Married Canadian doctors and kids moving to Malawi for year to fight HIV-AIDS

TORONTO — Dr. Michael Schull is no stranger to the world of international medicine, with past stints in Iraq, Burundi and Bangladesh under his belt.

But this time around, things will be decidedly different when he heads abroad - and not just because of the destination.

Schull will be joined by his wife, Dr. Josee Sarrazin, and their three young children as they leave the comforts of Canada behind to relocate to Malawi to help battle HIV-AIDS in the impoverished African country.

The family is slated to leave Saturday to spend a year in Malawi. It will take several days for them to make the journey, travelling first to London, then Johannesburg, before flying next week to Blantyre located about 45 minutes away from their new home in the town and district of Zomba.

Schull, an emergency room physician at Sunnybrook Health Sciences Centre in Toronto, is on the board of directors of Dignitas International, a medical humanitarian organization which works to increase access to life-saving HIV-AIDS-related prevention and treatment.

Dignitas has focused its humanitarian efforts on Malawi, where an estimated 930,000 adults and children are living with HIV, and where more than 500,000 children have been orphaned due to AIDS.

Schull will serve as a senior research fellow leading a project on innovations to integrate HIV care with other primary care in rural health centres where currently only nurses and medical assistants are working.

"Traditionally, the care of HIV patients has been kind of segregated: it's lived in its own kind of sphere with its own staff and people who are very specialized in that domain treating those patients," Schull said in an interview from the family cottage in the Laurentians in northern Quebec.

"That's just not a viable model in many, many countries where there simply aren't enough staff, so it's critical, in fact, that staff be trained and see HIV as just another primary care condition, because that's really what it's become now."

Schull said the organization has offices based out of a central hospital, and they work through a network of rural health centres. The work is done in sync with Ministry of Health personnel.

"Our philosophy is there's no point in building a parallel system that may run very well while we as an organization are there and paying salaries for staff but will tumble the minute we leave," Schull said. "What we're trying to do is strengthen the existing system in such a way that it is sustainable and doesn't require our presence forever."

Sarrazin, a radiologist at Sunnybrook who specializes in abdominal radiology, plans to teach medical aides and residents.

And to say her mere presence will boost the ranks of radiologists in Malawi would be an understatement: Sarrazin said there is only one radiologist for a country of 14 million people.

Sarrazin plans to have an ultrasound technician come to Zomba in January and February to see where it would be best to establish training sessions for ultrasonographers.

She is also taking a miniature, portable ultrasound machine with the resolution of big equipment found in North American institutions in hopes of demonstrating its use.

"There is no point in us going there, doing our best and then come back - then you don't leave anything behind," Sarrazin said. "If we train people in Malawi, then they can train other people themselves, so it's a starting point."

The couple's decision to relocate their children - Camille, 10, Gabriel, 8, and Juliette, 6 - was not entered into lightly.

Schull said he and his wife discussed the idea for many years. About two years ago, the family went to southern Africa for three weeks and visited Malawi in part so they could see how the children would react.

"They were great and they loved it and we certainly loved it, and so it just kind of gradually became more and more real," he said.

Sarrazin said while the primary feeling among the kids is excitement, she anticipates there will certainly be a period of adaptation.

Sarrazin said they've purchased electronic books to download for the avid readers, and since power frequently shuts down around 6 or 7 p.m., they also have headlamps.

Nothing electronic is making the journey, meaning Nintendo fan Gabriel will have to leave his DS behind.

The children will attend an international school in Malawi.

Schull said Africa is an "absolutely wonderful place" that gets tagged as being a place of poverty and disease when it is in fact much more.

"We want our kids to arrive thinking about more than that - not just thinking about the fact that there are diseases and poverty," he said.

"Of course, those things are there, they need to see that and they need to understand that; but also see that it's a place of happiness and joy and love of life.... We want them to have that as a predominant feeling about the continent."