CONTRIBUTIONS
1. Creation of New Facilities
i. Instrumental in starting Liver ICU at PGIMER, Chandigarh for sick patients with liver diseases
ii. Instrumental in starting a new super-speciality course (DM) in Hepatology at PGIMER, Chandigarhfor the first time in the country.
iii. Startedsuccessful Liver Transplantation program at PGIMER Chandigarh
iv. New Department of Hepatology at Sanjay Gandhi PGIMS, Lucknow
v. New upcoming Departments of Infectious Diseases, Head & Neck Surgery and Pediatric Endocrinology at SGPGIMS, Lucknow
vi. Rajdhani COVID Hospital 1 & 2, Sanjay Gandhi PGIMS, Lucknow
vii. Tele-ICU Project in Uttar Pradesh: Tele-ICU services model is based on SGPGI as Hub and 06 old state medical Colleges of UP [Medical colleges in Gorakhpur, Prayagraj, Kanpur, Agra, Jhansi and Meerut] as Spoke. The whole network would be of 100 beds.
2. Contribution in Fight Against Covid in Uttar Pradesh
The success of Rajdhani Corona Hospital (RCH) is embodiment of the immaculate planning, designing and implementation of the COVID-Care-Model of SGPGI, and clearly shows the preparation that a Global Pandemic like COVID demands. The aspects of this SGPGI-COVID-Care-Model was emulated in 52 State Medical Colleges of Uttar Pradesh (UP) is enumerated here as follows.
Creation of state-of-the-art RCH, as well as Protocols/SOPs for patient monitoring and management was done in record time, including rapid commission and operationalization of Liquid Oxygen Plant in RCH. Telemedicine was utilized to its fullest during these troubled times in several aspects of care and education. Capacity building of 52 State Medical Colleges of UP, via COVID-Version-1.0 (55-sessions) and 2.0 (95 sessions), comprising of 13 training modules, helped train over 40,000 HCWs; also included were life support skill training sessions. Electronic COVID Care Support (e-CCS) & e-OPDS (Nearly 55000 Tele-consultations/assistance); Tele-ICU for improving care at 21 State Medical College ICUs; Tele-ICU based on Hub & Spoke model is being created for 06-old State Medical Colleges (Gorakhpur, Kanpur, Agra, Jhansi, Meerut and Prayagraj). COVID Expert Teams of SGPGI, on the directions of the State Govt, have guided COVID Care in many State Medical Colleges at par with that of RCH. Covid Advisory Board on directions of Chief Minister, Shri Yogi Adityanathji and under my chairmanship, have provided guidance and assistance in strategic planning, implementation and management of COVID in UP in the following areas: (a) Micro-containment, stricter CAB discipline and enforcement, enhanced RT-PCR testing, serosurvillance and genomic sequencing have profoundly contributed in bringing down the COVID Positivity Rate in UP. Strategies employed in UP in fight against COVID have been well appreciated by WHO, Australia, Niti Ayog and media; (b) Predicting & preparing for the 3rd Wave of COVID-19 in UP; Delta-plus variant of COVID-19; Preparation for pediatric facilities for 3rd Wave of COVID-19; Evaluation & Management of COVID Associated Mucormycosis; Use of IVIG in MISC; etc; (c) Covid Associated Mucormycosis (CAM), a dreaded consequence of poorly managed diabetes and rampant indiscriminate use of steroids during COVID. On directions of State Govt, an advisory board under my Chairmanship was also constituted to manage, mitigate, and control CAM in the state. The protocols/SOPs and interactive case discussions with the State Medical Colleges helped tremendously in reducing the case load in UP.
3. Efforts for Hepatitis C Elimination in India
Viral hepatitis is a leading cause of death in the world, which is comparable to that of HIV, tuberculosis and malaria. Cirrhosis and hepatocellular carcinoma, which are the sequelae of chronic hepatitis B and C, accounted for more than 90% of all hepatitis B and C related deaths. While prevention can reduce the rate of new infections, treatment eliminates existing infections; thus, combining both prevention and treatment makes hepatitis B and C elimination feasible long-term goal. India is working towards the “Targets/Goals” set by WHO - “a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with chronic hepatitis C infections” by 2030.
The Punjab has high prevalence of hepatitis C (3.6%) against the National average of less than 1%; more than 8 lakhs of people need to be treated with Direct Acting Anti-virals (DAAs). Dr Dhiman devised a cost-effective highly effective algorithm for the treatment of hepatitis C at the public health level. He was instrumental in training more than 120 primary care provider physicians and pharmacists across the Punjab in an initial workshop followed them with telemedicine case-based training every fortnightly, empowering them to treat hepatitis persons in all 22 district hospitals and at all Government medical colleges across Punjab. More than 1,00,000 persons with hepatitis C have been treated in Punjab in 3 years before he moved to Lucknow to join his new assignment as Director, Sanjay Gandhi PGI, with a success rate of 93%, best among other similar programs running across the world. The program has now been further expanded for micro-elimination of HCV infection in other populations, such as, co-infection with HIV, incarcerated persons, persons who inject drugs (PWID), persons on oral substitution therapy (OST), etc.
Based on the success of Punjab model, Government of India launched the National Viral Hepatitis Control Program (NVHCP) on 28 July 2018 with provision of free diagnosis and treatment for viral hepatitis through the National Health Mission. Dr Dhiman is the Chairman of Technical Resource Group (TRG) of NVHCP; Scientific Advisor to Hepatitis C Control Program in the Punjab [Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF)], and Chairman, Injection Safety, Punjab. Dr Dhiman developed guidelines on Viral Hepatitis for its elimination in India, which were released by the Honourable Health Minister of India, Sh JP Naddaji. These guidelines are – (i) National Viral Hepatitis Control Program: Operational Guidelines, (ii) National Guidelines for Diagnosis & Management of Viral Hepatitis and National Guidelines for Diagnosis & Management of Viral Hepatitis B
He was the member of prestigious “Coalition for Global Hepatitis Elimination (CGHE)” aimed to eliminate viral hepatitis globally. He was a member of Asia Pacific Regional Advisory Council; he represents India, Pakistan, Sri Lanka, Bangladesh, Nepal, Myanmar and Bhutan.
In the capacity of Chairman, Injection Safety in Punjab, Dr Dhiman guided the introduction of Re-Use Prevention (RUP) syringes in all government hospitals in Punjab, a step toward safe injection practices for the prevention of new viral hepatitis infections. WHO has also recognized these achievements. All these concerted efforts would be able to achieve WHO Goals set for elimination of viral hepatitis by 2030.
4. motion of Organ Donation for Organ Transplantation
Demand of organs for organ transplantation outnumbers the number of organs available. Hence awareness about the organ donation among peoples should be promoted. Dr Dhiman has been front runner in promoting the organ donation. With all his efforts, the “Pledging for Organ donation” on driving license in Chandigarh UT became a realty in 2013; Chandigarh UT is the 2nd state/UT in India to have this honour.
He started the website http://www.lampoflife.in for organ pledging in 2012, conducted several public forums, poster making competition amongst school children, etc for promoting organ donation in the region.
As a result of active campaign for Organ Donation in this region since 2011, Chandigarh became the 2nd State/UT for Organ Donation in India. The organ transplantation at PGIMER, Chandigarh, a Government Institute, has become routine including, kidney, liver, pancreas, heart, etc