Viral Hepatitis and Liver Cancer Prevention
“Mongolia has the world’s highest rate of liver cancer (deaths) – six times the global average – and the number is increasing… According to the (World Health Organization) WHO, one of every ten deaths in the country is due to HCC (hepatocellular carcinoma or liver cancer) or its frequent precursor, cirrhosis.”
The combined factors of a small population (3 million people), 97% literacy rate, and excellent infrastructure of the health care system places Mongolia in a unique position to comprehensively combat viral hepatitis, setting an example for the world on how to eliminate a viral epidemic. The high literacy rate and small population makes awareness campaigns extremely effective.The small population also makes screening, testing, vaccination, and intervention campaigns manageable. The well-designed health care system infrastructure ensures that policy changes and training can be well-disseminated throughout the national system.
Since 2009, FIRE has been supporting the Mongolian Ministry of Health and Sports (MoHS) to prevent and diagnose viral hepatitis and liver cancer across Mongolia. FIRE’s strategic, multi-layered programs are implemented with various stakeholders at every level. These programs are designed to be replicated not only across Mongolia, but hopefully anywhere, empowering individuals and health care systems to end this epidemic. One of the leading forms of transmission of hepatitis in Mongolia comes from the improper handling of hazardous materials in the health care environment. FIRE is helping to stop this national epidemic with multi-faceted initiatives targeted at both the general population and health care facilities. For more information please visit our Hepatitis in Mongolia page.
FIRE’s partners, who are helping to implement these programs, include the Mongolian Ministry of Health, the World Health Organization (WHO), the National Institutes of Health (NIH), the Asian Development Bank (ADB), the Canadian Society for International Health (CSIH), and the Asian Liver Center at Stanford University.
The first step to ending the epidemic of hepatitis and liver cancer in Mongolia is creating awareness of the problem among the general population and providing education on actions that need to be taken. FIRE works with local, state, and community-based organizations, health departments and health care facilities to conduct awareness campaigns through the media and community events. Mongolia’s high literacy rate and small rural communities make awareness campaigns very effective methods for instigating change. Because of the size of the communities, promotion of the events is easily accomplished and the events are usually well-attended. The high literacy rate means a large amount of information can be clearly and comprehensively communicated to the majority of people.
In addition to implementing these community awareness campaigns, FIRE trains local of officials and community leaders on the logistics involved to carry out these activities and how to address the relevant health issues. This training ensures that local communities have the resources and knowledge to continue awareness campaigns independently. Awareness activities include: conducting media events, including TV and radio programs and press conferences; distributing information and communication materials; and organizing events in gathering centers of local communities.
Awareness Campaigns are organized in support of:
- World Hepatitis Day – Since 2010, FIRE has worked with the World Health Organization (WHO), the Mongolian Ministry of Health and Sports (MoHS), and rural health care providers and departments to mark World Hepatitis Day on July 28 in Ulaanbaatar and rural areas of Mongolia
- Screening Events – Community Awareness Campaigns are also conducted in conjunction with our Viral Hepatitis and Liver Cancer Screening Project.
Viral Hepatitis and Liver Cancer Screening and Testing
In 2011, FIRE began conducting viral hepatitis testing and liver cancer screening programs in rural areas of Mongolia. FIRE works closely with local primary care clinics to identify and invite the highest risk people to testing and screening events. High risk people are considered health care workers, social workers, police of cers, and anyone who has a family history of liver cancer. Priority is given to anyone over 18, who has not been tested before and can not afford to be tested. The FIRE tream and specialists from Ulaanbaatar including an ultrasound specialist, hepatologist (liver specialist) and oncologist conduct the activities.
This project helps newly diagnosed individuals with hepatitis and/or liver cancer gain the knowledge to effectively manage their conditions. It also helps us to detect several forms of cancer in members of the community, and more specifically, early stage liver cancer. By discovering their liver cancer early, these people will have more treatment options, a greater chance of long-term survival, and a better quality of life.
Participants proceed through the following steps:
Step 1: Participants are tested for viral hepatitis B and C
Step 2: Participants who test negative for viral hepatitis B and have not previously been vaccinated are given the first of three shots for the hepatitis B vaccination.
Step 3: People who tested positive for viral hepatitis B or C are given an ultrasound examination.
Step 4: People who show a lesion on their liver during the ultrasound examination are then tested for AFP, the protein that indicates liver cancer. Since they are considered to be at risk for liver cancer, they are physically examined and counseled by an oncologist.
Step 5: Participants who test positive for viral hepatitis B or C but who’s ultrasound examination did not indicate current cancer risk are physically examined and counseled by a hepatologist.
This project helps communities in rural Mongolia learn their status of viral hepatitis B, C and other liver diseases, including cancer. During the ultrasounds, various abdominal and liver related disease are discovered, including cirrhosis, fatty liver, gall bladder, and other abdominal organ diseases, to name a few. It also helps to detect several other forms of cancer, and more speci cally, early stage liver cancer. Newly diagnosed individuals with viral hepatitis and/or cancer gain the knowledge to effectively manage their conditions. By discovering their disease early, these people will have more treatment options, a greater chance of long-term survival, and a better quality of life.
For more information about the results of our first screening and testing program in 2014, please visit our viral hepatitis and liver cancer screening and testing page.
Viral Hepatitis B Vaccination
Since 2011, FIRE has been vaccinating health care workers in rural Mongolia. FIRE continues to vaccinate health care workers who test negative for hepatitis B and have not previously been vaccinated. Additionally, vaccinations are given to participants of FIRE’s Viral Hepatitis and Liver Cancer Screening Project who test negative for hepatitis B.
Advocacy with Policy Makers and Community Leaders
Long-term, life-saving changes can only be achieved through sustainable, inter-sector cooperation, and support from a community’s government and business leaders.Through strategic advocacy meetings and targeted information sessions, FIRE informs community leaders and policy makers about the nation’s viral hepatitis and liver cancer epidemics.They are given solutions to bring both the logistics and financial in influences of the community together to implement further solution-based programing.
Some of the results of these meetings include:
- Commitments to fund and build a centrally located, community medical waste management disposal site following the proper and necessary guidelines.
- Designs and commitments to upgrade the current autoclave sterilization system of the community health care facilities before medical waste is disposed of.
Capacity Building for Health Care Workers
Capacity building for local health care providers is vital to the prevention and improved quality of managed care of viral hepatitis and liver cancer. In support of the World Health Organization (WHO), and the Mongolian Ministry of Health and Sports’ (MoHS)priorities and policies, FIRE conducts trainings for rural health care providers across Mongolia in their local facilities. These trainings are conducted by visiting specialist from Ulaanbaatar and include multi-day classroom lessons and half-day hands on “shadow training” sessions. Shadow training means that specialists from Ulaanbaatar work side by side with local doctors, teaching them techniques through a hands-on approach. Our efforts have been most successful when done in conjunction with our Viral Hepatitis and Liver Cancer Screening Project while visiting rural communities.The classroom training sessions followed by the hands on shadow training allows health care workers to put the training into action under supervision and further guidance.
FIRE’s two training objectives include:
- Proper Care Management of Viral Hepatitis and Liver Cancer
This training teaches local health care providers to assist their patients in making healthy lifestyle choices. To supplement this training, FIRE has created several materials in conjunction with our program partners. These materials include toolkits complete with a hepatitis treatment manual created by the National Center for Infectious Disease and Clinical Research, and the “Physician’s Guide for Hepatitis B” written by the Asian Liver Center at Stanford University.
- Early Detection of Liver Cancer
This training teaches health care providers to detect early stages of liver disease. It is taught be an ultrasound specialist, an oncologist, and a hepatologist (liver specialist) visiting the community from Ulaanbaatar.