Management of the HIV Infected Patient - Decication to Brett Tindall
: 01 July 1994
: The Hon Justice Michael Kirby AC CMG, President, Court of Appeal, Supreme Court of NSW (1984 - 1996)
: HIV/AIDS, Person
For some reason which I have never discovered, Brett Tindall has always been known to his friends as Badger. Mind you, I can see some similarities between that remarkable creature and the hero to whom this book is dedicated. The similarities derive from the fact that each traces their origins to the Northern Hemisphere. Each is a small but powerful animal. The habits of each are generally nocturnal. Above all, each retains its hold upon the object of its attention with a terrible tenacity.
Brett Tindall was born in Sydney in 1961. At the time of this publication he is therefore 33 years of age. But what an amazing life he has packed into those years.
He took his first degree at the Cumberland College of Health Sciences. He spent four years as an undergraduate medical student at the University of Newcastle in New South Wales. He did not complete his primary medical degree. I suspect that it was because something more important came along. The AIDS epidemic. He worked for a time in various para-medical capacities - as a tutor in nursing studies at the Kuring-gai College of Advanced Education and as a speech pathologist in Sydney.
But by the mid-1980s, he was in the midst of the scientific response in Australia to the AIDS epidemic. He began as a research assistant in the Centre for Immunology at St Vincent's Hospital in Sydney in 1985. In 1987 he was promoted to scientific officer. When the National Centre in HIV Epidemiology and Clinical Research was established he was appointed a research assistant to Dr (now Professor) David Cooper. In due course he was appointed Senior Project Scientist and for a time acted as Manager of the Administration of the Centre.
His busy life as a research scientist did not detract from his Badger-like activities in national and international programmes addressed to the scientific and community responses to HIV/AIDS. He served as a committee member of the AIDS Council of New South Wales. It was the high opinion in which he was held by his professorial colleagues, and his own outstanding contributions to national and international conferences, that caught the attention of the World Health Organisation in 1988. Dr Jonathan Mann, the charismatic Director of the Global Programme on AIDS utilised Brett Tindall repeatedly in WHO meetings concerned with the prevention of the transmission and the reduction of discrimination once transmission is established. Amongst the more important WHO appointments were those in 1991 and 1992 as consultant to various governments in the Western Pacific region to assist in the establishment of an effective HIV surveillance and policy. Brett Tindall did not just talk about Australia's relationship with its geographical region. He did something about it.
According to those who know him best, a critical moment occurred in Brett Tindall's life when he discovered when he was himself infected with HIV. The usual, one might say human, response to that discovery would be rejection, denial and despair:
"Close up the casement, draw the blind,
Shut out that stealing moon,
She wears too much the guise she wore
Before our lutes were strewn
With years-deep dust, and names we read
On a white stone were hewn."1
But this was not the response of a Badger. Brett Tindall's discovery coincided with the visit to Australia of Dr Robert Gallo, a famed scientist, now controversially associated with Luc Montagnier, in the identification of HIV. In a small workshop which Brett Tindall attended, Gallo was asked what he would do if he found that he was infected. One scientist who knew of Brett Tindall's late discovery of his own condition allowed his eyes to wander to the Badger as Gallo gave his answer. "I would spend the rest of my life trying to find a cure". Brett Tindall had his mission.
"'O where are you going?' said reader to rider
'That valley is fatal when furnaces burn,
Yonder's the midden whose odours will madden,
That gap is the grave where the tall return.'
'O what was that bird,' said horror to hearer,
'Did you see that shape in the twisted trees?
Behind you swiftly the figure comes softly,
The spot on your skin is a shocking disease.'"2
Brett Tindall has not discovered the cure for HIV/AIDS. Some sceptics say a cure will never be found. But he did concentrate his considerable intellect upon the task. His research, shown by his publication list, is phenomenal. And its central focus has been upon the process of sero-conversion and the body's responses to the entry of the AIDS virus into its midst. If the differential impact of the virus and of the available, rudimentary modes of treatment could be examined, out of the variations might spring ideas for the cure. They may not present a silver bullet cure. But they may point the way to the control of the infection and a scientific response to it which will save lives, reduce pain and prolong the quality of life of those living with HIV/AIDS.
I first met Brett Tindall at the IIIrd International Conference on AIDS in Washington in June 1987. He was, by then, two years into his mission. He was publishing furiously, usually with other heroes of the Australian scientific work on HIV/AIDS. Ron Penny. David Cooper. Basil Donovan et alios
. The Australian contingent in Washington stole away from the rest. We took an early dinner in a sidewalk cafe in the summer light. Ita Buttrose, who was then (as she still is) communicating understanding to middle Australia presided at this feast. By chance I sat next to Brett Tindall. So began a friendship which endures. I recall how he talked of his work and how it was the sense of urgency that he projected that was infectious. If only that infection would overtake the other.
My service on the WHO Global Commission on AIDS threw me into contact with Brett Tindall at the Stockholm IVth International Conference in June 1988 and at the Montreal Vth International Conference in June 1989. But then I drifted away from AIDS whilst Brett Tindall, true to his Badger instincts, continued to work at the burning furnaces.
In recognition of his original scientific work, the Faculty of Medicine of the University of New South Wales admitted him to an MSc programme. The University awarded him that degree for a thesis on "Factors Associated with Human Immunodeficiency Virus Infection and the Development of Acquired Immunodeficiency Syndrome". In 1993 the same University conferred upon him its Doctorate of Philosophy. And still the co-authored papers were produced addressed to the detailed scientific data and targeted upon the process of sero-conversion.
At the beginning of 1994 Brett Tindall went to Spain to attend the wedding of a friend. By chance again, I was there. But this time we did not meet. He returned to Sydney, struggling with illness. But he was ever determined and resourceful.
Brett Tindall's life has become a series of goals. He has not given up. He is an inspiration to friends and colleagues alike. And his work points the way to the ongoing struggle against HIV/AIDS. It is a copybook example of the lesson which one of his mentors, Dr June Osborn constantly taught. Good strategies - scientific and social - in response to HIV/AIDS must be based upon vigilantly observed and scrupulously recorded scientific data. Not out of myth and prejudice but out of truth will come the effective responses to this horrible and unexpected challenge to human health.
When I think of Brett Tindall. I think of his fierce determination, his sense of urgency, his prodigious industry and his happy mixture of attention to the scientific and social features of HIV/AIDS. He is an example and a model for all of us. He teaches lessons about the indomitable human spirit. When HIV/AIDS is finally tamed, Brett Tindall will have an honoured place amongst the heroes.
"Near the snow, near the sun, in the highest fields
See how those names are fêted by the waving grass,
The names of those who in their lives fought for life,
Who wore at their hearts the fire's centre
Borne of the sun, they travelled a short while toward the sun
And left the vivid air signed with their honour."3
Sydney, 1 July 1994
* President of the New South Wales Court of Appeal. Chairman of the Executive, International Commission of Jurists. One-time Commissioner of the WHO Global Commission on AIDS and Trustee of the AIDS Trust of Australia.
1. Thomas Hardy, Shut Out that Moon
2. W H Auden, O Where are you Going?
3. Stephen Spender, I Think Continuously of Those