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Jul 16th 2015

On the Importance of Dignitas International

On the Importance of Dignitas International

I am hosting an event at my house Thursday to shine a light on Dignitas International.  I joined the board of this organization about a year ago.   At first glance you might wonder why a urologist without any expertise in infectious disease or HIV would want to join such an organization. I know about men’s health and kidney stones; prostate cancer and urinary tract infections. As I reflect on my near 20 year career however, it seems like a natural evolution.

 

Like most specialists as I finished my training I embarked upon my practice with great confidence in my skills and some trepidation.  Although lacking for experience, I felt I could look after many complex problems.    I have cared for many patients over the years. This includes all elements of general urology as well as complex stone cases from across Ontario and urological malignancies.  It is a technologically demanding specialty that relies very much on adequate funding and resources.   Over time I have started to realize that despite the constraints of our healthcare system (and my complaints about it) I still am able to draw on resources needed to deliver the best in modern urological care to my patients. Giving advice based upon the best evidence available from around the world is assumed.  In many respects as I reflect on this as a surgeon living in Canada there is an element of good fortune that comes with it.

 

As time goes on however I am also struck by the notion that while surgical outcomes in large measure depend upon appropriate decision-making and completing a task efficiently there are many factors upon which I have less control. Outcomes can vary widely depending on a patient's access to social support and community. Lack of computer literacy, particularly among the elderly is still an impediment to healthcare.  Others can’t afford the cost of drugs they are prescribed. Still others may skip an appointment if it means an expensive cab ride or jeopardizing their position at work. Social economic determinants of disease really do matter.  Here. Today. In Canada.

 

Imagine then if we look at this inequity and lack of access on a more global scale.

 

The HIV pandemic has been well documented and has been a catastrophe particularly in the developing world. In 2003 Malawi was no exception.   In the west, access to modern drug therapy has effectively made HIV a chronic disease.   In Sub-Saharan Africa it resembles a clinical course I remember from medical school in the 1980s.  Even the natural history of prostate cancer, often a slow-moving disease for many here, is fundamentally different due to a big gap in basic primary care.  

 

In 2004 James Orbinksi co-founded Dignitas International. In those 10 years a remarkable transformation has occurred.  To date over 200,000 people have been placed on antiretroviral care.   Clinics designed to educate people, reduce maternal to child transmission and break down stigma continue to inspire.  The integrated HIV-TB clinic is a model for others.   Hundreds of healthcare workers have been trained to provide support at nearly 200 facilities.  Thursday's keynote speaker, Gabriel Mateyu, has been instrumental in the drive to decentralize HIV care in Malawi.   Reading through DI's 2014 annual report highlights its many achievements

 

Essentially what this all speaks to is bringing access to fair and reasonable health care to every human being and addressing some of those gaps in care.    While not immediately apparent, the health of the developed world will be increasingly tied to what happens around the globe.   The recent Ebola outbreak highlights that.  As this very important organization looks ahead it is hoping to build on its experience and scale what is has learned in HIV care and potentially other important diseases in Malawi to elsewhere in the developing world. Learning from our experience abroad can also lead to a better understanding in trying to bridge gaps in healthcare back home.   DI’s vision to address this domestically with our aboriginal population is one such example.

 

The future is bright but much work remains. Healthcare workers in every capacity around the world must be willing to understand care outside of local sensibilities.     The movements of Dignitas will be worth following.

Comments

Posted: April 09, 2017

By: Dave Hooper

Hi Rajiv :

Hope all is well wherever you may happen to be at this particular moment. I believe you are still in Malawi, but not certain of that fact.

As you so eloquently pointed out, poverty of many forms does limit ones ability and motivation at times to seek out proper medical care.
Even in a country as rich in resources as Canada. Fear more than likely being another major factor.

With todays age of instant access to information, there is really no need for anyone conversant with the World Wide Web to have even the slightest reluctance to at the very least obtaining good if not excellent medical care in a country such as Canada. Especially in a city as diverse as Toronto. Seniors do have access to the internet if they so choose to participate. There are widespread organizations offering basic introduction to the internet specifically designed with seniors in mind. I myself know of three in our immediate vicinity here in Toronto.

In your post here you describe what can only be referred to as a worldwide pandemic, now chronic disease which is still a major concern for all of on this big blue marble. Unfortunately, how many of us can directly become involved remains the question at hand.

There are small things each and every one of can do as human beings which may go a long way. First and foremost is taking care of our own health and well being through proper diet, nutrition, exercise and medical check-ups. Nothing earth shattering in that declaration mind you, but it remains inconceivable to myself personally just how many of us choose not to visit our family doctors on a regular basis.

Small donations do add up to something that can become quite substantial. Crowd funding has been used successfully for quite some time in business, so why not for a Foundation ?

Other small things like blood donations, volunteering for organizations like the Red Cross, The Diabetes Wellness Foundation, being in touch with the Ontario Nurses Association,
attending a symposium or a seminar at CAMH, supporting the Ontario College of Physicians and Surgeons - these can all have a positive effect if implemented and focused wisely.

After all, we are all human beings who wish only the best for our fellow man and woman and to be able to live our lives to the best of ones ability.

A definition of success I once heard is this : A successful man / woman is one who has lived long, laughed often and been loved by many.

We all have legacies in our lifetimes. Wouldn't it be nice if our own legacies had less to do with unnecessary suffering and more to do with how we are viewed as persons doing good for others ?

See you back in Toronto.

Dave Hooper

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