Life depends on the liver
NEW DELHI: What would you call 15 doctors and a hepatologist connecting over some bile juice through the internet? Officially the project is called the Extension for Community Healthcare Outcomes (ECHO) and will soon be underway at Institute of Liver and Biliary Sciences (ILBS) in Delhi.
Hepatologists (liver specialists) at ILBS will soon begin a series of teleclinics with doctors in semi-urban areas to identify and treat cases of chronic liver disease. Super specialist liver doctors at ILBS will discuss treatment with doctors in locations like Sonipat, Panipat and Sikar (Rajasthan) when the latter present symptoms and details of their own patients through videoconferencing during the clinics. The clinic, scheduled to be held at least twice a month for 90 minutes—will include a lecture by the hepatologist.
The doctors will thus get to update skills through these sessions, to be held at least thrice a month for a period of two years. They will also receive a certificate from the ILBS at the end of the course. Perhaps the best part about the hands-on training is that it comes free of cost for the doctors. Hepatology in India is a relatively new super-specialisation, and only a handful of students pass out every year. It is a specialisation which is usually taken up after specialisation in gastroenterology, with which it was clubbed earlier.
“The idea is a specialist can reach out to more patients. The focus is on reaching out to Hepatitis B and C patients through doctors who are already treating them.
“Doctors gain expertise in treating the disease while the patient need not travel a great distance to meet a specialist,” explains Dr Shiv Kumar Sarin, Director, ILBS. There are around six crore Hepatitis B and C patients in India, which is around six per cent of our population, adds Sarin.
Some forms of hepatitis are not easy to diagnose as all of them do not show typical symptoms like jaundice. In addition, the disease has spread through transfusions as blood may not always be screened for hepatitis. Doctors also learn through listening in not just through presenting their own patients, they gain the latest information on treatment of liver disease through participation in the clinics. Fifteen doctors have been identified for the first batch of the project which is expected to commence in February. All 15 will be online for the clinic at the same time, thus enabling them to learn from each other as well.
The specialists will understand the prevalence of liver disease in different areas and be able to guide the doctors in the underserved areas.
The doctors have been asked to install a software and an internet connection with a broadband speed of 512 Kbps, which is double the speed of the average 256 Kbps—to ensure clarity of the videoconferencing session. Since technology is what makes the system work, it was essential to train the doctors and carry out trial runs with the software. “The ECHO concept is being very widely used in the US by Dr Sanjiv Arora over a much wider range of specialities. He is an Indian doctor at the University of New Mexico,” says Dr Rakhi Maiwall Assistant Professor Hepatology at ILBS.
Dr Arora has been successfully conducting these clinics at the university and the specialised care clinics include management of diabetes, heart, HIV/AIDS and obesity.