Transcription of Dr. Thomas Courtney for the show Profiles of Resilience #188
Dr. L. Belisle: This is Dr. Lisa Belisle and you are listening to Love Maine Radio, show number one eighty-eight, Profiles of Resilience airing for the first time on Sunday, April 19, 2015. AIDS and HIV are very different entities than they once were, no longer an infection that leads inevitably to death. The human immunodeficiency virus and acquired immunodeficiency syndrome can be managed with long-term medications.
Today we speak with infectious disease specialist Dr. Thomas Courtney about the evolution of AIDS and HIV in Maine. We also speak with Smith Galtney who created Seeing ME: Profiles of Resilience a collaborative photography project with the Frannie Peabody House. Thank you joining us.
Here on Love Maine Radio we like to think about the impact of illness on community wellness. This is a subject that I know that our next guest has quite a lot to say about. This is Dr. Thomas Courtney who is the Chief of Infectious Disease at Southern Maine Healthcare. He is also the President of the medical staff at SMHC, raised in Massachusetts and New Hampshire Dr. Courtney now resides in Saco having practiced medicine in the area since 1988.
He joined Frannie Peabody Center’s Board of Directors in July of 2012. Thanks so much for coming in and being with us.
Dr. T. Courtney: Yes, it’s my pleasure.
Dr. L. Belisle: Dr. Courtney infectious disease is something that not everybody understands all that well. I mean we know it could be anything from chickenpox to measles, but recently AIDS or [maybe recently 00:03:05] the last thirty years maybe AIDS and HIV have become a pretty important part of our society. It’s continued to evolve. Tell me what it was like when you first started practicing to now as to how we all viewed AIDS.
Dr. T. Courtney: The field of infectious diseases is indeed quite broad. I might go back to when I started medical school in the early 1980s because that’s when HIV became a recognized disease. I had the wonderful opportunity at the University of Texas Medical Center at Houston witnessing the evolution of HIV/AIDS in medical practice. I’ve grown up with it. It is a wonderful vantage point to see where we were at a time in a disease that uniformly was fatal to a disease now that is uniformly not fatal.
It’s been a very exciting journey to see that change over time. The tools that we now have with medications and medication regimens have become far more tolerable than they were in the late 1980s, far more tolerable and far more effective. It has been a great journey I guess.
Dr. L. Belisle: As you’re talking about your own training, I’m thinking about where I was in the 1980s and I was in high school and we were doing reports on this new disease that I’m not even sure everybody was calling AIDS at that point. We all thought it maybe came from Africa or Haiti and it seemed very scary because everybody was dying of it. It reminds me of what’s going on now with infectious diseases like Ebola. Do you think that the diseases we’re seeing now are going to have a similar evolution or is that something that it’s just too difficult to compare them?
Dr. T. Courtney: No, I think that there is some comparison but they definitely are not apples to apples, looking at HIV this was a disease that was initially very hard to make a diagnosis, hard to understand what was going on and it took many years to understand the virus that causes HIV/AIDS. The different also from a disease like Ebola in that untreated it takes a decade or more for a person to die from the illness, whereas in Ebola you either die quickly or you recover from the disease.
Certainly a different sort of a disease process. I guess in looking at Ebola where we have to act quickly and make sure that we have all the proper support to see a person through the illness takes a tremendous amount of resources at the very onset of the illness. HIV is a silent disease in many respects where many of those who have the illness are not aware of it. We can be walking around not knowing that we have the illness and the only way to know for sure is by testing.
Dr. L. Belisle: I’m remembering when I was a resident in the mid ’90s and at that point there was still a stigma attached to HIV testing. There’s all kinds of information out there about privacy laws and HIV testing. I think it has become less stigmatized, but I think there still is something very scary about HIV/AIDS.
Dr. T. Courtney: A lot of it has to do with what the education about the illness when people were quite obviously ill and dying from the disease that we were all afraid of it and afraid of acquiring it. In some ways, that has subsided because I go back to my last statement that we don’t know who has HIV/AIDS. There was a recent conversation I had with somebody at the Salt Institute. There was a nice photographic view of how HIV was affecting different people in the state of Maine.
A person came up. I was one of those pictures because I am a board member at Frannie Peabody Center and this individual was saying to me do all of these people have HIV/AIDS and they said, “I know you don’t have HIV/AIDS.” I said, “How do you know I don’t have HIV/AIDS [today 00:08:09]?” He set back again and I didn’t tell him because it wasn’t important that anybody could have HIV/AIDS. We just don’t know.
In a way, the illness has become very silent that we don’t think about it because the medications that people are taking make them well and they are active community members, that they are fully productive and this HIV has become a chronic illness not unlike diabetes or some other chronic disease that can be well controlled with medications.
Dr. L. Belisle: What must it be like and I’m guessing you to guess so I don’t even know if you know the answer to this, but I think about the generation of men and to a lesser extent women who lost partners, friends to HIV and AIDS back when we weren’t able to treat it well. I’m wondering what it must be like to be living now seeing all this availability of medicine and resources and people living with this to know that all of these people died.
Dr. T. Courtney: Well, that’s true. That’s the nature of medicine. We learn things over time and we’re better at taking care of illnesses, allowing people to live longer. Sad for the losses that have been there. The only benefit is that it was all of those losses that really demanded the research into the illness, demanded the development of new drugs to come with it. Those lives more in the loss of those lives were by no means meaningless, very, very important that got the drug industry and the medical community out there to find how to take care of this illness. They’ve done a fantastic job.
Dr. L. Belisle: Do you think that in some ways the HIV/AIDs problem actually created maybe a more positive way for people who had been marginalized before, maybe people who are gay for example, a more positive way for them to be out in the community?
Dr. T. Courtney: Certainly, the communities of people that have come together involved in the care of HIV, in particular the LGBT community who have rallied together and provided support have advanced that principle you’re speaking of well over time. When it does become more common to know that people with HIV are in the community. They are interacting with us daily even though we don’t know it, but also put a positive face on an illness and the great amount of talent that people with HIV/AIDS are able to contribute. That I personally see a lot and witness the great contributions, the color to the world that the HIV/AIDS community brings.
Dr. L. Belisle: Tell me about your work with the Frannie Peabody House. I understand that this is an organization that has also evolved over time. From early on, I believe there was more work that was being done within house care of patients, more like a hospice model and now it’s really providing resources and connections for people who are working and living in the world today. How does that look to you?
Dr. T. Courtney: Frannie Peabody had to change over time. It was established by Frannie Peabody and her son who had HIV/AIDS and ultimately passed from that disease. She provided a resource, a place where people could come with the intent to die with the illness. That became an outdated model when people stopped dying of HIV. It doesn’t happen any longer. If people don’t want to die of the illness, they wish to [take care 00:12:55] of their medications, they don’t die from this illness any longer. They die from heart disease or cancer or something else that we all have to face in our later lives.
Frannie Peabody gave up that model of being directly caring for people with advanced HIV to a more forward looking model trying to identify people early in the course of their illness so that they can be put on appropriate medications. They have helped people who are in need, socioeconomic need or are challenged in some other manner providing that individual to interface with, to help them get the things they need to survive whether that is food or housing or medication or testing or transportation, so many different facets to Frannie Peabody Center and they do a fantastic job.
I have interacted with the case workers at Frannie Peabody Center for many years as they would come in to my office with patients, bringing them there, often times coming in to the appointment with them so that they can help interpret what’s going on there in those who needed it and that this was clearly a wonderful organization. I was asked to become a member two, three years ago and I thought a wonderful opportunity for me to contribute to that effort. These are dedicated people who try very hard on sometimes limited budget to accomplish a tremendous amount and just thank God that they’re there. They do a great job.
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Dr. L. Belisle: We at Love Maine Radio enjoy a special relationship with Apothecary by Design. Join us in the offices of Maine Magazine for Seeing ME: Profiles of Resilience which features photography by Smith Galtney capturing the story, struggles, and victories that form the changing face of HIV and AIDS in Maine. This photography exhibit will be available from March 27th to April 24th at 75 Market Street, the offices of Maine Magazine. We hope you take the time to stop by.
Infectious disease is a very as we said when we started this whole conservation, it’s been an evolving specialty. At some point, you had to make that decision. You had to decide I’m going to be an infectious disease specialist. We’re lucky because in Maine we have some very good infectious disease specialists, but there aren’t a lot of you. Why did you decide that this was going to be your path?
Dr. T. Courtney: I like talking about this because in my training at UT Medical School in Houston there were some tremendous infectious diseases specialists there. When leaving medical school, you don’t necessarily know exactly where you’re going to be but as an internist coming to Maine, to Maine Medical Center where I did my internship and residency and then again meeting such well qualified doctors who love the field of infectious diseases and seeing how it inspires them, seeing how we can make a tremendous difference in the lives of people, ID, infectious diseases is in some ways different from a lot of other fields of medicine where it is often an acute problem, a problem that is here and now that needs to be treated.
I consider myself a success when I say goodbye to my patients, when they no longer need to come and see me any longer. Although I do have seen some HIV patients for twenty years that almost all of my patients get better and we say goodbye and that is a good end.
Dr. L. Belisle: When I get to the point as a primary care doctor, as a family doctor where I need to send somebody to an infectious disease specialist, it’s either one of two things. One something came up on a lab test that I was not expecting and I don’t know how to deal with it so can you please help me with this. Another is I’ve checked all of these labs, I’ve checked all of these tests, this person still has all of these symptoms could it be infectious and can you help me rule this out.
That’s an interesting in one you have to be the specialist, in one you have to be the detective/specialist. That’s an interesting set of skills to need.
Dr. T. Courtney: Absolutely. That’s the beauty of having such a broad education in internal medicine so being aware of all of the other possibilities that exist for a complaint that comes in and with a narrower vision that it would be easy to attribute a certain complaint to something or this illness or that illness that when you can see it in a broader perspective you can take a look at laboratories and the presenting complaints that people have in the exam that you do on them and tell them sometimes this is not an infection that is causing it, but I think there might be a problem here.
I think that sometimes it comes down to mental illness, to depression and anxiety that people have about their well being and getting them to see the proper professional can make a big difference in their lives or there might be a medical reason for their other complaints and being able to refer them to the proper specialist is an important part of that job.
Dr. L. Belisle: It is an interesting quandary because by the time you see people, many people, they’ve seen me, they’ve seen maybe orthopedic doctor, they’ve maybe seen a joint specialist, a rheumatologist, they’ve seen lots of other people so by that time they probably are fairly frustrated.
Dr. T. Courtney: Often times that is true and you need to deal with that. I would say that in the field of infectious diseases, thankfully it’s not always that way that more often than not we do have a pretty clear and convincing diagnosis and can set about to treating that particular problem, but there are chronic illnesses that people have that become much more frustrating especially when we [can’t 00:20:33] attach a specific diagnosis to that.
Dr. L. Belisle: I’m enjoying this conversation because I think that the older that I get, the longer I’ve been in medicine, the more history I have behind me the more I’ve actually participated in the history of medicine. I think sometimes we would all do well no matter what our age to have some sort of historical perspective on medicine and to understand why we are vaccinating kids, what happens when we don’t vaccinate our children or what happens when you have a disease like HIV/AIDS that hasn’t really been well defined, we don’t know how to treat it and how it can evolve over time.
I think this is a really important thing for people to always be aware of just that things do evolve and there are sometimes very good reasons for why things are being done now based on the past.
Dr. T. Courtney: Yes, there are a lot of illnesses that we don’t see in the United States anymore. Take for example malaria, malaria used to be endemic in the United States and I heard a nice bit on [NPR radio 00:21:36] about yellow fever yesterday and the area of Missouri and that these are illnesses that we’ve been able to get rid of. We don’t have any real sense of how dangerous these illness that still exists in other countries and in Africa and South America and whatnot and the tremendous effect that it has particularly on children. Malaria for example and the half million or more lives that are lost a year to this disease.
The good work by the Gates Foundation to try to figure this out and provide ways to prevent malaria in children and vaccines that work well. I think maybe in some other countries they are far more aware of all of the problems that can exist that we don’t see any longer in the United States. Still our issues and when you travel another part of our business through Southern Maine Healthcare Travel Well we do see people before they travel to various countries and are able to provide them with the appropriate immunizations and medications to prevent illness in their travels.
Dr. L. Belisle: I’m assuming that people who are interesting in learning more about travel medicine, HIV/AIDS, the work you do with infectious disease or Southern Maine Healthcare can go to the Southern Maine Healthcare website.
Dr. T. Courtney: Absolutely.
Dr. L. Belisle: Also can Google the Frannie Peabody Center’s website as well.
Dr. T. Courtney: Yes.
Dr. L. Belisle: We’ve been speaking with Dr. Thomas Courtney who is the Chief of Infectious Diseases at Southern Maine Healthcare and also President of the medical staff and on the board of directors with the Frannie Peabody Center. It’s really been a pleasure to speak with you about all the work that you’re doing and keep it up.
Dr. T. Courtney: Thank you very much. I appreciate our conversation.