A GNA Feature by Prince Acquah
Cape Coast, June 26, GNA – Ewurama Sekyiwaa (not her real name) has just stepped out of the doctor’s office with a bright face and holding a big white folder clung to her chest.
It was Tuesday morning; so, she attended the Hepatitis B clinic at the Cape Coast Teaching Hospital (CCTH) for her routine monitoring and treatment.
Scenario
The big folder contained results of her latest Computed Tomography (CT) scan which reveals she has developed liver hemangiomas – noncancerous mass in the liver made up of a tangle of blood vessels.
“The doctor said it is not really dangerous; it is nothing to worry about,” she said undisturbedly.
The 36-year-old teacher, looking lankier than she was some few years back, is determined to live a normal life and thus, is religiously committed to the lifelong treatment of her chronic condition.
But her treatment is taking a grim toll on her feeble pocket as she has had to pay through her nose for the various tests and medications regularly using her meagre salary.
WHO on Hepatitis B
According to the World Health Organisation (WHO), the Hepatitis B Virus (HBV), is a primary cause of liver cancer and the second leading cause of cancer deaths in the world, Sekyiwaa is therefore more concerned about her treatment because, the infection is gradually wiping away her family.
For her, she occasionally experiences abdominal pains, stomach bloating, unusual heat in the stomach, pains in the right and left parts of the belly, fever, and passes dark urine.
In a soft voice, she said “it is sorely expensive. I paid GHC1,250 for today’s CT scan. For every liver function test I do, I pay GHC850 and for viral load, it is GHC450. I also do the combo test which is GHC60.”
“The truth is, if you do not have money to treat yourself, you will die from the complications,” she said soberly to the journalist as she gently cracked and twisted her knuckles.
Every month, the young teacher coughs up, at least, GHS300 for her medications to slow the progression of the disease to live longer and stay productive.
The news of testing positive for Hepatitis B in 2008 was not as throbbing as the vile comments of stigma hurled at her and a few others by her colleagues at one of the College of Education in the Region.
“I would fall in the sea and die if I had this disease,” one said. “People look innocent but today their sexual immoralities have been found out,” another remarked.
But the truth in Sekyiwaa’s case is, she caught the virus from her mother at birth and only found out during a Hepatitis B screening and sensitisation exercise by CCTH at the teacher training college.
“My positive status did not hit me immediately but the kind of words I heard from friends made me sad; they were heart breaking,” she said.
Before the health screening exercise, the then 21-year-old level 200 student had no knowledge of the disease at all.
“In 2004, I lost my mother when she was 55. The autopsy results said her liver was damaged. That was what prompted me that she might have died from the disease,” she recalled.
“Sir, it is really good they came because I may be dead by now,” she said thankfully.
The doctors advised Sekyiwaa and a few other students who tested positive for the virus to visit the hospital immediately because the disease was dangerous and expensive to treat particularly when it progresses.
When she arrived home, Sekyiwaa broke the news to her family and persuaded all her siblings to get tested too.
“And when they did, my first, third and fourth-born siblings all tested positive.
“But my second-born twin siblings, were miraculously negative. We don’t know what really happened in their case,” she said.
Because they were all asymptomatic, the two brothers and sister of Sekyiwaa dropped their guard in the treatments process and the consequences have been dire.
In 2010, Sekyiwaa’s eldest brother died from liver complications aged 45.
Her second brother also passed on two years ago at age 42 from similar complications, and now her elder sister, Ewuresi (not her real name) is battling liver cancer which is creeping to other organs.
Ewuresi only manages to pay the more than GHS2,000 for her drugs every month by the benevolence of a cousin.
She always must go through hell to get one of her drugs, Sorafenib, estimated at GHS1,680 because it is not common in pharmacies in the Central Region.
The side effects of Ewuresi’s medications will not allow her to feed her three-month-old baby. For now, the baby depends on artificial baby foods.
“In fact, her condition is not looking so good and so she will be on chemotherapy drugs soon,” Sekyiwaa remarked.
When Sekyiwaa had her only child in 2014, she managed to get her jabbed with immunoglobulin (an antibody that helps the immune system to fight foreign objects such as pathogenic bacteria and viruses) within the first three days even though she could barely afford it.
Later, the baby girl received the Pentavalent vaccine to give her full protection from Hepatitis B and four other diseases.
Sekyiwaa has vowed to take her little secret as a Hepatitis B patient to the grave for the fear of stigmatisation.
Ambassador?
However, she has made herself an ambassador for the disease, constantly urging people to get tested and encouraging patients to take their treatment more seriously.
“I live a normal life most of the time because I am consistently monitoring my condition,” she said.
“I have changed my dieting completely. I don’t take meat, fish and most protein foods. I don’t drink alcohol or sugar and consume very little salt,” she added.
By eating lots of fruits and vegetables and drinking a lot of water every day, Sekyiwaa is keeping well.
More importantly, she believes going for regular check-ups and getting vaccinated against the virus is the surest way to keep safe.
Transmission and stages
Sekyiwaa’s Doctor, Dr Dora Dadzie, a Public Health Physician Specialist at CCTH, corroborating some of Sekyiwaa’s narrative, indicated that only five per cent of patients show symptoms of the disease.
She said the virus is usually transmitted through unprotected sex, sharing of needles and syringes, pregnancy or birth.
However, she clarified that research had not yet established the popular belief that the virus could be transmitted through sweat.
She explained further that after exposure to the HBV, some people will have acute Hepatitis B infection and will go on to be disease-free within a few months because their body will clear the virus. For others, the infection persists into a chronic stage.
“Chronic Hepatitis B is not curable and fatalities among patients are high if complications arise,” she said.
Frightening numbers
Data published by the Hepatitis B Foundation, a US-based charity committed to fighting the disease, indicates that some two billion people have been infected with HBV globally.
Additionally, it shows that even though only about 10% of infected people get diagnosed, there are nearly 1.5 million new infections every year, with almost 300 million people at the chronic stage.
In 2019, it was estimated that 820,000 people died from hepatitis B-induced liver cancer worldwide.
In the case of Ghana, the national prevalence of chronic Hepatitis B disease was estimated around 12.3 per cent in 2016 and 8.36 per cent in 2020.
It is estimated that some three to 4.6 million people are suffering from chronic Hepatitis B in the country.
At CCTH, Dr Dadzie said they record new cases nearly every day and describes the figures in the country as ‘unacceptable’ because “the disease is 100 per cent preventable.
“There are vaccines for Hepatitis B, and they are very accessible and affordable in pharmacies across Ghana,” she added.
High cost of drugs
Like Sekyiwaa’s baby, she said babies born to Hepatitis B parents are to be given Immunoglobulin and Hepatitis B vaccine in the first three days of their birth to keep them immune from the virus after which they are given Pentavalent vaccine like all other babies.
Unfortunately, the exorbitant price of GHS1,000 of the immunoglobulin cannot be afforded by most mothers, a situation which puts thousands of babies at risk.
Dr Dadzie explained that unlike HIV/AIDS which receives support from donors, the testing and treatment of Hepatitis B is squarely on the shoulders of the individual even though HBV is said to be 100 times more infectious than HIV.
Need for intervention
It is on the back of this that Mr Alexander Afenyo-Markin, the Member of Parliament (MP) for Effutu, is pushing for the National Health Insurance Scheme to cover the testing and treatment of Hepatitis B.
Making a compelling case on the floor of Parliament on Tuesday, February 14, 2023, the Deputy Majority Leader said the high cost of testing and treatment for the disease contributed to the high cases in Ghana.
“Ghana must take a bold decision to make viral Hepatitis B prevention, vaccination, testing and treatment part of the package of services for Universal Health Coverage (UHC) programmes.
“In short, the NHIS should bear the cost of testing and treating Hepatitis B cases in the country.
“This approach is vital because most citizens, particularly pregnant women in rural communities, do not get routine, reliable and affordable access to Hepatitis B testing facilities during pregnancy,” he argued.
Reiterating the call of the MP and her longtime view, Dr Dadzie said the Hepatitis B disease has enormous socio-economic impact on patients and the country and must be dealt with head-on.
Way forward
Dr Dadzie noted that Ghana is making progress regarding awareness creation on HBV, but the cost of treatment is a major challenge because it is not covered by any health intervention.
She stressed that the treatment of Hepatitis B, including the use of immunoglobulin and vaccine to prevent mother-to-baby transmission, must be subsidised by the State if the situation in the country were to improve.
Additionally, she advised patients to quit drinking alcohol and smoking because that lifestyle compounds their condition.
Beyond vaccination, Dr Dora also advised citizens to practise safe sex especially with condoms and avoid multiple sex partners.
“Pregnant women should also avail themselves for Hepatitis B testing because children born to Hepatitis B mothers have higher risk of chronic infection and related complications,” she said.
The report was made possible with technical support from the Centre for Science and Health Communication (CSHC), and funding from the National Research Foundation, South Africa.
GNA