Australian doctor Heidi Spillane writes from China

Australian doctor Heidi Spillane consults a patient.
© Jonathan Browning, courtesy of GPRA.

Since August 2009, Heidi Spillane, a doctor from Byron Bay on the NSW north coast, has been working for Médecins Sans Frontières in China. She is based in the city of Nanning, in Guangxi province, in a project providing healthcare for HIV positive patients. This is Heidi’s second field placement with Médecins Sans Frontières, having previously worked in Kenya.

Worlds divide the traditional Médecins Sans Frontières project I imagine, and the context I find myself in here in Nanning in China, a sprawling city at the heart of consumerism.  I live in a city full of skyscrapers and fluorescent lights. In stark contrast to my last project with Médecins Sans Frontières in Kenya, where conditions were basic, electricity, running water and street lights a thing of the future! Internet at home, an unknown luxury on past Médecins Sans Frontières placements, connects me to family and friends back home.

The HIV project here in Nanning was opened by Médecins Sans Frontières in 2003, and despite the wealth and economic progress that is apparent here, rural communities, migrant workers, and the marginalised, seem to have been left behind.  Our clinic population reflects this disparate group; thirty per cent are injecting drug users, and many others travel for hours from remote villages to attend their clinic appointment, and the sex workers and gay men are happy to have a haven where they can be themselves for a few hours without fear of persecution.

The 1,170 adults and 80 children who come to the clinic receive free HIV treatment are cared for by a team comprising three national Chinese doctors, 10 counsellors, nursing, pharmacist and admin staff.

There is a strong focus to provide holistic care to the patients who, outside the clinic environment, are discriminated against at every turn. HIV positive children are refused entry at school, employment contracts are terminated, families turn their backs, and even healthcare providers refuse medical services to this marginalised group.

My role is to supervise the three national doctors, to coordinate the medical activities of the project and to assist with the education and training at other HIV healthcare facilities.  My lovely translator is constantly at my side and is invaluable at interpreting the subtleties of communication, and corrects me when I am about to make a culturally insensitive faux pas that I would otherwise be oblivious to with our Chinese counterparts.

While the national HIV program now provides access to free antiretroviral treatment for HIV, much of the cost of laboratory investigations, treatment for opportunistic infections and the cost of a hospital admission still falls on the patient.

There are many obstacles yet to be overcome however, the context of HIV care in China is gradually changing. In 2003 when there was very limited access for patients to receive HIV care in Guangxi province. Now in 2010, there are 35 HIV clinics providing free antiretroviral drugs.

With this in mind, Médecins Sans Frontières has decided to withdraw, and is gradually handing over patients to government counterparts.  The handover of the 1,250 patients by October 2010 will be a challenge for the team, and every effort is being made to maintain the quality of medical care and psychosocial support for the patients, and to advocate on their behalf.

Personally my next challenge will be to document the impact that Médecins Sans Frontières has had on working on this HIV project in Nanning, from the perspective of the patients, the staff, and our partners.  What are the lessons we have learned and how will this shape what we do in the future? This is a critical component of any field project.  In the process I am sure I will do plenty of self-reflection on my experiences and the lessons I have learned, and maybe will bring a new set of skills and ideas with me to the next project!