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Treat Patients with Life-Saving Hepatitis B Meds

by Hepatitis B Free
Treat Patients with Life-Saving Hepatitis B Meds
HBF with clinic nurses in the Kingdom of Tonga
HBF with clinic nurses in the Kingdom of Tonga

To all of our supporters:

The COVID-19 pandemic has proundly affected each of our lives, whether we have suffered from infection or not.  Many of us have a friend or family member who has been ill from the virus, and we have all experienced the social and economic challenges that have changed our world.

Hepatitis B Free has likewise been affected.  Some of our team have been directly involved with COVID-19 patient care in Australia and in the USA.  Our ability to visit our projects has been entirely curtailed by travel bans on international travel by our home countries and by the countries in which we work.  In North Korea shipments of essential supplies such as medications and lab equipment have been halted because of quarantines on imports.

Despite these limitations, we continue to press ahead.   We are holding regular teleconferences to train and discuss cases with our colleagues in other countries.  We are pressing ahead with donations of hepatitis medications to ensure that there is no disruption in the distribution of life-saving drugs to our patients.  Where needed, we have arranged for transfesr of medications from one country to another if supplies run low.

We are pleased that a paper describing our program in Kiribati has been accepted for publication.  We will post a copy on our website once it is in print.  We have submitted another paper, currently under review, which describes the prevalence of chronic hepatitis B in Oro Province, Papua New Guinea, where we have a project.

We are laying the foundaton to start our trial of tenofovir to prevent maternal to child transmission in pregnant women in Kiribati.  Once we are able to travel again to Kiribati, we hope to have this important study underway.

We are indebted to you for your support, especially during these difficult time.  Please know that we endeavor to use 100% of donations towards direct patient care.  Please stay safe and healthy.

Best wishes,

David C. Hilmers

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We wish all our supporters a very happy New Year and a prosperous start to a new decade.  We are pleased to report several significant advances in our programs and are thankful for the continued support that we have received from all of you.

Grant approved for new program in Kiribati.  We recently received news that funding has been approved to begin a program to prevent maternal to child transmission of hepatitis B in pregnant women in Kiribati.  This project will use anti-viral medications to lower the risk of transmission of hepatitis B to newborns from their mothers with high viral loads.  In addition, the program will support testing and immunization of individuals at high risk of contracting hepatitis B.  This program is funded for two years, and we hope that it will be self-sustaining thereafter.

New Pacific Island programs.  The team is currently traveling to the beautiful island of Tonga to work with this country’s Ministry of Health on the initiation of a national hepatitis B treatment program.  This represents the latest of a growing number of treatment projects supported by HBF that have started in the Pacific, including Kiribati, Fiji, Papua New Guinea, Vanuatu, and East Timor.  Our support includes the purchase of medications, training, and direct patient care.  We are also in discussions with the WHO to provide assistance in the Solomon Islands and Samoa.

Active Projects in Myanmar.  A team of 3 physicians from HBF traveled to Myanmar in January, 2020 to provide training and support for a new project in the most northern part of Myanmar.  There are large numbers of patients in this area co-infected with hepatitis C and HIV.  We are coordinating with our partners from Medical Action Myanmar (MAM) who have received a grant to treat these patients.  HBF will provide the technical support and some of the supplies needed to carry out this program.  In addition HBF will support another partner, the Myanmar Liver Foundation (MLF), on a large-scale hepatitis B vaccination program that is in progress in remote areas of Myanmar.

Progress in Papua New Guinea.  A team from HBF visited our hepatitis B treatment project in Popondetta, Papua New Guinea in November, 2019.  We are happy to report that the first patients are now on treatment, and new laboratory equipment is being purchased for our clinics located in Oro Province.  The results of our efforts there will be presented at a conference in Indonesia in early March.

Challenges in North Korea.  Our team last visited North Korea in October, 2019 with expectations to return in March and May of this year.  However, the country has decided to close its borders to foreign visitors because of the corona virus outbreak.  As a result, our scheduled visits are currently on hold.  Fortunately, adequate supplies of medications have been delivered that will support the continued treatment of the 2000 patients who are receiving life-saving drugs.

We are looking forward to a busy and productive year.  As always, we are extremely grateful for the continued support from each of you. Without your help, none of this would be possible.

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We continue to expand our programs in new sites and consolidate the gains we have made in established projects.  All of this is made possible by you, our generous supporters.

North Korea.  Drs. Alice Lee and David Hilmers spent a busy 9 days in the DPRK, holding clinics in 4 different cities, Hae-ju, Kae-song, Pyongsong, and Pyongyang.  This visit marked the first appearance and utilization of a GeneXpert machine, the gift of a generous donor.  This machine allows us to measure the quantity of hepatitis B and hepatitis C viral particles in a patient’s blood.  As a result, we will have improved capacity to diagnose which patients will need hepatitis B treatment and now have the capability to treat patients with hepatitis C.  With 12 weeks of therapy for hepatitis C, about 90% of those taking the medications will be cured.  We started our first 50 patients on treatment for hepatitis C and now have over 2000 patients on life-saving medications for hepatitis B.  This program has been successful beyond our wildest expectations, but we are always aware that the political climate can change at any time.

Tonga and Vanuatu.  We are happy to report that new hepatitis B treatment programs are about to start in these two Pacific Island nations.  Local program managers have been identified and infected patients have been screened.  Anti-viral medications have been purchased by Hepatitis B Free to start the first patients on therapy using funds from our donors, and they will arrive soon.  Our medical team will visit these countries near the start of the new year to help train local physicians.

Papua New Guinea.  This continues to be one of our most challenging projects.  Medications to treat hepatitis B have arrived, but lack of resources in local laboratories who are tasked with analyzing blood samples for routine tests have slowed the pace.  The first patients have been started on medications, and we are considering buying some modern blood analyzers for the clinic in Popondetta to obtain lab results more quickly.  Drs. Lee and Hilmers will visit Papua New Guinea later this month.  This program has great potential, and after 6 years of labor in PNG, we are committed to its success.

We will continue to provide quarterly updates on these and other projects in Fiji, Timor Leste, Myanmar, and Kiribati.  As always, we are indebted to you for your support.

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Hepatitis B Free Project Report.  August, 2019.

Our volunteers continued their work across the Pacific during the past 3 months and we are happy to report the progress that has been made.  With your support and generous donations anti-viral medications purchased by Hepatitis B Free have been shipped to Fiji and Papua New Guinea.

Vanuatu and Fiji.  Dr. Alice Lee visited the island nation of Vanuatu in July to explore the implementation of a hepatitis B treatment program with members of the Ministry of Health.  There appears to be enthusiasm for a new program in Vanuatu, and we are investigating grant opportunities. Dr. Lee continued on to Fiji where she delivered a number of lectures to local physicians.  Anti-viral medications that were purchased by Hepatitis B Free have arrived and patients will soon be started on treatment.

Kiribati.  In July, Sue Huntley and Aidan Foy went on their second trip this year to Kiribati.  They were happy to meet the new Hepatitis Project Officer. They found that a number of their recommendations from the previous trip had been adopted, including increasing hepatitis clinic time and the addition of a dedicated hepatitis clinic nurse.  The clinics that they attended were functioning smoothly, and more patients have been referred for treatment. The trip corresponded to World Hepatitis Day, and the Kiribati Health Promotions Department organized activities including health fairs in which hepatitis information booklets were distributed, question and answer sessions were conducted, and point of care hepatitis testing was performed.  Patients testing positive were referred to the hepatitis clinic for treatment.

Sue and Aidan were able to visit one of the neighboring islands, Abiang, for the first time.  It is about two hours by speed boat from the main island of Tarawa. They evaluated the health care facilities on the island to see if a hepatitis B treatment program can be supported in the outer islands.  The local health care providers are very enthusiastic about starting such a project. 

Papua New Guinea.  We were pleased to have an infectious disease physician from the United Kingdom, Dr. Luke Mair, spend three months volunteering in Popondetta.  He was an extremely valuable asset to both the local clinics and to Popondetta General Hospital. Shortly after Luke left PNG, anti-viral medications purchased by Hepatitis B Free arrived in-country, and patients who have already been screened will be started on life-saving therapy.  A return trip by our volunteers is scheduled for later this year.

North Korea.  Drs. Alice and Lee and David Hilmers will be traveling to North Korea in October to continue the work of Hepatitis B Free there.  We currently are working in clinics in five different cities and have nearly 2000 patients on therapy with more being added on each trip.

Once again we thank you for your tremendous support of our work.  We can see the difference that your generous contributions are making in the lives of those to whom we reach.

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May 20-22, 2019

Written by Dr Alice Lee on behalf of trip team Drs Alice Lee, David Hilmers & Thao Lam.

The HOPE C project in Yangon is about to be completed. One hundred ninety-three patients have started hepatitis C treatment, with 18 remaining to start at Myanmar Liver Foundation (MLF). There are enough medicines left to treat 40 people. With this first cohort of patients about to finish, we have been asking, what next for the program? This is where Putao comes in. Putao, Myanmar had been proposed by MAM (Medical Action Myanmar) as a potential site to expand our work in hepatitis C treatment.

Putao is a city in the northernmost part of Myanmar, only accessible by air. It is home to 60,000 people, who are mostly farmers, miners and mountain herb gatherers. It is cold in winter and surrounded by mountains. MAM have worked in Putao since 2012, where they provide care for a community, many of whom are “persons who inject drugs” (PWID). This region has one of the highest rates of PWID in Myanmar. There is no hepatitis treatment here, and the closest treatment centre is more than 14 hours away by bus.

Thao, David and I arrived in Yangon on Saturday 18th May. At 5:30 am the next day, we went back to the airport to fly to Putao with Dr. Thet Myat, the hepatitis program officer at MAM. This was also her first trip to Putao. It was a four-hour flight with two twenty-minute stops along the way. We worked on the talks for the day and tidied up our laptops. I tried to mentally prepare for what needed to be done. I needed to get a good handle on this, have realistic expectations and develop some relationships.Putao represents many challenges. First, we needed to assess whether it was feasible to work here. But at the same time, is this not why we organized Hepatitis B Free in the first place? -- to work in areas where it seems too hard, whatever the reason may be and to help those who are least likely to get help.

Putao felt immediately different from Yangon. China is to the east, and India to the west, a 7 day walk over land and 6 hours or so by car to the other side. I was told that there are no real check points at the border, but the soldiers on the Indian border will shoot to kill. We were met by customs officers who scrutinised our passports. We need special government permission to be anywhere but in the town. We were picked up by the program medical coordinator in Putao. (This is his fifth day on the job). We checked into a local hotel and made our way to the MAM office where we were greeted enthusiastically by the Medical Director and the Organisational Director. They came to Putao ahead of us with the Global Fund audit team. We get to know each other and plan the one and a half precious days we have here so as to make the most out of our time.

We arrive at the MAM clinic and are met by a very young but enthusiastic group of doctors. The success of a new hepatitis program will rely on them. These doctors come from all over Myanmar, the most junior having graduated only 2 months prior and the most senior 4 years ago. We spend the afternoon chatting and getting to know each other. They are excited to have us here. David runs a hands-on ultrasound training session, with local doctors as models. There is a palpable excitement in their desire to learn, quickly replacing my reservations about the youth of the group.

The clinic lies at the end of a long driveway of dirt and gravel. Chickens roam freely. There is a needle exchange box at the entrance of the driveway; gates are closed for security; the staff house on the left has laundry hanging over the fence and wherever there is space. It seems fitting for a house for young men. The clinic has two medical and two counselling/consulting rooms, a dispensing area, a waiting room, reception, a data room, a lab, and a kitchen. Apart from the ultrasound, there is a small nebulizer, one sphygmomanometer and a small pulse oximeter. The doctors would like a little more. This is the better equipped of the two MAM clinics.

We had dinner with Ye Aung, Thet Myat and Yan Lin Aung at the dining pavilion at the hotel. We sit in a hexagonal room with a bar at one end, one of just two tables of people in the restaurant. Deer heads feature in the centre, looming over the drinks. The menu includes dried venison, and lots of garlic, onions, chillies and salt on top of piles of white rice. Discussions bounce between sharing stories of our journeys to date, what we would like to do here and the challenges that lie ahead. I don’t imagine for a moment that any of us sitting together are naïve as to the task that lies before us. I am reminded of the goal of Hepatitis B Free – to help and provide services where it seems impossible. Putao seems like the perfect fit.

The next day we start with a local breakfast of noodle soup, sticky rice, toast, “two in one” (tea, coffee and powdered sugar/milk), and walnuts. At the opposite end of the dining hall is a team from Canada here to train local pastors. Christianity is the most common religion in this area – many cross the border to India to study, then return to set up a church. Some villages have more than 2 churches.

Our first stop is the methadone clinic at the Putao hospital. It is nothing more than a small stand-alone building with 3 small spaces, including a waiting room, consult room and a dispensary. Two ladies in uniform sit behind a barred window and dispense cups of methadone. More than 200 people come each day. In just 30 minutes, at least 10 people come by, mostly on bike to collect their daily dose. No fuss. Next door is the back entrance to the hospital, a square building surrounding a central courtyard. We glimpse into the wards and see the windows without glass frames, metal beds with minimal bedding, and no flow of air. Patients are lying on their beds, and some have a person sitting nearby, presumably a caretaker. In one corner of the hospital, the doctor rounds with the nurses. Otherwise, it is a quiet area with very little activity.

We make a short visit to the lab. The power is unreliable and there is little here, rapid tests remain the basis of most laboratory assessments. Machines including fridges are plugged in, but none are on and most are empty. One patient waits in the corner, the kindly lab technician looks on as we walk around. The ART clinic is one room with a curtained space for consults with the doctor and a table with the meds for dispensing. Discrimination and privacy are not major concerns here.

We head to the MCB clinic, about a 30-minute ride from the hospital. Two physicians ride ahead of us on their motorbikes – the deputy project medical officer and the preventative doctor – and three ride in the back of the car with the back wagon flipped down. David offers to ride in the back but we know it is useless. It is unusually hot and humid today. There are mountains every direction we look, green pastures and lots of cows. There is little traffic, just the occasional truck, army vehicle, car or motor bike.

Waiting for us at the MCB clinic is the team leader doctor, who has just graduated two months ago from medical school. He now leads a clinic that cares for over 1000 patients and also covers the nearby hospital when the local township medical officer is away. Sleeping in a room on the second floor of the clinic, his job is his life. He must look forward to the weekends when he can head back to the main clinic to socialize (drink and smoke) with his fellow medics from clinic #1. Despite his seemingly extreme youth and inexperience, he had identified a young 24-year old woman who came to his clinic soon after giving birth to her second baby with abdominal pain, low grade fever and a mass. Local physicians had diagnosed a liver cancer based on ultrasound findings, and he wanted us to review her case. Her husband was a PWID, and she was found to have a positive hepatitis C antibody test, but otherwise she was well. She was back to her usual routine, attending to the farm and caring for her two young children, one now 2 months old. Hearing her story, examining her and completing an ultrasound, we wanted her diagnosis to be anything but a liver cancer, but an alternative diagnosis seemed less and less likely. With no blood tests, no pathology, no other imaging, we needed to come up with a reasonable action plan. As best as we could, we tried to explain what we thought. Her response was unexpectedly calm, without hysteria or tears, simply, “I would prefer it out of me if possible.” We all hoped this would be possible. However, the reality was that we needed to do further tests and at best, if she could have an operation, it would cost over $1000 USD. This was well beyond anything that was within her family’s reach. A 24 year-old lady with a possible life-saving intervention at that price….we thought. MAM would have a policy and we needed to ensure that we were not crossing boundaries.

In the afternoon we travelled down the main road and off a short dirt track to a village. MAM signs and a needle sharing box identified our destination, a simple structure with a palm roof, bamboo floors and windows framed with colourful cotton curtains. It was both home and clinic to the community health workers (CHW) who had been providing first-line care to her village for nearly two years, and she lived here with her three children and husband. PWIDs come to the clinic for needle exchange and general health needs. Her main concerns are that the needles are not returned and that they steal her chickens. We promised to look into that. Outside we saw just one chicken roaming around with her chicks. Three patients were invited to come and share their story. The first was a 34-year old opium turned heroin addict who has now been abstinent for 5 months. He tested positive for HIV and HCV. He was unaware of his status, but happy that he can support his family. He would do whatever the doctors recommended to stay well. The next two were women, both hepatitis B positive. The first lady had three children, all under the age of six, and her husband is a PWID. She gave birth in hospital, and her baby was vaccinated. The second women was found to be hepatitis B positive before the delivery of her youngest baby – one of five children. Although she delivered in the village, her baby received the birth dose hepatitis B vaccine. Having been advised of its value, her husband took the baby to the hospital within 24 hours of delivery to have their first dose. However, none of her children nor her husband have been tested.

There is much to do in Putao, and a lot of it is very simple. Sitting on the floor of the clinic room, in a circle with the local doctors, my head spun in a million and one directions, trying to process it all and form a strategy. I felt a sense of familiarity in this space, so similar to Papua New Guinea in its physicality, but different in people and culture. The team was waiting back at the main clinic at the promise of a training session. The heat was finally subsiding, replaced by wind and a sudden welcome downpour. We narrowly escaped getting soaked. The projector was set up in the waiting area, wooden benches lined in row, an open-air teaching space against the backdrop of tall bamboo trees. Over the next two hours, eyes were glued to the projector, and despite my computer screen blacking out with power cuts, the doctors interrupted with questions along the way and not a single head nodded off in a nap. I am pleased to share what I can and wished we had more time together. As we closed the session, we wanted to encourage and say that we will do whatever we can. I wanted them to know that they are not alone in this. We promised to train and be back, no matter what, and this promise we know we can keep. I just hope that some of these doctors will still be here.

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Organization Information

Hepatitis B Free

Location: Linley Point - Australia
Website:
Facebook: Facebook Page
Twitter: @hepatitisbfree
Project Leader:
Alice Lee
Linley Point, Australia
$35,205 raised of $95,000 goal
 
149 donations
$59,795 to go
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