They're colourful, loud and on the move. Meet the UQ graduates and doctors changing lives and removing the stigma of Hepatitis C.
Every disease and health condition that devastates the lives of people around the world is followed by a call for a cure. The COVID-19 global pandemic is no different.
But what if the disease is something the voiceless in our society have lived with in silence for decades? When a cure is finally found, how do you ensure you reach them?
According to UQ graduates and doctors Matt Young (Bachelor of Medicine / Bachelor of Surgery '89; Bachelor of Arts (Archaeology) '12; Diploma of Arts '19) and Joss O’Loan (Bachelor of Science (Honours) '05), the answer is simple – do it in a Kombi.
Since 2017, the doctors and their Kombi Clinic team have been on the road delivering a cure for Hepatitis C to at-risk communities.
Hepatitis C affects about 230,000 Australians and can lead to liver cirrhosis and liver cancer. With the majority of cases contracted through intravenous drug use or unsanitary tattoo practices, many of those impacted aren’t regularly accessing mainstream health services, which is greatly reducing their chances of early diagnosis and treatment.
Drs Young and O’Loan were working from their general practice (GP) clinic in Inala in 2016 when a new, direct-acting antiviral (DAA) treatment for Hepatitis C was released. The new treatment was in a simple tablet-form, had minimal side effects, and boasted a success rate of more than 95 per cent. Within a year, the doctors had cleared what was previously a high population of Hepatitis C cases from their clinic.
For the two GPs, the experience was almost as rewarding as it was for the patients who were cured.
“We realised just how much of a game-changer this was for our patients,” Dr O’Loan said.
“It was an amazing achievement for us as GPs to be able to tell someone they’d been cured.”
Dr Young said Hepatitis C is one of the very few life-threatening diseases that doctors now have a huge amount of control over.
“Some people have lived with the dark cloud of cirrhosis and liver cancer hanging over their head. They have family members that alienate them because of it.
“From the moment you tell them they're cured, you see the emotion on their faces. They hug you, kiss you, they start crying because this grim reaper that’s been haunting them isn’t there anymore. It’s like they’ve been liberated from that oppression."
“It’s a magical thing for both of us. It reintegrates them into their families. And that’s a special feeling.”
But this experience with their own patients was only the tip of the iceberg.
“The people who have this disease are typically disenfranchised and marginalised – they're people who don’t access mainstream medical services freely,” Dr Young said.
“They’re usually living on the streets, sleeping in rough locations and frequenting drug-rehabilitation centres and needle-exchange services.
“We know where they are, and our idea was to take the cure to them.”
In July 2017, the doctors launched the Kombi Clinic. Three years later, their iconic yellow Kombi and eye-watering Hawaiian shirts can still be spotted around the Brisbane region, servicing the community from homeless shelters, drug and alcohol rehabilitation centres, and even public parks.
Along with Drs Young and O’loan, the Kombi Clinic team is made up of nurse Mim O’Flynn and phlebotomist Mick Mooney. Between them, they meet with patients to discuss the risks of Hepatitis C, collect blood samples, counsel patients and administer treatment.
Despite the treatment being readily available in Australia for several years and a high frequency of Hepatitis C cases still being recorded, Drs Young and O’Loan were disheartened to learn at a conference in 2019 that 90 per cent of GPs were still yet to write a single script for it.
It’s a concern noted also by Professor Mieke van Driel, UQ’s Chair in General Practice, who has called for more general practitioners to step up and contribute to treatment of patients with Hepatitis C in the community.
“Initiatives like the Kombi Clinic are making amazing strides to ensure the treatments reach community members of all backgrounds,” Professor van Driel said.
“But it is also vital that GPs follow their lead, and ensure they are offering education and treatment for Hepatitis C as a standard part of their clinical practice.”
Drs Young and O’Loan say the lack of impact on Hepatitis C rates is likely the combination of a few factors.
“It’s not a medical issue, it’s a social issue,” Dr O’Loan said.
“If you’re living on the street, living rough or whatever – it’s not the patient who’s hard to reach, it’s the doctor.
“And there are really good studies that show where patients with Hepatitis C are. If you’re not taking the cure to the patients, then you’re not doing your job.”
Watch the video about the Kombi Clinic.
“It’s not a medical solution that’s going to lead to eradication – it’s about public awareness and publicity.
“We need to make doctors more aware of Hepatitis C cures, but also make the public more aware so that someone might think, ‘you know what, I did use a needle about 20 years ago. I'd better go and get tested'."
In the current climate of social distancing to manage the COVID-19 pandemic, the Kombi Clinic’s delivery model has been temporarily adjusted to a primarily telehealth service – but the doctors' determination to help the community has seen them reframe the barrier as a new opportunity.
“The silver lining is that the Kombi Clinic can now be everywhere at once, virtually,” Dr O’Loan said.
“We’re using this as a way to break down another barrier for healthcare inequality.
“And rest assured, even if we are on the phone, we are still wearing loud, obnoxious Hawaiian shirts!”
To learn more about the Kombi Clinic, visit their website or Facebook page.
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