From childhood, Dr. Michael Silverman had been primed for the role he would eventually take on after medical school – one he saw as a vital blend of social justice and medicine. Today, Dr. Silverman is Medical Director of St. Joseph’s Infectious Diseases Care Program, citywide Chair/Chief of Infectious Diseases, and a scientist at Lawson Health Research Institute who is breaking new ground in care and research for those living with HIV and other challenging conditions.
For World AIDS Day, this visionary physician talks about just what led him to London, the patients he cares about so deeply, and a calling for compassion.
When Michael Silverman’s father came home one evening with two live chickens as payment for legal services, it was a lucrative day in the Silverman household, even though his mother had no idea what to do with the feathered fowl.
For much of the time, Jack Silverman, a lawyer, worked for nothing – his clients were those no one else would represent. It was the 1960s. Racism was rampant and many immigrants were considered undeserving of due process. Police brutality and the threat of deportation were real, and with no legal aid, people were too poor to pay for a lawyer.
For Jack, the son of Jewish immigrant parents who had escaped persecution in their native Russia, and with the horrors of the Holocaust in the recent past, championing the rights of individuals whom others considered unworthy was the right thing to do. It was a sensibility deeply imprinted on a young Michael.
“Nothing made my father more upset than when someone said ‘they are not our problem, they are not important.’ The concept of prejudice was unacceptable.”
The family had little, at times going without heat and running water in winter in downtown Toronto. It was Jack who suggested Michael attend medical school because something called the Ontario Health Insurance Plan was newly available. He could help the most vulnerable AND get paid.
“While it wasn’t my idea, turns out I liked practicing medicine.”
An inherent sense of justice
Graduating from the University of Toronto in 1985, the HIV/AIDS epidemic was just emerging.
“These were people others didn’t want to treat. There was talk about it being their fault, that they weren’t worthy of compassion. It didn’t sit right with me. People were dying and many people were refusing to provide care, partly out of fear, partly out of prejudice.”
The injustice resonated and was eerily familiar to the brand new physician. Dr. Silverman chose infectious diseases as his specialty. His father’s sense of responsibility had become his own. It would be the start of a career that would take him to remote corners of the globe and groundbreaking achievements defined by ingenuity, an inherent sense of justice, and unwavering compassion.
Dr. Silverman would go on to a fellowship in infectious diseases in Winnipeg, followed by a fellowship in HIV research at the University of California, San Francisco.
“Once we started getting medications for HIV in the United States and Canada that were effective, it was like a miracle. People started to get better. But it became clear those medications weren’t as available for the poor, particularly in Africa, where HIV/AIDS remained a death sentence.”
People, places and heroes
In 1999, Dr. Silverman began travelling to Zimbabwe where, without access to long-term treatments, he developed a short-term regimen for pregnant women that could prevent HIV transmission to the newborn during delivery. Within the first few years, the lives of about 500 children were saved. As the cost of the drugs decreased Dr. Silverman expanded the program to prevent breastfeeding transmission, which would become the World Health Organization’s standard of care.
For the next 15 years, from his home base at Oshawa General Hospital, Dr. Silverman would travel to Zambia, Zimbabwe, Uganda and the rainforest of Guyana at least twice a year to treat people afflicted with HIV and other infectious diseases. When he first arrived in one rural area of Zimbabwe, neither HIV testing or treatment was available. With the cemeteries full, peopled carried bodies on their shoulders at night to bury by the side of the road. There were five businesses in the area – one bar and four coffin makers.
Such places, the people, and the “heroes” among them dot Dr. Silverman’s memories of those years. All helped to propel his work and fuel his passion. While the challenges were tremendous and the human condition often deplorable, “you’re taking care of people who, if you didn’t come, they would be without,” he says. “It was very satisfying.”
A public health emergency
In 2014, Dr. Silverman became a dad to twin boys and fatherhood began conflicting with long weeks away. (He also has a 29-year-old son who is a physician). He shifted his humanitarian work to Canada, moving from Oshawa to London to head up the Infectious Diseases Care program at St. Joseph’s Hospital.
As a Jewish physician in a Catholic hospital, he saw no incongruity. The Sisters of St. Joseph, after all, were trailblazers in serving those in greatest need. Amid the fear and unknowns, St. Joseph’s began treating HIV/AIDS from the time it mysteriously appeared. With the Sisters as champions, St. Joseph’s would become the only hospital in the region to develop a formal treatment program for the disease, one that was groundbreaking in its scope, then and now.
In London, as in cities across the country and around the world, the stigma of living with HIV/AIDS and intolerance towards homosexual men as well as injection drug users remain a significant barrier to care. In 2016, when Middlesex London Health Unit officials sounded the alarm about staggering increases in HIV, hepatitis C and endocarditis in the city, they were responding to concerns brought to light by Dr. Silverman and his colleagues, who were noticing a disturbing trend among injection drug users. London was dealing with a public health emergency.
Much to do
Working on all fronts to understand the problem, treat patients and stem the spread, Dr. Silverman’s team forged unique partnerships in the community to reduce barriers to care for marginalized individuals. He also engaged a citywide team that not only uncovered a novel method of HIV transmission among injection drug users, but also a solution. A public health campaign called "Cook Your Wash" now educates injection drug users about the importance of heating their equipment. Since its introduction in 2017, local rates of new HIV cases have fallen dramatically.
There is much more to do. Stigma and suffering continue to weigh heavily on this devoted physician.
“Those whom society puts at arm’s length are the ones who need you the most,” he says. “The stigma is still so massive. Addiction is a disease. Almost all victims wish it would stop and are often suffering homelessness, poverty and terrible isolation, much of it related to the stigma.”
Seemingly undaunted by the magnitude of any problem, Dr. Silverman takes his lead, he says, from the values learned from his father and his religious Jewish education that teaches “You are not obligated to complete the task, but neither are you free to desist from it,” (Pirke Avot 2:21).
Like his father, it is this call to action and rejection of apathy to which Dr. Silverman subscribes, even when the task seems overwhelming.
“You can’t focus on what you can’t do,” he says. “You have to focus on what you can.”
About St. Joseph’s Infectious Diseases Care Program
The Infectious Diseases Care Program meets the outpatient needs of HIV-infected and affected populations across the region, providing medical, nursing, social work, pharmacy, and nutrition services. About 650 patients with HIV/AIDS, from infants to patients in their 80s, and about 350 patients with hepatitis C receive care either at St. Joseph’s Hospital or through a partnership with the London InterCommunity Health Centre.
The program also provides care for patients with a broad range of other acute and chronic infectious diseases.