Early this year, I
raised the alarm about the poor knowledge and attitude, by both patients
and some medical practitioners, about the endemic called hepatitis in
Nigeria. Less than 24 hours after the article was published in
Daily
Trust and The PUNCH, I got no less than 100 emails from
Nigerians on this disease. I had always questioned the veracity of
public statistics, but the gale of email messages I received made me to
change my stand: those statistics by the World Health Organisation and
other agencies about the prevalence of one disease or another are not
far from real. While reading up on hepatitis shortly after I was
diagnosed in 2009, I got to know that more than 400 million people are
infected the world over and 20 million in Nigeria. I doubted it, but now
I am convinced. 20 million means 1 out of every 7 Nigerians has
hepatitis. It’s no longer about some pseudo-researchers sitting in one
air-conditioned room and fabricating statistics, it is very real. I have
received emails from no less than 200 Nigerians, 95 per cent of whom
are also hepatitis patients, since my article was published. I still
receive till now from people that must have bumped into the piece
recently.
If out of the very
limited population of Daily Trust and PUNCH readers, 200 people have and
are aware they have hepatitis infection, I wonder how many other
readers have it but don’t know. Not to mention the multitude of
newspaper non-readers or illiterate people out there that are infected
but don’t know. We cannot run away from it any longer, the 20 million
hepatitis prevalence rate cannot be far from real. I am now very
convinced.
Apart from co-patients,
among the people that got in touch with me after the article were a few
medical doctors. I must commend the erstwhile Chief Medical Director of a
top Federal Government-owned hospital in the north who was very
passionate about the points I raised in my earlier article and compared
notes with me, despite not being a gastroenterologist or hepatologist.
He was humble enough to refer us to his colleagues, one in Abuja, the
other in Ibadan, whom he stuck his neck out for. A couple of other
medical doctors also got in touch and we shared ideas on how awareness
could be increased on this silent killer. A gastroenterologist faulted
my emphasis on fibroscan and omission of liver biopsy as a reliable
procedure for knowing liver status. I concede that biopsy, which is
available in Nigerian hospitals, especially teaching hospitals, can
equally be used as a means of checking liver fibrosis and cirrhosis, but
being an invasive process, it definitely carries greater risk than
fibroscan as a means of testing for liver damage. There is also the
limitation that since liver is a very large organ, the portion pinned
for test in biopsy procedure may not be fully representative of the
condition of the whole liver, as parts other than that sampled for
biopsy may be damaged whereas the portion cut for test may be healthy.
This is why I believe we should find a way of introducing fibroscan
technology to Nigeria.
Unfortunately, among
those that contacted me was a young medical doctor, who, rather than let
us compare notes, hauled insults at me for questioning the knowledge of
some medical personnel on hepatitis management in Nigeria. There was
however another young medical doctor, who, through our conversation,
heard for the first time the test called hbsag quantification, as
different from viral load (HBV DNA). He was humble enough to promise to
read up on it and update his knowledge.
The above said, I
concede that this knowledge gap is a reflection of the Nigerian system
as a whole, and not only limited to medical practice. I therefore tender
my apologies for hitting medical personnel too hard in my first
article. Yet I believe, even in the face of these limitations, our
medical personnel, like practitioners in other fields, can do more.
Also worthy of mention
is the lamentation I received from some co-patients that they were
denied jobs because of hepatitis infection. A young man narrated how a
bank took back a job it offered him because his pre-employment medical
test showed he was hepatitic. This is discrimination that should not be
allowed. In as much as a prospective job applicant is in a proper
physical or mental state, being a hepatitis carrier should not be a
hindrance to his opportunities, except of course for a job that has to
do with working with blood, like nurses and laboratory scientists. I
also changed job between the period I wrote my last article and now, and
my pre-employment medicals showed hepatitis infection, but my very
mature employers still offered me the job. This is how it should be. I
hope government will look into this and sanction employers that
discriminate against hepatitis carriers.
Hepatitis is still a
cause for concern in Nigeria and it is under-reported. The awareness is
low, that is why it continues to spread at an alarming rate in this
country. Employers and schools can consider a scheme for testing people
under them and giving vaccination for those that are still negative
while those that are positive can begin management process. The cost of
prevention is too insignificant to be ignored.
-Adamu, a Chemical Engineer, wrote in from 1004 Estate, Lagos, via johndeadamu@yahoo.com
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