Hepatitis is a very serious, infectious and life-threatening disease. In parts of South Sudan the occurrence is so high that it can be categorized as an epidemic. Dr. David Anthony Tikimo, a specialist in tropical medicine and endemic diseases, has volunteered to help get the spreading under control.
Vomiting blood and putting everybody else at risk
Dr. David boards the MAF Caravan in Juba together with boxes of medication and a young girl. She is one of the students from Ibba Girls’ Boarding School, who were tested two weeks earlier when Dr. David was in Ibba to conduct a Hepatitis screening of the inhabitants of the town.
The girl on the plane was tested positive with the Hepatitis B virus. The virus had entered the secondary stage, and she was vomiting blood (haemoptysis), her adomen and her legs were swollen, and it was difficult for her to defecate.
“Haemoptysis is a very serious condition, so I took her with me to my clinic in Juba for further treatment,” Dr. David explains. “She responded well to the medication, and I have now taken her with me on the MAF plane to bring her back to her parents in Ibba. Her condition has improved greatly, and she will be able to resume her studies.”
10 minutes before the plane lands on the airstrip in Ibba the girl vomits into a paper bag. Very fluid, but without blood. Hoping it won’t begin to leak I hold the bag until the plane lands and I can dispose of it among the bushes at the side of the airstrip. It makes me feel bad, but this is not an airport with garbage cans.
When Dr. David started his voluntary work he discovered that the virus was widespread, and that 5 or 6 individuals of the same family could be infected. This gave him the idea to start screening people in certain areas. The aim would be to vaccinate and treat people and also to give people knowledge about how to avoid getting and spreading hepatitis. Hepatitis can be infectious, and once a family member has the virus it can spread and eventually kill the rest of the family.
Last year Dr. David started the Hepatitis immunisation campaign in Wau and Malakal (northwest and north) and the disease is under control in those areas. In 2018 the focus is on Ibba, Maridi and Yambio (southwest).
On his first visit to Ibba Dr. David was amazed to see that the disease had spread all over Ibba county, and especially prevalent in the small villages around Ibba. Most of the population was infected by Hepatitis B virus without knowing it.
“At the boarding school 40 % of the students were infected, so we have instructed the administrators that every child should be screened before they are enrolled,” Dr. David says. “If they carry the virus they cannot enter the school, while the rest must be vaccinated. It is vital to get the spreading under control, and these are crucial measures to be taken seriously!”
Ahead of him was a big task of vaccinating those who were not infected and to instruct and treat those who were.
Immunisation or isolation
Advanced stages of hepatitis are untreatable in South Sudan and have to be treated in other countries which makes treatment unaffordable for the vast majority of the population. A solution could be to keep people in advanced stages of hepatitis isolated from other people to keep the virus from spreading. But to isolate people in small communities where people live closely together and share utensils and toilets is very difficult to ensure, and therefore immunisation of everybody else is of paramount importance.
“Adults who are not infected will be given a combined Hepatitis B and C vaccine, whereas children from 8 to 16 years of age can only be given B-vaccines,” Dr. David explains. “For those who are tested positive Interferon is a very effective medication for preliminary treatment, but if the infection has reached an advanced stage it can have caused hepatoma, cancer of the liver cells, which can become malignant and deadly.”
“We also advise infected people to keep to a special diet, and they have to refrain from drinking alcohol and eating certain things, especially meat from bush animals and pigs who can be carriers of the virus.”
Time for tea
At the airstrip the commissioner of Ibba, Tito Gersoma, had arranged for us (MAF-pilot Wim Hobo and myself) to be picked up at the airstrip together with the doctor and taken to the town’s health center. Before we leave, an elderly gentleman is appointed the task of guarding the aeroplane.
First stop is the ECSS church of Ibba, where a pastor greets us welcome with a prayer and invites us inside for a cup of tea. After all, the The Episcopal Church of South Sudan (ECSS) facilitates the transportation of medicine and health workers, provides accomodation and work locations, and handles a great deal of the administrative work together with the county and its commissioner. The campaign is carried out in collaboration with The Ministry of Health in South Sudan, The Institute of Endemic Diseases in Germany who has donated the vaccines and medication, and ECSS.
“We are going to test the clergy of Ibba diocese,” Dr. David says. “If they prove negative they will be given immunisation, if positive they will be taken to Juba for treatment. If they respond positively to the treatment and improve they will be sent back to Ibba.”
Going back for more
At the health center people are waiting by the scores – in an attempt to avoid the blazing sun many have crammed inside a narrow passageway in a stench of sour sweat. Two weeks ago there were not enough supplies at the health center, so Dr. David decided to go back to Juba to get more equipment for diagnosing and to get more vaccines and medication.
“The level of infected people was much higher than anticipated,” Dr. David says. “We are now increasing the screening programme and engaging more people to assist with testing and vaccinations.”
Outside a man is calling out people’s names and one by one they go to the room in the outpatients’ ward where Dr. David is ready with syringes and vaccines. There is enough work to be done, so Wim Hobo volunteers to assist with registering the patients.
On our way back to the airstrip the commissioner takes us to see the boarding school. Here we meet Vicky Ajidiru, the deputy headmaster, who shows us two of the classrooms where the students are taking a midday nap across their school bags. In the yard we meet a large group of girls. They will soon be rolling up their left sleeves to receive a vaccine against hepatitis.
The day after MAF will come back to Ibba and fly the doctor back to Juba. Hopefully, he has achieved what he came out to Ibba to do – getting the Hepatitis epidemic under control.
Text & Photos: Thorkild Jørgensen.