by Marika Azzopardi

So many Maltese doctors have travelled far and wide and created niches for themselves within new medical settings around the world. Such is the case of Dr Mark Agius who left Malta in the mid-seventies to follow medical training in the UK.  Spending the first three years in General Practice training, he was obliged to follow a series of rotation jobs, which experience proved to be crucial to his eventual professional development.

Whilst in Malta to attend the 7th Malta Medical School Conference, Dr Agius shares some memories, “The very first job I held was in psychiatry. The area was new to me and whilst I went on to concentrate on General Practice, those first weeks probably did the trick. It eventually led me to change jobs down the line in 1996 and join  my old boss who was a senior psychiatrist in Luton.”

Dr Agius found himself immersed in a practice with 13,000 patients on board and taking on all the psychiatric cases. Then he changed roles in 1996, to work full time in psychiatry.

“I eventually became an Associate Specialist and was sort of co-opted into doing psychiatry.  Luton, 35 miles north of London on the M1, is a highly deprived area and there is a far greater chance of finding people with psychotic illnesses there than anywhere else. The inner city is particularly deprived and this provoked me to work towards getting funding to set up a specialised service in Luton.”

The funding totalled one million British pounds which amount the government was allotting for each county to set up early intervention services for psychotic illness. Dr Agius lobbied for his plan to be accepted, targeting the area which had no intervention services for early psychotic cases. One of the projects saw the involvement of two junior doctors with whom he checked 62 patients who were treated for early symptoms of psychosis in his team, and compared them to 62 patients who received treatment as usual in ordinary community teams. “A care coordinator would go out to meet each patient in town, take a walk or have lunch and discuss symptoms. Each patient learnt to recognise symptoms in the most friendly manner possible. It was a matter of assertive outreach and it worked.”

The project was significant in that its outcome proved to be a good illustration that a government policy of funding early intervention in patients with psychosis does help. The project also helped demonstrate how to measure the outcomes of mental health services in Britain. Eventually news of the success of the project obtained Dr Agius wider recognition, bringing in invitations to conferences wherein he could speak about his work and foresight.

“The project was a natural continuation on what I had discerned from the very start – the need of collecting data and analysing it on efficient computer systems that could help the general practitioner draw conclusions from his own stock of patients. At that time, psychiatry had not as yet started to delve into this potential and as I followed my new practice I realised how important for the medical field all this data keeping could become.”

Dr Agius started to measure rates of improvement using functional outcomes to gauge progress in patients. The Department of Health became  interested in this as it needed to study the population in question, the problems inherent within the area and subsequently make viable decisions regarding potential service requirements, staff required to man these services, and the kind of finances needed to make it all possible. The data also helped measure what was being achieved within the community.

Being highly pro-active has been the highlight of Dr Agius’ career so far. Presently he is involved in the Local Foundation Programme that provides junior doctors the chance to try out different specialities and gain invaluable experience. As early as 1987 when he was still a General Practitioner, Dr Agius had contacted Professor Rizzo Naudi who was at the time Parliamentary Secretary for the Elderly and offered him help. “It was that offer to give something to the Maltese community back then that led me to contact a small group of local family doctors and encourage them to set up the founding committee of the Malta College of Family Doctors. I acted as a link between the Royal College of General Practitioners and the MCFD and brought two UK doctors over to help with the launch of the college in Malta. I still remember the launch’s reception at Casa Leone. I am so proud of the fact that I had the privilege to enable the college to happen.”

Today Dr Agius is Associate Specialist in the Bedfordshire and Luton Partnership Trust, as well as being visiting Research Associate of the Department of Psychiatry at the University of Cambridge. In this capacity he has conducted research, scholarship and teaching and is involved in several ongoing activities as last yearwas the University’s 800th year celebration. “It is fantastic to be associated with such a prestigious University – just think of the fact that it has produced 41 Nobel prizes mostly in the Sciences. Yes, I have a lot on my plate and there is even more… I am quite interested in the folklore of the Mediterranean and get invited to different countries to give lectures… travelling Europe is my hobby and it has helped me compare notes and learn about what influences the Mediterranean draws upon. Yes, it has been a long journey of discovery all the way and still going strong.”