World Hepatitis Day 2016: How His Parents Caused His Death

It was a lovely Wednesday morning as I get prepared for the day’s clinic. I wasn’t expecting much, today is going to be like every other day. It is almost always an infection, if not malaria it will be one of those bacteria infections with typhoid being the most common. But on few occasions, some patients present with chronic diseases like diabetes mellitus or hypertension.

The clinic was normal until a pregnant man came in. A pregnant man! Other patients in the waiting room wondered. A middle aged man with a huge abdominal distention was wheeled into the hospital. He was in an obvious distress, he looked as if he is seconds away from death. So jaundiced and pale that he could barely stand. I swung into action with the hope of helping him but my enthusiasm was soon shattered. There’s little I could do on knowing the diagnosis. He has liver cancer from chronic hepatitis B infection.

The most touching part of this tragic story was how he got the hepatitis B infection. Before going neck deep into his story let’s form a background by knowing some basic information about hepatitis B. Hepatitis B is a viral infection just like HIV but 100 times more infectious. WHO 2014 facts sheets estimates that 2 billion people have been infected with hepatitis B virus worldwide. 90% of those with the infection don’t know they have it and only 1 in 100 gets treated. It is transmitted by sharing of sharps, unsafe sexual intercourse, exchange of body fluids, needle pricks and also from mother to child. Most people with this infection go unnoticed as the immune system have the ability to contain it but when this fail, an infected individual becomes a chronic carrier of the virus. And in the long run, the chronic carriers develop liver cirrhosis and liver cancer. Chronic hepatitis infection is the commonest cause of liver cancer in sub Saharan Africa.

So how did my patient got his? Exactly 42 years ago, his family of 7 felt the need to empower themselves against metaphysical powers. His parent felt they needed to fortify the children and protect them from their numerous imaginary enemies. This made them visit an herbalist whose method of doing this was through incisions. He incised the five children twenty one different times, lacerating different parts of their body while he rubbed a black substance on each incision. He used the same blade for all the five children. He ended up infecting all the children with hepatitis B virus in the process. Three of the children later became a chronic carriers as evidenced by being positive to hepatitis B surface antigen. None of the children knew until one of them developed liver cancer. I referred him to a gastroenterologist but little could they do to help him. He died 2 months after.

Important lessons from this story are:
About 20 million Nigerians are chronic carriers with most being unaware.
Everyone should go for a screening test, it is not expensive.
One should avoid high risk behavior like sharing of sharps and having unprotected sexual intercourse.
Parent with the infection should take adequate measures to prevent its transmission to their unborn child.
All new babies must be vaccinated against the infections
If you have this infection it is not the end of the road, it can be cured.

Let me leave you with the recommendation of Prof. Olusegun Ojo, the former President, Society for Gastroenterology and Hepatology, Nigeria and the current President of Africa and Middle East Association of Gastroenterogy (AMAGE), “At the same time, Nigerians should take steps to determine their Hepatitis B Virus and Hepatatis C virus statuses by getting screened in hospitals and medical laboratories. If negative, they should seek to be vaccinated and, if positive they should ask to see hepatologists, specialist physicians who are knowledgeable and conversant with further testing and treatment.”

An important question I ask myself is, should one blame the parent or excuse them for the good intention that turned sour?

This article was written to commemorate the world hepatitis day, July 28 and in remembrance of a fellow nairalander, DJDOLA who died from chronic liver disease 2 years back. May your soul and that of my patient rest in peace.