More Precious than Gold
With the threat of fuel shortages soon, I topped up my tank at this petrol station this morning, drove next door to a small supermarket and while Chris shopped I walked back to the station’s cash machine. The screen said it was busy rebooting Windows 7 and scanning a faulty hard disk, so I thought better of inserting (and the machine perhaps permanently swallowing) my debit card. Turning round I was confronted by this truck filling up at the same pump as I had just used – it only just fitted under the station’s canopy.
Come with me into my medical work for a few minutes. Something I have had to adapt to, and that I absolutely hate, is that not all medical care is affordable for my Ethiopian patients. A very generous allowance is made by SIM Ethiopia for all its employees to cover the cost of medical, dental and optical care but sometimes it isn’t enough. Treatments and interventions I took for granted in the UK can become prohibitively expensive here - even such simple things as good physiotherapy. So we have a special fund – the Ethiopian Staff Medical Provision Project (ESMPP) – that takes charitable donations and is used to provide life-changing and sometimes life-saving treatments for SIM’s Ethiopian staff that are too expensive and wouldn’t otherwise be possible.
Very early in my time here a young man in our Bible translation department died of liver cancer leaving his wife and two children. Had SIM not provided her with work she would have really struggled. The cancer was probably the end result of viral hepatitis, and I soon discovered that I had three other patients actively infected with hepatitis C. This long-term often symptomless infection is caught from dirty needles or transfusions with infected blood. It can hide for many years, then in a subset of suffers it can cause cirrhosis, liver failure, liver cancer and inevitable death. In the UK around 214,000 people are thought to have hepatitis C - mostly intravenous drug users who share needles. That’s around 0.3% of the population. Here in Ethiopia estimates vary, but it’s thought around 3-4% of the population is infected – ten times higher than the UK, and largely due to tooth extraction, hospitalisation and blood transfusion. And of course, for my patients with hepatitis C like most viral illnesses there was no treatment. Until now.
Enter ledipasvir/sofosbuvir 90 mg/400 mg. No, I can’t pronounce it either, so let’s call it “Harvoni”, the trade name given it by the pharmaceutical company Gilead Sciences when they marketed it in October 2014. This drug, taken once a day for 12 weeks, gives a better than 98% chance of clearing hepatitis C - permanently. There’s a problem though – it’s rather expensive. So expensive in fact, that even the healthcare system in the USA (not known for rejecting treatments for purely financial reasons) baulked at the cost. Milligram for milligram, it’s 54 times the price of gold. A 12-week course costs $94,500. It’s cheaper for the NHS in the UK – only £39,000 per 12-week course. Each tablet costs £464.29, so not a pill you’d want to accidentally drop down the toilet in the morning. What about my Ethiopian patients? Well, a single course of Harvoni would cost over 20 years’ wages. Barring a miracle, the ESMPP couldn’t come close to funding this for them.
However, recently one of my patients brought me a note from their consultant that nearly made me fall off my chair. Harvoni is coming to Ethiopia, and it will “only” cost $400 a month. Still an impossible expense for the averagely paid Ethiopian, but affordable for the ESMPP. So thanks to the generosity of those contributing to the fund, two of my three patients have now started curative treatment (and the third will hopefully do so shortly) for hepatitis C that’s 54 times as valuable as gold and pretty much unaffordable in the USA. It’s a topsy-turvy world sometimes.