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Order of Canada recipient now helping Malawi fight AIDS [], Sunday, January 31, 2010

By Norm Nelson

A quarter of a century after his volunteer work for Doctors Without Borders involved him in the heart of the Rwandan genocide, longtime Annex resident Dr. James Orbinski has received one of the top civilian honours bestowed by both Canada and the province of Ontario.

Orbinski, a married father of two, was made a Member of the Order of Canada on Dec. 30 and a Member of the Order of Ontario on Jan. 25.

“It’s a great honour,” said Orbinski in an interview that actually took place just prior to the Ontario announcement.

“It recognizes the work that I’ve been involved in for many years, and the work that I continue to be involved in through Dignitas International and through my role at the University of Toronto and most especially St. Michael’s Hospital (where he serves as professor of medicine and research scientist, respectively).

In part, the national honour recognizes his advocacy “for those who have been silenced by war, genocide and mass starvation.”

His horrific experiences in Rwanda, as well as other hot spots such as Afghanistan, have been recounted in a critically acclaimed autobiographical book from a few years ago called An Imperfect Offering: Humanitarian Action in the 21st Century, later made into a moving documentary, which captured Dr. Orbinski’s return to Rwanda.

Together with Romeo Dallaire’s book Shake Hands With the Devil, also turned into a documentary, the two books are essential reading for any Canadian seeking information on the Rwandan Genocide.

Dr. Orbinski would later become president of Doctors Without Borders, accepting a Nobel Peace Prize, on behalf of the group, in 1999.

While such humanitarian work would surely be enough, in and of itself, to warrant one of Canada’s highest civilian honours, he has actually gone on to do much more.

The official statement also cites his “contributions as a physician who has worked to improve health care access and delivery in developing countries.”

His downtown-based Dignitas International, which he founded along with fellow Toronto resident James Fraser, has made a real difference, over the last half decade, in the fight against the HIV/AIDS pandemic in the impoverished African country of Malawi.

While Dr. Orbinski and Fraser are regular visitors to Malawi, Diginitas has several Toronto residents on the ground right now in Malawi.

Dr. Adrienne Chan has served as Dignitas’ medical coordinator for the past couple of years. She spends most of her time in Malawi, coming back to St. Michael’s several weeks a year where she is an infectious disease specialist.

A couple from Sunnybrook Hospital are also in Malawi for a year – and they also took their three pre-teen children.

Dr. Michael Schull is an emergency room physician at Sunnybrook, but also wears a number of other hats including U of T associate professor and a researcher. It’s in the latter category that he’s in Malawi, helping to come up with ways to improve health care delivery. His wife Josee Sarrazin is a radiologist at Sunnybrook and is helping to train medical practitioners.

“And there are others who have been and continue to be involved,” said Dr. Orbinski, including, for instance, Dr. Katherine Rouleau a family physician at St. Michael’s who has served as a medical advisor for Dignitas and for clinicians working in the HIV/AIDS clinic at Zomba District Hospital.

Last year, Toronto district Rotary clubs also helped in a big way, not just raising money, but sending several members to Malawi as part of their ‘sweat equity’ program.

“The Toronto community has been one of the strongest supporters of Dignitas since its inception,” acknowledged Dr. Orbinski.

“And that includes St. Michael’s Hospital, Rotary, the Bank of Montreal, thousands of private citizens who’ve donated and supported the organization.”

An event at last year’s Toronto International Film Festival (TIFF), which they’ll repeat again this year, raised a whopping $700,000 for amfAR (The Foundation for AIDS Research) and Dignitas International, and featured a special concert by Sarah McLachlan.

The annual Ride for Dignity in Yonge-Dundas Square, thankfully, was not affected by the economic downturn, raising $270,000.

A lot of the research is done at Toronto hospitals and universities, led by Dr. Orbinski and Fraser, and also including Dr. Ross Upshur, head of the U of T’s joint centre of bioethics “and then we have research partners at University of Capetown, South Africa and also in Malawi.

“And we have relationships with Ottawa University, B.C. Centre for Excellence in HIV/AIDS, Partners in Health at Harvard, Doctors Without Borders.”

“We’ve established an office in the U.S., in New York, and we have extensive support from people in New York, in Dallas, in Los Angeles, San Francisco.

“And as well we have chapters of the organization in universities across Canada and in the U.K. and soon in continental Europe.”

It’s a drastic difference from the first part of Dr. Orbinski’s life where he literally helped bring medical care, through Doctors Without Borders, to needy people in the most dire circumstances, often in spite of the government.

With Dignitas in Malawi, the country is stable, the government is a willing partner – and it’s poverty and HIV/AIDS that is the feared killer.

Dignitas is not just a humanitarian health organization, but a research one as well. Specifically what they’re researching is the delivery model – so it can be taken elsewhere.

And they already have. Dignitas started in the Zomba district in 2004 and since that time have helped the local health care system surpass the 12,000 mark in terms of patients now receiving crucial, life-extending HIV-AIDS drug regimens. They also do more, of course, for instance, helping reduce mother-to-newborn transmission as well as prevention education.

“What we wanted to do is develop and test a model of community-based care for people living with HIV. And now we’re testing the prototype, essentially, that we’ve developed in Zomba, we’re testing it in different regions.”

Those different regions surround Zomba and will increase their catchment area to “three million people.”

“And we’re also expanding the focus from HIV to also tuberculosis and eventually to a full package of primary health care services.”

This year, he said the goal is the biggest expansion yet.

“In the Zomba District we would expect probably somewhere between 18,000 and 22,000 (on the life extending drug regimens) and then as we expand services in different parts of the country, we would expect that number to increase. I’m reluctant to put a number on it just because the start-up phase is the most difficult and it’s where you actually have the fewest patients, but it’s where you’re actually establishing systems and training and procedures and so on, and then you expand from there.”

Their ultimate goal is for the delivery model to be taken to other impoverished countries that could use a hand.

“We want to share the model with other organizations, with governments, with international organizations like UNAIDS, WHO, so that we can learn from them and they can learn from us in getting community based health care to people in the developing world.”

Dignitas InternationalOrder of Canada recipient now helping Malawi fight AIDS []