Dr Tonia Marquardt uses her global experience to help build healthcare bridges between areas of need.
As much as general practice training prepares you to be a generalist, there is only so much any medical training can help when faced with a situation as challenging as, for example, introducing antiretroviral medication to HIV patients in an impoverished south-east African nation.
For Dr Tonia Marquardt, however, this type of circumstance – and an ability to handle it – has become somewhat par for the healthcare course throughout a career that has taken in some of the most far-fl ung corners of the globe as a practitioner with Médecins Sans Frontières (MSF) (Doctors Without Borders).
‘Trying to work out how we adapt a tertiary-level healthcare-facility approach to a remote African context with limited resources was really interesting,’ Dr Marquardt told Good Practice in an example of an understated manner that, in truth, tends to belie the gravity of much of what she has accomplished in an extremely varied career journey.
It all started in rural Victoria
Now based within the hustle and bustle of Tokyo, Japan, Dr Marquardt grew up in the north-west Victorian town of Stawell before undertaking her medical studies at the University of Melbourne.
While she may not have seen her global career path from the start, Dr Marquardt did always envisage a life in primary healthcare, an attitude that ultimately served her – and her many patients in desperate need – very well.
‘It was appealing to not be focused on just one area,’ she said. ‘General practice was always going to be an answer to what I thought healthcare should be; providing care for the patient as a whole.
‘I still find the comprehensive approach to care of all of the patient’s issues more interesting than just targeting one disease.’
Soon after her medical training, Dr Marquardt decided to embark on an overseas adventure and gain some more life experience.
After spending four years doing the ‘Aussie thing’, namely living and working in the UK and travelling to Europe whenever she could, Dr Marquardt found further career interests in tropical medicine and infectious diseases. These interests led her to join MSF in 2000, where she started out as a fi eld doctor in the HIV/AIDS project in Malawi, in south-east Africa.
‘This was at the time when antiretrovirals [HIV drug therapy] were being introduced to the country,’ she said. ‘I had to read huge amounts about HIV and try to understand more about antiretrovirals at a time when most of the things you read were based on tertiary-level healthcare facilities.
‘It was almost inconceivable to implement the use of antiretrovirals in this setting, due to the cost involved and the Malawian healthcare system having a very low health budget per person. But the head of our division had a strategy and was really determined to prove that antiretrovirals could be used in Africa.’
The combination of Dr Marquardt’s efforts, her colleague’s optimistic attitude and a pragmatic approach to introduce new treatments to the remote setting, rewarded the MSF doctors with a successful project outcome.
‘We started really small and within a year it was a massive HIV care program which is still running 20 years later and is one of [MSF’s] biggest HIV programs,’ Dr Marquardt said. ‘So from small things it really grew.’
With her interest in working with some of the world’s most impoverished populations having been thoroughly piqued, Dr Marquardt stayed with MSF for the next decade, making stops to work on projects across Africa and the Middle East. It was on these projects, during which some of her work included being part of a response unit and managing infectious disease outbreaks through clinics she helped set up, where Dr Marquardt felt she had truly found her place as a generalist.
‘I worked on a huge variety of different projects, as one of the coordinators on the emergency team setting up the Darfur response, Ebola outbreaks in South Sudan, measles outbreaks, malnutrition, obstetric care,’ she said.
Dr Marquardt refl ects on her decade delivering humanitarian aid with MSF as challenging and fulfi lling. Exposure to almost unimaginable disease and crisis was confronting, but it taught her new skills in medicine and helped to broaden her perspective on remote healthcare settings, not to mention the patients within them.
‘I didn’t have a single mission where it wasn’t really different and something new and unexpected. It was an interesting challenge and I learnt a lot,’ she said. ‘Having to also learn how to deal with HR [human resources] issues and confl ict, working in a remote context, trying to cope with limited resources and diffi cult living circumstances.
‘You really learn something about yourself, too. I learnt to be fl exible, because the situation is never what you expect.’
Dr Marquardt ultimately returned home to Australia in 2010, but it was hardly a move to a comfortable position in a suburban practice. Rather, she found herself based with the Royal Flying Doctor Service (RFDS) in Cairns, working with remote Aboriginal and Torres Strait Islander communities, predominately in Kowanyama on the Cape York Peninsula in Far North Queensland.
Dr Marquardt was again able to put her rural generalist skills to good use with the RFDS, providing fl y-in fl y-out clinic care and retrieval services. She found her background with such a diverse range of patients helped her to consider, address and follow up health conditions during consultations with patients in remote parts of Australia who may rarely be seen by a healthcare professional.
‘It requires great fl exibility and pragmatism,’ she said. ‘Being with the RFDS was interesting and I had various roles there, in clinical care, as a manager, as a trainer. It was crucial to be a rural generalist.’
The seven years Dr Marquardt spent with the RFDS did not mean she ceased contact with her international MFS colleagues. She was voted onto the MSF board and had a two-year stint as a women’s health advisor in the organisation’s Sydney offi ce. Dr Marquardt was able to put her time in Sydney to very good use and upskill in obstetrics.
‘The role [in Sydney] basically entailed going back into the fi eld but in a more advisory role, supporting people with women’s health activities and setting those up,’ she said.
As much as she enjoyed her time in Sydney, the lure of unfamiliar territory soon proved too much and Dr Marquardt accepted a new position with MSF in Tokyo in March of this year. She is now part of a team that follows medical projects to Cambodia, the Philippines and Papa New Guinea (PNG), including updating current care in tuberculosis, hepatitis C and women’s health. Her rural GP background has again proved its worth.
‘Working with remote populations in Australia and Africa has helped me look at places like PNG quite differently,’ she said. ‘I think this is where having a GP mindset is useful.
‘To be able to manage these scenarios and work out an approach as a generalist, providing more simplifi ed care for the patient as much as possible, rather than thinking it has to always be complex, high-level specialist care.
‘I like the holistic “one-stop-shop” approach; thinking outside the box. ‘As GPs we tend to think about every component of the care and each step along the way, what needs to be done there and what needs to be incorporated to make it simpler.’
Dr Marquardt’s determination, skill and courage to embrace new opportunities have helped to contribute positive results to remote areas of need. She is indeed a doctor without borders.
First published in Good Practice September 2017: 22-23