STOPPING THE SILENT KILLER

Thousands of people have already had to hear that terrible diagnosis - hepatitis - from the doctor. How many hopes come tumbling down in the doctor's surgery, since just that one word gives rise to so many new problems. And what a train of feelings we pull along with us from the hospital into our everyday lives, when we become tense and alarmed, unlike other people. Something new appears in our lives - a secrecy, an ability to keep quiet about something. You see, it is customary to regard this illness as something "indecent". Rumour and the views of philistines have it that you can catch it at a dubious hairdresser's, from a second-rate dentist, from taking drugs or getting a tattoo.  Every year on 28 July World Hepatitis Day is marked, and the World Health Organisation calls on governments to act against the threat of this disease.

What rumours and myths surround hepatitis, what do you need to fear or not be afraid of in actual fact?

Myth No. 1: This is the end

As our expert, a hepatologist and specialist in viruses, who wishes to remain anonymous, tells us, very many local doctors, either owing to lack of experience or in order to frighten the patient, often say that the disease is fatal. Many doctors who are distributors for pharmaceutical companies, prescribe expensive anti-viral preparations, literally enslaving the patient and growing rich from him. Just as in the case of the treatment for many serious diseases the psychological state of the carrier plays an important part in hepatitis. Therefore a good doctor should be a psychologist as well, rendering the patient support, inspiring and reassuring him and under no circumstances make his depressed state even worse. It is not worthy of a servant of Hippocrates to take advantage of the physical and emotionally weakened state of the patient entrusted to him.

The expert thereby notes that the doctor cannot call himself a specialist in hepatitis, if he has only upgraded his medical qualification. "We are faced with a very important task, that of educating the public about hepatitis," he says. 

According to the virus specialist, most of the people suffering from hepatitis are chronically sick, since acute hepatitis is not all that common in the world. We are mainly talking about hepatitis C. Since the introduction of the compulsory vaccination against hepatitis B, the number of carriers has been declining from year to year, while people suffering from hepatitis C form the majority. 

Myth No. 2: a lot of people are suffering from hepatitis 

There are objective criteria relating to the study of the spread of hepatitis. Doctors from the Institute of Haematology and others have studied, some 70,000 people over the last 10 years, the expert recounts. These people, the main blood donors, range from 18 to 60 years of age. Among them there were approximately 20,000 pregnant women. Approximately three per cent of all those studied had hepatitis C. With this assertion the doctor refutes the exaggerated figures amounting to 30-40 per cent suffering from hepatitis. Approximately 2.5 per cent, that is one sick person per 40 people," he says. If we correlate that with the population of Azerbaijan, then it turns out that as many as 200,000 of us aresuffering from hepatitis. Naturally, the figure is a frightening one, if you are not aware of one important factor: 80 per cent of all those sick people have hepatitis in a subclinical form. They are not essentially regarded as sick people," the expert says. "That is, if people who are carriers of hepatitis don't drink spirits and generally lead a normal, healthy life, then there is no threat to their lives nor can there be." 

Once the infection in the blood has been diagnosed, then first and foremost attention is paid to the activity of the enzymes in the liver. If they are normal, then there is no need to treat the infected person. The only thing that is recommended is a periodic check-up by the doctor. The indices for the liver also have to be monitored, to ensure that they stay normal, then there is no need to worry.

Myth No. 3: everybody needs treatment

The doctor emphasises that the absence of changes in the liver enzymes is only a reason for keeping a patient under observation, but is in no way a reason for treatment. "Unfortunately, many doctors turn out to be so unqualified (or so dishonest) that they subject the infected person to treatment," he comments. "It needs to be understood that, if the figures for the liver are normal, then we are not talking about hepatitis, but purely about an infection. Therefore the diagnosis should not be hepatitis, but a subclinical infection. In this case, how can we talk about some kind of treatment? For we are treating a disease, not an infection." All we can talk about is preventative treatment. Naturally, anyone in whom an infection has been diagnosed, can demand a more exact and in-depth examination and many do of course want to get rid of the infection in the blood altogether. The doctor may attempt to do this, but there are no guarantees of success. Treatment is required when there is a drastic increase in the liver enzymes and the presence of an infection in the blood.

Ministry of Health data indicate that 300-500 may go down with an acute form of hepatitis per year. But the number of chronically sick people exceeds that figure many times over, so gastroenterologists need to treat those people. Moreover, there are only two hospitals in Azerbaijan that have a hepatitis section in the gastroenterology department: these are the oil workers' hospital and the 5th city hospital. There is a provision in the Ministry of Health national programme, according to which doctors have to undergo special training at the institute for the upgrading of doctors, but this project has never been particularly developed.

The doctor says that it should be noted that at a number of specialised hospitals they have a very serious attitude to hepatitis and take the relevant measures. "For example, at the National Oncological Centre the attitude to patients with hepatitis is a very strict one: everything is sterilised, and the specialists also take a very serious attitude to their work. Their articles in the relevant scientific publications not only come out here but also in Russia and abroad. But if this work is to be brought up to scratch, the Ministry of Health needs to take the initiative, he thinks.

Treatment really is expensive

Treating hepatitis C is very expensive. At the present time, this involves three components, the cost of which amounts to 40,000 manats. All those who are seriously ill require this treatment. Are there many people in our country who can permit themselves such expenditure? The doctor sees improving the doctors' qualifications as the main task in easing the hepatitis situation, so that they can realise that the virus as such cannot be treated. Only the manifestation of it can be treated, that is the current illness. For carriers of the virus it is sufficient to monitor them from time to time and take the appropriate measures.

In the view of a therapist from the department of liver diseases, Zaur Orucev, at the present time the most effective method of avoiding hepatitis B is vaccination. "It is more difficult to protect people against hepatitis C, since there is no vaccine against it at the moment, but they are working on one," he says. "First and foremost you need to monitor your dentist, gynaecologist and surgeon more strictly, if that is possible. For the moment, you can only put your hopes in the vaccine against hepatitis B which is being given to all new-borns.

It needs to be taken into account that the process of treating hepatitis is extremely complicated, painstaking and expensive. Therefore, once the virus is diagnosed, you should consult a specialist immediately to get his advice on what to do next. Then the person goes soundly into remission and returns to a normal way of life.