Nunatsiaq Online
NEWS: Around the Arctic May 19, 2016 - 1:25 pm

A better liver through chemistry: Pauktuutit takes aim at hepatitis C

National Inuit women's association develops partnerships, continues awareness campaign on viral infection

JIM BELL
Here are some of the posters that Pauktuutit has developed as part of its hepatitis C awareness campaign. The organization has also produced and distribute booklets, brochures, information cards and videos in most languages and dialects used througout Inuit Nunangat. (PHOTO BY JIM BELL)
Here are some of the posters that Pauktuutit has developed as part of its hepatitis C awareness campaign. The organization has also produced and distribute booklets, brochures, information cards and videos in most languages and dialects used througout Inuit Nunangat. (PHOTO BY JIM BELL)
Merv Thomas of the Canadian Aborigional Aids Network. He said the risk of hepatitis C transmission for Aboriginal people in prison is extremely high. (PHOTO BY JIM BELL)
Merv Thomas of the Canadian Aborigional Aids Network. He said the risk of hepatitis C transmission for Aboriginal people in prison is extremely high. (PHOTO BY JIM BELL)

OTTAWA — It’s a disease that often strikes in silence, and many victims learn of it only after many years, when their livers are scarred by cirrhosis or eaten away by cancer.

Hepatitis C, a chronic liver infection caused by a virus that wasn’t discovered until 1989, lives inside the bodies of more than 220,000 Canadians.

Though it’s current prevalence within the Inuit population is still unclear, Pauktuutit, the national Inuit women’s association, wants to ensure that Inuit understand the risks posed by hepatitis C and how to protect themselves from it.

To that end, Pauktuutit teamed up with their long-time partner, the Canadian Aboriginal Aids Network, for an awareness event in Ottawa held May 15 as part of National Aboriginal Hepatitis C Awareness Month.

“It’s been a wonderful partnership,” Pauktuutit’s executive director, Tracy O’Hearne said at the start of the event.

Right now, the Nunavut government has little or no information on hepatitis C infection rates in the territory since the middle of the last decade, though between 2005 and 2009, Nunavut’s rates were lower than elsewhere in the country.

But a report from the Public Health Agency of Canada on hepatitis C rates 2012 contains no information from Nunavut.

Past surveys cited by Health Canada reveal hepatitis C infection rates in Nunavik and Nunatsiavut that are lower than provincial averages.

But it’s a worrisome disease, for many reasons. Based on very rough estimates, researchers believe First Nations and Inuit suffer hepatitis C infection rates of between 1 per to 18 per cent.

That compares with a national infection rate of about one in every 100 Canadians.

One reason for worry is that researchers in Canada have found that 44 per cent of carriers don’t know they have the virus. Some people show no symptoms when they’re first infected and can carry the virus in their body for 20 to 30 years without knowing about it.

But it can lead eventually to liver cancer, cirrhosis of the liver — and after the liver is destroyed, it can be treated only through a liver transplant.

Another reason for concern is that unlike hepatitis A or hepatitis B, no vaccine for it has yet been approved, though some are now under development.

And after hepatitis C is detected, treatment, which usually requires combinations of expensive drugs, can be difficult to access for people living in remote communities.

The virus is spread by blood-to-blood contact from one person to another, and in Canada that means the most common method of transmission is intravenous drug use.

Sexual transmission of hepatitis C is rare — that happens only in sexual contact where bleeding occurs.

But a pregnant mother can pass it on to her newborn child.

Hepatitis C can also be transmitted by home-made, amateur tattooing and body piercing, especially when it’s done outside licenced establishments.

For that reason, Pauktuutit’s information campaign gives priority to the risks posed by these potentially dangerous forms of bodily modification.

Another transmission method is the sharing of pipes among people who smoke crack, heroin or meth, especially when their mouths are covered with sores or bleeding.

And it can be passed on through sharing personal care items like toothbrushes, razors or nail files.

Transmission rates are also high among people in prisons.

Merv Thomas, a communications co-ordinator for the Canadian Aboriginal AIDS Network, says it’s not uncommon for Aboriginal inmates to enter prison clean, but come out at the end of their sentence with a hepatitis C infection.

As for Pauktuutit, they want to focus their awareness campaign on issues that are specific to the Inuit experience, said Ashlee Pigford, the organization’s manager of health policy and programs.

That includes advice on the risks posed by homemade tattooing and body piercing, and advice about the risks posed by activities like sharing lip balm and toothbrushes.

Another group they want to target are older adults who start new relationships, Pigford said.

To find out if you have hepatitis C, you have to take two tests.

The first, a basic screening, is done to find out if you carry antibodies for hepatitis C.

If that first test comes back positive, it means that you were infected with hepatitis C at some point in your life, but it doesn’t necessarily mean you have the virus in your body now.

That means you need a second test, sometimes called an RNA, to find out if the virus still lurks in your body and if so, how much, a concept called “viral load.”

If you get a positive result from that test, the disease can be treated with expensive medications like sofosbuvir or simeprevir that are able to cure most infections.

Pauktuutit says these pharmaceutical cures are not enough: patients often also need guidance on developing healthier diet and lifestyles and advice on how to avoid risky actions.

Julie Beaulac, a clinical health psychologist for The Ottawa Hospital who works on its regional hepatitis program, said her institution uses telemedicine to reach patients in remote and rural communities in Ontario and Nunavut, including hepatitis C patients.

Using that method, she said her group has reached about 300 people, including some patients from Iqaluit and Pond Inlet, but she didn’t say how many.

Dr. Indu Gambhir of the Akausivik clinic located in the Vanier neighbourhood of Ottawa, which serves an Inuit clientele, said all patients who use the centre are tested for hepatitis C, hepatitis B, HIV and given other basic blood tests “so that we have a baseline on every patient.”

But she warned that hepatitis C — which she described as a “flavor-of-the-year disease” within the health care community — often occurs in combination with other illnesses.

“Contrary to the popular belief that hepatitis C is the only disease that a patient can have, they have a lot of co-morbid conditions,” she said.

This means that hepatitis C patients need constant follow-up to monitor the side-effects of their medication and any complications caused by other health conditions, Gambhir said.

And a big part of the health care service at Akausivik is to teach patients to ask questions when see a doctor or nurse.

That includes people who, elsewhere in the health care system, have never been given understandable information about the disease they’re carrying or the treatment they’re receiving.

“For hepatitis C, we do the explanation, the follow-up, the care for hepatitis C patients. We co-ordinate with the clinics at the Civic and the General and we follow them up for complications and side effects,” she said.

 

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