N.Z. doctor a ‘workhorse’ in A.I.D.S. fight

Press, 24 September 1987, Page 19

N.Z. doctor a ‘workhorse’ in A.I.D.S. fight

NZPA correspondent London Prompted to amplify on his role in London’s fight against the plague of the 1980 s, Dr Charles Farthing says with a fatigued sigh that he is a “major workhorse” in A.I.D.S. treatment. Dr Farthing, who set out from Christchurch, New Zealand, in 1981 to train abroad in dermatology, ended up at Fulham’s St Stephens Hospital and was working there when the acquired immune deficiency syndrome epidemic hit three years later. He started a clinic at the hospital "because at that time nobody knew about A.1.D.5., nobody was interested in A.I.D.S. and very few cared much for the sub-group it was occurring in. The people were generally considered undesirable.” He has been there ever since and, with a caseload which doubles every eight months and no new junior doctor posts to help because of cost restraints, is “seeing patients continuously.”

“In fact, I think I’m starting to sound like a lot of the doctors I see interviewed in New York — really feeling very trodden down by this because there’s so many patients, so few doctors with expertise. “So many patients want to see you, and all of them have huge demands. They are very, very ill, they have multiple problems, they have psychological needs. They want to talk to their doctors at length.” Dr Farthing, who will return home to address a Napier conference on venereal disease and seminars at hospitals, works among what he says is heroic forbearance of the “horrible” virus that kills by destroying immunity. “It is quite amazing to see the heroism among the patients and their caring for each other. You become impressed with human nature. “It’s also impressive how they die. “I heard today that a man who I had been looking after for three years had died at home. My last conversation was with him a week ago

when he had been put on morphine and understood he was dying. He phoned up to thank me and said he felt everything possible had been done. "All the way through he conducted himself with tremendous dignity. “He had been in Paris two weeks ago and discussed the fact that that might be his last trip there. It is just impressive how most people handle these horrendous things that happen to them.” Dr Farthing works nonstop when he is not grabbing what sleep he can in his bed just down the road from the London hospital. "Work is virtually continuous. It is most evenings as well if I am not going out to give a talk or if I have got some social event, which is often A.1.D.5.-related because of fund-raising. “I sound like a proper martyr, don’t I?” Dr Farthing runs the treatment centre at St Stephens’ John Hunter Clinic, near Earls Court, a gathering point for London’s homosexual and drug-using population at high risk from A.I.D.S. His appointment book is packed into the evening with meetings, speeches aimed mainly at educating, doctors, and consultations with a ward full of A.I.D.S. sufferers or the many with the A.1.D.5.related complex, human immuno deficiency virus (H.1.V.). The message that he has to offer these days is at least one of some hope after the mass despair and panic that prevailed as soon as the reality of A.I.D.S. first became known. The anti-viral drug Retrovir developed by the American National Institute of Health has been a big advance since April, providing St Stephens patients for the first time with treatment which is slowing or arresting the destruction of their immune systems. “Patients seem to improve quite a bit — if they are able to tolerate it,” Dr Farthing said. “Only about two-thirds to three quarters can tolerate it and the others don’t suffer from the side effects so long as they come off it. “It is not the perfect drug because you cannot

give it to all patients and it doesn’t give them back their immune systems. “If their systems were already largely destroyed when they went on it, it might prevent further destruction but they still remain at-risk individuals — at risk of developing further infections and tumours.

“But we are slowly beginning to treat patients earlier and earlier in an effort to prevent them developing A.1.D.5.” Clinical research (the testing of new drugs on patients and monitoring of patients with and without treatment) has indicated that Retrovir does prevent the destruction of the immune system, says Dr Farthing. “The immune function tests cease to progressively fall.” The doctor and his patients are both encouraged with the development, and about 80 people are currently being treated at St Stephens by Retrovir.

, “A lot of the patients are feeling very well on this new drug. They are also very aware that other anti-A.I.D.S. drugs are in the pipeline. If the early studies hold out some of them might be better than Retrovir and far less toxic.” Dr Farthing, educated in Christchurch and Dunedin, spent his early

years in medicine in Christchurch after graduating in 1976. He said St Stephens* first case of A.I.D.S. was probably in 1981 "but nobody knew what it was then.” “We started to see significant numbers of cases during 1984 and started doing the clinic on my half day off from dermatology. “I wound up doing almost two jobs because it escalated very rapidly through 1985 as the number of cases rose dramatically and now we have a ward full most of the time.” When he addresses doctors in New Zealand he expects to deliver practical advice on the type of drugs to administer and to discuss who should be responsible for care of A.I.D.S. patients. "There’s quite a debate in medical circles because the disease falls into several different camps. “It is correctly a sexually transmitted disease because the vast majority of cases are sexually transmitted so logically physicians in that field should look after it. “But they are not in many ways the most ideal because to date they are trained only as outpatient doctors. “I feel A.I.D.S. is such an enormous problem that what we need is A.I.D.S.

specialists.” “It is being considered strongly here that we will appoint doctors purely to deal with A.LD.S.” More shared care is being organised with surrounding general practitioners, who have “become very knowledgeable on the disease.” Dr Farthing is also thankful that the public attitude towards A.I.D.S. sufferers has “changed considerably” in Britain and he feels a Government campaign through the news media has “got a lot to do with it” “People in most parts of the country are beginning to treat A.I.D.S. patients with a great deal of consideration and sympathy, which is appropriate considering the horrible disease they have got.” But he is not so impressed by the lack of money available for treatment. The Health Service will not create more junior doctor posts for A.I.D.S. treatment at St Stephens and the system is in chaos, Dr Farthing said. “And yet with this epidemic the number of patients doubles every eight months.”

The unknown factor at the moment is how many people giving a positive HIV test will go on to develop the deadly A.I.D.S.