During Liver Awareness Month 2022, we feature a series of videos and interviews that profile those working in liver health and those with lived experience of liver disease. Articles and video interviews are by Sarah Liversidge, Journalism student from RMIT University.
This week, we feature Dr Amanda Wade, an infectious diseases physician from Barwon Health, and Nurse Inga Tribe, a Viral Hepatitis Outreach Nurse in South West Victoria.
For Dr. Amanda Wade, it is a great privilege to look after other people. She loves being involved in treating people with hepatitis C. Telling someone they are cured brings her joy, as does reassuring someone that if they get infected again, they will be treated again, because “that’s how this works”.
Amanda is an infectious diseases physician with a particular interest in blood-borne viruses. She helps run the liver clinic at Barwon Health, which is part of the Barwon Southwest Public Health Unit. Amanda looks after people with HIV, hepatitis B and hepatitis C in the community, and also supports nurses and doctors in the hospital to look after people with those infections. The Geelong region has the highest hepatitis C treatment rate nationally and this is a direct result of Amanda and Barwon Health’s work.
When Amanda undertook training in infectious diseases she was encouraged and inspired by the relationship between doctors and the community sector in the treatment of HIV. She remembers the experience as a privilege to witness and a driving force for her to keep going in the field. Amanda subsequently went on to do a Ph.D. in hepatitis C and has never looked back.
She has seen huge changes in the testing and treatment for viral hepatitis. She describes the toxicity and morbidity associated with old treatment regimens as being terrible and likens it to chemotherapy. Amanda wants people to know that treatment has improved dramatically from these “bad old days”.
Amanda says collaborating across silos of different providers, for example partnering with community psychiatry or needle and syringe groups, is key to improved care for people. These networked relationships invite collaboration and the sharing of resources and knowledge, which ultimately leads to better care for people living with hepatitis. She stresses that people with hepatitis do not typically present with one issue, so if they can be linked in with other services that they need then they are going to get the best holistic care.
In terms of the sector itself, Amanda believes improvement is needed for hepatitis B treatment as it has been underinvested in for a long time. She says practitioners need to work on relationships to engage people living with hepatitis B and to improve number of people being tested, monitored and treated.
Amanda expects the Barwon South West region is on track to meet targets for hepatitis C if people keep working as hard as they have been. For hepatitis B however, she thinks there needs to be a “massive restructure” and much more work needs to be done.
Amanda believes we can all, no matter who we are, strive to be more accepting and less judgemental about drugs, alcohol, and mental health and to encourage others to do the same. She would like to see more routine conversations about these issues and normalise accessing help and support.
Inga Tribe loves her work. She has long been fascinated by blood-borne viruses and loves the problem-solving required to work in the field of hepatitis health.
Working as Viral Hepatitis Outreach Nurse in South West Victoria, Inga’s job is to help link clients to appropriate care for the management of their condition. She also has a mobile FibroScan machine that she uses to conduct assessments for fibrosis of the liver. This helps physicians and doctors determine ongoing care needs.
Inga loves to chat, and she loves helping to make hepatitis care easier for clients, as well as taking away the barriers to accessing that care. She enjoys working with different teams and clients and says the doctors she works within the field are an incredibly empathetic bunch. For Inga, working with like-minded people who have the common goal of health equality at the center of their care makes going to work a daily pleasure.
Being able to help cure people of their chronic hepatitis C infection with new treatments is rewarding for Inga, as is educating clients to better understand their condition so that it can become a small, manageable part of their life. This empowers people to make good health decisions.
Inga has seen advances in treatment change outcomes for patients enormously. Older hepatitis treatments such as interferon and ribavirin were grueling for clients, with poor results and many side effects. However, in treatment today, pan-genotypic direct-acting antivirals (DAAs) taken in tablet form have minimal side effects, work in a shorter timeframe and have a 95-98 percent cure rate if taken correctly.
She has witnessed many people cured of hepatitis C experience benefits such as improved energy, a clearer mind, a sense of achievement, and feeling less stigmatised. At a cellular level, their hepatocytes are much healthier and the risk for liver damage and liver cancer is dramatically reduced.
Inga has been surprised by the level of stigma people with hepatitis regularly face. She has also been surprised by the difficulty clients have in accessing Medication Assisted Treatment for Opioid Dependence. She says it has been eye-opening to realise the complexity of care required for many patients.
Inga believes her greatest achievement is being able to help bridge the gaps in accessing a range of services for clients. She is grateful to be able to share knowledge with other health professionals so they can successfully get their clients treated for hepatitis C.
According to Inga, targets for the elimination of hepatitis are largely realistic. For the elimination of hepatitis C by 2030, Inga proposes a focus on people who are incarcerated, current injecting drug users, and people with dual diagnoses. She says managing reinfection is key to elimination, so ongoing rescreening for people who have been tested and treated for hepatitis C in the past is important.
She also thinks ongoing training is needed for health practitioners to feel comfortable talking to clients about drug and alcohol use and associated risks. Inga would like to see people with addiction and mental health issues treated with respect. She sees the benefit in making stigma training and education mandatory for all healthcare workers, with annual updates akin to current CPR training. This would help break down the stigma of living with chronic hepatitis.
Watch the video below!