Esperance Nyirampongera, a resident of Kanzeze sector in Rubavu District, found herself battling an unseen foe. For months, a relentless fatigue shadowed her every step. Joint pain turned even the simplest movements into struggles, and her stomach churned with constant nausea and discomfort.
Desperate for answers, in April, she ventured to Bigogwe Health Center, in Nyabihu District seeking a path out of this labyrinth of ill health.
There, a swift diagnosis confirmed her worst fears – Hepatitis B. The weight of the news settled heavily upon her, but amidst the despair, Esperance found heroes where they least expected them: the nurses, the unwavering guardians of health on the front.
Esperance Nyirampongera, a resident of Kanzeze sector in Rubavu District at the health centre
Among them stood Marie Gorette Umuhoza, a hepatitis nurse at Kabali Healthy Center whose dedication and expertise shone brightly. Umuhoza became a patient’s anchor, ensuring that hepatitis patients received not just an accurate diagnosis but a clear path towards recovery.
In a meticulous review of Nyirampongera’s medical records, Nurse Umuhoza discovered a critical detail: a previous diagnosis of Hepatitis B, not Hepatitis C as initially suspected. This highlights the importance of a comprehensive examination.
To ensure Nyirampongera’s received the most effective treatment, the nurse recommended a follow-up viral test to determine Nyiramojera’s chronic infection. Secondly, the nurse requested Nyiramojera to bring in her current medication to verify if it aligned with Hepatitis B treatment.
“The viral test is a crucial part before prescribing the most appropriate treatment for Hepatitis B.” Umuhoza noted.
Many patients with hepatitis C or B may mistakenly believe all their symptoms stem from the condition, leading to hesitancy in taking additional tests. This is according to interviews with nurses conducted by Rwanda Dispatch.
Just like Nyirampongera, Hep Augustine’s world shifted on its axis when a blood donation turned into a life-altering experience. The news of a positive hepatitis test hit him like a bolt of lightning, leaving him stunned and reeling.
The news slammed into Hep like a runaway train. It felt impossible. A torrent of questions flooded his mind. How long had this invisible enemy been lurking within him? How could he have felt so seemingly healthy for so long? Despair threatened to drag him under, a suffocating weight threatening to consume him. But just as the darkness threatened to engulf him entirely, Nurse Umuhoza’s calm voice cut through the fog, a lifeline thrown into the storm.
“Don’t worry, Hep,” the nurse said gently. She started him on medication right away and closely monitored his progress for 12 months.
“We test almost everyone who enters the health facility for treatment on any given day.” Nurse Umuhoza revealed. Adding, “We have five patients who are on medication at the health centre. Hepatitis B is treatable but cannot be cured.
Hep was cured of Hepatitis C, he credits his successful recovery from the disease entirely to the nurses at Kabali Health Center. “Their dedication went beyond just treatment; they provided me with constant monitoring, education, and most importantly, courage throughout the journey.” he notes.
Amani Nkubito, a dedicated healthcare worker in the hepatitis department at Kabali Health Centre, emphasizes a comprehensive approach. They prioritize testing, screening, and patient education, ensuring everyone receives a clear understanding of their condition. Treatment plans are then tailored based on the specific viral strain. “We typically prescribe medication for a period ranging from three to six months,” Nkubito explains, “followed by a year-long monitoring process with retesting to track progress.”
Thankfully, the health facility appears well-equipped to address this challenge. “We’re fortunate to have ample testing resources and medication,” says Amina. “In fact, we routinely test over 10 people every day.”
Nurses like Claudine Uwamahoro, a registered nurse at Bigogwe Health Center, play a key role in hepatitis elimination by administering various tests for hepatitis B and C, including blood tests and rapid antibody tests.” This emphasizes the importance of nurses in the fight against hepatitis.
In tackling Hepatitis C or B, the health facility faces logistical challenges, such as reaching diverse populations and enough skilled personnel.
Dr. Gilbert Uwiragiye, head of the Kabali Health Centre, highlights: “While we actively screen for the virus, our capacity to treat patients is currently limited. We have only five on medication, and those requiring specialized care are transferred to hospitals.”
Despite these limitations, the healthy centre demonstrates remarkable initiative. They’ve implemented a resourceful outreach strategy to maximize their impact. “We target high-traffic areas and collaborate with community health workers,” explains Uwiragiye. “This allows us to test a wider population while simultaneously educating them about Hepatitis.”
Uwiragiye further emphasizes another critical hurdle: misconceptions surrounding Hepatitis C. “Some community members believe the illness stems from witchcraft, leading them to seek help from traditional healers. Others might turn to religious solutions first. These delays in proper medical treatment can have serious consequences, sometimes even putting lives at risk.”
Dr. Gilbert Uwirahiye, says there is misconception surrounding Hepatitis C, some community members believe the illness stems from witchcraft
Pelagie Tumukunde, a nurse at Shalom Medical Clinic, a private facility in Nyabihu District, emphasizes a proactive approach. “We routinely test over ten patients for Hepatitis B and C every day,” she explains. “This integration into general checkups ensures patients receive a well-rounded assessment of their health, including their hepatitis status.”
In Rwanda, there’s also a strong support network available for people living with Hepatitis. The country’s national push to eliminate hepatitis saved Hep and others patients after some time, thanks to a routine test.
Hepatitis is an inflammation of the liver that is caused by a variety of infections viruses and non-infectious agents. Five hepatitis viruses- hepatitis A (HAV), hepatitis B (HB) hepatitis C (HDV), and hepatitis E (HEV) can infect humans and cause hepatitis.
Data from the World Health Organization (WHO) shows that hepatitis is a significant public health challenge of this decade. An estimated 1.3 million died from chronic viral Hepatitis B and C in 2022 i.e. 3500 deaths per day.
In a global push to eliminate hepatitis, Rwanda emerged as a leader in 2018. Selected by the WHO as one of just seven pilot countries, Rwanda set an ambitious target: achieving hepatitis C elimination by 2024.
This goal surpasses the WHO’s global target deadline of 2030, showcasing Rwanda’s commitment to exceeding expectations in the fight against the disease.
Rwanda has become a global leader in the fight against Hepatitis C. The country has achieved all its national targets, including screening over 7 million people aged 15 and above, initiating treatment for 60,000 individuals, and driving down the prevalence of Hepatitis C infection to less than 1 percent.
Much of that success can be attributed to the many nurses who were trained to screen and treat straightforward cases at the primary health care level. Nurses like Umuhoza and Amani Nkubito say the training has allowed them to help patients who would otherwise be waiting for a doctor.
Dr. Janvier Serumondo the Director of the Sexually Transmitted Infections and other blood-borne infections unit at the Rwanda Biomedical Centre (RBC) explains that nurses do not only offer counseling, they offer a complete package of hepatitis management as they were trained to help doctors and the task-sharing program.
“Nurses in public hospitals and health centres have been trained on hepatitis management to share the task with doctors. So, they are able to perform all the required steps in hepatitis management cascade of care including prevention, diagnosis, care and treatment as well as follow-up.” Dr. Serumondo observes.
