Treat Patients with Life-Saving Hepatitis B Meds

GlobalGiving Project Report March 2023

To our valued support team,

We have just returned from a very successful trip to our hepatitis B project in Papua New Guinea from March 4-11, 2023.  Because of COVID, this was our first visit to PNG since November 2019.  During our trip we conducted three clinics at Mamba, Embi, and Siroga and also saw patients at Popondetta General Hospital.  While our team concentrated on the care of patients infected with hepatitis B, we also saw uninfected patients with a wide range of medical problems.  We saw approximately 200 patients, conducted nearly 300 rapid tests for hepatitis, and started about 40 patients on treatment.  We were blessed to have Grace Moon, an expert sonographer, join our team whose insightful ultrasound interpretation greatly enhanced our diagnostic capabilities.  We also initiated discussions with the CEO of Popondetta General Hospital and managers at NBPOL (the company that supports our efforts) to renew and revise our Memorandum of Understanding.  As always, hepatitis B training of health care providers and public health education were important objectives.  A general lecture and public forum was held during one evening gathering.  Training of health care workers was done at each of the clinic sites and a half day lecture series was performed at Popondetta General Hospital.  Donations of medical equipment such as vital signs monitors, birth kits, EKG machines, fetal heartbeat monitors, and pulse oximeters were carried with the team and distributed to the clinics and Popondetta General Hospital.  One of our team members has a particular passion for childhood health education and gave several talks at local schools about hygiene and public health topics.

We were encouraged by the enthusiasm displayed by our colleagues in PNG.  There is a growing realization by policy makers in PNG of the magnitude of the public health problem that hepatitis B presents.  The unique partnership with a local business, the provincial health authority, government, and our non-profit NGO has become a widely recognized model to emulate.  It is significant that our project is the only hepatitis B treatment program that exists in all of Papua New Guinea.  We are hopeful that we can extend our model to other provinces in PNG.  We have entered into negotiations to establish a similar program in the Milne Bay region and plan to return every 6 months.

We are also busy with our other projects in Tonga, Fiji, Kiribati, and Myanmar.  Hopefully, we will have the opportunity to visit these locations within the next year.  Our next new project will commence in April, 2023 when two of our team members will travel to Madagascar.  Once again, we are so thankful for your support which helps us finance our treatment programs, bringing hope to areas greatly affected by this insidious disease.

With great appreciation,

David

To our faithful partners around the world.

Season’s greetings to all of you!  We pray for peace on earth and good health to each of you as we approach the end of 2022.   We are happy to report that HepBFree completed our first team trip to one of our overseas projects since the start of the pandemic curtailed our travel. 

During our trip to Kiribati from October 31-November 10, 2022, our group of 3 doctors and 2 nurses made a number of accomplishments:

-We provided direct patient care in 2 hospitals on the main island of South Tarawa and at 3 villages in one of the outer islands.  This care included upper endoscopy, colonoscopy, attending rounds on the internal medicine wards, hepatitis B clinics at each location, Fibroscan (to determine if liver fibrosis or cirrhosis is present), ultrasound evaluation, lab testing using point of care tests for hepatitis B, and distribution of anti-virals for hepatitis B.

-We donated over 6000 rapid hepatitis B test kits.

-We started over 100 patients on anti-viral treatment for hepatitis B.

-We donated 3 Olympus 190 endoscopes and a colonoscope.  Endoscopy had not been available in Kiribati for over 3 years because of lack of equipment. 

-We trained several local physicians to perform upper endoscopy and colonoscopy.

-We performed 18 upper endoscopies, including banding of varices and 2 colonoscopies, which revealed a colon cancer in one patient.

-We tested over 500 patients in the outer islands for hepatitis B.  Seventy-four of these were positive (prevalence of about 15%) and were started on treatment.

-We met with the nation’s Minister of Health and discussed further funding opportunities and strategies to eradicate hepatitis from the country. 

-We coordinated our efforts with other organizations working in Kiribati on antenatal care and tuberculosis surveillance by offering hepatitis test kits to their projects.

As always, we were struck by the lack of resources that are available, particularly in the outer islands.  All treatment for hepatitis, which affects about 15% of the population, is a result of the generous donations that you have made.  We plan to continue our efforts to secure additional grants, as our previous grant has now been completed. We will return for our next trip in the summer of 2023.

The new year plans to be busy for us as we juggle our “day jobs” along with trips to our projects.  In February and March we will visit Papua New Guinea with hopes of expanding our presence to the capital, Port Moresby, and Milne Bay.  In April two of our team will travel to Madagascar to investigate the initiation of a new hepatitis project there.

We thank you for your gracious and faithful support over many years.  We look forward to regaining the momentum that we lost during the pandemic and working with you to eradicate hepatitis around the world.

With gratitude,

David Hilmers and the HepBFree Team

Dear Team,

We send greetings to all our gracious supporters. We are hopeful that the worst of the COVID-19 pandemic is behind us now, and our medical team is looking forward to returning to visit some of our established projects and to start new ones.

Our first major journey will take a team of doctors and nurses to Kiribati from October 31 to November 10, 2022.  We plan to provide hands-on teaching, classroom lectures, and clinical guidance as we evaluate old and new patients.  We will be focusing on our program to interrupt the transmission of hepatitis B from mother to child which is the most common method by which our patients acquire the disease.  We will also be extending our outreach to some of the outer islands where the clinics are not as well equipped.  We will be bringing supplies, including endoscopy equipment, that have been donated or purchased with your generous gifts.

In February-March 2023 another team has been organized to travel to Papua New Guinea.  In addition to our long-standing project in Popondetta, we will be speaking with national and local governmental officials as well as business executives in Port Moresby and Milne Bay.  We hope to establish other provincial and possibly national hepatitis B programs in PNG where liver disease has a very high prevalence.

In April 2023 we will travel to Madagascar with an organization called Australian Doctor for Africa (ADFA).  This group has been working in Madagascar for many years, and we have had virtual meetings with the local physicians who will assist us in establishing hepatitis programs in the areas where they practice.  This is an exciting opportunity to extend our presence into Africa.

We are hopeful that a return to Tonga will follow thereafter.  We have been working with the World Health Organization to write national guidelines and provide further assistance to the program which started just as the COVID pandemic was evolving.  Our partners in Myanmar continue to do amazing work under the most difficult circumstances.  We have regular meetings via the internet to discuss patient care and teach topics of interest.  Communication with North Korea is still non-existent, but we pray for a revival of the program there, which in the past was our largest.

These are exciting times, and we are thankful to each of you for your continued support.  Take care of yourselves and each other.

With gratitude,

 David

Greetings to friends and supporters of Hepatitis B Free.

As always, we are very grateful for your encouragement, gifts and prayers.  We see encouraging signs that travel around the world is opening up again.  It is too early to say that the worst of the COVID epidemic is behind us, but greater understanding of the disease itself, improved therapeutics and increased vaccination rates make us hopeful for a better future.

We would like to provide you with a few country-specific updates:

Kiribati. We are currently planning a technical trip to the main island of South Tarawa and some of the outer islands in the October-November timeframe. The timing will be dependent on availability of our counterparts in Kiribati and the quarantine requirements for COVID.  Since our last report, our team has participated in the creation of the new Kiribati National Hepatitis Action Plan which is awaiting final approval by the government.  A new electronic medical record system, Tamanu, has been proposed to link hepatitis programs across the various island chains that make up the country.  It is hoped that software, hardware, and training for this system will be supported by the Australian government.

Papua New Guinea.  Our hepatitis activities at Siroga clinic have centered around case-based lectures, re-supply of hepatitis B medications, and training for laboratory personnel.  We are excited about possible opportunities to begin projects in the very remote Central Highlands region, the capital of Port Moresby, and Milne Bay.  A shipment of donated anti-fungal medications that treat one of the most common local skin diseases, called “grille.” is being sent.  We are planning on making onsite visits to our PNG projects early next year.

Myanmar. Our colleagues who work in the Putao project in northern Myanmar continue to amaze us with their dedication despite a very difficult political situation.  We have biweekly patient discussions via Zoom to provide consultations for over 300 individuals who are infected with hepatitis C and are being treated.  It is unlikely that our teams will be able to visit for the foreseeable future, but we plan to continue our close collaboration via teleconference.

North Korea.  As many of you may know, North Korea is in the midst of what is presumed to be a large outbreak of COVID-19.  We are deeply concerned about the situation in this nation because of the widespread malnutrition that we have seen during our patient encounters, the lack of medical infrastructure, and the absence of immunity (either natural or through vaccinations).  Many of our patients whom we were treating are immunocompromised due to hepatitis.  We are hopeful that this unfolding disaster will motivate the leadership to reach out to the world and accept humanitarian aid.

We have deep gratitude for your continued support, without which we could not continue to provide the services that we do.  We send our best wishes to each of you for good health and much joy in your lives.

Best wishes,

David C. Hilmers

Greetings to all our friends and supporters,

The New Year brings hope for relief from the ravages of COVID and for lifting of some of the travel restrictions that have hampered our efforts to combat hepatitis.  Travel in and out of Australia is now open to both residents and tourists which allows our volunteers greater access to our project sites.  While some of the locations, such as Kiribati, have partially opened to selected visitors, there are still quarantine rules in place upon arrival that complicate travel.  We are hopeful, however, that we will be able to visit some of our partner nations later in 2022.  We are very anxious to see our colleagues once again and to continue the progress that was being made before the start of the pandemic.  We are very grateful for your encouragement, gifts and prayers, particularly over the past two years.

We would like to provide you with a few country-specific updates:

Tonga. This small Pacific Island nation is one of our newest projects.  Our volunteer team visited the main island in March, 2020, just as the epidemic was beginning, in order to start a new hepatitis treatment program.  Many of you are aware of the volcanic eruption that occurred in January, 2022 which caused a thick layer of ash to cover the islands, contaminate water supplies and sever the only fiber-optic communication link.  Shortly after the eruption, a tsunami struck, leaving destruction in its wake. If this disaster was not enough, the international relief effort brought COVID along with much needed supplies.  Up until the eruption, there had only been once case of COVID in the country.  Over the past month there has been an additional 234 cases which has strained the local medical system.  A lockdown was imposed that has further complicated clean up efforts.  We were relieved to hear from our colleagues in Tonga that they and their families are safe.  The lockdown should be eased soon and about two-thirds of the population has been vaccinated against COVID.  Work on the fiber-optic network is nearly complete.

Kiribati. After opening its borders, there has been local transmission of COVID for the first time since the start of the pandemic, necessitating a lockdown.  Hopefully, this will soon be under control. Our team has been involved in the development of the National Hepatitis Plan which incorporates our goal of reducing the maternal to child transmission of hepatitis B.  Training sessions for local medical professionals continue. Dr. Thomas Russell, our program director and a native of Kiribati, continues to manage our efforts to expand hepatitis treatment from the main island of Tarawa to the outer islands.

Papua New Guinea.  Our hepatitis activities at Siroga clinic have centered around case-based lectures, re-supply of hepatitis B medications, and training for laboratory personnel.  We are excited about possible opportunities to begin projects in the very remote Central Highlands region, the capital of Port Moresby, and Milne Bay.

Myanmar. We have been very encouraged by the progress made in the Putao project where nearly 300 patients, many of them co-infected with hepatitis C and HIV, have been started or have completed a 12 or 24-week course of medication to cure hepatitis C.  In regular on-line meetings our team has reviewed each patient that has been placed on treatment in order to ensure the proper selection of medication and duration of therapy.  This has been a truly amazing project in which our partner, Medical Action Myanmar, has continued to provide top-notch care to these patients despite the political strife that has beset the country.  We feel truly honored to be involved in this program.

North Korea.  Our most extensive project to date has been in the DPRK. Unfortunately, we have received no updates from our friends and colleagues who labored beside us.  We continue to keep them in our thoughts and prayers as we wait for the lifting of travel restrictions.

We cannot thank you enough for your continued support, without which we could not continue to provide the services that we do.  We send our best wishes for a healthy and prosperous 2022 to each of you.

With gratitude,

David C. Hilmers