Do Kenyan hospitals have the capacity to treat liver failure?

Dear Doc,

Does it mean that doctors in Kenya do not have the capacity to treat liver failure? I have a patient whom I have taken to different health facilities. One hospital did tests and concluded that he had a failed liver since levels of bilirubin are very high and his eyes are yellowish. His urine is dark yellow. At first, he was put on a special diet but he was later asked to buy a drug that is not locally available. (Mavyret). On seeking further treatment, a private hospital suggested to admit him for five days to carry out a procedure that would flush out bilirubin at a cost of Sh15,000 per day after which he goes for a magnetic resonance cholangiopancreatography (MRCP) test. Since he couldn't afford, we decided to seek help at Kiambu Level Five Hospital, which referred him to Kenyatta National Hospital —  accompanied by the MRCP test. Do Kenyan hospitals have the capacity to treat liver failure or is it a death sentence?

Michael

Dear Michael,

There are medical specialists and facilities in Kenya to manage liver disease. The specific treatment that is required is dependent on the diagnosis and the stage of the disease. Jaundice refers to the yellowing of the mucus membranes and the skin as a result of high bilirubin levels in the blood stream. Bilirubin is mainly produced from the breakdown of red blood cells, and the liver filters it from the blood stream, and processes it, followed by excretion from the body, mainly through stool. Bilirubin levels may be high because there is excessive production of bilirubin, or if the liver is not able to process it well, or if there is a problem with the drainage and/or elimination of the bilirubin.

Having high levels of bilirubin in addition to causing yellowness can also cause dark urine, light-coloured stools, or itchy skin. If the brain is affected, then there may be confusion, sleepiness and coma.

Jaundice is usually a symptom of an underlying illness, one of which may be liver failure. Jaundice may develop due to diseases that destroy red blood cells too fast, for example, sickle cell anaemia. It may also develop due to inflammation of the liver (hepatitis) as a result of liver infection, or alcohol or substance use, or following exposure to some chemicals. It may also be as a result of other liver diseases like cirrhosis, scarring of the liver, which may occur as a result of alcohol-related liver disease, or non-alcoholic fatty liver disease, or following infections, or due to some genetic or autoimmune disorders. It may also occur due to kidney or heart disease. Liver dysfunction or damage may also develop as a side effect of some medications. Also, jaundice may develop if there is blockage in the process of draining the bilirubin. This may happen due to gall stones or from a pancreatic tumour that is blocking the drainage pathway. Each of these possible causes would have other signs and symptoms, in addition to the jaundice.

Liver failure is a life-threatening condition, where the liver is not able to carry out its functions. The symptoms may include nausea, lack of appetite, diarrhoea, abdominal pain and swelling, jaundice, easy bruising and bleeding, anaemia, oedema and confusion. In most cases, liver failure occurs after a long period of progressive deterioration in liver function, though rarely, it may occur very fast.

Since the patient was asked to get Mavyret, it is likely that he has chronic Hepatitis C since Mavyret is a combined anti-viral medication for Hepatitis C treatment. With Hepatitis C, jaundice may develop due to liver inflammation, viral infection; or it may be as a result of liver scarring(cirrhosis) from a long-standing infection; or due to liver failure and/or liver cancer.

Jaundice is best managed by treating the underlying problem. In addition, the high bilirubin levels can be reduced by use of some medications, or through phototherapy, or exchange transfusion. Surgery may be required to remove a blockage to bile drainage. The nutritionist also advises on the required special diet. MRCP is an imaging technique that checks the ducts in the liver and gall bladder and the pancreatic ducts for blockage and any abnormalities.

It is advisable for this patient to be followed by one specialist (gastroenterologist) and one team of health professionals for ease of access of medical information to guide decision making. Some of the health facilities may not have the specialists or the necessary laboratory or radiology set up to attend to this patient, which is why he has been referred to the national referral hospital. The likely outcome of the treatment process depends on underlying cause and severity of the disease.

Doc

My wife developed some mental challenges way back in 2016. After visiting several health providers and a variety of drugs, she was finally diagnosed with Alzheimer's disease. The problem is that for about two years now, she has been on diapers as she lost control both of her bladder and bowels. Could there be a way to help her and ease my troubles of changing her? She cannot do anything on her own. Please help

Mwangi

Dear Mwangi,

With Alzheimer’s, there is progressive decline in some of the brain’s functions, leading to damage and poor connectivity between nerve cells and eventual cell death, and shrinking of the brain. There’s a gradual deterioration performing daily tasks and in relationships due to problems with memory, reasoning, decision making, behaviour and personality and mood. As the disease progresses, other functions are affected like swallowing, bladder and bowel control, and balance. At this stage, the individual is at high risk of complications like falls, malnutrition, dehydration, changes in bowel habits and recurrent infections.

There is no exact known cause of Alzheimer’s and it cannot be cured. There are some medications that in some people may improve or slow down disease progression, for a short while. The individual requires constant support for safety, good health and social interaction. Any underlying illnesses should also be treated. Those caring for an Alzheimer’s patient need support from the social support system, from mental health practitioners, or from support groups of fellow carers. It is also healthy to occasionally get respite care – get assistance for caring for the patient (within the home or outside the home) for a few days so that you can have a short break.

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