Liver damages caused by Bilharzia in Uganda, feedback from a gastroenterologist

Liver damages caused by Bilharzia in Uganda, feedback from a gastroenterologist

Liver damages caused by Bilharzia in Uganda, feedback from a gastroenterologist

Dr Christopher Opio is a gastroenterologist in Kampala. Many of the patients whom he treats at the hospital suffer from portal hypertension and ascites caused by Schistosoma or the hepatitis B or C virus. As the on-site doctor, he has been working with our teams along the banks of Lake Albert for several years. We would like to let him speak, in order to have a better understanding of the destruction caused by these hepatic illnesses, which affect communities in Uganda.

Dr Opio, how do you know about BILHI Genetics?

I met Professor Dessein, from the Aix-Marseille university Medical School, at the Vector Disease Control. It was the previous Director who put us in touch. Professor Dessein’s work was based by the banks of Lake Albert. He would visit on-site and, like me, would be witness to the devastation caused by the illness, and the limited control programs in place. Together we have a common desire to “push the agenda forward” in the fight against Bilharzia.

What are the characteristics of this disease?

There is a high prevalence of bilharzia in Northern Uganda and along other water bodies in Uganda. This disease has the characteristic of being asymptomatic, which would explain the number of my patients reaching the advanced stages of their disease. They didn’t know they were ill until they started bleeding. I’m sure you can imagine their distress. For some, they considered themselves to be in good health, until they started vomiting blood. When I asked them how they felt at that moment, their response was explicit: “I thought I was going to die”.

How do you treat Bleeding due to Bilharzia?

Initially the aim is to stabilise the patients with bleeding, at the same time attempt to stop the bleeding, and prevent future re-bleeding. We do this by drugs, bands, and shunts. These treatments aim to reduce blood pressure in the portal veins. Once we manage to stop the bleeding and stabilise the patient, we will then treat the cause. We are quickly able to determine if the bleeding has been caused by a hepatitis virus, or by the presence of the Schistosoma worm infection in the liver. We treat Bilharzia by administering Praziquantel. However, we must be extremely careful because this medicine has been linked to worrying side effects in patients with severe or extensive fibrosis. In this group of patients it is advised to give praziquantel in a hospital under close monitoring.

What is the biggest problem about Bilharzia?

The problem is that when we talk about Bilharzia, we rarely talk about bleeding, even though it is the most frequent cause of hospitalization and death.

It has been identified as such in numerous cases: in Tanzania, in Malawi, in South Sudan…There are many cases in South Sudan. You can find articles about it. People do not always make the connection with Bilharzia, which leads me to say that the prevalence of this disease is even higher than people say.

In your opinion, how can we combat Bilharzia?

Only those having seriously suffered from Bilharzia can truly understand the disease and talk about it. This is why we must work with patients and let them speak up to raise awareness. It is very complex because Bilharzia is a “poor person’s illness”. For example, Water represents 20% of the territory in Uganda. People enter the water daily because it is their key resource livelyhood. If I need to wash my child, fish, feed my family, wash my clothes…I’ll go back in. I can’t worry about getting Bilharzia when I am starving, and my first concern is to feed myself and my family. You cannot stop people entering into the water, because the water is part of their life. And it only takes one person to contaminate the water. Treating people is a good thing, but it does not solve the problem. The core solution is to raise the country’s economic standards.

Kampala, December 2017.