Investigating Hepatitis C in Pakistan

Presentation at the Pakistan Society of Gastroenterology Conference at The Pearl Continental

2006-05-04T15:50:00.000+01:00

So here I was, my first ever opportunity to speak at a National Conference and I turn up late! It took longer than expected to get ready, to cross town. and we were too late for our slot. I was reallly sad. I had decided that what I wanted to speak about was the patient experience of Hepatitis c. I had asked Shabana to speak, and althoughtshe was very nervous she agreed. I just think at these conferences its all too easy to forget who it is all about.

The wonderful kind Dr who gave us the opportunity managed to twist and squeeze the programme and got us on later that morning. Yippee! we were off!

I uploaded our slides of shabana's family, so many of whom have Hepatitis C, and we paced the hotel, waiting for our turn.

We stood on the stage, nervous as hell, in from tof Dr's, mainly surgeons as the talks before had been about Liver Transplant, so here we cam ewith something completely different. It went down like a lead ballon. As Shabana began to speak, people spoke to theri neighbours, got out hteir phones, left the room. it was awful. She spoke of how difficult it was to be told she had Hepatitis C, she spoke of her treatmetn in UK, she spoke of what we had learnt in paksitan. Of how so many of her family have Hepatitis C and can't afford the treatment, of how so many of her family have died of Hepatitis C. It was painful to talk about, especially when the audience was uninterested. Perhaps we were speaking to the wrong Dr's. Remeber we had missed our slot! And we were not mentioned in the the programme, so any Dr's who would have been interested could not come. In another conference room a very senior Dr from USA was speaking. So its perhaps understandable. And after wards a man with a son dying of liver disease, who was really distreseed and happy to speak to a nother real person came over, so maybe it was worth it. At the time it was demoralising. I strongly beleive that its the real true life stories from people with hepatitis C that will eventually transform this issue, in UK and Paksitna. There are no words that mean anything as strong as the patients words.

Visiting the slums

2006-05-04T15:15:00.000+01:00

All round Islamabad, as in all the other cities in Pakistan, there are numerous areas with slums. The slums are mostly made of fabric, draped and shaped in to homes. ICAN workers kindly took us around one to meet some of their friends. In one way the slum village reminded me of glastonbury, or a peace camp. the main difference being that at Glastonbury or a peace camp people have other homes to go to.

Of course we have all watched tv shows with slums on them. But what the tv show can't tell us is the smell. In the street between the tents a stream of sewage ran, with shit floating or piling up.

the other thing you never see on tv is the pride that people take in their homes, however simple. Or the friendlines, or the endless cups of chai I was offered. One of the families we visited had lots of pets, including a rabbit and a green parrot!

In one of the homes there had just been a wedding. The lucky couple had the room decorated, it looked really beautiful. the young woman shyly showed us a few phots of her happy day. here is aphot of me and the lovely family with Carol from ICAN. The decorated bed is in the background.

Beautiful eh!

After spending time with the drug users and in the slums I was really knocked sideways. I think i've seen q bit of the world but I had never seen poverty like I saw today. Here we are in the 21st Century, I live in a land where each home has a couple of cars, where we rip out our kitchesns to fit the newest colours, where we all try to live like footballers wives, and here there are, lovely kind funny friendly people living in such poverty. It breaks my heart.

Visiting heroin users in Rawalapindhi

2006-05-04T14:31:00.000+01:00

ICAN they took me and Shabana out to meet some of the local heroin users. We went to one of the spots where they use drugs, and visited one of the spots where they live.

In Rawalaphindhi the most common way of taking heroin is smoking not injecting. Apparently in Karachi and Lahore, much bigger cities that Rawalapindhi, there are more heroin injectors. But here the common method is much safer regards transmission of Hepatitis C. The heroin users live and take drugs in the most unimaginable filth. The smell was undescribable. The area they were living was under a stream of sewage and rubbish, living on layers and layers of rubbish. Here are some photos...you can't see much in the first one, then I zoomed in. If you look carefully in the dark you can see a blanket where somebody is sleeping.
Here's a photo of me and a few of the other workers standing on the tiny bridge over the open sewer/stream :

One of the lads we met was really upset. he had been beaten up by the police the night before:

They were a friendly bunch of young lads, and reminede me of lads from england. I think they quite enjoyed the attention!

Hepatitis C prevention with ICAN

2006-05-04T14:07:00.000+01:00

ICAN are a small Chrisitan NGO that work with drug users and help them with rehabilitation. They have a residential communtiy where clietns can have a detox, and spend time learning hwo to live without drugs. When we visited them they were without premises, and were only able to do the minimum amount of work. they are hoping to move into a bigger building soon so that they can admit people and help them come off drugs.

Shaban and I spoke to them about Hepatitis C. they had not heard much about it, having concentrated all their efforts on HIV. They had never worked with a client with HIV. We gave the group of staff our Health Promotion Presentation, and found out that a few of the staff had Hep C or had family members with it. so much for all the work with HIV! As I discussed with them, by concentrating on Helatah Education about HIV they are missing an opportunity. The disease has different routes of transmission. Unlike HIV Hepatitis C is rearely spread by sex. Instead it is almost soley spread by blood. But unlike HIV it lives for along time outside the body, and terefore can be spread by every bit of kit that is used when people inject drugs. its not just needles, it can be spread by filters, spoons, water. Also as so few people in Pakistan have HIV the Hepath Promotion message means notheing. But Hepatitis C is rife. By concentrating on Hepatitis C prevention perhaps people will change their behaviour, because everybody knoows somebody with it.

Day 11 - Weekend in Islamabad and Rawalaphindhi

2006-04-26T09:49:00.000+01:00

Today we travelled from Faislabad by motorway to the capital city Islmabad and its twin Pindhi. Islamabad is so strange. Its a new city, built on the edge of the himalayas. Its really beautiful, lots of green green parks, and wide boulevards. It looks like some European or American city. Even the traffic is less. But look again. Everywhere, tucked into every bit of green, is shanty towns. Strange mix again of a 21st city merged with a deeloping world city.

Its mostly the wealthier people who live in Islamabad, but all the workers and the usual chaotic, crowded, colourful Pakistan lives in Rawalapindhi.

My next stop, after we had got comfortable in our hotel, was off to a conference In the Pearl Continental to meet Professor Foster.

Professor Foster is a well known Hepatitis C researcher and consultant in London. After he moved from woking in the Royal Free in West London to working at the The Royal London, he noticed a change in his patients. No longer were they all from the drug using population. Suddenly he was confronted by many many ptients from Pakistan. Similiarly to me he wanted to find out more, and has done some imprtant research into the field (see D'Souza et al (2005) Prevalence of Hepatitis C–Related Cirrhosis in Elderly Asian Patients Infected in Childhood Clinical Gastoenterology and Hepatology Volume 3, Issue 9, Pages 910-917 ). So it was great to meet him. He's been at the conference for a few days, Honourable Guest, so he spoke with great enthusiasm about what her'd found out, and I spoke about the sad experiences I had meeting patients and clinicians on the front line.

Then one of orgainisers spoke to me about speaking at the conference on the sunday. Why not, I'd never get such an opportunity otherwise, so I jumped at it!

Day 10 - Listening to the stories

2006-04-17T14:57:00.000+01:00

Spent today meeting people with Hep C in Faisalabad. In the morning a car load of people came, mother daughter son and his wife. The wife was a relative of somebody at one of the meetings in Yorkshire. 3 of the group have Hepatitis C. They had driven for 2 or 3 hours from a village in the countyside, i guess wanting treatment. All we could give them was some answers. We interviewed them about their symptoms and how they might have caught and then showed them our health education presentation. It was so very sad. We worked out that they had all caught it from the same untrained medic who worked in the village. They all used to go to see him about their everyday ills. They would always get an injection. And everybody in the village knew he reused needles. And everybody in the village went to him. Does the whole village have Hepatitis C?

Next we went to visit a family with a very ill mother, a huge abdoment filled with fluid. She was just out of hospital. She was so ill. Amongst the saddness of the family dealing with their beloved mother, looking so ill, so old. And dying aged 45. Amongst all this they ed us and made us tea and made pleasant conversation. Again we answered questions, interpreted their medical notes, gave nursing advice. We interviewed them. And educated them all.

Finally I spent a few hours with MsSB's family. She has 3 aunts with Hep C and an uncle. And one of the aunts husbands died of it. As have 2 other aunts, both in the week we have been there. And Baby, my favourite relatives mother in law did of it too. Again questions and education.

I feel so hopeless. What can I give these people? Advice about unaffordable drugs? Information about how they caught it? Its too late for them. So much illness. So much sadness. So much tragedy. I say at the end of each training session: " Right, now you know more about Hepatitis C than almost everybody else in Paksistan. You now have a duty to pass this information on. You have a moral duty. This information will save lives.

Day 9 - resting in Faisalabad

2006-04-15T08:43:00.000+01:00

After a long drive we spent the next few days we at Faisalabad. In Faisalabad Ms SB has a family home and a small bit of land in a nearby village. Her aunt and her large family live in the house, added to by many many relatives passing by. They are not well off, but they were so genorous and kind. I quickly became very close to this wonderful warm family. We spent half the day sitting under a tree in the country, enjoying the warm sunshine and the differrent country sites. We weere busy on the phone making appointments, and relaxing a little.

Day 8 - sight seeing in Lahore

2006-04-14T21:45:00.000+01:00

I really love Lahore, I think everybody does! It has some amazing Moghul architecture, and the whole city is buzzing with life! We spent the day looking around the magnificient Fort and mosques, finishing up in a fantastic traditional restaurant. Here's some photo's!

Day 7 – Meeting with Rotary Club

2006-04-14T21:28:00.000+01:00

Had interesting meeting with these important philanthropist businessmen. They are eager to part fund a Project for raising awareness about Hepatitis C in Pakistan. They suggested that a small area is chosen, and a model of awareness rising is developed. This is certainly something that I will consider.

Day 7 – meeting with Chairman of Sheikh Zed hospital, and meeting Dr Alam, Consultant Gastroenterologist

2006-04-14T21:21:00.000+01:00

Dr Altaf Alam and myself

We jumped into our cars and raced off to the nearby Sheikh Zed Hospital, a large Private Hospital with Lahore’s only Hepatology Department. There I had a brief meeting with Dr Anwar, where we talked of the epidemic happening in their country, and the difficulty thay were having taking control of it. The Sheikh Zed Hopistal have been instrumental in the drawing up of a Green Paper being considered by the Punjab Parliament. The Green Paper considers legaslisation to stop the spread of Hepatitis. This would include the disposal of sharps, the re-use of needles and the terrible situation where herbal healers or quacks promise 100% cures for Hepatitis C with the use of herbs. The newspapers and street signs are full of these, bringing false hope and exploiting the poor.

I then spent time talking to Dr Altaf Alam Consultant in Gastroenterology. We discussed the difficulty in giving health promotion campaigns with a country with one of the lowest levels of literacy in the world. He shared with me some of the leaflets and posters that they have developed. He was a kind and interesting man, but obviously overwhelmed by the epidemic. He invited me to speak to the Dr’s next Friday at 8 a.m. He also promised to show me around the Gastroenterology Ward so I could see the epidemic for myself.

Day 7 – Giving a lecture to BSc Nursing Students

2006-03-24T07:21:00.000Z

After meeting Professor Husnain I met Kauser Parveen. She is a highly inspirational woman who is the Principal of the College of Nursing at the Allama Iqbal Medical College in Lahore. Amazingly enough we were both studying at the Queen Margaret College, Edinburgh at the same time. She was doing her MSc in International Health, and I was doing my original nursing degree! Small world!

Kauser Parveen has developed a degree-nursing programme in Lahore from scratch. This is almost unique in Pakistan where, until recently, nurses were seen as the lowest of the low, and a totally unrespectable career for a woman. The training was minimal as were there responsibilities. By examining curricula internationally she has designed an excellent 4-year programme for nurses. It is now in its second year, and there are plan to design an MSc and MA course to follow on. I met some of her ambitious young nurses, and was inspired by their knowledge and enthusiasm.
I delivered a lecture to over 100 nursing students, lasting about an hour, on the basics of awareness, prevention and treatment of Hepatitis B and C. I do hope it went down well!

Day 7- Meeting with Professor Syed Sibit-u-Hasnain

2006-03-24T06:42:00.000Z

We were met by a welcoming committee, made up of Dr Sohail Saqalin the hospital nursing superintendent and a couple of men in turbans and uniforms. The door was opened for me and I was swept into the building, accompanied by Dr Sohail Saqalin I felt like a visiting dignitary, not just a nurse from West Yorkshire. As we walked along to the door of the medical school Dr Sohail Saqalin said, “You can give a lecture?” I swallowed hard, quite unprepared, and said “Yes” with a confidence I did not feel!

We were brought into the office of Professor Syed Sibit-u-Hasnain, and sat across from him in his large desk. He had a meeting to go to in 20 minutes, and so I had a very short time to learn what I could from him.

In Pakistan expert such as Professor Husnain have built up a wealth of knowledge of treatment of Genotype 3 Hepatitis C, and I feel that I can learn a great deal about Hepatitis C treatment for him.

In Pakistan it is known a Kala Jarkhan or black jaundice, perhaps because it is like the Black Death out here, or perhaps because of the change in skin pigmentation that occurs due to the poor metabolism of melanin stimulating hormone.

The history of Hepatitis in Pakistan has been traced to the pricker used to test for reaction to the smallpox virus mass vaccination programme carried out by the WHO. When we think how much compensation the Skipton Fund gives to people infected by with Hepatitis C by the NHS, you would think that the world would take some responsibility for the spread of this terrible disease.

The spread has been increased by the use of glass syringes, and a cultural proctice common amongst women of up to daily Vitamin B complex injections, a placebo that was supposed to act as a tonic.

One major worry is the 40% of clients who have no clear mode of transmission, ie no major medical treatment, no blood transfusion. Perhaps it is these people who have been infected by barbers, therapeutic injections, circumcision, baby head shaving and other cultural practices, which can transmit the virus if sterile equipment is not used.

A Hepatitis C Antibody test is performed. Similarly to the International Experience, approximately 25% of people clear the virus, and so a PCR test is done to find out if the infection is chronic or acute. The PCR test done is a Viral Load. The results of this can then be used to predict treatment results. A low Viral Load prior to treatment can predict better results, and it can be used as a baseline to predict success whilst on treatment.

Pegylated Interferon is expensive, and has no advantage over standard interferon for people with Genotype 3 (unlike with Genotype 1) and so standard interferon is used in treatment naïve people. It is used at a standard 3 million i.u. 3 x week with weight based Ribavarin. Pegylated is only used in people who have relapsed after treatment. Liver biopsies are not indicated, which is understandable as the treatment has a high success rate and the disease has a high probability of causing cirrhosis. And liver biopsies have risks and are expensive. Instead good quality ultrasound is used to detect any gross changes, and LFT’s are examined.

The Viral Load is retested after 8 weeks, and if a 2-log drop occurs successful SVR is predicted. If this does not happen consideration is made for a 48-week treatment course. He told me about a client who after not achieving SVR continued on treatment for 120 weeks, and finally did achieve SVR!

One important piece of information that the Professor told me that his results are showing a poorer SVR after 12 months than had been expected from International Literature, even with a PCR negative at 6 months.

Due to the amount of Hepatitis C in Pakistan, and the length of treatment it is here there has been a huge rise in cirrhosis with all it attendant problems of bleeds varices, encephalopathy, ascites and jaundice. It is now the biggest source of hospital admissions, where it used to be cardio-vascular diseases. And the number of cases are rising and rising every year.

Day 7 – Meetings from Dawn to Dusk in Lahore

2006-03-23T06:11:00.000Z

We set off from Faisalabad at 8, an hour later than I planned. We jumped in the back of the posh car we had been given and sped off. We had meetings booked all day, from 10-30 with Professor Syed Sibit-u-Hasnain, President of the Hepatology Society in Pakistan, and Principal of the Allama Iqbal Medical School. At 2 we were to meet Dr Anwar, Director of the Sheikh Zed Hospital, the only hospital in Lahore with a Hepatology Department in Lahore. We were to catch up with the friend of a patient of mine from Huddersfield who has Hepatitis C. And at the end of the day we were to meet The Rotary Club to look at funding for the future of this project. What a day we had ahead.

Our first appointment was the one of the most important one of our trip, with Professor Syed Sibit-ul-Hasnain. I felt very privileged that he wanted to meet with me, and I most certainly did not want to be late – but by 9.30, with more than an hour to go, I couldn’t see how we could make it in time. But our driver broke the speed limit, we zoomed along the motorway, wove through the mad traffic in Lahore, took a few false turns, and then, just on time, we arrived at the Jinnah Hospital, and on to the Allama Iqbal Medical School.

Day 5 – Sunday March 19th – What a day!

2006-03-21T19:15:00.000Z

One of those days! I guess, inevitably when you are in a foreign culture, a very poor country, there are times when nothing goes as planned!

In the morning Ms SB had to pay respects to a relative who had had a recent death. By the time she got back the morning was over. We packed up and set off for the city centre, so we could find a hotel for the next few days. We went to another hotel that promised internet access…..it was a creepy male place, with very unfriendly staff. And no internet access. They directed us to another hotel. We were very relieved when we arrived, as it was fairly luxurious and they promised the Internet! They took us to the ‘family’ section.

After we had settled we went out sight seeing. Ms SB wanted to visit a shrine to a Saint, to say some prayers. It was mad hectic but fascinating driving through Lahore, always much to see, 21st Century imposed on top of medieval city, range rovers weaving between carts pulled by buffalo. Dark passages, dusty tiny shops, people in rags, and huge flash shopping malls. But as we got closer to the monument the crowds tightened around, closing in. Drumming sounded, and suddenly, outside the monument we could not move at all, jammed in by people everywhere. Apparently it was Urs, an Islamic 3 day festival, and people had come on pilgrimage from everywhere. The crowds scared me, we pulled out scarves right around our selves, hiding our faces except for our eyes and as soon as we could manage we moved on.

Next we went to the Lahore Fort, the major tourist site in Lahore. Again the crowds from Urs where full-on, the car surrounded. Then, guess what! The car went dead! Not a peep. Electricity all dead. Now I was really scared. Me and Ms SB sat in the back covered in cloth, whilst our young driver tried for over an hour to get it working, with the hustle and bustle of strange costumed crowds around. Finally a kind gentleman helped, and straight away put the right two wires together, and we moved again.

We gave up sight seeing and went back to hotel, shattered. But no internet! Ms SB’s relatives called the hotel and threatened all sorts of things, and they scuttled off to get the wires to get it going. We locked ourselves in our room, and waited. And waited. And waited. It was almost midnight and we heard that it was almost ready, when! Boom! The electricity went off! All we could do was lie on our beds and laugh and laugh and laugh! Nothing more could possibly go wrong!

It flickered back on and off for an hour, and finally chocked back into action….and then finally, I got onto the net! I could finally send some emails to start working out our schedule for the week ahead.

4th Day – March 18th Karachi to Lahore

2006-03-21T19:04:00.000Z

Today we flew to Lahore. We met our driver just outside the airport. And then disaster hit, as the hotel I’d booked and paid for had not heard of us when I phoned. They even denied taking internet bookings! But luckily Ms SB saved the day again! Se phoned her family and before we knew it we were caught up in the loving bosom of a huge warm kind family. I could not count how many women lived in the big airy home, and there were children of every age everywhere smiling shyly at me. I immediately felt so at home and safe. They fed us the most delicious Saag Aloo and lamb. Heavenly. I spent a few hours feeling tense whilst the family worked out where I could get to an Internet café that was safe. After another tasty meal of rice and the most delicious spicy meatballs, we sped off in the car with 2 young men to take care of us. I spent an hour on the net, sorting stuff out, and leaving a lot more relieved.
We bought a huge cake for an aunt who had just arrived from Saudi for the birth of her daughter’s first child. It was her birthday, and the house was even more full of women and children, with blankets being laid out on every floor for all the extra guests, including us to, a surprise extra

March 17th – 3rd day. Meeting Professor Hamid Saeed

2006-03-21T17:57:00.000Z

We took a taxi to the Aga Khan University. I knew I had an appointment with Professor Saeed Hamid from the GI department, but I did not have any opportunity to check my emails to find out what time…..so we turned up at 3 and hoped for the best! Luckily he had time to see us for a short time…..but wow! Did we learn a lot about Hepatitis C in Pakistan in that short half hour!

Professor Saeed Hamid is a renowned researcher in the field of Hepatitis C in Pakistan. He has produced a wealth of research and he has spoken at numerous seminars to increase awareness about this disease.

In Pakistan 79% of people are Genotype 3a. 8% Genotype 3b. This is the esiest Genotyp to kill with treatment, but I wanted to speak to him about how expensive the treatment is. He told me some news which surprised me. He told me that they use a Generic Interferon which costs them only 8 000 Rupees (£80) per month. This is hugely cheaper than the branded Interferon which costs 12 000 Rupees per injection (£120). The dosing they use is standard (not Pegylated Interferon) 3 million i.u. 3 x pr week and weight based Ribavarin.

I asked him about how it is passed on in Pakistan. Therapeutic Injections are given for all sorts of conditions, and the injections given maybe vitamins or antibiotics. A piece of research carried out by Aga Khan showed that of people who had 5 or more injections in last year 10% have Hepatitis C. The other way is bblood transfusions. 50% of blood banks use professional blood donors, who may well be drug addicts. The blood is most frequently tested for HIV, because funding is provided by UNAID, even though Pakistan is a country with low prevalence of HIV, but only 25% is tested for Hepatitis C. And in Pakistan people will ask for blood transfusions for conditions such as ‘General Malaise’. Another common practice is for families to give blood transfusions to other members of the family, completely untested. In this way the pattern of familial transmission is occurring. He also highlighted the huge problem that exist with unsterile practices in dentist’s.

There has been a huge growth in hospital admissions due to Hepatitis C. At present this is running at about 10% of ALL hospital admissions at the Aga Khan hospital.
Overall in Pakistan the prevalence is thought to be 6%, however in some periurban areas the prevalence is as high as 20%.

2nd day – Thursday March 16th

2006-03-21T17:54:00.000Z

Me at Jinnah Monument

A welcome day of rest! We went out to buy me a Shalwar Kameez. We dressed in a long black coat each and covered our hair with a scarf. We walked across the railway lines and caught a brightly cololoured bus to the town centre. We spent hours looking at fabrics and comparing shoes. Finally I bought a gorgeous black and orange half made suit for £8, to be made up in Faislamabad.

Me and Shabana on a camel on Karachi Beach

Manchester to Karachi!

2006-03-19T18:21:00.000Z

We left Manchester airport at 9 in the morning and did not arrive in Karachi until 2 am (Pakistani time) the next day! Exhausted and releived we were met at the airport by Ms SB's relative who whisked us away in a car with all our bags to stay with the family member.

They live in a poor area, in a high rise beside a railway, 2 roads and a rubbish dump. But the welcome they gave us was overwhelming! We were soon settled in for the night.

Documentary interview!

2006-03-06T23:27:00.000Z

This evening after work I met up with Ms SB and 2 lovely women from Fulcum TV productions who are in the middle of making a documentary about Hepatitis C. We went out for a lovely meal to Royal Cuisine, little curry house on the corner, I had a tasty Fish Masala and we had the best dhal! Then we went back to Ms SB's workplace, ThorntonLodge Learing Centre, and they set up for the interview.

It seemed to take ages for them to set up, then...camara...lights...ACTION!

They asked me questions about Hepatitis C locally. I spoke about the different high risk groups in Calderdale and Huddersfield. Then Shabana spoke about her experience of going through six months of treatment. Then they asked us about the trip to Pakistan. We spoke about how importance it is to stress the Hepatitis C in Pakistan is about poverty. That the risk involves blood, so anybody visiting for long periods or being born in poor countries is at risk of getting Hepatitis C. I'v only noticed the connection with Pakistan because many people in W Yorkshire has visited Pakistan. If I lived someplace with many Egyptians, perhaps that would be were I'd be off to!

Then they asked us the questions again, from different angles. We had to keep everything just where it was for continuity. It all took ages, and I was aware how late it was getting. Finally it was finished! We all had a big hug and swapped contacts. They promised we'd be invited to the film's opening. They went off, to find the motorway and drive to Dudley to do more filming. Shabana dropped me at the rail station and shattered, I set off home.

a documentary mystrey

2006-03-02T21:59:00.000Z

Today I had an amazing phone call from 2 women making a documentary about Hepatitis C! They want to interview Ms SB! its happening next Monday. I'll tell you about it afterwards!

Public Meeting in Hudderfield to raise awareness about Hepatitis C

2006-03-02T21:47:00.000Z

Wednesday, 7th March, Ms SB has arranged a public meeting to raise awareness about Hepatitis C at Thornton Lodge Community Centre. I hope to do a presentation about Hepatitis C, but mostly I hope to have a question and answer session. We will also be raising awareness in Huddersfield about our trip to Pakistan. I hope I remember to take photos this time! If I do, you'll be first to see them!

Our Itinary

2006-03-02T21:20:00.000Z

Finally I can tell you where we are going and who we are visiting....

Day 1
Wednesday March 15th
Manchester Airport to Karachi

Day 3
Friday March 17th
Karachi
Meet up withDr. Saeed Hamid Aga Khan Universtity. Aga Khan University has been at the forefront of Hepatitis C research in Pakistan. The aim of meeting Dr Saeed Hamid is to to find out how Hepatitis C is being transmitted within Pakistan.

Day 5
Sunday March 19th
Mr IS who was a patient of mine in the UK who is now living in Pakistan. I wish to interview him and some of his family in Pakistan who have Hepatitis C

Day 6
Monday March 20th
Lahore
Visit Prof. Syed Sibit-ul-Hasnain who is the President of the Hepatology Society in Pakistan. I wish to discuss the epidemiology and transmission of Hepatitis C in Pakistan. I will be very interested in any Health Education material that exists in Pakistan.

Day 7
Tuesday March 21st
Lahore
Various places eg Barber shop, dentist etc. We have been commissioned by the Hepatitis C trust to take photos for use in leaflets in UK for people of Pakistani origin showing methods of transmission in UK. The Hepatitis C Trust plan use the photos and information to make leaflets for the Black and Ethnic Minority people in the UK.

Day 8
Wednesday March 22nd
Faisalabad
Dr Abdul Mannan general GP used by local people in Lahore. He is a relative of a patient in Halifax with Hepatitis C. I will speak to him about his experience of Hepatitis C, his opinion on methods of transmission, and give him as much information as I can to help him prevent and treat Hepatitis C.

Day 9
Thursday March 23rd
Outside Faisalabad
Mrs SS who has Hepatitis C. I will interview this lady who has Hepatitis C, using questions provided by Professor Graham Foster to attempt to discover the route of transmission for her Hepatitis C. I will provide advice as relevant.

Day 9
Thursday March 24th
Faisalabad
Various places eg Barber shop, dentist etc

Day 11
Saturday March 25th
Islamabad
Professor Graham Foster who is an eminent Hepatitis C Consultant and researcher in the UK. He is also involved in research re Hepatitis C. We hope to meet to discuss our findings

Day 11
Saturday March 25th
Mirpur
Family with Hepatitis C

Day 12
Sunday March 26th
Mirpur
Family with Hepatitis C

Day 13th
Monday March 26th
Islamabad
ICAN Drug Rehabilitation. Visit to drug agency, to discuss problem of Hepatitis C. Also to plan teaching session.

Day 14
Tuesday March 27th
Mirpur
Various places eg Barber shop, dentist etc

Day 16
ThursdayMarch 29th
ICAN Drug Rehabilitation to Provide teaching about Hepatitis C testing

So interesting and exciting. A real oportunity to look at Hepatitis C in Pakistan, and make some links between the UK and Pakistan (two countries already linked on so many levels) about Hepatitis C.

Hepatitis C Awareness afternoon in Halifax

2006-02-21T23:27:00.000Z

Today I held a public meeting at the Queens Road Neighberhood Centre for local Asian people about Hepatitis B and C. I held the group jointly with Qadir, the men's worker at the local Healthy Living Centre. He invited some gentlemen from the local DIL health group, and I invited my Pakistani clients. About 15 people turned up.

I gave a presentation about Hepatitis B and C, about how they are spread, how common they are, and advice for people visiting Pakistan or Saudi. The main advice regarding Hepatitis B is for everybody who even might spend time in Pakistan or Saudi to GET YOUR HEPATITIS B VACCINATIONS!!!!!, just in case you get a sudden invitation for a wedding and don't have time to have the 3 Hepatitis B injections (they take about 6 months to complete). The main advice about Hepatitis C is for anyone visiting Pakistan to be BLOOD AWARE. Be careful about injections at the Dr, ask the Dr to open the needle in front of you. Be careful at the barbar shop, bring your own disposable razor just in case there has been a bit of blood left on the razor in the barber shop.

After the presentation I spoke to the group about the trip to Pakistan. Although many people in Halifax hail from Mirpur I have not yet made contact with people there. One person in the group gave me the address of a cousin who is on the treatment in Mirpur. We swapped numbers and addresses so that I can contact her and then visit her in Mirpur.

Also today I spoke again to a taxi driver, also originally from Mirpur. He is helping me contact a Dr from the Government Hospital in Mirpur. He also has a friend who has just been diagnosed with Hepatitis C.

I think all in all it was a good meeting.

Article in Asian Leader

2006-02-18T18:38:00.000Z

There was an article in this weeks Asian Leader, local free asian newspaper. http://www.asianleader.co.uk/Stories/issues/issue-106/story-9.asp. This is really great publicity for our project.

Also this week our itinary for the trip has been accepted by theFlorence Nightingale Trust, and funding has been confirmed. We really are going to Pakistan! I almost can't beleive it, it seems to have all happened so fast.

Interview with Sunrise Radio

2006-02-12T14:01:00.000Z

On Wednesday Ms SB and I were interviewed by the lovely Gail from Sunrise Radio in Bradford http://www.sunriseradio.com/. We spoke about the epidemic of Hepatitis C in Pakistan, and how important it is for people who have visited Pakistan to think about getting tested for Hepatitis C. We also spoke how important it is for people visiting to be very aware of blood, and to be careful especially if visiting the Dr or barber shop. Ms SB discussed her experiences of undergoing treatment for Hepatitis C.

The programme was transmitted on Friday. We do hope that people heard the show! It was great to have the opportunity to let people know a little bit about Hepatitis C.