Dr Janus Ong led a great life as a transplant hepatologist in the USA; he had a meaningful job, a new Master of Public Health from Johns Hopkins University, a good quality of life and a loving family. Then he returned to the Philippines and stayed, to the astonishment of many. Why? “I never thought hepatitis B was such a big problem in the Philippines until I came back. It affects so many people. Something has to be done.”
An estimated 7.3 million Filipinos, or 16.7% of the adult population, are chronically infected with the hepatitis B virus – a much higher rate than in other countries in the Western Pacific Region. (1)
In the Philippines, Dr Ong sees as many liver cancers caused by hepatitis B within a six month period than he saw over his 12 years in the USA. “Here, many young men in their 20s and early 30s have very severe liver cancer and die within 12 to 18 months. What is even sadder is when liver cancer decimates an entire family.
I have a 31 year-old patient with liver cancer caused by hepatitis B. He was diagnosed in November 2013 and had immediate surgery. Unfortunately the cancer came back shortly after. At this time, he urgently needs a liver transplant or his disease will progress. And - his wife is pregnant with their second child.
But the story doesn’t end there. This man’s youngest brother died of liver failure. A few months later, another of his brothers died of liver cancer. Then, another brother died of liver cancer. How can I not try to help him? His mother, who is herself infected with chronic hepatitis B, had four sons. Now she only has one. If there is a way to potentially cure her remaining son, I have to do it.”
The main concern of this young man is fighting disease. Yet Filipinos infected with hepatitis B also fight a parallel battle against stigma and discrimination. In the Philippines, many assume that people who have hepatitis B infection acquire the virus through immoral acts, and that they can transmit the disease through casual contact. They do not know that hepatitis B can be unknowingly transmitted through contaminated blood products including during blood transfusions, contaminated medical devices and from infected mothers to infants during childbirth.
“The other day a young carpenter came to my clinic, and asked, crying, ‘Am I going to die tomorrow’? He had applied for a carpentry job and as part of the mandatory physical required before he is hired, he was tested for hepatitis B.
The test was positive for hepatitis B. He was told unceremoniously he could not work for the company because he had hepatitis B, and that he needed to see a doctor right away. No explanation. The carpenter felt ashamed and told no one about this. He went online and saw that hepatitis B causes liver cancer and many people die from it. He thought he was doomed.
Why is mandatory testing for hepatitis B still ongoing during pre-employment physicals? This practice was stopped in the USA many decades ago, and in China a few years ago. What does hepatitis B have to do with carpenters, masons, painters, construction workers and other laborers?
This type of discrimination doesn’t just happen to laborers; these scenes don’t just happen in my clinic. They happen repeatedly in many doctors’ offices across the Philippines – unnecessarily. This is not how things should be done in 2014 in the Philippines. Some steps have been taken to remove the mandatory testing but not everyone is aware yet. "
In 2013, Dr Ong and his colleagues at the Hepatology Society of the Philippines brought together stakeholders involved in the fight against hepatitis in the country to create a National Viral Hepatitis Task Force. They put out an official Call to Action for the Prevention and Control of Hepatitis B and Hepatitis C in the Philippines. This call to action has not yet resulted in concrete actions.
“Every week, I see so many new patients with hepatitis B and liver cancer, it’s frightening. But here is still so much stigma and discrimination that no one wants to step up as a champion.”
Dr Janus Ong is stepping up to the challenge of providing effective care and treatment and advocating against the ongoing discrimination that continues to affect people living with hepatitis B in the Philippines.
(1) Hepatology Society of the Philippines 2013 Position Paper