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A long-awaited treatment for Cambodia’s ‘silent killer’

A patient consults with a clinician at Preah Kossamak Hospital’s Hepatitis center.
A patient consults with a clinician at Preah Kossamak Hospital’s Hepatitis center. Sahiba Chawdhary

A long-awaited treatment for Cambodia’s ‘silent killer’

A free Hepatitis C diagnosis and treatment clinic run by Medecins Sans Frontieres is the first step towards forming a national plan to fight the deadly virus

For Chea, this is the second visit to Phnom Penh’s Preah Kossamak Hospital in recent months – a more than 120-kilometre trip from his home in Kampong Thom. In a cramped room connected to the waiting area, he meets with a doctor from Medecins Sans Frontieres, who is advising him on how he can take care of his health.

Chea, who is using an alias due to privacy concerns, is one of approximately 200,000 people in Cambodia with the Hepatitis C virus, a slow-moving but potentially deadly infection that affects the liver.

He says that he learned that he had the disease 15 years ago, when a friend arranged for a blood test at a lab. Like most people in Cambodia infected with Hepatitis C, until now, he has not undergone treatment. Over time, the infection can lead to cirrhosis and cancer.

“I haven’t received any treatment since [diagnosis],” he explains. “In order to find a cure, I would have had to go to Vietnam, and the price would have been around $15,000 per year.” Although Chea does not feel or show any symptoms, he is eager to address the problem before it worsens.

Doing so may now be possible thanks to this free clinic, which opened last October and is run by MSF out of Kossamak Hospital. The clinic is the first stage of what the organisation hopes will lead to a national program to address the Hepatitis C virus, treatment for which has, until recently, been too costly for average citizens. Since opening, clinic staff have had to adapt to a higher-than-expected caseload. Patients from around the country have been showing up to be tested and, for some, treated.

“We try to have around 60 patients per day, but in the early days, until about two or three weeks ago, we could have 150 patients coming,” Mickael Le Paih, MSF’s country director, told Post Weekend last Friday. “There are great needs.”

Hepatitis C has been a growing concern globally, especially in the developing world. The World Health Organization estimates that between 130 million and 150 million people are chronically infected around the world. Until recently, the treatment has been both unreliable and expensive.

But in 2014, the pharmaceutical company Gilead put onto market what’s known as a direct-acting anti-viral (DAA), which has been found to cure approximately 95 percent of patients after a three-month course. The drug remains expensive – in the United States it can reach $70,000 – but because of Cambodia’s low-income status, the country is granted permission to use cheaper generics made elsewhere.

The price reduction and success rate makes it possible for MSF and Kossamak doctors to treat patients, with priorities given to those with more severe medical conditions. Patients who are diagnosed with the virus, but who have good liver functions, will receive counselling sessions to help them to slow the disease progression until treatment opportunities become available.

The others diagnosed with Hepatitis C but who do not fit this urgent criteria will need to wait. “One important challenge we have is that we can’t cover everybody,” Le Paih says, citing budget constraints. “There are some patients being diagnosed and we won’t be able to treat them soon.”

As of mid-February, the clinic had enrolled 580 patients into treatment, a six-month process that will include regular visits to both take the medicine and for follow up, and it plans to postpone new admissions from April to June to catch up on a backload.

More than six out of 10 of those in treatment are older than 50 and, among all patients tested for the virus, 45 percent have come from outside Phnom Penh and Kandal province – a sign, Le Paih says, of the overwhelming demand throughout the country.

Le Paih is open about the limitations of MSF’s outpost at Kossamak Hospital; it is not a solution to the country’s Hepatitis C issue but instead the start of an effort to identify and treat the most severe cases, collect data on the patient outcomes, and then hopefully to expand, alongside the Ministry of Health (MoH), to other provinces. The organisation has recently started working with the MoH on helping to develop a national program for Hepatitis C, but Le Paih expects implementation to happen in three years at the earliest.

In order for the MoH, which was unavailable for comment for this article, to begin treating the virus on a national level, the costs will need to be lowered. At the moment, diagnostic costs per infected patient are about $175. New equipment expected to be put in place would drastically lower the price.

Chan Yeun, a Hepatitis C patient, outside the clinic.
Chan Yeun, a Hepatitis C patient, outside the clinic. Sahiba Chawdhary

For now, the focus for doctors in the clinic is on treating the most severe cases. Chan Yeun, a 78-year-old from Takeo province, fears that he may be one of these. He was diagnosed at a private clinic about five months ago and jokes that, although his children are nurses, they have not been able to help him.

Undergoing exams at the clinic last week, if Yeun qualifies, he may have a chance to eliminate the virus altogether after potentially living with it for decades. “When I first found out about the virus, I was so worried. I didn’t know what to do,” he says. “Now I have some hope that I will be cured.”

Yeun is not sure how he contracted Hepatitis C but it is likely that medical malpractice that occurred decades before played a role.

“Most of the cases will be malpractice or lack of hygiene in health facilities where the health-care workers didn’t have enough means back then,” Le Paih explains.

Yeun has seen the impact of the slow-moving virus around him.

“Some of the people in my village were infected with it,” he says. “Most of them died because of it.”

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