Cover story published in Shifa News, July 2016
Hepatitis C: Prevention is better than cure
24 year old, Umair was feeling pain in his body on his wedding day but he ignored it considering it to be due to the hectic routine. The pain increased with time. The resident of Faisalabad, now also remained fatigued and feverish most of the time. Unfortunately, a year later while donating blood he was diagnosed with chronic hepatitis C, an inflammation of the liver. Umair started using boiled water, thinking the disease was caused by contaminated water and avoided visiting a doctor. His health however, deteriorated. Ten years later, his liver had completely damaged; he had cirrhosis. Only a liver transplant could save his health. “Kaash mai apni bemari ko itna na latkata aur time pe haspataal chala jata to ye naubaat na ati (Had I not prolonged my disease and went to the hospital timely, I would have saved myself from the severity),” says the now 34 year old farmer. Other than two children and a wife, Umair has a large family to feed as he lives in a joint family. With a low income, he was forced to take heavy loan for his transplant. Now he has been successfully treated but has still the burden of repaying the debts that amount to 58 lakh.
There are many stories filled with misery like that of Umair’s. According to World Health Organization (WHO) about eight million Pakistanis are infected with hepatitis C virus at present. 150 million are chronically infected and at risk of developing liver cancer or cirrhosis in the world. In 2007-8, a survey undertaken by the Pakistan Medical Research Council (PMRC) and Pakistan Ministry of Health showed that HCV prevalence rate was 4.8 percent with equally affected males and females in the country.
Pakistan is the second largest country after Egypt with Hepatitis C cases. And the disease is common among people between 30 to 50 years. It is a blood borne disease that produces liver inflammation. It is also called the silent killer as it damages the liver slowly and stealthy.
HCV has two basic forms: acute and chronic. The difference between acute and chronic is that the latter is persistent and it can even reoccur. “In Pakistan 60 percent of the patients have chronic hepatitis C,” says Dr Nasir Khokhar, a gastroenterologist and hepatologist at Shifa International Hospital Islamabad.
He further adds that chronic HCV has a long incubation period (initial contact with the virus and onset of the disease) that ranges from two weeks to six months. During that period, it does not show any symptoms or signs and it can even take years to affect the liver.
The virus only causes inflammation for the first ten years and this does not disturb the patient except for causing exhaustion or pain in the body. “These symptoms are non specific because anyone with or without the virus can feel fatigued or have body pain,” says Dr Nasir.
In the next ten years, the virus damages the liver and causes cirrhosis or contraction of the liver. It is at this time when clear signs start to appear: blood vomits, swelling, nausea and water retention. While in the next ten years, liver cancer is formed. Umair was at stage two when he was diagnosed with the disease.
Hepatitis C can be transferred through contaminated or used needles and razors, unsterilized or used syringes, injectable drugs, unsterilized dental or surgical equipment, unprotected sex and mother to baby during birth.
According to experts, the common use of therapeutic injections in Pakistan is the main cause of its spread. A study says use of injections in the country is the highest in the world. PMRC reported that 30 percent of Pakistani population takes six to seven injections (per person) a year, which is very high.
Disposable syringes are usually not disposed off appropriately. Many syringes are sold and packed again in the markets. “This is particularly happening in small towns and villages. And sometimes patients have been injected with the same needle repeatedly,” unfolds Dr Nasir. This practice is extremely dangerous and becomes one of the major reasons for the spread of hepatitis C virus.
Moreover, excessive and unnecessary use of injections and drips is a harmful trend. “People think drips and injections would boost their energy even when it is not required,” says Dr Junaid Saleem, a member of Pakistan Society of Gastroenterology and Gi Endoscopy (PSG).
Yet another cause of the spread is unscreened blood transfusion. And visiting roadside barbers is the third largest cause of transmitting the virus in Pakistan.
When it comes to diagnosing, different types of blood tests are done to confirm the disease. ALT test checks inflammation in the liver. Its presence indicates that the person has the virus. Moreover, antibodies of HCV are examined in the body to confirm its presence. Another blood test called HCV PCR examines the genetic material of the virus. Lastly, tests are done to determine the percentage of liver damage and its position.
Unfortunately, there is no vaccine for hepatitis C virus. And the treatment is of long duration and expensive. According to Dr Nasir, though medicine prices have reduced recently but the cost of tests are still high. In this scenario, affordability becomes a big question for the bread earner. And if the disease progresses on to cirrhosis, transplant becomes inevitable. Money for the transplant, getting a healthy donor and finding the right hospital are enough challenges in itself.
“Not all hospitals in Pakistan offer liver transplant facility,” informs Dr Junaid. It is an expensive treatment that costs up to 5 million excluding hospital stay and tests.
The good news is, HCV positive patients need not confine themselves to bed. “They can certainly practice normal life, do light exercise and continue routine activities as the disease can even take 30 years to develop in a body,” says Dr Nasir.
There are however, several daily life practices that should be avoided to prevent the disease. For instance: do not insist on taking injections and drips unnecessarily for common ailments, avoid visiting roadside barbers, tattoo makers and ear and nose piercing shops and dentists with sub standard equipment as they pose a huge health risk. Always ensure that you get properly screened blood and demand sterilized equipment at dental clinics,” advises Dr Nasir.
Prevention can only be possible if people are aware of the modes of transmission and realization of how the disease impacts not only the individual but also his family. This can be done through effective awareness campaigns especially at school level. There are a lot of myths and misconceptions regarding the disease that need to be addressed too. Like Umair believed contaminated water caused the disease. Other than this, ganny ka juice (sugarcane juice), mooli aur karaily ka pani (radish or bitter gourd extract) can cure it and living with a HCV positive patient or using the same utensils will spread the disease.
Public education is extremely essential in this regard and effectively using print, electronic and social media can be helpful. Parents should also educate their children about the disease and patients should not hesitate in asking the doctors or other medical practitioners if their equipment is sterilized.
Do not compromise on your health at any cost as an ounce of prevention is better than a pound of cure.