Warning! Red Alert! ....Hepatitis in Nigeria

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I find it compelling to call attention to the dangerous state of medical knowledge in Nigeria, as experienced in the last three years of my battling a chronic disease called

Hepatitis B. Without prejudice to my respect for professionals in Nigeria, I owe it a duty as a concerned Nigerian to raise a red flag on this.

I was diagnosed with Hepatitis B infection in 2009 after a suspicious doctor subjected me to the test in the process of treating conditions that bore resemblance to malaria in his hospital. As is expected of any educated person (although most educated Nigerians don’t do this, unfortunately), I did further research on the disease, especially as it is a condition that is, for now, more realistically managed than cured. I joined a number of global health discussion forums on the internet and met co-patients, doctors, as well as researchers from across the world where we interacted extensively on the disease. In what I have concluded as the best benefit I have ever derived from that technology called internet, I learnt a lot on the disease. I met people that have been managing the disease for more than 30 years, even as the newly diagnosed join the community on daily basis. From Italy to the United States of America to Brazil and Asia, we shared results of our regular tests and the potency of the management drugs everyone uses, not leaving out the discussions on the latest research results by world renowned researchers in Hepatology. Through the medium, I also met a couple of Nigerian co-patients who, like me, had also stumbled on the online Hepatitis community and we began to discuss our situation and exchange knowledge on telephone. It is an online community I will forever remain grateful to for offering such robust platform that has assuaged the trauma that comes with such diagnosis.

Within weeks, I realised even the doctor that diagnosed me is no longer in the same page with me in our discussions. I changed doctors and hospitals, and the story remains the same. Except two of the consultants I met, every other doctor I met in more than 10 otherwise highly rated hospitals in Lagos knew practically nothing about Hepatitis management, other than how it is tested and a few basic things about it. I find the situation very pathetic. I had been lamenting the situation in private but I find it hard to hold again when my co-patient friend from Abuja called me few days ago to narrate her experience with a doctor in – wait for it – National Hospital Abuja, the nation’s number one government hospital. Now, I know why rich Nigerians travel abroad for treatment for a medical condition as little as headache.

This young lady, whom I met at the US-domiciled but globally accessible online health community and have established contact with to share knowledge and experience in Hepatitis management, had just come back from England where she had gone to do some tests required regularly by an Hepatitis patient, but she found it more than confounding when the doctor could not make any meaning of the tests. The tests: Hepatitis B surface antigen quantification (Hbsag quantification), Hepatitis B viral load, Fibroscan and Vitamin d level. But more unpardonable is the doctor’s statement that Hepatitis B. like A, is caused by intake of contaminated foods. That Hepatitis B and C are transmitted by blood and body fluids as opposed to A that results from taking contaminated foods, is too basic for a qualified doctor not to know.

The medical doctors are not the only ones wallowing in this knowledge gap, it is worse in the laboratories. I have been to the best laboratories in Lagos and was surprised to hear that they have never heard of Fibroscan or Hbsag quantification. Fibroscan is the latest technology to detect at its early stage Liver damage called liver fibrosis and its advanced form called Cirrhosis. No laboratory has this technology in Nigeria and that is the only Liver monitoring test I have not done in the last three years. Hbsag quantification is the test that shows the quantity of the virus in the infected person’s blood, but my experience with the only laboratory that clams to do it in Nigeria is rather suspicious. I paid close to N40,000 for the test in this highly-rated lab located in Lagos, which they told me they will DHL my blood sample to India. However, two things raised serious suspicions about the veracity of this test they said they did. One, when the result was given to me a couple of weeks later, the unit of measurement was left out as against standard practice of stating units, making me to suspect if somebody somewhere had not just sat down and typed something in a paper for me as test results. Two, when I referred my co-patient friend to the place few weeks later, they said they don’t do that test again! Why the abrupt stoppage? I seriously smelt rat with the operation of that laboratory which commands high regards in Lagos.

I have met many doctors that had never heard of anything called Fibroscan before. Most Nigerian doctors still do not know that ultrasound scan can only detect carcinoma but can never isolate fibrosis until it gets very advanced in which case it would have become almost impossible to reverse. This is what Fibroscan does. I am not saying that ultrasound scan is not useful for hepatitis-induced liver condition monitoring, but Nigerian doctors and laboratories will do well by bringing themselves up to date with latest developments in medical technology and treatment.

By far, the most dangerous is the ease with which doctors in Nigeria dismiss Hepatitis and tell patients not to worry about it; that they should just forget about it. The Abuja doctor also said this to my friend, stating that many of his colleagues have it and they don’t worry. It is good to work on patients’ psychology by downplaying its gravity, but what is standard practice in Hepatitis management the world over is to tell patient to run at least blood tests and ultra scan, at least once, if not twice or more, a year. This is important to quickly detect at the early stage if anything is going wrong with the liver. Nigerian doctors’ total discharge of patients they diagnosed and this has led to many deaths from hepatitis virus-induced liver damage in the country. I heard of someone that was diagnosed in 2002 but instead of the doctor telling him to be doing annual check on his liver, he was told to forget about it, that it was harmless. By the time the man was discovered to have Hepatocellular carcinoma (Liver Cancer) in 2010, it was too late as the liver had been irreversibly damaged. He died few weeks later. It was at that critical point that he remembered he was told by a doctor some eight years ago that he had hepatitis virus in his body but should not worry about it. I am therefore surprised that in this 2012, doctors are still telling patients they found Hepatitis on, that they should just go home and forget about it.

It is also noteworthy that the classification into active and inactive carrier matters less in liver watch. Truth, according to world class researchers from top American and European medical faculties, is hepatitis virus can never be totally inactive, it can only be extremely low in activity, so even for people whose status are said to be inactive, they still need to monitor it, at least yearly.

I am aware that in medical practice, there is specialization and the specialists in liver are called Hepatologists, or gastroenterologists who specialise in the whole digestive tract. But not being a specialist in this is no excuse for poor knowledge of Hepatitis management as displayed by Nigerian doctors in our experiences in top hospitals in Lagos and Abuja. I believe whether a GP or not, every doctor should know more than basic about Hepatitis, and indeed all diseases. Nigerian doctors need to keep themselves abreast of latest developments in the field of medicine. They appear to be generations behind in this knowledge. It becomes pitiable when patients in the US know virtually A to Z of Hepatitis, as we encountered in our online interactions with them. Our laboratories and diagnostic centres also need to step up their game. Fibroscan technology should be made available in Nigeria, so that we don’t have to travel abroad for this simple test that costs no more than $300. Same for hbsag quantification test, which is also not available in Nigeria. All these are critical to proper management of Hepatitis.

There is also the need for massive enlightenment about this disease, which though deadly, can be well managed, as I have come across foreign patients that have been managing it successfully for 30 years and living above average healthy lives. I advise anybody that comes across this article not to hesitate to not only screen himself but also carry the message to other people, and if found negative to go take vaccine immediately. Thankfully, Hepatitis B is vaccine-preventable. If found positive, hope is not lost and hepatitis is very treatable. This writer has been managing it since I got to know about it three years ago and by the special grace of God has never passed a night at the hospital. We live healthy live like any other person and also need to adjust our diet and go about our businesses normally, while only monitoring it through regular tests. It is also worthy of mention that being a consumer of alcohol and drugs increases risk of liver damage in hepatitis patients. Early diagnosis of hepatitis will mean putting stop to their intake, but many people that have it but don’t know still continue taking alcohol, making it easier for the liver to cave in. That is another reason why everybody should screen himself or herself.

 Adamu, a chemical engineer, wrote in from 1004 Estate, Victoria Island, Lagos via johndeadamu@yahoo.com

Source (punchng.com/opinion)

Waooohhh! What a great piece, this is very informative for anybody that cares to live. Please everybody including me should as a matter of  Life go check your/our/my self(ves).

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