Disease Relief through Excellent and Advanced Means (DREAM) is a health program consisted of a group of volunteer physicians and community workers partaking in the global effort to curb the HIV/AIDS epidemic throughout sub-Saharan Africa. To date, the DREAM program has treated 500,000 HIV-positive people, free of charge, and 120,000 babies have been born without the virus to HIV-positive mothers. The program has made healthcare technology readily available in low-resourced settings and promotes women in these communities.
Dr. Massimo Leone, a neurologist of the Carlo Besta Neurological Institute in Milan, Italy, has been involved with the DREAM program since 2004, where he has traveled to many African countries caring for patients and taking part in the fight against AIDS, malnutrition, and neurologic disorders endemic to these regions.
1. What are some of your favorite memories working with DREAM?
One of my favorite memories? The memory of Catherine. She was born HIV+ from a HIV-positive mother who died soon after delivery. Catherine and her grandmother lived far in the bush (Photo 1), nzima was their main food. DREAM activists who were mainly community workers took care of Catherine and her family. They taught Catherine’s grandmother how to administer syrups containing the antiretroviral drugs, how to preserve the drugs, when to administer them, and how to cook proper food for the malnourished baby. Catherine has grown substantially, and her viral load is always undetectable. I did not believe it was possible under their circumstances.
Image courtesy: Dr. Massimo Leone
This is like a “drop of memory.” It can be easy for a busy neurologist of a western country research institute like myself to forget. Many of these “drops” followed along the years – they have worked as a vaccine against my natural tendency to forget such “drops.”
Image courtesy: Dr. Massimo Leone
"Dreams guide the change and good dreams lead to positive change for all globally." - Dr. Massimo Leone
2. What initially sparked your interest in global neurology?
In 2004, a friend told me of the HIV/AIDS epidemic in Mozambique. I had been completely unaware of this situation. The Disease Relief through Excellent and Advanced Means (DREAM) program was just started in 2002 in Mozambique, where there were only a few doctors. I decided to go help.
In Maputo DREAM centres, Mozambique, I met numerous patients and their families. I was surprised to see how happy they were to see me.
Why me? One year later I came back. Then year after year, visit after visit, I become more and more involved.
Antiretroviral treatment has prolonged the lives of many HIV+ people – the gift of a longer life. But the double burden of HIV and non-communicable diseases (i.e. stroke, epilepsy, cancer) gradually emerged. There was also an increasing number of (abandoned) elderly and HIV+ children becoming adolescents who were aware and afraid of their illness, often refusing a life marked by stigma. With this new life came new problems. Two-thirds of the sub-Saharan African population live in rural areas, hence, a big proportion of these problems are there. It triggered me to think how do we bring neurology there? This calls for greater support and a larger following of global neurology efforts.
Image courtesy: https://www.ilfattoquotidiano.it/2014/10/10/swaziland-lotta-allaids-18-dollari-al-mese-alle-ragazze-che-restano-vergini/1150773/
3. Do you have any words of advice to other physicians who are interested in global neurology?
The world has changed and continues to change fast. The speed and type of change vary according to the geographic area. These changes leave many behind. Global neurology requests the physician to adjust to these changes and to adapt to a global culture – to know local health systems and diseases, but also local history, poetry, arts, literature, religions, way of thinking, and more. Physicians should get to know patients in the places where they live (and where they get sick). Listen to them, ask them questions, share their problems. Medical scientific knowledge and humanities should go together. Dreams guide the change and good dreams lead to positive change for all globally.
Image courtesy: Dr. Massimo Leone (pictured on right)
Learn more about the DREAM program here at: https://www.dream-health.org