Hepatitis prevention, treatment PKLI’s first step to excellence

Dr Abdul Nadir

AS I reflect on my one-year experience in Lahore, which I celebrated with my colleagues of Pakistan Kidney and Liver Institute (PKLI) on January 15, 2018, I can vividly recall how I stumbled upon this incredible undertaking, one I would no doubt classify as the best opportunity of my medical career. Prof. Dr. Saeed Akhter, President and CEO of PKLI, and I had known each other for more than a decade when he approached me to be a founding member of PKLI.
In our initial conversations, he passionately expressed his desire to build a state-of-the-art hospital that will become a center of excellence inhealthcare where the people of Pakistan will get equal care irrespective of their ability to pay.
Of course, I embraced the idea. With a 20-year experience of practicing gastroenterology in the United States under my belt, I felt prepared. “Anything is possible as long as one is willing to work for it; when we can do it in the United States, why not in Pakistan?” Dr. Saeed Akhter desired PKLI to become the Yale of Pakistan, and thus he has worked diligently to build strong foundations and systems within the institute to preserve the founders’ spirit and mission far into the future.
Our vision was to stretch PKLI beyond the care of liver and kidney patientsto every organ of the body. We wanted every medical practice at PKLI to be based on sound scientific principles, and we yearnedto groom a younger generationof healthcare providers. We realized the enormity of the challenge,butwe also believed we had the wherewithal to make it happen!All members of the board of governors- whether they were doctors or not-were committed toproviding the best possible care to Pakistani citizens and sincerely believed in the cause.
As things continued to unfold, our first venture became a clinic we named Hepatitis Prevention and Treatment Clinic (HPTC),which opened in Lahore on March 19, 2017. We wanted the clinic to be unique and to provide holistic medicine. We desired to listen to our patients and to go beyond the surface of medical management.
We aimed to treat their bodiesas well as their minds. We hired liver specialists, a psychiatrist, a nutritionist and a pediatric physician. We provided onsite facilities for laboratory, liver-related imaging, and upper and lower endoscopy. We provided treatments for viral hepatitis and screened thousands of individuals for the presence of viral hepatitis and vaccinated them against hepatitis B virus, which is completely preventable after successful immunization.
Very soon the clinic became free and a glut of patients were knocking on our doors. These patients suffered every manifestation of consequences of viral hepatitis. They felt tired, their bones and muscles hurt, they had frequent headaches, they were not hungry, they were depressed or anxious; and many of them were very poor, finding it extremely difficult to cope with their illness.
A very significant number of our patients at HPTC had developed end-stage-liver-disease (ESLD). Their bellies were filled with water and their muscles were shrunken. Large veins in their food pipe would bleed frequently and their minds were only intermittently alert.
While we were operating HPTC, simultaneously we were working on completion of our hospital so that we could care for these patients with ESLD soon in our own hospital. In the meantime, we referred these patients to other facilities in Lahore for medical care of conditions that required hospitalization.
We also emphasized to our trainees that patients without any definitive care of their illness can still find comfort in the hands of a caring healthcare provider and we did all we could for them.
The government of Punjab, led by the Chief Minister (CM) Mian Muhammad Shehbaz Sharif, continued to provide unstinted support to Dr. Akhter. The CM knew that PKLI’s team was bubbling with energy and entrusted us with yet another task to open few clinics in rural Punjab, and to live up to the mission of World Health Organization to eradicate hepatitis C from the globe by the year 2030. When Dr. Akhter asked me about the feasibility of opening these clinics, I said, “Go for it.”
In a short amount of time, the project had advanced quickly. We started a franchising operation, giving the rural clinics a look similar to the HPTC in Lahore. The operation was named Hepatitis Prevention and Treatment Program (HPTP), and of the 25 sites initially planned, 19 satellites are already open. Meanwhile, PKLI was also assigned the task to teach and train close to 100 doctors who were hired by the government of Punjab to treat hepatitis in rural Punjab as well. As our system in HPTC continued to mature and our junior healthcare providers were gaining invaluable experience, we were able to train close to 150 junior doctors for a period of one to two weeks in HPTC. We gave them interactive lectures in the morning, and let them spend the rest of the day in our clinics to get well- rounded experience of liver diseases.
Our 25 rural clinics were given the name of “satellites,” and when our satellite Medical Officers (MO)went on to start their rural clinics, they were asked to keep in touch with consultants by the cellular phone. We encourage our MOs to call us whenever needed, so they can provide the best care to their patients while receiving further guidance in the treatment of viral hepatitis.
Our team of healthcare providers not only treated and vaccinated hepatitis patients, but they also worked on collecting data for purposes of continued learning. Under Hepatitis Prevention and Treatment Program, we participated in caring for approximately 50,000 patients over a 9-month period and treated thousands of them with specific medications available for viral hepatitis. We also provided additional supportive medications to help alleviate their symptoms.
We have continued to learnhow to make the most efficient and cost-effective use of the diagnostic tools that are available to us. Finally, we continued to streamline the processes in HPTCs to reduce waiting times before specific treatments for viral hepatitis can be initiated.
We have also improved the triage process in the clinic to expedite care for our patients based on the level of their illnesses. We continued to share and implement our experiences of HPTC to our satellite clinics.
It has been a roller coaster ride forcing us to think on our heels, and adapt our strategy not infrequently to provide the best possible care to a large number of patients. Our hospital opened on December 25, 2017, and continues to grow and improve. We know there are obstacles in our way, but we are confident we can deliver the level of care that our patients and well-wishers expect from us. We will not leave any stone unturned to succeed!
—The writer is Director Hepatology, Pakistan Kidney and Liver Institute (PKLI); and member, Board of Directors PKLI

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