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Changing shape, changing needs

18 October 2013

As Mildmay celebrates its 25th anniversary, Rebecca Paveley hears how it is still pioneering in HIV care, at home and now also abroad


An artist's impression of the garden space to the rear of the new hospital building, intended to be completed next year.

An artist's impression of the garden space to the rear of the new hospital building, intended to be completed next year.

WHEN Mildmay Hospital opened its doors in the late 1980s to care for patients with HIV, it was intended to be run as a hospice. Patients, largely white gay men, came to the hospital for end-of-life care.

Twenty five years later, with rapid advances in medication and subsequent life-expectancy for people with HIV, the patients who come to Mildmay now come for rehabilitation, with three quarters of them returning home afterwards to live independently.

The hospital now specialises in treating the neurological problems that can come with late stages of the disease, and is the only hospital in Europe dedicated to the rehabilitation of people with HIV-related brain disorders.

Despite improvements in medication and awareness, HIV is still one of the fastest growing serious health conditions in the UK, with about 7000 new cases every year. Up to 100,000 people are living with HIV in Britain, although about a quarter are thought to be unaware that they have the disease.


THE profile of the patients who come into the hospital has also changed in the past quarter of a century, the executive director of Mildmay, Ross White, says. "Now, two-thirds of patients who come to us are heterosexual, a large proportion of whom are from overseas, places like sub-Saharan Africa. We can treat very young patients - 18-plus - who were born HIV positive; but more and more are older people living with HIV.

"They tend to have motor problems and cognitive issues, as well as behavioural problems. They get 'blue-lighted' in to us from an acute hospital, and we focus on getting them to back to health from a seriously ill state."

Mildmay remains a Christian hospital: its motto is "Life in all its fullness", and the care it provides is holistic: spiritual, as well as physical. Its money may now come from referrals from the NHS, as well as charitable donations, but in ethos it is true to its founder, the Revd William Pennefather.

The Vicar of nearby St Jude's, Pennefather developed a number of projects known collectively as Mildmay Institutions, providing spiritual guidance and care for the sick. But it was the 1866 cholera epidemic that established the nursing service for which it became famous. Two of the Mildmay deaconesses volunteered to go into some of the worst slums in London, where even the police feared to enter, to care for the sick and their dependents.


THE first Mission Hospital was established in a disused warehouse near to Shoreditch Church. It consisted of 27 beds, in three wards, one doctor, three nurses, and five deaconesses in training.

In 1892, Mildmay Mission Hospital opened, becoming a part of the NHS in 1948, but, as a hospital with fewer than 200 beds, it was regarded as uneconomic, and was closed down in 1982. Six years later, after campaigning, it reopened to care for patients with HIV.

Another new chapter in Mildmay's history will open next year, with the completion of its new hospital building on the site of the demolished Victorian building. The new hospital will provide 26 beds for inpatients, with specialist rehabilitation as well as a centre for outreach work in the community, and training facilities.


MILDMAY has also expanded its reach overseas, and has large testing and treatment projects in Uganda and Kenya.

It was approached by the Ugandan government to set up a programme. Since then, it has grown to be the biggest HIV care and treatment provider in central Uganda. Currently, about 45,200 people receive care and support from Mildmay Uganda every year.

The work is supported financially by the government of the United States - the last Bush administration pumped billions of dollars into testing and treating HIV AIDS in Africa.

Mildmay's Kenyan project works with those who are marginalised and cannot access treatment, whether they are orphaned children or prisoners. But some projects in countries such as Rwanda have had to close, owing to lack of funding.

"When Mildmay began in the slums of Shoreditch, it was working with orphans, sex workers, and itinerant workers," Mr White says. "Now our work has spread to other parts of the globe; but we are still working with the same marginalised people."

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