Dear Friends,
Happy Holidays and warmest wishes for winter to you and yours! It has been a busy year at FIRE as we have striven to make up for years lost to Covid. Personally, I have been dealing with a bad bout of Covid since October, upon my return from Mongolia. Hence, the very late delivery of our annual letter and greetings. We hope you and your family are well and healthy.
We finally started our full-scale work on Hepatitis Free Mongolia, Phase 2, in Sukhbaatar province in spring 2022, almost two years after we initially planned to start. However, we made the most of the delays. We spent countless months working with local government officials and healthcare workers to create accurate lists of the people still to be screened and treated for hepatitis throughout the province. We also spent many months building a comprehensive online database, www.hepatitisfreemonogolia.com, to track the thousands of participants who needed to be reached to accomplish the ambitious goal of
eliminating hepatitis C (HCV) across the province. Please read the short article below for a more detailed update on Hepatitis Free Mongolia, Phase 2.
As health-related programming funds have been diverted to Covid and other grant sources have changed course, we have tried to be creative with our fundraising. To your delight and surprise, our sales of Mongolian gers|yurts increased significantly in 2022, helping fill some of the newly created funding voids we have been struggling with. We spent some time this year developing our ger|yurt program. We are almost finished with a new website at www.mongolianyurts.org, and we have created a 48-minute instructional video and illustrated booklet. It is an honor to share these beautiful hand-crafted pieces of Mongolia and to help create jobs for Mongolian craftspeople.
Our annual matching donation of $20,000 is happening. We need to raise $20,000 by January 31, 2023. Our request is arriving much later than usual! We hope you will still consider supporting us this year or in early 2023. We have already raised almost $9,000 towards the $20,000 needed. Every little bit helps and gets us closer! With the two-year delay of Hepatitis Free Mongolia, Phase 2, and the resulting three-fold increase in administrative programming costs in Mongolia — YOUR support means more now than ever! You can Donate Today - HERE! Thank you.
Best wishes,
Meredith Potts
Executive Director
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Hepatitis Free Mongolia, Phase 2
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The goal of Hepatitis Free Mongolia, Phase 2 is to eliminate HCV in Sukhbaatar province. We can accomplish this through inter-sector partnerships, collaborating with and supplementing the already robust government social systems, networks, and initiatives. To meet the World Health Organization’s (WHO) standards for qualifying as successful elimination, 90% of the available population must have been tested, and 80% of those who test positive would have been successfully treated.
Hepatitis Free Mongolia, Phase 2 started similarly to Phase 1, with a 6-week mobile screening with specialists from Ulaanbaatar and Japan, including comprehensive liver testing, local health worker training, and a community awareness fair. From April through June 2022, FIRE visited all 15 clinics and hospitals across Sukhbaatar province. Hepatitis Free Mongolia, Phase 2 included hepatitis coordinators’ roles and tools and financial support for the insured needing treatment.
FIRE began working on liver health in Mongolia in 2009 at the request of the National Institutes of Health (NIH) and Rotary International. Mongolia had the highest rate of liver cancer and among the highest rates of hepatitis in the world. In 2017, the Ministry of Health launched the national Healthy Liver Program (HLP) to eliminate HCV by 2024. The same year, FIRE started Hepatitis Free Mongolia.
Over the years, FIRE has weathered many obstacles and witnessed significant changes. Notably, the change in the prevalence of hepatitis C virus (HCV) throughout our screenings. In 2011-2012, the prevalence at FIRE’s screenings for HCV was 22%. In 2014 it was 19%, and 11% in 2015. For Hepatitis Free Mongolia, Phase 1 in 2017, the prevalence was 9%. So far, in Hepatitis Free Mongolia, Phase 2, we are seeing a prevalence of 5.2%. Something is working!
In November 2019, 45% of Mongolia had been screened through the HLP. By late 2020, 53% had been screened. Despite the well-designed and ambitious goals of Mongolia’s national Healthy Liver Program, Covid and politics have gotten in the way of success. We hope Hepatitis Free Mongolia will serve to reinvigorate Mongolia’s government commitment to the HLP, but also as an example of how it can be done quickly and efficiently in Mongolia and other parts of the world.
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Screening Results to Date
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- 4,285 people were tested for hepatitis, Of those:
- 525 (12.3%) were positive for HBV
- 223 (5.2%) were positive for HCV
- 14 (0.4%) people tested for both hepatitis B and C positive.
- Of the 223 who tested positive for HCV:
- 75 proved negative upon more advanced testing
- 79 have been treated
- 15 are being treated
- 86 people still need advanced testing
- 38 people are waiting for treatment
- We covered the insurance and HCV treatment cost for three people.
- 2,950 ultrasound examinations were given.
- 1,333 FibroScan examinations were given.
- 1,862 people were seen by a hepatologist.
- 85 people were seen by an oncologist.
- 160 people were tested for the alpha-fetoprotein test.
- 43 people were suspected of liver cancer.
- A community awareness fair was held at the province center.
- 40 healthcare workers and 113 social workers were trained as hepatitis coordinators.
- 43 health workers from across the province were trained with shadow training by visiting specialists.
- Distributed 50,000 copies of 5 types of pamphlets, including “Liver cancer,” “Viral Hepatitis B,” “Viral Hepatitis C,” “Love the liver,” and “Liver cirrhosis.”
- Donated an ELISA reader machine (for non-rapid hepatitis testing) and a portable ultrasound machine, each worth about $11,500, to the provincial hospital.
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Hepatitis Coordinators and Training
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Hepatitis Coordinators are government social workers and health care workers representing every community in the province whom we provide with extra training and income. We also provide the necessary supplies and tools to help them work with their communities. These include an online patient database, a 3-piece uniform, a badge, a training manual, and educational materials. They contact their assigned community members and update their residential information, ensure they are screened, facilitate access to insurance if needed and connect them to treatment. They are instrumental in finding the missing thousands of people still to be tested.
Everyone in Mongolia is registered with an ID number, similar to a social security number in the US. This number helps them navigate the government systems. These systems include being assigned to a local primary care health clinic and social worker. Through the Hepatitis Coordinators and utilization of the current systems, we can identify and track everyone registered in Sukhbaatar province.
Database
To aid the Hepatitis Coordinators in tracking the community members and increasing efficiency during the mobile screening, we worked with a local IT designer to develop a comprehensive web-based database, www.hepatitisfreemongolia.com. The specialists from Ulaanbaatar leading our mobile screenings were able to update the database via a tablet while with the patient. It includes anyone screened in Sukhbaatar beginning in April 2022. It will continue to be updated until everyone has been screened and treated in the province. The database is another vital tool that allows us to efficiently and effectively work within the community and as a cohesive team.
Partners
This project is generously funded by Rotary International and Gilead Sciences. However, our working partnerships on the ground in Mongolia are what turn the funds into action. These include the Rotary Club of Ulaanbaatar, the Sukhbaatar Governor’s office, the Health Department, 12 county clinics, 2 family clinics, the provincial hospital, and the social welfare offices. Additionally, 3 representatives from the Liver Center of Saga University spent 24 days traveling, training healthcare workers across Mongolia, and providing the ongoing “loan” of a portable FibroScan machine.
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Officially, there are about 9,000 people still to be screened in Sukhbaatar. After connecting with 15% of these remaining people, roughly 50% are unavailable. An additional 869 people who tested positive for HCV in Sukhbaatar before April 2022 still need to be treated. We estimate 4,500 people actually still need to be tested, 400 people will need treatment for HCV, and 160 people may need support with insurance (39% uninsured). We are hiring additional team members and working hard to locate and screen these remaining thousands to complete HCV elimination in Sukhbaatar province by June 2023.
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Thank you for your support! This matching contribution brings in more than half of our annual donations each year.
All donations received by January 31, 2023, will be matched up to $20,000.
The $40,000 raised through this match will support “Hepatitis Free Mongolia, Phase 2."
Thank you!!
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All-natural, custom-made, hand-crafted Mongolian ger.
The original tiny home. Time tested over millennia in the coldest climates. Choose your color, size (16ft up to 28ft in diameter); add windows and more.
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