Treating Africa’s HIV crisis…

490

As a medical student, when I traveled to India after my second year of medical school, I got involved in a medical outreach program that sparked my interest to work in international medicine. In the slums of Delhi, I remember going into families’ homes and realizing that although diseases were different, human beings and their needs are the same everywhere. I discovered that with my North American medical training, I had the capacity to provide medical help to people living in completely different contexts.

I first heard about Médecins Sans Frontières (MSF) through the media, as well as from friends and colleagues who had worked with the organization. Though MSF is medically focused, I discovered that my work could also involve the training of other medical and non-medical personnel while on mission. MSF requires experience working overseas or in rural communities, but most importantly, they look for open-minded individuals who have a willingness to learn and to adapt quickly to new challenges.

My first mission with MSF was in November 2001, to Bukavu in Democratic Republic of Congo (DRC), for an HIV/AIDS project. This was an exciting pilot project as MSF was the first organization to provide comprehensive HIV care in a chronic conflict zone. We were in effect setting an example and encouraging others to action. The project offered several components, such as HIV prevention activities, condom promotion, treatment of STI (sexually transmitted infections,) and the prevention of opportunistic infections. In 2003, the project started offering patients antiretroviral treatment.

Working for MSF is not just about caring for patients and their medical problems. All determinants of health (socio-geo-politico-economic issues) must be taken into consideration. The most rewarding experience was to see patients get better, and to know that my presence there had contributed to improve patients lives. One of my very first patients in the HIV clinic was a nine-year old girl who was really quite sick. We fought hard to get her treatment for the entire year I was on mission. When my colleague went back to DRC one year later, he found her thriving and going to school. This kind of experience is something that I’ll always carry with me, though there were also days when I wanted to give up. I would see patients for example, who would start to get better, then something would happen and they would stop seeking treatment.

The project could be a challenge at times because in addition to the usual hurdles of providing health-care in a resource-poor setting, our patients had to deal with the stigma of having HIV. I remember clearly one experience while working in the opportunistic infections clinic. I was treating an HIV-positive women who was carrying on her back what I thought was a two-year-old baby. In fact, it was her six-year-old son who was severely malnourished and dehydrated. At that time, for various reasons, I was not able to admit him to the hospital or to a feeding centre right away. So I gave the mother oral rehydration salts to take home and arranged to see them at their home the next morning. Unfortunately, the child died that night. I will never forget the feeling of frustration I had that next morning, when I showed up at her house and found out that they were preparing the funeral for the little boy. The one thing I learned about the medical context of HIV in sub-saharan Africa is that it is a harsh reality, and beyond the statistics, numbers and policies, this is a true crisis, in which an entire generation of peers is quietly and slowly dying.

Three years on I am still very proud to have been a part of the pilot project, which has had an overall positive impact on the health of our patients by giving them healthier, longer and more productive lives, and helped decrease the stigma associated with the illness. Showing that HIV treatment is possible in resource poor settings has also had an impact on the larger community both nationally and internationally.

Dr. Sumeet Sodhi is currently a family physician at the Toronto Western Hospital. Dr. Sodhi has worked in Northern Ontario, India, Nepal and Dominica and the Democratic Republic of Congo (DRC).