Health personnel spread hepatitis

Lahore: A year after Muhammad Ahsan’s elder brother, Muhammad Rafiq, 40, died of hepatitis C, the family has learnt that the widow, Amna Bibi, 35, has also contracted the infection.

“We spent over Rs 150,000 [US$1,764] on my brother’s treatment. The doctors prescribed injections and medicines that were really expensive. How are we to find more money for my sister-in-law and what will become of their three young children if she dies?” asks Ahsan who earns Rs 20,000 (US$235) a month as an office telephone operator, and has two children of his own to support.

Hepatitis is a viral infection spread through the transfusion of blood and body fluids, sexual contact and the use of improperly sterilized instruments. According to the World Health Organization, [ ] all five types of the hepatitis virus (A, B, C, D and E) exist in Pakistan.

Hepatitis A and E can be spread through faecal (sewage) contamination of food or drinking water, while B, C and D can be spread through transfusion of blood and body fluids, sexual contact and use of contaminated instruments which are not sterilized properly. While hepatitis A and B have an effective vaccine, the other types have no known vaccine for prevention.

A 2008 study [ ] on the prevalence of the disease carried out by the Pakistan Medical Research Council (PMRC), found that 12 million out of a population of 165 million were infected by hepatitis B or C. Mortality rates due to liver failure caused by hepatitis C were also among the highest in the world, according to medical researchers [ ] who noted that “Pakistan carries one of the world’s highest burdens of chronic hepatitis and mortality due to liver failure and hepatocellular carcinomas.”

The lack of access to medical care for people like Ahsan is a factor in this.

Unsafe techniques

But what is especially alarming is the finding that healthcare practitioners themselves are responsible, in many cases, for the spread of the virus due to unsafe techniques. These include the re-use of syringes and needles. According to the PMRC, nearly 15 percent of paramedics [ ] are themselves infected by the hepatitis virus, as are 7.3 percent of nurses, 6.8 percent of doctors and 5.2 percent of medical students based at major hospitals.

The improper disposal of hospital waste adds to the risks. “Sharp waste generated at hospitals and similar settings contribute to a minimum of 20 percent of all infections in the country,” PMRC deputy director Waqar uddin Ahmed said.

“The published literature on the modes of transmission of hepatitis B and hepatitis C in Pakistan implicate contaminated needle use in medical care and drug abuse and unsafe blood and blood product transfusion as the major causal factors,” the researchers noted. [ ]

Media reports have suggested one in every 10 Pakistanis [ ] suffers from hepatitis B or C, and that the failure to implement laws such as the Safe Blood Transfusion Act of 2002 [ ] which puts in place rules for the screening of donated blood, has exacerbated the situation.

“One of the problems is the widespread belief among patients that injections are more effective than oral medications. People who come to clinics, such as the one I practice at, frequently demand an injection even when pills are available. This contributes to the spread of diseases such as hepatitis, since needles are quite often re-used at some places,” Aziz Ahmed, a doctor in Lahore, told IRIN.

The theft and re-sale of hospital waste, [ ] quite often by hospital staff, makes matters worse.

“There are people in this hospital – lab assistants, nurses, cleaners and others who take away used items, such as IV [intravenous] bags, and re-sell them in the market,” a doctor at a government hospital in Lahore, who asked not to be named, told IRIN. “Who knows what illnesses are spreading because of this?”