Hepatology

A Sydney hepatologist’s mission to eradicate hepatitis B in PNG


It started with a plan to vaccinate a small village in Papua New Guinea.

A team of five doctors and nurses – led by hepatologist Associate Professor Alice Unah Lee – travelled to Itokama in 2013 at the request of a young Sydney-based patient whose mother had died there from suspected complications of hepatitis B. The young boy also had hepatitis B.

“We thought we would be able to vaccinate his village so no other kids would be exposed, because the kids remained at risk and most were not vaccinated,” muses Dr Lee.

But the simple mission soon grew into something much bigger.

Four years later the group has delivered over 9000 pentavalent or hepatitis vaccines in the remote and under-serviced villages of Papua New Guinea, where the estimated rate of hepatitis B is well over 10%, a rate similar to that of the Pacific islands where the highest global prevalence of hepatitis B is noted.

They work under the auspices of Hepatitis B Free, a charity they set up to deliver vaccines in areas of unmet need, including Myanmar and North Korea.

“You are looking at a disease that is killing people, many very young. Most don’t get medical attention until it’s too late… it’s a silent killer.

“There is currently no treatment available in these areas. We have had access to these life-saving drugs for over a decade.”

That first visit was the biggest eye opener, said Dr Lee.

“Your idea is very romanticised then when you arrive in country it’s very different.”

PNG 1

Dr Lee treats a patient.

After arriving at Port Moresby airport, the team boarded a twin engine Kodiac plane.

“Every individual person is weighed and then they distribute the weight throughout the plane and you fly just above the clouds, which is beautiful.”

Arriving at the small grass air strip they were greeted by the villagers waiting behind a ribbon.

“There were just hundreds of faces and what really struck me that there were so many kids, it was overwhelming.”

The group spent a week trekking from village to village, sleeping under mosquito nets on bamboo floors in thatched roof huts with pigs roaming underneath.

There was no running water, no electricity and the toilets were basic drop boxes.

“It was like time travel, but the reality for these communities, an alternative universe. We had to take in our own solar powered fridge for the vaccines and then have the locals carry it from village to village. It remains there today.”

The group had planned to buy vaccines from Australia but ended up using local supplies that had been allocated but never delivered, leaving enough for local health workers to continue the vaccine schedule.

“We were told there was a couple of hundred people, but that wasn’t exactly the case. It was a huge community, with villages scattered in the middle of the forest, linked by footpaths.

“It was hot, wet and muddy. We walked through the jungle and set up for clinic, stationing ourselves into separate regions and doing what we could to provide what little help we were able to.

“The locals waited patiently, having travelled a long way on foot. One mother carrying one toddler on her back and another on her head in a billum. She had walked two days to come to ensure that her babies were vaccinated.

“Most locals had never seen a doctor, let alone an entire group made of female health care providers, with an Asian woman at the lead. It was quite an adventure for all.

“Now, as we plan to return, both sides are eager to reunite and see old friends. Trust and relationship building has been critical to the work.”

 

Hepatitis B Free directors Associate Professor Alice Lee and Sue Huntley

Hepatitis B Free directors Associate Professor Alice Lee and Sue Huntley

The core group has now made five trips, each filled with challenges and rewards.

On World Hepatitis Day this year, Hepatitis B Free finally secured an MoU with the local authorities for a novel funding model to provide support for the first hepatitis B treatment program for a small cohort of patients in the Oro Province.

“For the first time, patients with chronic hepatitis B will have access to antiviral treatment, one that is safe and lifesaving,” Dr Lee says.

It is hoped the pilot that can be expanded to a national program.

“There is no treatment for hepatitis B in Papua New Guinea. People just die…It makes me mad and sad. It doesn’t have to be that way,” she says.

“It’s really complicated because hep B treatment is lifelong but so is HIV treatment and these places have HIV treatment…We need to be advocating for those with hepatitis B who have no voice. Our role in Hepatitis B Free is to facilitate and to advocate and where possible, to make it happen.”

Hepatitis B Free is seeking doctors and other health professionals to volunteer with the charity, and is also seeking sponsors and donors.

For more information go to: www.hepatitisbfree.org.au

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