Dec. 1 marked World AIDS Day 2008

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Dr. Adrienne Chan had just one task left to do before getting back to her regular job as an infectious disease physician at St. Michael's Hospital in downtown Toronto last Monday.

And that was to field morning media interviews on World AIDS Day 2008 in hopes of enlisting more support in the fight against the pandemic in third world countries.

You would be hard pressed to find someone more qualified to comment on the subject, having just returned a few days earlier from Malawi where since September 2007 she has served as medical co-ordinator for an Annex-based non governmental organization (NGO) called Dignitas International, whose sole purpose is to help people in the Third World battle the AIDS pandemic.

"St. Michael's has been very kind and generous enough to allow me to just spend two months here and spend the rest of my time in Africa," Dr. Chan said.

Her short sabbaticals back in Toronto, she said, are important not just to allow her to fulfill her professional commitments, but also for personal reasons.

"It's very challenging to work there (Malawi). It's extremely exhausting and extremely draining. So it's good for me to come back just to re-ground myself."

But you can bet Africa is never too far from her thoughts.

"I miss the people I work with - they're fantastic."

And the country, she said, can be breathtaking.

"I love just driving around in the countryside. It's absolutely beautiful. Right now it's rainy season, so they've just planted the maize.

"Malawi goes from being extremely dry and then it literally rains twice and then it's like the most green verdant place you could imagine. It's absolutely stunning - these rolling hills.

"You see women and kids running around with bags of water and bags of maize on their head and people bicycling on the side of the road."

She lives in Zomba, in the southern part of the country.

"It's the old capital city so it's a very small town. Eighty per cent of the population is rural and so I live in the town, just around the block from our office and five minutes from the hospital where we have our clinic."

In Toronto, on the other hand, she said, with a chuckle, "right now I live nowhere, I'm living out of a suitcase, I kind of live out of my friends' houses downtown when I'm working here (in Toronto)."

As one could imagine, this past week marked a startling change for Dr. Chan waking up in a big city and going to work in a big city hospital with all the amenities.

"I don't like those words - third world. I was just telling the people here (at St. Michael's) it really feels like two different planets, I have to tell you between being there and being here.

"In our (Canadian) hospitals we have flat screen TVs people can watch in the waiting room whereas in Malawi I haven't been able to order liver tests or kidney tests for six and sometimes seven months. We don't have medications - you have to kind of make do with things you wouldn't normally use here so it's a completely different standard of care. It makes you really want to try to do what you can to equalize things."

Malawi is the fifth poorest country in the world, according to the United Nations Development Programme.

"That's one of the things that motivated me to really want to go work there, just to be confronted with that amount of disparity."

Dr. Chan paid her first visit to Africa in 2005 to complete her final year of infectious diseases training in Zimbabwe, and the experience ended up having a profound affect on her.

"I really had very much of a life-changing experience just kind of confronting the (AIDS) epidemic head on.

"Seeing with my eyes, with the patients that I was seeing how devastating it was, made me really feel like I have skills, and there really is a moral obligation for me to be here and try to help mitigate the devastating impact of the epidemic."

She can attest that the donations - such as those received through Canadian-based Give A Day (which raises money equally for Dignitas International as well as the Stephen Lewis Foundation, also based in downtown Toronto) - are working in the field.

"When I got there (Malawi) we had about 4,000 people who were enrolled on treatment.

"And with the same amount of staff, one year later, we now have 8,000 people enrolled on treatments.

"With a skeleton crew of about eight implementers in total, we've managed to scale up antiretroviral (ARV) care.

"Probably the majority of the patients who actually need ARVs immediately are getting it. We're not at a 100 per cent yet; but I'm hoping that will happen in the next couple of years.

With continued donations, she said, "we'll be able to continue the work we're doing.

"I'm pretty sure we're going to have more than 10,000 patients on treatment by next year. And we're going to continue to scale up and push care out even into the rural health centres."

Dr. Chan will return to Africa in January.

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For Malawi, one of the poorest countries in the world, HIV/AIDS is a national emergency that is overwhelming the health of the population and the social and economic structures that are needed to respond to the pandemic.

POPULATION: 12.8 million.

MEDICAL CARE: only 94 qualified doctors (i.e., one doctor per 136,000 people), one-third of the required number of nurses and an annual social services budget of $15 per capita (including foreign aid).

HIV POSITIVE: Approximately 940,000 Malawians are HIV, including 91,000 children and 500,000 women.

AIDS LEGACY: 10 per cent of all families are headed by a child, and half of all families are headed by a person over 65 - most often by a grandmother. As of the end of 2005, there were 550,000 orphans in Malawi: in five years, there may be over one million.

ZOMBA: one of the largest districts in Malawi, with a population of approximately 670,500, about 87,000 of whom live in the urban centre. Zomba has the second highest adult HIV infection rate in the country at 17.8 per cent. Zomba Central Hospital and Zomba District Health Office cannot meet the demand for HIV/AIDS related health services. Over 50 per cent of healthcare posts remain vacant. There is a lack of financial resources, an erratic supply of medicines and medical material, a lack of technical knowledge about the treatment of HIV/AIDS patients, and a dysfunctional referral system. Populations in the periphery have very limited access to health services.

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WHAT:

World Aids Day 2008, Monday Dec. 1.

CANADIAN CONNECTION:

Give A Day is a hugely successful Canadian fundraising campaign designed to help in the battle against the AIDS pandemic in third world countries.

It kicked off in 2004 when doctors at Markham Stouffville Hospital raised $33,000 - a day's pay from each contributor - in response to a challenge put forth by one of their colleagues, Dr. Jane Philpott.

Dr. Philpott worked in Niger Republic, West Africa from 1989 to 1998 where she practised general medicine and developed a community health training program for village health workers. In 2005, she worked in Niger with Doctors Without Borders during the food crisis in that country.

Since 1998 she has been a family physician in Stouffville, and is on staff at Markham Stouffville Hospital.

She also has University of Toronto ties.

Dr. Philpott will be the founding program director of a new teaching site for the University of Toronto Department of Family and Community Medicine to be located at Markham Stouffville Hospital. The Family Medicine residency at this location will begin in July 2010 and will have a focus on global health.

She is also part of a delegation from the U of T involved in establishing a partnership with Addis Ababa University in Ethiopia for postgraduate medical education.

Meanwhile, her fundraising initiative continues to grow every year.

In 2005, eight hospitals took part and $100,000 was raised. In 2006, three lawyers took it to the legal community and $500,000 was raised. In 2007, it went to the general public and $700,000 was raised.

This year the target is $1 million.

LOCAL CONNECTION:

Give A Day splits all the money it raises between two non governmental organizations (NGOs) that are based in downtown Toronto - Dignitas International with headquarters at 2 Adelaide St. W. and the Stephen Lewis Foundation with headquarters at 260 Spadina Ave.

According to info on its website, Give A Day has chosen these two local NGOs because...

* "They have been founded specifically in response to the AIDS pandemic;

* "Administrative costs of these organizations are deliberately low so that almost all of the donated funds go directly to the community level for AIDS care;

* "They have Canadian roots."

Dignitas International was co-founded by Annex resident Dr. James Orbinski, a University of Toronto research scientist at St. Michael's Hospital.

His recent book, An Imperfect Offering - which was turned into a documentary - recounts his harrowing time spent with Doctors Without Borders, and was nominated for the recent Governor General's Award.

Stephen Lewis is a former provincial NDP leader from Scarborough West riding who has fought Third World injustice through a renowned career that continues at the United Nations and through the Stephen Lewis Foundation.

FOR MORE INFORMATION

To contribute, or for more information, the three above-mentioned groups all have accessible, informative websites. Log on to www.stephenlewisfoundation.org; www.dignitasinternational.org; www.giveaday.ca