Tag Archives: Hepatitis

Cherokee Nation Chooses to Proactively Fight Against Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Native Americans (NAs) in the United States have largely gotten the shaft. Forced from their native lands, herded into reservations, and the victims of innumerable false promises and broken agreements on the part of the U.S. government, NAs have also had the misfortune of being disproportionately impacted by infectious disease. Such is the case with Hepatitis C (HCV). According the most recent Surveillance for Viral Hepatitis report released, this year, by the Centers for Disease Control and Prevention (CDC), NAs have by several integers the highest rate of HCV per 100,000 people out of any race demographic with a rate of 12.95 (CDC, 2017). The Cherokee Nation – the second-largest NA tribe in the U.S. – has decided to actively come out swinging against HCV.

White House honors CN physician for hepatitis C program

Photo Source: Cherokee Phoenix

Roughly 130,000 Cherokee Nation (CN) tribal citizens live in northeastern Oklahoma within the tribe’s boundaries, and within this community, aggressive measures are being taken to combat the disease. Dr. Jorge Mera (seen in the photo being honored by the Obama Administration for his Hepatitis C program), Head of Infectious Diseases at Cherokee Nation in Tahlequah, OK has worked with various agencies and private partners to create a comprehensive approach to dealing with their HCV epidemic (Taylor, 2017):

  • Using newer Direct-Acting Antivirals (DAAs) to treat and achieve Sustained Virologic Response (SVR) in infected tribe members
  • Partnering with Gilead Sciences (makers of three currently available HCV DAAs – Sovaldi, Harvoni, and Epclusa) to receive funding for screening kits and research through the Gilead Foundation
  • Adopting a proactive compulsory screening policy of screening all tribe members aged 20-69 for HCV (rather than just the Baby Boomer Birth Cohort), as well as offering tests to all children of any mother who screens positive for HCV
  • Expanding screening locations to include dental clinics to screen tribe members who may not access other healthcare services
  • Pushing and receiving approval for the establishment and funding of a tribal Syringe Services Program (SSP – Syringe/Needle Exchange) within the tribe’s territory (Hays, 2017)

This type of aggressive approach to combating HCV is, in fact, the type of action that Viral Hepatitis (VH) advocates have been pushing for years, but the unique circumstances under which tribal healthcare operates allows for more freedom than in the greater U.S. “Because Cherokee Nation citizens, under a treaty right with the United States Government have access to medical care, tracking them, and screening them is slightly easier than might be so for other US populations,” explains Dr. Mera (Taylor). Additionally, since their focus is on a smaller, specific population, the CN is able to focus its care on a smaller pool of individuals, rather than attempting to address the healthcare needs of millions of citizens.

That said, HCV transmission does not occur within a vacuum – tribe members do come in contact with people who fall outside of the tribe’s jurisdiction, meaning that, even if the CN’s efforts to screen, track, and cure all members of the tribe within its boundaries are 100% successful, they are still susceptible to new infections by way of contact with those outside of their community. This means that the types of progressive Harm Reduction, screening, and treatment measures being undertaken by CN need to be replicated in the state of Oklahoma, as well as the surrounding states (and eventually, the entire U.S.) in order for their efforts to not be undermined by failures to provide similar services on the parts of state and Federal governments.

These tactics also serve as a roadmap for dealing with HCV in some of the states hardest hit by the disease, particularly in smaller Appalachian states like West Virginia and Kentucky, where geography and smaller, more remote populations make reaching, screening, tracking, and treating not only HCV, but every health condition more difficult.

The tribe will present its progress at the World Indigenous People’s Conference on Viral Hepatitis in Anchorage, AK on August 08-09, 2017. For more information on that conference, please click on the following link: WORLD INDIGENOUS PEOPLES’ CONFERENCE ON VIRAL HEPATITIS

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Michigan Hepatitis C Surge Related to Prescription Opioid and Heroin Abuse

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award

By: Marcus J. Hopkins, Blogger

The Michigan Department of Health and Human Services (MDHHS) released its 2016 Hepatitis B and C Annual Surveillance Report, indicating drastic increasing in new Chronic Hepatitis C (HCV) cases in the state, particularly among residents aged 18-29. Two factors posed significant roles in the transmission of these cases – Injection Drug Use (IDU) and Incarceration.

HEAL Blog has consistently reported on HCV transmission as a result of IDU and within incarceration settings, and report is further evidence of those positions. There were 11,883 new Chronic HCV cases reported in 2016 for a rate of 119.78 out of every 100,000 people. 69% of those cases were followed up on and epidemiological profiles were made; of those IDU was a risk factor in 64% of cases, while incarceration was a risk factor in 63% (MDHHS, 2017).

More striking, however, was the vast increase in Chronic HCV in people aged 18-29 between 2005-2016 – an alarming 473%, of which 84.2% were reportedly related to IDU in that same age group. This trend is replicated all over the country, especially in areas where prescription opioid and heroin abuse levels are more prevalent.

Logo for the Michigan Department of Health & Human Services

Photo Source: MDHHS

MDHHS reported that viral hepatitis-related hospitalizations, liver cancer incidence, liver transplants, and viral hepatitis deaths have all increased over the last decade, largely driven by the impact of Chronic HCV infections (Mack, 2017). With so many of these cases ostensibly linked to opioid and heroin abuse, a robust response to the addiction epidemics is needed, as well as compulsory “Opt-Out” screening at clinics, emergency rooms, hospitals, and correctional settings.

The Lansing City Council recently voted to allow Syringe Services Programs (Syringe/Needle Exchanges), a proactive Harm Reduction measure that studies indicate reduces the rate of transmission amongst both People Who Inject Drugs (PWIDs), as well as the general population (Cook, 2017). Selling these programs to citizens who are unfamiliar with the programs, staunchly opposed to drug use, or believe that the exchanges encourage drug use remains a difficult proposition. Proponents argue that PWIDs are going to use drugs, regardless of whether or not there are exchanges; that being the case, it makes logical sense to prevent the spread of disease.

Michigan’s increase in Viral Hepatitis (VH) follows a national trend that will be replicated – possibly with farther reaching, deadlier impact – in other states.

References

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Illicit Tattoos and Piercings Increase Risk of Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Early this month, police in Pulaski, Virginia arrested four men for unlicensed tattooing – a misdemeanor offense with a fine of $2,500 and a maximum penalty of one year in jail. The investigation into the illegal tattooing operations began in May 2017, when police received a warning from the Pulaski County Health Department (PDHD) of a rapid increase in the number of new Hepatitis C (HCV) infections in patients who had recently received a tattoo in the area surrounding Meadowview Apartments near the 800 block in Pulaski (WDBJ 7, 2017).

While tattoos and piercings were relatively uncommon during the 1980s, the less conservative 1990s gave birth to a rise in the popularity of both. Now, nearly 4 in 10 people born after 1980 have a tattoo, and 1 in 4 have a piercing in a location other than an earlobe (Mercer, 2017). While most people have their tattoos and piercings done by licensed professionals, the high cost of body art leads many people to seek out less reputable, unlicensed tattoos that can be done cheaply and off the books.

Makeshift tattoo artist

Photo Source: India Times

Others, still, manage to acquire their tattoos via even less professional means than that while in jail or prison. In late June 2017, authorities at the Bladen County Jail in Bladen County, North Carolina, found a makeshift tattoo gun after being told that three inmates received tattoos and that one of them had contracted HCV. Jailers then found that two other inmates received tattoos from the makeshift device, and they are now being tested for the disease (Donovan, 2017). Further complicating matters is that jailers are uncertain where the HCV-infected inmate contracted the disease in jail or was infected prior to being incarcerated. Screening for HCV is required during the intake process, but few jails follow this protocol.

Part of the reason why work from licensed artists is so expensive has to do with the safety regulations rightly put in place to avoid the types of infections faced by Pulaski residents. Proper cleaning, sanitation, storage, and tattooing procedures is supposed to be closely monitored by state health departments as part of the licensing process, which does drive up the cost of the practice. However, each state is left to its own devices when it comes to regulating body art. North Carolina, for example, has a law dating back to the 1990s that regulates tattoos, but fails to regulate other forms of body art (e.g. – branding, piercing), meaning that artists to provide those services do not receive the same level of scrutiny as tattoo artists (Mercer).

These safety issues exist in every state in the U.S. Public health officials in Fargo, North Dakota, recently issued a warning after people in the metro region contracted HCV and HIV through illegal tattooing (Filley, 2017). The allure of cheap body art is often the primary reason why people go to “this guy I know who does cheap tattoos.” Unfortunately, “that guy you know” likely isn’t licensed, and putting one’s life into his hands, regardless of the quality of the artwork, may result in longer-term consequences than just a bit of ink.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Hepatitis Policy Project Releases Report on HCV Monitoring in the U.S.

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Report Cover: "Monitoring the Hepatitis C Epidemic in the United States"

Source: Hepatitis Policy Project

The Hepatitis Policy Project (HPP), a project of the O’Neill Institute for National & Global Health Law at Georgetown Law in Washington, D.C., released in June 2017 their latest report, “Monitoring the Hepatitis C Epidemic in the United States: What Tools Are Needed to Achieve Elimination?” The report highlights five key recommendations that the institute believes need to be implemented in order to ensure the elimination of Hepatitis C (HCV) in the United States.

It is important to note that these recommendations fall in line with what HCV advocates and organizations have been stating for years: state and Federal governments are failing to adequately address the lack of concrete reporting data for the disease that kills more Americans each year than the total combined number of deaths from 60 other infectious diseases, including HIV, tuberculosis (TB), and pneumococcal disease (CDC, 2016). The primary reason for this failure on the part of all parties: financial resources – neither the Federal, nor state governments are allocating adequate funds in order to make mandatory the reporting of HCV infections in every state, and as a result, the Centers for Disease Control and Prevention (CDC) and other research and reporting bodies must rely on inaccurate, passive, and/or outdated data reporting that is simply inefficient and unacceptable.

HEAL Blog, in May 2017, wrote about this data issue when the CDC and Emory University revealed its Hepatitis monitoring tool, HepVu, that contains data that is seven years out of date (Hopkins, 2017). Our argument contends that seven-year-old data is an ineffective tool for helping lawmakers and government agencies to craft data-driven policies and regulations. If the data is not current within one or two years, policymakers have little use for it. The HPP report makes five key recommendations designed to eliminate these data collection issues:

  • Expand and standardize reporting to the CDC: The CDC’s Department of Viral Hepatitis (DVH) is only now expanding funding efforts from 7 jurisdictions to 14 – an unacceptably (but expanded) low number. The DVH should work with Congressional appropriators to create a five-year plan to expand and build the capacity to conduct active surveillance to the great majority of states. This should include the development of a standardized reporting rubric that details the specific patient information that must be provided by clinicians and subsequently passed on to the states – a strategy that has been in place for HIV since the 1990s, and has helped to create more accurate data reporting and craft data-drive policies to address the epidemic. This will require more money.
  • Utilize electronic medical records to collect data on HCV cases and the cure cascade: Modern medicine makes great use of technology, including the collection and retention of medical records; what is lacking is a system to centralize and analyze these data. Better use of electronic medical records information could improve the consistency, quality, and accuracy of case reports made by states by lessening the burden on providers and laboratories to report new cases to state health authorities that is required under the current scheme. The current requirement for providers and labs to le reports strains their already limited time and personnel resources, and often leads to incomplete reporting. This data could instead be pulled together by state epidemiologists using an integrated electronic medical records database, which would also provide matching metrics with cases, such as race, age, gender, sex, and progress of treatment.
  • Fund epidemiological research using clinical data sets: Clinical care data are a largely untapped resource that relies on data that already exist. As such, greater efforts are needed to fund analyses of such data. This recommendation also suggests that several agencies across the Federal Health and Human Services department be directed to fund epidemiological research on HCV.
  • Integrate improved monitoring of HCV with responses to the opioid epidemic: With most new cases of HCV being related to Injection Drug Use (IDU), largely driven by the nation’s out-of-control opioid addiction epidemic, it is imperative that we tie HCV prevention and treatment efforts to substance abuse prevention and treatment measures, elevating HCV as a signature component of the national response to opioid abuse.
  • Establish and monitor HCV elimination plans across major U.S. health systems: The U.S. has several large established health systems – Medicaid, Medicare, the V.A., and various correctional systems. It is, therefore, imperative that we focus HCV elimination efforts on these major systems in order to adequately approach the elimination of HCV across all health systems. Starting with government-funded health systems allows for better monitoring of patients and patient outcomes.

The HPP report is an excellent document that outlines several real-world solutions that could (and should) be implemented across local, state, and Federal governments in order to achieve the elimination of HCV in the United States. Download the full report.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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U.S. Department of Veterans Affairs Requests Increase in HCV Funding

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Cover of the FY 2018 Budget Submission

Source: U.S. Department of Veterans Affairs

The United States Department of Veterans Affairs (VA) has laid out plans to continue their open treatment policy for eligible veterans living with Hepatitis C (HCV) into 2019 and beyond. The budget request sent to Congress – Fiscal Year (FY) 2018 and FY 2019 Advance Appropriations – highlights some of the successes the program has achieved in delivering comprehensive HCV treatment using Direct Acting Agents (DAAs) to cure HCV, as well as puts forth a request for an additional $751 million in funding specifically for HCV treatment. This is a $151.2 million increase from the 2018 Advance Appropriations requested in the previous year’s document.

The VA began offering treatment to all veterans in its health system regardless of their disease stage in March 2016 (Kime, 2016), a major step forward for the program, as the high cost of newer DAA drugs have proven prohibitive to decisively moving to eradicate HCV within other government healthcare programs enrollees. This also allowed veterans who were “…waiting on an appointment for community care through the Choice program [to] turn to their local VA facility for this treatment or elect to continue to receive treatment through Choice.” The Veterans Choice Program – introduced in 2015 – is a temporary benefit that allows veterans who were enrolled in VA health care prior to August 01, 2014, or who are eligible to enroll as a recently discharged combat veteran, to receive care in their communities, rather than waiting for a VA appointment or traveling to a VA facility (Peterson, 2015).

In the document recently sent to Congress, the VA also touted some of the successes of the program:

  • As of December 2016, 78.8% of Veterans in care in the 1945-1965 Birth Cohort – those most likely to have HCV in the U.S. – were screened for HCV, and the VA estimates that an additional 15,500 veterans in VA care remain undiagnosed.
  • From January 2014 through March 2017, the VA has treated over 84,000 veterans with cure rates over 90%.
  • As of February 2017, 61,000 veterans diagnosed with HCV were potentially eligible for treatment.
  • The VA estimates that approximately 80% of all veterans with HCV enrolled in VA care will be treated by 2020. Veterans remaining in the untreated pool at that time are estimated to be more difficult to engage in care due to issues like homelessness, mental health, and substance use comorbidities, or may be uninterested or unwilling to receive HCV treatment.
  • The number of total national HCV treatments increased from approximately 2,800/year in 2011-2013, to over 30,000 in 2016. This growth reflects the additional demand for HCV treatment with DAAs, beginning the second quarter of 2014 through the present.

The VA’s approach to treating veterans is a success story that CAN be repeated by other government-run healthcare programs, but doing so will require state and Federal governments to exponentially increase funding in order to eradicate HCV within the populations most likely to become infected. The Centers for Disease Control and Prevention (CDC) estimates that the vast majority of new HCV infections is a result of Injection Drug Use (IDU) among rural and suburban white men and women aged 18-35 (Dwyer, 2017). The populations are likely to also have lower incomes that may make them eligible for coverage under state Medicaid programs (in Medicaid Expansion states).

The full VA Budget Request can be viewed at the following link:

Department of Veterans Affairs – FY 2018 and FY 2019 Advance Appropriations

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Pennsylvania Medicaid Opens HCV Treatment to Virtually All HCV Patients

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On May 16th, 2017, Pennsylvania’s Department of Human Services (DHS) announced changes to the state’s Medicaid policy that will expand coverage to treat virtually all enrolled clients living with Hepatitis C (HCV). Beginning July 1st, 2017, HCV-infected beneficiaries with liver scoring of F1 will become eligible for treatment coverage for the newer Direct Acting Agents (DAAs) that are highly effective, easily tolerate, and also very expensive. Beginning January 1st, 2018, clients with liver scoring of F0 will become eligible for treatment coverage. Prior to the July 1st policy change, treatment coverage will be available only to clients whose liver scoring ranges F2 to F4, unless other mitigating complications exist that warrant immediate treatment.

These changes come in response to a number of factors, most notably the 290% increase in new HCV infections between 2014 and 2015 reported by the CDC earlier this month. The deciding factor in this case, as in many other state Medicaid decisions, was the threat of a class action lawsuit. Attorneys from the Center for Health Law & Policy Innovation at Harvard Law School, the Pennsylvania Health Law Project, Community Legal Services, and Kairys, Rudovsky, Messing, & Feinberg, LLC sent a formal demand letter in late 2016 on behalf of their clients, Pennsylvania Medicaid recipients. This letter notified DHS that unless it agreed to remove “categorical coverage exclusions” of HCV medical cures from its Medicaid policy, the state could face a Federal class action law suit (Harvard Law School, 2017).

For the uninitiated, a little explanation is likely in order on the topic of “F scoring.” The “F” stands for fibrosis – the thickening and scarring of connective tissue, usually the result of injury. In relation to the liver, F scoring describes the length in expansion of fibrotic areas between portal tracts (also known as “portal triads”), and these changes are staged at F0 (No fibrosis) to F4 (Cirrhosis) (Hepatitis C Online, 2015). Patients with F4 Cirrhosis is characterized by a loss of liver cells and irreversible scarring of the liver. A healthy liver regulates the composition of blood, including the amounts of sugar (glucose), protein, and fat that enter the bloodstream. It also removes bilirubin, ammonia, and other toxins from the blood (WebMD, n.d.). A cirrhotic liver cannot properly perform these functions, leaving the patient susceptible to numerous painful and life threatening illnesses and side effects of failing or failed liver function.

The changes to Pennsylvania’s Medicaid program make it one of the first in the nation to adequately address the burgeoning HCV epidemic by treating patients early in the disease cycle. While the newer DAA drugs are all very expensive, the cost of curing patients outright, rather than continuing to pay for their long-term health degradation while waiting for their liver to become scarred enough to treat their HCV. Aside from being costly, it is also inhumane. While HIV patients underwent similar treatment in relation to the recommendation of when they begin Antiretroviral Therapies (ARTs), eventually we came to the realization that treating the disease early would result in fewer long-term complications for HIV patients. This way of thinking in terms of HCV patients is likelier to come more quickly, now that we have medically curative treatments.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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A Conversation About HCV in Incarcerated and Post-Incarceration Settings

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On Thursday, May 11th, the Community Access National Network (CANN) hosted a Community Roundtable on Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C (HCV). Three speakers, including myself, gave presentations detailing the various barriers, opportunities, and complications that surround ensuring that incarcerated citizens receive the car to which they are legally entitled under the 8th Amendment’s “…cruel and unusual punishment” provision.

State/Federal HCV-Related Lawsuits Involving Prisons (2007-2017). At least 18 Class-Action and Civil Rights Action lawsuits were filed in 11 states between 2007-2017.

My presentation covered the legal aspect of treating HCV in prisons and jails, much of which I detailed in last week’s HEAL Blog; as such, I will spend this blog discussing the information presented by my peers:

Wayne Turner, Senior Attorney with the National Health Law Program, delivered an excellent and thorough explanation of how Medicaid-eligible incarcerated persons can have their treatment paid for through the Medicaid program if they are taken to an outside facility for care. What this means is that, using a provision written into the Medicaid law, so long as the prisoner is treated at a hospital outside of their incarceration facility, their treatment and care can be covered and paid for through the Medicaid program, rather than relying upon the prison healthcare and pharmacy budgets.

This has the potential to be a hugely beneficial resource for prisons, as treating HCV is very costly. It also raises an interesting question – would this mean that prisoners can be taken to hospitals, be prescribed one of the new Direct Acting Agents (DAAs) to treat their HCV at the hospital, and fill that prescription at the hospital pharmacy and have the drug covered by Medicaid, rather than the prison pharmacy budget? It’s an interesting question, and could be the solution needed to ensure that inmates receive the care they need.

A. Toni Young, President and CEO of the Community Education Group, also delivered a rousing call to action, discussing her work in trying to figure out how to improve access to Medicaid and HCV education both inside the prison system and for the general population. What this really requires, she posits, is that medical professionals as well as Federal, state, and local governments dramatically increase education campaigns to teach people about HCV, and most importantly, how to avoid contracting the disease, both inside and outside of prison settings.

What makes this approach vitally important is that HCV education is something that is sorely lacking in the areas that are hardest hit; not just HCV education, really – healthcare literacy in general is an issue. As such, we must, as Toni suggested, work on ways to get people to actually care about what we’re trying to teach; get them to understand that learning about and preventing the spread of HCV will save their lives.

Another fantastic point brought to the fore by Elizabeth Paukstis, Public Policy Director at the National Viral Hepatitis Roundtable, was that, despite advocates calls for prisons to treat everyone, the reality is stark – the budgets are what they are, and no matter how often or loudly we insist that they treat inmates with HCV, many states simply do not have the resources to do. At that point, litigation is really the only route that many inmates can take to ensure that they receive treatment.

This Community Roundtable was a fantastic event, and I look forward to participating in future roundtables to figure out the best ways in which we can help combat the HCV epidemic.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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