30 years of HIV care: Marijke Schoemaker and Reinier ten Kate reflect on their careers in HIV
HIV nurse consultant Marijke Schoemaker and HIV physician Prof. Reinier ten Kate have been involved in HIV treatment at the Kennemer Gasthuis Hospital in Haarlem since the early days in the late 1980s. In April this year, Marijke was rewarded for her work in HIV with a royal honour, and later this year both Marijke and Prof. ten Kate will retire. We look back with them at more than 30 years of HIV care in the Netherlands.
Difficult early years
During their careers, HIV phyisician, Reinier ten Kate, and HIV nurse consultant, Marijke Schoemaker, have seen the landscape of HIV care change dramatically. “In the beginning, we had very young people dying”, explains Marijke. “They were told that they were HIV-positive and you could basically add that the coming years, if any, would be very difficult.” According to Marijke, this was also a tricky time for physicians and nurses, marked by great deal of fear and ignorance: “Particularly for those who did not deal with it on a daily basis. How infectious is it? Can I shake hands with them? A great deal of education was required.”
From no treatment to a chronic disease
“It’s a wonder that things have gone so fast, from patients for whom there was no treatment to a chronic disease”, observes Prof. ten Kate. He explains that this rapid development was partly driven by the patients' own willingness to take part in research into medicines and treatment: “As a result, a lot of research was carried out in a very short period of time; the patient associations made an important contribution.” But, continues ten Kate, the way HIV care was organised in the Netherlands also played an important role: “Channelling care through designated treatment centres contributed to the rapid development of treatment.”
A need for specialised nursing skills
In the beginning, there were no HIV nurse consultants. Marijke explains that this role arose from a need for specialised nursing skills: “It was new for everyone. There were questions like ‘How do we support people?’ ‘What care can we offer them?’, and ‘What are the latest developments?’.” As well as providing specialised nursing care to the patients, nurse consultants played an important role in transferring information to primary care. “At the time, we had an AIDS platform”, continues Marijke, “where we regularly met with the hospital and the primary care providers, such as social workers and nursing homes, to discuss patient care.”
Today the HIV nurse consultant is an integral part of HIV care. The HIV nurse consultant remains the link between the treating physician and the primary care providers, such as social workers and general practitioners. In addition, the HIV nurse consultant plays an important role in patient support. “In particular, we are important in maintaining treatment compliance,” explains Marijke. “We have the time to support patients when starting new medication.” Moreover, the nurse consultant also helps patients with general questions, such as relationship issues. As a doctor, ten Kate further highlights the importance of HIV nurse consultants: “The nursing staff deal with so many of the things that I simply don’t get round to.”
Just one pill for HIV
Not only has HIV become a chronic disease, but its treatment has also improved markedly. “We started with a number of pills that we had to administer every 4 hours,” explains Marijke, “Now patients only have to take one pill every 24 hours. Some people look back at that time and think it’s a miracle that they are still here, with today’s quality of life.” Ten Kate picks up the story, saying: “Patients are now 20 years older. They started when they were 30 and now they’re over 50, with all the usual over-50 issues.” As a result, they are back to taking more medication. “These patients may be taking just one pill for HIV, but 5 or 6 pills as comedication,” adds Marijke.
Proud achievements
Prof. ten Kate and Marijke Schoemaker are grateful that they have been able to contribute to the current level of HIV care. Looking back on more than 30 years’ in healthcare, Marijke is especially proud of the successful HIV and STD education project that she set up for schoolchildren in Haarlem: “The way this project is spreading is extraordinary. More and more primary schools are taking part. This year we have already had 540 year 8 students.” Marijke is also proud that the HIV treatment in Haarlem has led to a designated hepatitis treatment centre in Haarlem, in collaboration with the gastroenterology outpatients’ clinic.
As they move towards retirement, Both Prof. ten Kate and Marijke are also happy to have been able to make a difference at a personal level. Prof. ten Kate says: “We have cared for some people for 20 to 30 years. You do have a bond with these people.” He goes on to illustrate this with a touching story: “Last week, a female patient came by to say goodbye and she said: ’16 years ago you told me I had HIV. At the time, my daughter was 2 years old and I wondered who on earth would bring her up?’ Now this patient has a second child, a degree and a job”.
Making way for the next generation
When we ask if Kennemer Gasthuis hospital is going to manage without them, they both laugh: “Absolutely!” says Marijke, “we have every confidence in them.” Ten Kate adds: “We were some of the first HIV professionals; it’s now time to make way for the next generation”.