World Hepatitis Day - 19th May

We organized a mammoth campaign to raise awareness on Hepatitis and educate people about prevention from this group of viral diseases on World Hepatitis Day, 19 May, 2010 The programme comprised a wide range of exciting activities and events aimed at reaching out to a large number of people in the community and enable them to protect themselves from Hepatitis B and C.

The highlights of our programs is as follows :

Activity- Screening of Hepatitis-B

Places- SGPGI, Civil Hospital, Vivekananda Polyclinic and St.Joseph Hospital 

Materials Used- Screening kit, vaccutainer, syringes, cotton, spirit, ternicator, centrifuse, registration format, result format

Three days camp in Civil hospital and St. Joseph hospital, two days camp in Vivekanand polyclinic and one day camp in SGPGI  were organized with support of Pharma company and  hospital administration  by Liver foundation on the occasion of world hepatitis Day. Two days camp in Central Reserve Police Force, Lucknow was also organized.  Total 4399 persons were screened and 127 tested positive among them.

 Details of Screening Camp

Hospitals	Date	Number of Screening	Number of Positive
SGPGI	19/5/10	585	37
Vivekanand Polyclinic	20/5 & 21/5	1090	40
Civil Hospital	17,18 and 19th	1051	17
St. Joseph	17, 18,& 19th	850	22
Sair Pur Bazar	22/5/10	78	3
CRPF Camp	2 & 3rd may	745	8
Total		4399	127

Activity- Radio- Mirchi Campaign

Three days advertisement in Radio-Mirchi was broadcasted in every 15 minutes. Jingles were prepared on hepatitis awareness. 20 seconds jingles were made on how Hepatitis- B spreads, hepatitis B vaccination and  regarding World Hepatitis Awareness day. Four different jingles were prepared on four different messages. This was aired in set interval of 15 minutes from 7 am to 9 pm from 16th to 19th may. RJs of Radio mirchi discussed on hepatitis in their own style to give the information to audition. On 15^th may special interview of Dr. Choudhuri was aired for 45 minutes. He talked on various issues related to Hepatitis. 

Activity-News Paper Advertisement-

Half page Colored advertisement was printed on leading newspaper Times of India, Hindustan times, Dainik Jagran and Pioneer Times. These four newspaper reaches to cover around 95 percent population in central Uttar Pradesh.

Activity-SMS Regarding Hepatitis Awareness

One lakh and ten thousand people got SMS on World Hepatitis day regarding its prevention and vaccination. SMS were sent at 8.45 am on 19^th may. Hundreds phone received on number given on message. Queries were to know about vaccination and screening camp. Lot of people turned in camps after receiving this message.

Meassage-

Today is world Hepatitis Awareness day. Protect yourself & your loved ones against hepatitis-B by getting vaccinated. Call Liver Foundation-91-8127455440

Activity- Puppet Show on Hepatitis Awareness.

This activity was specially designed to cover the rural and sub urban people around lucknow districts. One hour show on hepatitis awareness was prepared in story form which was shown through puppet. 30 villages were covered in 15 days. One day two villages were covered. Don Bosco institute in Mohanlalganj supported well by pre announcement of the program in villages, they also distributed pamphlets regarding hepatitis before puppet show. Questions regarding hepatitis- B were asked to the people after each show and prizes were given to the persons who gave correct answers.

Activity- Advertisement on Railway Platform-

Slide on hepatitis were put in glow sign board above the railway reservation chart on 5 different platform of Lucknow Railway station. Size of the advertisement board was 6 by 2 feet. This was advertised from 5^th may to 31^st may. It was 24 hours advertisement. Four different slides on way of Hepatitis spreads, prevention and vaccination were made.

Activity- Slide show in Picture Hall

Slides showing the different aspects of Hepatitis shown in five different picture Hall of lucknow, From 5^th may to 31^st may. One minute slide show in picture hall before start of film and during intervals in each show for 25 days was arranged. 

Plans for World Hepatitis Day on May 19th

Liver Foundation

We are planning to organize a mammoth campaign to raise awareness on Hepatitis and educate people about prevention from this group of viral diseases on World Hepatitis Day, 19 May, 2010. The programme will comprise a wide range of exciting activities and events aimed at reaching out to a large number of people in the community and enable them to protect themselves from Hepatitis B and C. We plan to reach out to all strata in both urban and rural areas around Lucknow.

Main activities for the week are listed below:

Date		Activity
6th -19th  May		“Video On Wheels” We aim to make awareness about Hepatitis in semi- urban and  rural areas through events like Puppet shows and film show on Hepatitis. A 30 minutes puppet show will be followed by 20 minutes Doumentary film  “Ek Prayas Jindagi ki or”. A Van which will be branded as “Hepatitis awareness van” will follow pre -planned route. Pamphlets on hepatitis will be distributed in large number. Around 30, 000 people  from 30 villages will be sensitized .
10 - 19 May		Skit is the most creative and easy method to propagate awareness. They will be organized at public places like railway stations, markets etc. It will be followed by quiz and attractive prize distributions. We expect to reach out 2000 people through this.
19th  May		One Lakh people in lucknow and surrounding districts will get SMS on 19th about Hepatitis world day
10-30 May		Large advertisement boards containing information about the hepatitis will be put up at the Charbagh railway station. It is expected that 200,000 people will view this.
19th May		Health messages on Hepatitis will be aired on Radio Mirchi which reaches both urban and rural audience.
19th May		Newspaper advertisements will be published both in leading newspapers like Hindustan Times, Times of India, Danik Jagran etc both in Hindi and Englih.
19th May		Pamphlets realted to hepatitis awareness will be distributed at various places as well at the screening camps.

 Screening of HBsAg                  

Free screening camps for HBsAg will be held in six hospitals. Three days’ camp will be organized at each site with collaboration of local hospital staff. Hospital staff, patients and general public will be encouraged to get theselves tested for HbsAg using a slide test card. Those found negative will be provided a pamphlet carrying instructions on vacciation. Those testing positive will be advised to consult specialists for furter work up and treatment.

The health care workers (hospital staff), who test negative and have not received Hepatitis B vaccination, will be provided the 1^st dose of Hepatitis B vaccine on 19^th May and advised to come for 2 more doses at 1 and 6 months to the same venue where the subsequent shots will be provided free of charge.             
The list of the hospitals covered is:

·        SGPGI

·        Civil Hospital

·        Vivekanand Hospital

·        St. Joseph Hospital

·        Program at Sitapur

·        Program under guidance of  Dr. Alok Mishra from Allahabad 

Liver Foundation Meeting

Dr Sanjeev Arora, noted Hepatologist and researcher from USA was recently in Lucknow as a visiting professor at SGPGI. He is the innovator of ECHO project. One of the most innovative way to take management of complex diseases to smaller towns has been devised through ECHO project running successfully in US. Addressing a group of 85 Gastroenterologists and physicians at Liver foundation meeting on 25^th Feb at Hotel Clarks avadh, Dr. Sanjeev Arora, director and principal investigator of Project ECHO described how this project is helping various patients of liver disorders. 
Dr. Sanjeev Arora is Professor of Internal Medicine at University of Mexico Health Sciences Center, USA. He has provided a unique project known as ECHO project for which he is internationally known. The ECHO project helps interactions between doctors, specialists and patients and has been immensely successful in extending care and improving community Healthcare outcomes. He discussed this innovative strategy that may help us towards improved care of liver patients in U.P.

This project helps take management of complex diseases to smaller towns under the co supervision of specialists. ECHO is one model of care coordination, with primary and specialty care providers working together to care for patients using tools such as videoconferences and shared electronic records. Because of severe shortages of specialty providers in rural areas, people with complex conditions such as hepatitis C or several other chronic diseases often have to travel long distances or wait months to get treatment.

An innovative project conducted by Dr. Sanjeev Arora in New Mexico uses telemedicine, case-based learning, and disease management techniques to expand access to care for patients with hepatitis C and other chronic, complex diseases. Specialty providers based at the University of New Mexico help guide rural community health providers in applying best practices to manage care towards the rural patients. They create local specialists who by this process of monitoring learn to provide a high standard of care to patients attending their centers. Project Extension for Community Healthcare Outcomes (Project ECHO) is designed to enhance the capacity of community health care providers to safely and effectively treat chronic, complex diseases such as hepatitis C in New Mexico's rural and medically underserved communities.  Project ECHO has expanded access to care for hepatitis C patients who otherwise would not have received treatment.

This system also has a Force Multiplier Effect. According to this more people can be treated using similar high standard protocol. Project ECHO recently launched a program to use the Knowledge Network model to train community health workers throughout the state. Project ECHO demonstrates that care delivered by primary care providers in rural areas and prisons can be as safe and effective as that provided by specialists in academic health centers. The goal of the project is for community providers to gain enough knowledge of hepatitis C care to become self-sufficient, though they can continue to access the Knowledge Network clinics as needed.

Dr Sanjeev Arora’s visit and talk have generated enthusiasm as SGPGI is gearing up to join the project from Lucknow.

by  Ankita Parihar                                                                                                            

Forthcoming Events of Liver Foundation

We are delighted to announce that Dr. Sanjeev Arora, an eminent Hepatologist from USA will be visiting Lucknow in February 2010. He has kindly consented to deliver a talk on our "Liver Foundation" meeting on 25th February evening.

Dr. Sanjeev Arora is Professor of Internal Medicine at University of Mexico Health Sciences Center, USA. He has provided a unique project known as ECHO project for which he is internationally known.

The ECHO project helps interactions between doctors, specialtists and patients and has been immensely sucessful in extending care and improving community Healthcare outcomes. He will discuss this innovative strategy that may help us improve care of liver patients in U.P. We request all members to keep themselves free on evening of 25th February for this meeting. We look forward to meet you all on 25th evening at Hotel Clark Avadh.

This can give all of you an overview of what are the current activities in the ECHO project -
http://www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2009/November-December-2009/Case-Study.aspx

Hepatitis C

Hepatitis C, a small RNA virus that causes infection and damage to the liver, had its moment of public recognition when the well-endowed silverscreen celebrity Pamela Anderson of Baywatch fame got diagnosed with it. The way she contracted it was equally sensational: she had shared the needle for a skin tattoo with her boyfriend, Tommy Lee, who carried the infection. The gossipy tale went further to her litigating against him for concealed the information, but as often happens there, they finally united by wedlock!

Hepatitis C infection is indeed more common than most of us probably know. Of all us who consider ourselves perfectly healthy and volunteer to donate blood, 1% harbour the infection. In other words, approximately 10 million people in India have the infection and do not know it.

Hepatitis C virus is a stealthy one that hardly ever produces jaundice, the commonly known symptom of liver disease. It lodges in the liver and nibbles away at its cells over years. During this phase of 10-20 years, the host has hardly any symptom and hence does not seek medical attention. When considerable liver damage has resulted in liver cirrhosis (20%develop it), symptoms begin to appear: lethargy, fatigue, swelling of the feet, abdominal distention or vomiting of blood, drawing attention to this underlying cause. It also increases the risk of developing liver cancer.

There are 2 common scenarios: one is of a person in forties, who, while undergoing blood tests for a visa application or executive checkup finds his liver tests (SGPT) to be abnormal, and further tests reveal the cause to be Hepatitis C; or tests positive during screening for blood donation. Almost invariably, when asked, they recall having had a blood transfusion, surgery or injections with non-disposable needles. These are the lucky ones as their liver disease is usually not advanced, and stand a good chance of cure with anti-viral treatment.

The other scenario is of a person, who presents with symptoms of Liver Cirrhosis, having had a blood transfusion from a commercial blood bank 20 or more years ago. They do not tolerate treatment well, their disease progresses relentlessly and find themselves in need of a liver transplanation.

Hepatitis C is the cause of liver cirrhosis in 20 -30%, alcohol and Hepatitis B being the other common ones. Any person who has underone a blood transfusion or surgery should get himself tested for this infection, as should anyone whose liver function test shows derangement. If diagnosed before much liver damge has occured, the infection is curable. Antiviral treatment consists of weekly injections of Interferon and daily tablets of ribavirin for periods of 6 to 12 months. The viral strain common in India (genotype 3) fortunately responds well to treatment, as more than 250 happy patients treated at SGPGI will tell you.

There is unfortunately no vaccine yet for preventing Hepatitis C, unlike Hepatitis B. Hence prevention and early detection assume greater importance. If you have ever received a blood transfusion or undergone a surgery, make sure you have taken the test for Hepatitis C, and have come out negative.

Published in HT City of Hindustan Times Lucknow edition dated 14 February, 2010.

Inaugration of Liver Foundation

The liver foundation was inaugurated on 20th Dec, 2009 at Gemini continental. The inaugural function was followed by launch of official website for the foundation. A 24x7 active helpline and Foundation’s blog was introduced to make doctors and patient networking effective. A unique software for management of records of patients with liver disease was launched. This software will be regulated amongst all the treating doctors in our network, so that better patient.

Internationally accepted guidelines for treatment of liver disorders were also discussed in order to implement the Foundation’s idea of following uniform line of treatment by doctors. Patients with liver disorders like liver cirrhosis,Hepatitis C were also invited to be part of active interactive session.Various issues related to patient care improvement were suggested and discussed by the doctors.

The need to create a separate body in the form of Liver Foundation was felt in a meeting of Gut Club held on 9th September 2008 in Lucknow. Here several members suggested that liver diseases (LD) have become very common in recent times and hence proposed the creation of a separate body that would concentrate on tackling liver diseases in U.P. The first meeting of liver foundation was held on 18th October, 2008 at Gemini continental to discuss the creation of Liver Foundation, Lucknow and was attended by leading Gastroenterologists and physicians from all over state.

Covered in Lucknow editions dated 21st Dec,2009 of following newspapers:

Hindustan Times

i-NEXT

Rashtriyasahara

Amar Ujala Mycity

Madhu and her new Liver

Madhu is in the 5th year of her new life. She had alsmost reached her end because of her failing liver, when on 14th February 2004, a new liver arrived in Lucknow almost by miracle.

She had been a healthy homemaker and mother till 1994 when she had an attack of jaundice. Unlike the common ones that pass away on their own, this episode, was persistent. One doctor after another and with one herbal tonic to be replaced by another, she finally reached the SGPGI. Tests revealed that her chronic liver ailment was not due to the common infective viruses B or C but due to a rare condition called autoimmune hepatitis, a condition in which the body’s defending cells and immune system start attacking its own organs, in her case, her liver.

Autoimmune hepatitis is somewhat rare: it accounts for 2% of all prolonged cases of hepatitis or liver cirrhosis. It affects women 5 times more often than men, and needs awareness for timely diagnosis. If detected on time, the disease can be controlled with immunosuppressants like corticosteroids.

Madhu had reached us somewhat late and a portion of her liver had already permanently damaged. She was however treated with immunosppressants to preserve the viable portion of her liver. She had her ups and downs, but remnained largely well for almost 8 years. By 2002, her liver had become weak; she had water in her abdomen, swelling of her feet and side effects of the medicines as well. It became obvious that only a liver transplantation could get her back to life and health at that stage.

Her husband, a bank emplyee, tried all he could; he consulted various liver transplant centers in India, offered to donate a part of his own liver and took large loans to provide for the increasing costs of her treatment. Unfortunately he was found to have fatty liver that was unsuiatble for donation, and his abdomen was closed. With that almost all hope diasappeared, as there were no suiatable relative in Madhu’s home who could donate her a part of his liver.

On 13th March 2004, a man who was on a ventilator in one of the hospitals in Delhi following an accident, was pronounced brain-dead. Under such trying circumstances, his relatives gallantly agreed to his liver being extracted for donation to a needy person. Dr Peush Sahni from AIIMS extracted the liver, and flew into Lucknow on 14th morning. Madhu was taken into the operation theatre and Dr Rajan Saxena and Dr Peush transplanted the new liver into Madhu. That indeed was destiny! The relatives of the donor were magnanimous enough not to seek publicity for saving someone else’s life, and requested anonymity.

Madhu continues to be well 5 years on. Her daughter got married this year. Madhu and her husband, and 5 more such heroes from Lucknow who have been through liver transplantation, have offered to provide counselling to patients and their relatives facing similar challenges, a service which we plan to provide through the Liver Foundation of UP that kicks off on 19th of this month