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Hepatitis is still regarded as ‘a shameful disease’ in Azerbaijan. And people learn about the disease more often by pure chance than through other means.
Hepatitis is often asymptomatic and detected when the disease is in late – stage development. According to official data, there are 2,900 hepatitis patients in Azerbaijan.
However, these statistics have been obtained from hospitals in a centralized manner and they mostly reflect the number of chronic patients or patients with acute, late – stage hepatitis. The exact number of people infected with hepatitis in the country can not be established.
It wasn’t easy to find someone for this article that was willing to speak about this disease. Every now and then, my acquaintances wrote to me in private something along the lines of the following:
“I have an acquaintance who has hepatitis, but, you know, she / he isn’t going to talk about it.”
Eldar. Hepatitis С
I met Eldar in a roadside diner, one that allows you to warm up inside with a cup of hot tea and enjoy a quick home – cooked meal before returning to the road. There is a shot glass of vodka and juice in front of him. He is nervously tapping fingers on a rough table. He is speaking slowly, carefully choosing his words.
“Eight years ago, I fell down the stairs and broke my hand. I went to the injury – care facility. They did some tests, which revealed that I was infected with hepatitis C. My wife and children were immediately examined and they were tested negative. Now I think that it was
then that I learned about it, and nobody knew for how long I had been infected.”
A doctor in that very injury care facility recommended that he should undergo treatment.
“He started listing medical preparations, saying they were to be brought from Turkey, that they would cost AZN 6,000each and that he couldn’t guarantee a full recovery. I promised him that I would think on it. But my liver was functioning well. Though it’s true that I was really very scared in the beginning. I started keeping a diet, I excluded all spicy and roasted food, as well as alcohol. A nurse in the outpatient clinic used to tell me, “take it easy, don’t be afraid, live as if there’s nothing.”
A few years later, Eldar’s condition started aggravating. There was excessive accumulation of fluid in his abdominal cavity.
“My mother noticed it and told me, my belly was growing. At first I laughed the matter off, saying ‘Mom, I’m just getting older and developing a pouch.’ “
Having looked at the ultrasonography results, the doctor told Eldar, there still were chances to save his liver.
But I couldn’t undergo serious treatment.
“I have to stop drinking, but I can’t do that. Once I leave the outpatient’s clinic, I immediately go to the shop for a bottle of vodka.”
Eldar recently had to visit a dentist and his friend recommended him an Iranian doctor.
“I visited him once, and the next time I turned up, he told me,
‘Why didn’t you warn me that you were infected with hepatitis?’
It turned out that they had some instrument to check patients. I was very upset. I told him,
“You should have asked me, whether I was diseased or not, in advance.”
And he responded, ’No, it was you who should have warned me.’
And I told him, ‘Am I supposed to go around crying out loud about it? Should I also pin the Star of David on my sleeve?’”
Aytyan. Hepatitis B
While we were talking, Aytyan was feeding her child. The infant’s babble could be occasionally heard through the handset while I was later going over the interview. She willingly agreed to be interviewed, making no secret of her disease.
“I got infected with hepatitis B when I was about 11,” says Aytyan “I have no idea, how it happen. I didn’t undergo any surgeries, neither did I visit a dentist. Probably I once cut myself accidentally in the yard or something like that. . .”
She happened on it quite by chance. “At first I experienced general fatigue, nausea, as if a case of common poisoning. Then my mother noticed that the whites of my eyes had turned yellow. I immediately consulted a physician and got tested. My liver was enlarged and I was recommended to check in to a hospital for 2 weeks.”
Aytyan wasn’t ashamed of her disease. “I thought: ‘Well, so what that it’s hepatitis, it’s the same as many other disease, like the flu or something like that. Besides, there were people infected with it in my environment.
Nevertheless, neither her present friends, nor her husband’s family, were aware of her disease.
“He learned about it just recently, when we were going to have a baby and we got tested.” She says, she leads quite an ordinary life, not much different from any healthy person’s one: “The only exception is that I can’t donate blood.” She gets tested from time to time just to be on the safe side.
Sevda. Hepatitis С
Sevda learned about her disease by chance. “It happened so that my husband and I couldn’t have a child for quite a long period of time. We turned to the Adoption Committee. A procedure there requires numerous checkups and tests. That’s how I learned that I was infected with hepatitis C. It came as a great shock to me, I had absolutely no idea of hepatitis.’
“There was no one who could explain at least something to me, everybody just scared me. To cap it all, the Health Ministry employee, who accepted my documents, told me: “Darling, just forget about having a baby. You’d better undergo treatment, otherwise you will die in your prime.’
The woman was convinced that she suffered from an incurable disease.
Sevda turned to a renowned hematologist. Without batting an eyelid over the fact that the diagnosis didn’t quite match his field, the doctor gave her referrals for an ultrasound and tests.
“As far as I remember, the sum amounted to AZN360 (about US$230). However, a physician, whom I always visit to get an ultrasound, got surprised and told me that in order to identify liver condition through ultrasound one’s liver should be practically destroyed by hepatitis.” Sevda suspected that the rest of the tests might not be required.
Finally, Sevda found a hepatologist, whose interview she had chanced to read on the Internet. “He looked through my test results and said: ‘You aren’t sick. Here’s the list of products that you can eat. Keep a strict diet to avoid activation of the virus.’ On the other hand, the Health Ministry staff warned me: ‘He is telling that everyone. You’d better undergo treatment, it’s very serious.’ I was at a loss.”
Sevda claims, people have little information about hepatitis and the healthcare system employees often take advantage of it. “I believe, there are decent doctors, but the system works so as to throw a scare into people and make them spend as much as possible on some useless tests and drugs.”
Zaur Orudjev, hepatologist:
“Hepatitis is regarded as a shameful disease in Azerbaijan, since earlier it could be more often found in drug addicts. Disposable syringes have changed the situation. However, people still conceal the disease, often due to misconceptions about transmission modes.
There is a state-run program in Azerbaijan, under which all newborns are vaccinated against hepatitis B in the maternity houses. However, parents aren’t urged to get vaccinated and children aren’t revaccinated either.
Hepatitis C can be treated with new, 3 – month – long treatments (as opposed to earlier treatments that used to last one year and carried heavy side effects). In Azerbaijan, a patient can seek treatment for around AZN 3,000 (US $1,720).
There is a serious problem with awareness of the disease, however. Hepatitis patients refer to themselves as ‘carriers’ rather than the diseased. And that wording is frequently used by many doctors, too. In case of Hepatitis C, there is no ‘carrier’ stage as such. As for Hepatitis B, people are mistakenly diagnosed as being ‘carriers’ without any relevant tests.
Medprosvet Facebook Public Group tries to deal with this problem. It offers free consultations, organizes various campaigns related to medical examinations with discounts or free of charge.
Due to costly medical services, preventative medical examinations (checkups) are not a common practice in Azerbaijan. Therefore, people often find out about hepatitis in dangerously late stages.
Similarly, many cannot afford to undergo hepatitis treatment. The state-run hepatitis program applies outdated interferon preparations, as well as Ribavirin, with the efficiency rate amounting to 15-12%. Treatment using modern drugs is obstructed by the lack of medicine registration and the patients oftentimes have to search for them abroad.”
Gulnara Aghayeva, Chairperson of the Hepatologists’ Association of Azerbaijan:
Screening tests that were conducted in Baku in 2010-2011 revealed that 6-8% of the population were infected with Hepatitis B and C, which is a rather high rate, in general. The majority of cases were detected in the areas with active drug traffic – border with Russia, southern provinces – Masally, Lenkoran. The infection rates are also rather high in such big cities as Gyanja and Mingechevir. But the average infection rate is around 4%.
The cunning of hepatitis is that no signs of liver disorder could be observed until the very last stage, when it is already too late. Given the present-day pace of living, fewer people pay attention to such symptoms as: easy fatiguability, abdominal heaviness after having one’s meal, etc. Therefore, everyone, irrespective of one’s age and gender, is recommended to undergo hepatitis checkups annually.