Sat, 23 Oct 2004 Feature Article

Hepatitis B, The health menace that has to be confronted.

Hepatitis B, The health menace that has to be confronted.

Amanfuo, good day.

It is nice to hear that our dear nation Ghana is still alive and well. I love Ghana, the most peaceful place on earth.

I understand some people, including an Osofo attempted to change Ghana's name to something else, but it did not work. President Kuffour and Ex-President Rawlings sat down the other day (thank heavens for that), I understand to a drink of pito (my tongue twister for the peace pipe), at the newly refurbished castle grounds. After a two-man talk, they decided and agreed for once that this name change should not happen. Thanks to the two elders.

Amanfuo, on the day when we are born, most people are given their names. Our fathers thought through all the good and bad names before selecting the one that will bring us good health, wealth and prosperity. I am sure this is what Nkrumah and his folks did. In later years, we only changed our birth names when our fathers, especially, did nasty things to our mothers, or the person after whom we were named did something horrible, such as stealing public money, to tarnish their reputation. That was then. Not now, when stealing from the public purse is glorified. Some names can sometimes self-fulfil the prophecies from which they were derived. Other times, the names can remained solid, but the person bearing the name will do something to bring that name into disrepute.

In Ghana's case, I do not see any wrong that the name Ghana has done to its people. It has given them food, gold, timber, brains to do good, diamonds etc. What did they do – loot, steal, connive, kill, plunder and do all sorts of evil in the name of the nation. My take on this naming debate will be that we the people rather change our names, since it is we and not the name Ghana that has committed all these deeds. Lets change Kwame to Ghakwame, Kwasi to Ghakwasi, Asiadze to Ghaasiadze, Bugri to Ghabugri, Anaba to Ghaanaba and Odartey to Ghaodartey and see whether the tribalism, jealousy, mpalapala will not vanish overnight.

Anyway back to business. I have visited two special places on earth in the last month – Ghana (the most peaceful land on earth), Basra in Bagdad and Darfur in Sudan thanks to obroni and my hard work. As a member of the special forces (humanitarian elite group (which has been a privilege)), I had the opportunity to see first hand the human suffering, destruction of civil society, hopelessness etc that dangerous and loose political talk, war mongering and war fighting, ethnocentrism can unleash on normal society. Amanfuo, some of our political leaders have played or are playing with “fire”. They are constantly blasting away at each other in a very aggressive, confrontational and minim minim ways. Not agreeing on common subjects is not unusual; it is the maturity with which it is handled that matters.

Lets look at the world wide political landscape from which most of our leaders have taken positions (instead of developing a true and distinct Ghanaian ideology). Once upon a time there existed two major world ideologies and powers – America and the former USSR, capitalism and communism and at our local level, the Nkrumah and Danquah traditions. Our leaders took us on a dangerous path of pursuing one of either ideology to a disastrous end. Now thanks to the old man above, one of the ideologies is dying slowly and we shall soon go to the Osu cemetery and bury it.

What our leaders should have learnt from this is that no two wise people can ever live under the same roof, especially if they are landlord and tenant. Amanfuo, In Ghanaian politics who is the former and the latter? Tough one. I think the incumbent should be the landlord and the opposition the tenant.

I can understand each person wanting the high office and undertaking all sorts of wayo manoeuvres to get there – the prestige, the privileges, the luxury, connections, wealth etc can be enormous and unlimited. Amanfuo, even Siamese twins who have the same stomach sometimes fight over food. Why? Because each one wants a bit of “the thing” to pass through their throat. That feeling of a bit of “the something” running through ones throat can be enough reason for someone to kill, abuse, spit and curse another.

Like former President Rawlings said sometime ago, if anyone desperately wants the chair at the castle, they should go to Dodowa and get the carpenters to make one for them. Let all the political parties sit down and talk constructive politics, policies and serious issues like the one that I am about to examine, for our dear nation is suffering because of our likeness for neglect, territorial domination, sectionalism, tomfoolery and greed. Someone has asked me what I intend to do about the Ghanaian situation and my reply is that a lot. Remember, the pen is mightier than the calabash, the animguasie akwaaba positions, the hardened mind, the obnoxious petty blob, the worthless and weightless ingrained attitudes.

Serious Business Amanfuo, This piece should then bring me to the main health topic of HEPATITIS B (there are other types – Hepatitis A, C and Delta hepatitis), the dangerous but silent menace confronting our dear nation. We have just introduced a national health insurance scheme, which is a good idea. But the core issue of what investments we put into our health facilities and campaigns remains questionably and wholly inadequate. We are a rich - poor nation, and that is ironically an acceptable fact, otherwise we wouldn't HIPC. The annoying thing for me is the levying of a so-called health tax or surcharge at the ports on the poor abrokyire people. Why does the government have so little respect for the abrokyire people? We, in various ways provide jobs, health, accommodation, food and most of the basic functions, which should normally be the government's responsibility. The least it can do is exempt us from further punishment through heavy taxation when we bring something small home. I am looking forward to a government that will one day stand up for the Abrokyire people, because life is hard here. There are some things basic, some essential, some critical, some less critical Sometimes you do not need all the huge resources to make a difference to people's health. Amanfuo, the Western countries spend billions, if not trillions on health education, facilities and health research, yet they have not been able to find the cure for many of the world's diseases or secured total quality healthcare for their citizens. Lets look at cancer, Alzheimer's, diabetes, malaria, dementia and the list can go on and on. This means that we the poor ones should adopt their cheap and unsophisticated methods and eschew the foreign - oriented, extremely expensive health programmes, because our societal foundations, cultural beliefs, attitudes and concerns are normally at variance with what pertains in the west. For instance, when someone is ill, we immediately tend to blame a member of the family. On the other hand when we travel to abrokyire and fall ill, we run to the doctors wanting a medical explanation for the cause of our ill health. It is therefore crucial that the government invests heavily in comprehensive local health EDUCATION AND VACCINATION (I mean free) programmes, to ease the burden on our local health facilities. I applaud the former health minister in the NDC government who is alleged to have done at great job at the health ministry, and the struggling health workers whose rewards are pitiful to say the least. We need more of such people in our national institutions.

Anyway, someone may ask just what I am talking about. Folks it is about a familiar but strange disease called HEPATITIS B and I feel my little contribution will make some difference to peoples lives. You see, some years ago I started training as a medical student. I started this during Nkrumah's time and then the NLC coup disrupted my training in 1966. I re-entered during Busia's government (you see my education only prospers during civilian regimes), then onimfuo Acheampong and his mates came and messed it up in 1972. I had decided to let it go when Limann came, so I re-started again. Then lo and behold came the revolution in 1979, and the chasing away of students from the campuses (Ghanaian students can sometimes be a pain in the stomach. They want free fees when even in Britain and America the thing is not free regardless of whether you are rich or poor. If you think that I am lying ask those posh and endowed people in Ghana who have their children in schools abroad.

A typical UK three year degree programme will set you back about £9000 (nine thousand pounds) per year or $ 12000 (twelve thousand dollars) in America. When we travel to the west, we are prepared to put up with all the fee increases etc without a word, yet we embark on demos on our university campuses home, sometimes destroying facilities that are in short supply, further aggravating the situation. I hear these days even the polytechnics and junior secondary schools do the same. Please if you are all listening, I will say cool it, take it easy because the parent called Ghana has not got it. It has all been stolen or yet to be stolen).

Amanfuo that finally nailed my medical education in the coffin and that is why I remain bitter and unforgiving. I was so devoted that I would never have given up on the motherland for the cold weather.

Amanfuo I am no quack doctor and do not pretend to be a specialist on the subject, so bear with me and we shall hopefully arrive in asomdwe. What will annoy me will be one of those quack doctors, who trouble passengers in the trotros and other buses stealing my information and passing it on for sale as theirs.

My greatest plea is to the honourable Minister for Health (sorry sir I do not know your name. These days they don't tell us the names of these ministers. In the good old days, that is during Kutu's time, we would normally hear of the commissioner for this, that and that. I can even remember Col. Bernasko being responsible for Agriculture, and Felli for health or something like that. Whenever they reshuffled, everyone will wait by the radio to see whom the next commissioner or regional minister will be. Amanfuo during that time, tribalism was not “tolerated” but its positives celebrated – I know some against people will disagree. You could have an Ewe commissioner for the Ashanti region, the Dagomba looking after the Fantiland etc. These days you can not try that, which is sad. Please Minister, read my piece and make an election promise that you will implement some of my ideas, otherwise generations yet unborn will not forgive you and your NPP government. Amanfuo, when cells in the body are injured the area that is involved becomes inflamed. Hepatitis is inflammation of the liver (which in turn causes damage to individual liver cells). It is most often caused by viral infection. However, it can also be caused by ALCOHOL (akpeteshi, gin etc), certain drugs, chemicals or poisons, or other diseases. The liver, the largest organ in the human body (if you have a healthy one please take good care of it), is located in the right upper abdomen behind the ribs. Among it's many functions includes, metabolising the medicines (breaking down the medinces we take when we are ill for use by the body) and alcohol that we take. It stores glucose for use and makes bile used for the digestion of food. It also sieves out germs, which invades the body. What this means is that if the liver malfunctions, it will be difficult to treat you with one of many types of medicines. Its function is central and strategic to the human body functions.

Acute and Chronic states: Hepatitis may be either acute or chronic. In the acute phase (patient may not display symptoms), the inflammation develops fast, but lasts for a period that is normally short, about 6 weeks up to several months. The infected person usually makes a complete recovery (Adam R. 2002). Amanfuo, the difficulty is that occasionally such an acutely infected persons fail to make full recovery and that is when we have problems on our hands. They may then assume a chronic state - the disease progressing at a destructive pace. Sometimes, an infected person can develop the chronic condition over a period of time without showing any signs of the infection or realising that they have it, and I believe this is the most dangerous scenario present. The liver is a very “self – repairing organ”, but because of the “destructive power” of the hepatitis virus, fibrous tissue resembling a scar, can be marked on the liver as if it were a healed cut. The advanced form of such scarring process often leads to what we call “cirrhosis of the liver”. This situation eventually damages the liver irreversibly, resulting in liver failure. A great example is our own famous footballer, George Best, who as a result of alcohol abuse developed liver damage. He had to have a liver transplant before preserving his life. Amanfuo, the costs of liver transplant does not come cheap and I doubt if many people in Ghana will be able to afford. It therefore makes sense to nip the disease in the bud before it is even transmitted through prevention schemes. How is the Hepatitis virus transmitted? The history of the disease manifestation from the time of infection to disease development can take anything between 1 month to 6 months, enough time to cause a great deal of destruction, especially in a situation where the infected person has multiple partners. Even where a person recovers from the initial phase of the disease, they may not go on to develop the chronic phase, but end up as “carriers of the disease” (they may know or not know it) or if their lucky the body fights off the virus by attacking it with the body's antibodies. In cases like this, the person displays no symptoms at all, but then goes on to infect anything in his or her path. I have often heard people in sikaman say that their relative or friend developed “yellow or jaundiced eyes” but that through herbal treatment that is now cured or disappeared. This I am afraid may not be the case, as the person could still be carrying the disease in their blood stream in a way, which could only be detected through a blood test. There is no treatment presently available for the carrier state. Once a carrier, always a carrier. Such individuals have a responsibility to adopt life practices that are safe so it is not passed on to others.

Spread: Amanfuo, like many of the viruses known to man, the mode of transmission is very similar. On a scale of 1 to 10, I will vote this nasty virus for point 8 behind the deadly HIV virus. It is considered more contagious than the Aids virus. Amanfuo, research indicates that whilst the Aids virus perishes minutes after exposure outside it's host or the body, the Hepatitis B virus can stay on dry surfaces for anything up to 8 days alive. So you those sikamanma who lose your senses during the act and put the other persons soiled pants or knickers on your heads, nose etc, be warned. Anything that is soiled with the virus-containing fluids becomes a potential hazard over a period of time (very dangerous stuff). According to the US Communicable Disease Control Centre (2002), the EXACT MODE OF TRANSMISSION IS NOT VERY CLEAR but the following routes are well established; 1. Unprotected sex with other humans and anything that can be infected (constitutes about 50% of reported cases). May God protect us all. 2. Contact with infected blood and bodily fluids containing blood (saliva with blood, urine with blood or menstrual fluid) that penetrates the skin through scratches, cuts, bites or rashes. 3. Contaminated needles and syringes or razors, or exposure to other objects, which may contain small traces of human blood. The barbers in town please take note and stop your lousy attitudes to sterilisation of your equipment. 4. In body fluids such as urine, semen, vaginal fluids, tears, saliva and breast milk can be transferred to inner surfaces of the mouth, the eyes, vagina or the rectum through mouth-to-mouth contact, sexual activity, kissing or biting. Amanfuo, please let us mend our sexual habits even in situations of stable relations because the world is becoming a dangerous place. 5. Contact with infected household members may spread the hepatitis B virus. 6. Pregnant women who have the hepatitis B virus can pass it to their babies, usually during the birth process. Vaccination at birth, with additional shots at one and six months of age can prevent hepatitis B in children at risk (Unicef 2000). Who is at risk? · People involved in potentially “dangerous” healthcare activities - health care workers, funeral workers, birth attendants, prison workers etc. · People living in a house or place with an HBV infected person · People with multiple sexual partners · Residents of normally congregated housing environments · Haemophiliac and haemodialysis patients · Prisoners · Intravenous drug users · Travellers to endemic areas including those from such areas. Diagnosis: § Diagnosis of the disease is made through a simple blood test. It is called the hepatitis B surface antigen test (HBsAg). § Abnormal enzyme tests found in routine blood testing (the early chronic stage may not show any symptom) § Ultrasound: tests like ultrasound may help to depict the liver's condition. § Liver biopsy: to determine extent of liver inflammation and / or scars. Symptoms of the Disease: q Loss of appetite, nausea, vomiting, fever, tiredness, diarrhoea q Abdominal pain, or pain underneath the right ribcage (location of liver). Sometimes palpation of the liver by a physician can reveal the physical state of the liver. q Aching muscles and sometimes joint pain q Tenderness in the right upper abdomen q Jaundice (yellowing of skin and eyes) q Dark-coloured urine q Sometimes white stool (NIAID, 1992). What is the treatment for hepatitis B? No known cure for hepatitis B. In the USA, the usual treatment of hepatitis B infection is interferon alpha (this may have side effects and normally used for those with abnormal Liver Enzyme tests) and lamivudine (trained medical doctors will need to decide course of treatment). Prevention: Immunization best offers us the only effective and less costly hope at present. It is useless to immunize one already infected with the virus. The vaccine has been available since 1982. It will usually offer protection for anything up to 10 or more years. The usual method is intramuscularly in a three-dose phase. The Ministry of health should have a country-specific immunization schedule. Alcohol – this is some serious information for all those who drink heavy agyata wuo, bobobo, vodka, gin etc. If one has HBV infection, such strong liquor becomes automatically off limit as more damage is done, which may shorten the life expectancy. Over – the – counter drugs or serious self-administration of medicines: In sikaman, we take life for granted. Sometimes it is difficult to blame Amanfuo, because we lack the health facilities or advice. Our noble pharmacists / chemist shops in their attempts to sell and get rich quick sell anything to anybody regardless of the consequences to health. Please reform this practice as it has serious future consequences for all of us. The government will need to control this situation. Do not share personal items that have been exposed to blood or body fluids. All HBV carrier –contaminated surfaces : Immediate cleaning with warm soapy water and then disinfected with house-specific bleach. DO NOT BLEACH THE HUMAN BODY. Hygienic practices: Hand washing with warm soapy water after coming into contact with an element of HBV infection has the magic effect of reducing the chances of cross infection. Contaminant factors like bleeding wounds, serum, bathroom used, saliva etc. Excuse me to say, but most of our folks do not wash their hands properly when they use the loo, especially our poor cooked food sellers in the streets, chop bars etc. Also some of our fellow special human beings never wash their hands (and nails) even when they have bits of faeces sticking under them, because they have beautiful, expensive nails. Amanfuo, when I was young, I went out with this beautiful creature, Esi Araba Adoobi Lamisi Asantewaa Edzi. She was the most beautiful piece of item on earth except that anytime we went to bed, I would find pieces of T-roll sticking up her backside. This person will go to the loo, then immediately to the kitchen to prepare me food without washing the “filthy” hands. Sometimes sticking the beautiful nails into the nose and then pouring me drink. Dirty under-wears could be soaked for three weeks in water – what a palaver ! Amanfuo, a very worrying habit. Because of EAALAE's poor hygiene practices, I never got round to marrying her, despite her insistence. I never summoned the courage to tell her why. The same goes for our men folk who take hygiene practices for granted. You will never get an expensive bird, and even if you mistakenly find one, she will fly away from you in the middle of night. Protect yourselves from anything blood or other peoples body fluids, even that of your closest relatives / friends unless we know their HBV status. Do please not share potential host items like needles, toothbrushes etc. For heavens sake, an infected person must not DONATE BLOOD. Please endeavour to inform people engaged in the care profession like doctors, nurses, dentist etc about one's HBV status if any invasive procedure is to be performed. For our hardworking healthcare workers, my advice is you already earn very little money. Do not risk your life and that of your loved ones. Please get immunised and protect yourselves (universal precautions). In order that pregnant women do not pass HBV on to their newborns, all pregnant women should be tested at the prenatal phase of their pregnancy to make sure they are not silent carriers of the disease. If they are infected, their infants should then be vaccinated to prevent disease spread. Final Thoughts:

Wuko awadea bisa (BEFORE YOU MARRY ASK THE VITAL QUESTIONS ESPECIALLY THOSE FOLKS WHO MARRY THROUGH THE EXCHANGE OF PICTURES). Please always ask the very serious health questions without the fear of causing offence to the potential partner. This deadly disease can run through generations of families, especially where one of the parents became infected before the child birth of the offspring. It is only immunization at birth or at an older age of an uninfected person that can break the cycle . It may be the answer that saves you a million dollars years later.

Wuni obi saanea bisa (even the “temporal” relationships, ask) Infants form the largest possible infection group, they should all be immunized routinely at birth to prevent exposure. Please screen all pregnant women for HBV at the prenatal stage of pregnancy management.

Amanfuo, the cost of one AK 47 assault riffle can immunize 300 children in Nima. The cost of a small presidential jet will immunize all the children in the Ashanti, Volta, Brong Ahafo and Northern regions. The price of one ministerial trip abroad will immunize the whole population of my village Kimkim. This I think is a price worth paying.

If you suspect infection, please consult a medical physician if you can find one in sikaman for diagnosis and all the other palaver.

There is no cure for HBV infection. Luckily there are preventative measures such as immunization, which is far cheaper, when one considers what the consequences of an infected population can do to productivity and the economy.

We should not be prejudiced against those unfortunate to contract the disease, but through the usual Ghanaian supportive spirit help them come to terms with its management.

May God bless all the people of Sikaman both home and abroad, May the Almighty increase the level of selflessness and patriotism in our politicians, God help us eschew corruption and give us the will to treat with some respect all those abrokyire people toiling to make the lives of folks in sikaman comfortable. Father, ensure peace among all political activists, Protect the President (including the past one) and the constitution. Let us all continue to love mother Ghana, the most peaceful place on earth. My last request to the NPP government – please change the Ghana Police Uniform.