Dr. Adrienne Chan, an infectious disease physician at St. Michael's Hospital, had a good reason not to be at the July 5 spinathon fundraiser at Yonge-Dundas Square which, at last count, had raised more than $260,000 to help in the battle against AIDS in Malawi.
That's because the doctor - born, raised and educated in Toronto - just a few days earlier had left for Malawi to rejoin the frontline battle against the pandemic.
With pledges still being officially accepted until the end of July, the final tally could still match or surpass last year's total of $275,000. It all goes to support the work of Dignitas International, a downtown-based non-governmental organization (NGO),
Dr. Chan is Dignitas' lead medical co-ordinator, spending 10 months of the year on the frontlines in Malawi, returning to St. Michael's Hospital for two one-month tours of duty.
She is North York born and raised, attending Earl Haig Secondary School and completing her undergraduate in medical school and residency training all at the University of Toronto.
Her decision to uproot and head Dignitas' medical mission in Malawi had its roots in her final year of infectious diseases training which she completed in Zimbabwe.
"When I went to Zimbabwe I really had an epiphany about my life as a physician and how I felt about myself as a person and really felt motivated and moved to go back to where I felt my skills were most needed," she told The Mirror in a phone interview just prior to returning to Malawi. "And I don't regret it for a second. I absolutely love my work, and I love the people that I work with."
Dignitas International was co-founded by Annex resident Dr. James Orbinski. An associate professor at the University of Toronto and a research scientist at St. Michael's Hospital, Orbinski once volunteered with Doctors Without Borders where he served in Rwanda during the genocide. As international president of the organization he accepted a Nobel Peace Prize in 1999.
Dignitas International recorded a major milestone while Dr. Chan was back in Toronto last month, enrolling its 10,000th patient on antiretroviral (ARV) therapy.
"We'll probably be at 12,000 (enrolled for treatment) by the end of December," predicted Dr. Chan.
They also hope to upgrade treatment.
"We've been giving a type of PMTCT (Preventing Mother to Child Transmission) called single dose nevirapine which is kind of standard-of-care for resource poor countries.
"We want to improve it to what we call combination prophylactic which is an additional drug on top of the single dose nevarapine so we're hoping to put that in over the course of the next half year because I think it will improve the rates of transmission of HIV from over 15 per cent to hopefully less than 5 per cent.
She's also hoping that funding will finally be freed up for a program targeting HIV-positive adolescents.
"We have about 250 adolescents that are on antiretrovirals and one of the issues about adolescents is that often with teenagers they're at risk for higher-risk sexual behaviours and also are less likely to maintain adherence to their medication.
"I think a lot of it is that sense of isolation and not knowing that there are a lot of other kids out there who have HIV and are living positively.
"We're hoping to create a teen clinic where all the teens can come once a month on the weekend so they don't have to miss school.
"In the morning they can get their medications and get their clinical assessments but in the afternoon we can do social activities, including music, drama and arts and crafts."
Teens would also receive information on life skills such as healthy sexual behaviours and self-esteem building.
Dr. Chan lives in the former capital city of Zomba in a house that is just around the block from the Dignitas office and about five minutes from the hospital which also houses another small, Dignitas office.
The region they serve has a population of about 700,000 people ("so about the size of North York") in an area, she said, that "would be a little larger than the size of the Greater Toronto Area."
Dignitas has brought in a handful of staff, including herself, the only medical doctor, and they're supported by a staff of more than two dozen locals whom she termed as "really the heart of our operation."
"They are really remarkable. Mostly they're clinical officers and nurses who have a lot of experience - basically working years in Malawi, doing HIV scale-ups."
One co-ordinator, Gabriel Mateyu, for instance, set up the antiretroviral program in Blantyre "and then came to help set up our program."
"Hopefully in the next few years when we expand to the other districts in the zone, Gabriel will probably be responsible for that as well. It's pretty amazing.
"I was telling him the other day that in three years from now he will have been responsible for helping scale up the RT for a catchment area of almost three million people, and this is one man who with a wealth of experience managed to do that.
"That's why I keep going back, is my colleagues are so inspiring and really remarkable."
Dignitas works "in partnership, hand in hand" with the Malawian government.
"Our goal is basically supporting all HIV services in the district (Zomba). That includes the treatment of people who are HIV positive, detecting that people are HIV positive and then preventing infection as well."
A successful approach for Dignitas has been to offer testing "routinely at places in the health system where people are at the highest risk for HIV or where we have the greatest impact of putting in an intervention."
For instance, they operate a TB-HIV clinic "where every patient who is diagnosed with TB is offered an HIV test because 70 per cent of patients who have TB also have HIV, so you're going to get high yield there."
At the hospital all malnourished patients, children and expectant mothers are also offered testing.
For expectant mothers who test positive - which happens, she said, 12 to 13 per cent of the time - "we are basically offering an intervention (PMTCT) which can potentially prevent new infection and transmission of the virus from the mother to the child."
New strategies are always being sought, she said, for instance:
* a tracking system "just instituted" allows Dignitas to follow the 10,000 people now on antiretroviral drugs "more carefully to make sure we're not missing any people who require antiretroviral treatment. That was one of the things we worked on in the last quarter that was great."
It promises to be another busy yet rewarding six months for Dr. Chan.
"That's the lovely thing about the job and working in a country like Malawi. One second you can be out in the field, seeing a patient in a rural health centre and then the next day you can be at the table at the ministry of health trying to make a policy change."
That exact scenario occurred just prior to her recent trip back to Toronto.
"We were out in the field supervising one of our mother-baby follow up sites which is for our prevention of maternal to child treatment sites and so one of the things we wanted to do is to make sure every woman who's eligible for antiretrovirals who's pregnant gets on it because getting women on full antiretrovirals is like the best prevention of transmission of HIV from the mother to the child.
"But the threshold of the CD4 count, which is a marker of immunity, the ministry had it at 250 and we felt very strongly it should be at 350 because you're much more likely to get more women on to treatment and prevent infection to the baby."
The very next day, she said, "we were at a meeting at the ministry where a bunch of us who are people that work on the ground through various organizations were able to advocate for this change."
It's nice, she said, to "be able to basically take it all the way from the patient to the people who actually change the policy."
In a lot of other countries, she said "you can't do that, just that there's a lot of extra bureaucracy that is involved. But the Malawian government and especially the people at the department of HIV/AIDS are extremely receptive to partner input and making sure all of the stakeholders in the country are kind of at the table and have a say in where the direction in their HIV programming is going."