally," says Dr Rachlis. Canada used to have
a successful scheme called the Canadian HIV/AIDS Mentorship
Program (CHAMP). But Ottawa pulled the plug on funding
back in 1998.
"The results were positive at the
time," she explains. "And now that time has gone on,
we can see there is a shortage [of experienced primary
care physicians], so we need to look at innovative ways
to recruit more family physicians who know HIV/AIDS."
New programs are starting to pop
up again on the provincial level — there's one
in Quebec and another in the works in Ontario —
but it's still not enough. Fortunately there are shared-care
models, says Dr Rachlis. "These offer an opportunity
for a physician who is less experienced to share care
with an infectious disease specialist, so the doctor
can still stay with those patients."
The shared care model has a good
many benefits for doctors and patients — especially
in rural areas. "Shared care can make doctors feel more
comfortable taking on new [HIV/AIDS] patients," Dr Rachlis
explains. "With extra training and mentoring, they'll
feel more comfortable so they can refer to a specialist
only when they have a problem. They don't have to do
it all on their own, but at least they don't feel they
have to send patients off immediately to a specialist."
MD
MENTORING ABROAD
On the international stage, the dearth of HIV-experienced
physicians is at the top of the agenda. Last month,
the WHO announced a new $7.2 billion US plan called
"Treat, Train, Retain" to confront that problem in developing
nations.
In the meantime, many Canadian
doctors are already on board, taking it upon themselves
to help by volunteering to go abroad and mentor foreign
physicians.
Dr Paul Nguyen, a Vietnamese-born
Montreal doctor, is one. In May he returned from a six-month
stint in Chad where he was part of a Médecins sans frontiÅres
(MSF) operation in refugee camps for people fleeing
the war in neighbouring Darfur.
A big part of Dr Nguyen's work
in Chad involved mentoring local physicians. This aspect
of MSF's mission, he says, is one of the most important.
"I think we have a small impact on both sides: the refugee
camps and the Chadian population. We have improved their
skills and the diagnostics of these health workers so
later on they can help the Chadian population."
Chad's medical system is one of
the world's least developed. International health agencies
have estimated that there are just several hundred Chadian
doctors — Dr Nguyen cited a figure of 270 doctors
— for a nation of 10 million. Their already basic
medical education definitely doesn't cover HIV/AIDS,
says Dr Nguyen. "Even MSF has not established a program
for treating the general population of Chad or the refugee
population for AIDS. TB and other diseases, yes —
but not HIV. It's like we are sticking our heads in
the sand for now."
The two refugee camps where Dr
Nguyen was stationed housed and served about 100,000
people. Many of the patients he treated had been injured,
raped or suffered from exposure, starvation, dehydration
or other diseases, including AIDS. "In Chad, the AIDS
problem is even greater than we think," says Dr Nguyen.
"We don't have the means to treat them and systematic
treatment is discouraged because we can screen them
and tell them and stigmatize them, but then we don't
have the resources to keep them in treatment."
But even so, thanks to MSF's presence
in the camps they're better off than most HIV-positive
locals. "When we see the local Chadian population around,"
said Dr Nguyen, "it is somewhat pitiful."
For Dr Nguyen doing this kind of
work isn't just about helping others — it's personal.
As a boy, MSF touched his very own life. "I was very
young at the time — it was during the Vietnamese
War," he recalls. "One of my cousins was treated and
rescued by MSF." He'll never forget what the charity
did for his family. When he became a doctor, attending
medical school in Montreal where he specialized in internal
medicine and pharmacology, he vowed one day he'd return
the favour. The opportunity finally presented itself
last year when Dr Nguyen was chosen to take over for
an MSF doctor who was at the end of his mission and
to continue his work.
He's glad to be able to make a
difference. "I don't think going for a few weeks or
months makes much impact, but we have to go in for the
long run if we want to make an impact."
For more information:
Quebec: Programme National de Mentorat sur le VIH/SIDA.
Tel 514-282-9606, web www.cmeonhiv.com/pnm/
Ontario: Ontario HIV Treatment
Network is working to establish a physician mentoring
program. Tel 416-642-6486
MSF Canada: 1-800-982-7903
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