June 2023 Update
Dear friends,
We continue to be grateful for your faithful support of our projects. Our teams are now able to travel to most of our programmatic sites, but political issues and COVID restrictions are still barriers in other locations. We would like to update you on our latest activities.
Drs. Alice Lee and David Hilmers travelled to Madagascar in April, partnering with Australian Doctors for Africa (ADFA). Madagascar is extremely resource-limited, and most medical services are self-pay.
Local prevalence studies report hepatitis B prevalence of 8-20 % and hepatitis C of 2-3%. The priorities of the trip were to connect with key local partners to understand regional priorities and capacity to implement hepatitis programs. The first week was spent in the capital city, Antananarivo, where the team worked at the Centre Hospitalier Universitaire. Drs. Lee and Hilmers spent most of the week seeing patients in clinic, performing ultrasounds and fibroscans, and teaching during ward rounds. Endoscopy training was also supported with the introduction of several new endoscopic techniques. All procedures, including ultrasound, fibroscan and endoscopy, were provided free of charge to patients. Without these services many of the patients could not have been diagnosed and treated. In one case, a ruptured appendix was found on ultrasound and funding was provided by ADFA for the costs of hospitalization and surgery.
The second week was spent in the coastal city of Toliara at the University Hospital Toliara where the resources are even more limited. Patients presented with a range of medical issues including new diagnoses of cancers (gastric, esophageal, colonic, liver and likely hematologic), gastrointestinal bleeding, as well as a range of non GI issues including sickle cell disease and pneumonia. A number of patients travelled from remote villages where access to medical care is not available. Several patients required admission for further management including blood transfusions and antibiotics.
Dr. Lee performed many endoscopic interventions including banding of large esophageal varices, dilatation of strictures, and colonic polyp removal.
Hepatitis B and C testing was offered to all patients who attended the clinics at both locations.
Hepatitis B Free and ADFA donated 2000 rapid hepatitis B kits and 500 rapid hepatitis C antibody tests. Our team carried donations from one of our partners of 2 ultrasound machines, 4 monitors, and 8 oxygen saturation finger probes. This equipment was much needed and appreciated. Our team established contacts at both locations to assist in the development of hepatitis programs.
Because of the very long travel time from Sydney (35 hours), we will probably do most training and case discussions remotely. However, we plan to return with a team in 2024. The need for hepatitis care is substantial.
In April, we applied for two large grants from the Australian government for hepatitis work in Kiribati and Papua New Guinea. One of the grants is in partnership with a group working on tuberculosis and leprosy in Kiribati. The other grant is with a US partner in which we are proposing a medication distribution center in Australia. If we receive funding, this warehouse will allow us to buy hepatitis medications and medical supplies at highly discounted prices and distribute them to Pacific Island countries. This process would allow us to economize on transportation costs. There are many large organizations applying for these grants, so the competition for funding is quite fierce. We are cautiously optimistic about our chances, but we should hear whether our proposals made the cut within the next several months.
Our next trip is to Kiribati in June where we will be participating in a training session for health care providers from some of the remote islands. We hope to introduce a new data base system that will simplify record-keeping and provide direct medical care.. Your donations help to make such opportunities possible. We cannot thank you enough for your support.
Sincerely,
David Hilmers and the Hepatitis B Free Team
