As a physician assistant, I never imagined that I could cure someone of hepatitis C.
But then I learned to think bigger.
For eight years, I worked at a community health center in Houston that mainly treated people who were uninsured or had little money to pay for health care. My clinic days there revolved around family planning, prenatal care, and well-child visits; preventive services like screening for colorectal cancer; acute issues like urinary tract infections and chest colds; and chronic health problems like diabetes and high blood pressure.
But not hepatitis C. That was not family medicine.
And yet, in 2014, I began treating John Rocks, who, at 52, discovered he had contracted hepatitis C some 30 years earlier from a blood transfusion — a revelation that came as a complete shock.
Mr. Rocks, self-employed and uninsured, was despondent when I met him. He thought hepatitis C had no cure. He thought it would kill him.
It didn’t.
I guided Mr. Rocks through a 12-week course of sofosbuvir, which eradicated his hepatitis C. Completely. He was 100 percent cured.
Mr. Rocks was so grateful he cried, and I cried with him.
I too felt enormously grateful. I’d saved a life by taking a path I hadn’t wanted to pursue. And now I saw so many new paths before me.
How did this happen?
The clinic where I worked had an agreement with CHI Baylor St. Luke’s Medical Center to implement a screening program for hep C. As the only provider on staff, I had to lead the new screening program, whether I liked it or not. (I didn’t.)
A few days after I (reluctantly) agreed to do the hep C screening program, I received an email from someone at CHI Baylor St. Luke’s regarding my participation in something called Project ECHO, a weekly videoconferencing education program where I would learn how to actually treat hep C.
I did not want to do that. How was I, a PA in a family practice clinic, supposed to learn how to treat hep C?
Plus, I had a lot of other responsibilities, between seeing patients and training students on family medicine rotation, as well as training new staff.
But I had no choice.
So one Monday afternoon, I logged onto my first virtual ECHO clinic. Think of it as grand rounds on Skype. On my computer screen, I saw PAs, doctors, and nurses logged on from community clinics around the state. Leading the teleclinic were Dr. Norman Sussman and Dr. Saira Khaderi, director and associate director, respectively, of Project ECHO at CHI Baylor St. Luke, and both hepatologists. With them was a team of specialists, including a psychiatrist and a pharmacist, and project manager Lizette Escamilla.
What surprised me most was how much the PAs and other community providers knew about hep C. They made case presentations, they described their progress with their patients, and they expressed their concerns. They sounded like pros.
The specialists paid close attention to what the community providers told them, asked questions, and determined next steps for their patients with them. They treated the community providers like colleagues.
I knew I could never get to that level.
I thought: Well, I can still refer out patients who test positive from the screening program. I don’t have to treat them myself.
But then I saw how many of our clinic patients tested positive for hep C. I couldn’t believe it. Hep C was a huge problem in my community, and I’d had no idea.
In addition, most of these patients couldn’t get to CHI Baylor St. Luke’s. They didn’t have cars. They couldn’t take time off from work. If they couldn’t get treatment closer to home, they probably weren’t going to get it at all.
I had to step up.
And that’s how I came to treat Mr. Rocks.
And here’s the thing: I DID get to that level. Not only did I cure Mr. Rocks, but, as a result of my participation with Project ECHO, I cured about a dozen other patients with hep C.
After Mr. Rocks’s successful treatment, The Houston Chronicle ran a story that included one of my favorite quotes ever, from Dr. Sussman, explaining the importance of Project ECHO: “If we see Mr. Rocks, we manage one patient. If we educate Renita Madu, she can see 20 patients. We are training an army of people — it’s a force multiplier.”
Project ECHO brings care to underserved areas by empowering providers like me, giving us the knowledge and the confidence to help the people we serve in ways we would not have believed possible.
I didn’t stop with hepatitis C. CHI Baylor St. Luke’s offers ECHO clinics on many complex chronic conditions — including hepatitis B, heart disease, HIV, and substance use disorder — and I participated in nearly all of them. To me, this was like free education. I couldn’t pass it up.
I got to know all kinds of specialists: psychiatrists, liver disease specialists, cardiologists, and infectious disease experts. They knew me, they took my calls, and they spoke to me as a colleague. I had their numbers on speed dial!
Being part of Project ECHO changed my thinking on so many levels: about health care, about education, about being part of a team, about my own strengths and capabilities — and about what I wanted to do with my life. I love being a PA and I love teaching, but, through ECHO, I also discovered that I am passionate about public health, and I am now getting my doctorate in public health.
I’m also thinking globally. After all, Project ECHO is in more than 20 countries now. My parents were born in Nigeria. I still have family who live in a small village where the only decent health care is hours away. People there are dying from common diseases that could easily be managed by trained health care professionals. One of my dreams is for them to have access to Project ECHO as well.
Project ECHO has indeed helped me to see the bigger picture. If you’re a health care provider — especially in a community setting — and you want to learn more and do more for patients, I encourage you to get involved with Project ECHO. It’s not just in Texas — it’s nationwide, and based at the University of New Mexico Health Sciences Center in Albuquerque, where it started more than 10 years ago.
Go ahead. Think bigger.
Contact Project ECHO — you won’t regret it!
If you want to learn more about Project ECHO — or if you would like your doctor to learn more about Project ECHO, please email the ECHO team at ECHOreplication@salud.unm.edu. For more information about the ECHO program at CHI Baylor St. Luke’s, please contact Lizette Escamilla at lescamilla@stlukeshealth.org or at 1.855.259.0028.
