Update: Dr. Michael J. Mangan, a liver specialist, gives his assessment of Assefa’s condition, along with suggestions for the next tests and steps to be taken. This correspondence is a summary of said assessment from Gregory Lloyd to Patrick Elms, Coordinator of International Missions for NCCL.
C. Patrick Elms, Jr.
Coordinator of International Missions
NCCL – Project “Looking East”
in accordance with our conversation of Monday, here follows the promised summary of liver specialist-Dr. Mangan’s assessments which Father Tesfamariam and I ask you please to share as soon as possible with the nephrologist at Medical Missionaries, Dr. Kenneth Kornetsky.
I beg your pardon for the prolonged delay in delivery of this summary.
Dr. Mangan will, please, correct any error in the summary, or the abstract, both given below.
ABSTRACT: As a first step, Assefa should be tested for hepatitis C as soon as possible, since (a.) the results of test(s) for that disease done on his care-giver/sister, Za’id, in the spring were inconclusive, (b.) she may have been a donor of blood which Assefa received in transfusion since he arrived at St. Yared last October, and (c.) even if she had *not* been a donor, someone else infected with hepatitis C might have donated blood to Assefa. Dr. Mangan assumes that the blood donated for transfusion in Ethiopia is not universally tested for hepatitis C before use. The risk of contracting hepatitis C from blood transfusions is very high. The above is important because hepatitis C is per se a worse disease than hepatitis B, is harder to treat before and after transplantation, and is riskier than even hepatitis B to recovery after transplant. Typically, the test for hepatitis C antibody level/presence is sufficient, but (although rare) someone could have the hepatitis C virus without the antibody; rarer still, that one has the antibody but not the virus. It is therefore advisable to test for both virus and antibody.
The following points are a summary of Dr. Mangan’s assessment of Assefa’s condition; and of Robiel’s condition based on the report & test results received recently from Dr. Mignot:
I. concerning Assefa Hailu Baraki, patient and prospective renal
1.a. Assefa should be tested for hepatitis _C_ (as per the abstract, above.)
1.b. Living at close quarters with Za’id is *not* an issue for concern about hepatitis C infection, since the disease is passed principally by blood. Dr. Mangan cautions against using the same toothbrush, for example, or razor, or drinking from the same glass, since those are *possible* ways for blood to be passed. However, saliva itself/alone has not the same risk to pass the disease. (Venereal contact also carries lower risk than blood transfusion to pass hepatitis C.) The most common way to infect with hepatitis C is the mutual use of hypodermic needles.
1.c. Dr. Mangan recommends that Za’id be tested again for hepatitis C.
2.a. As per treating Assefa’s hepatitis _B_ [sic], the drug lamivudine is probably the best but it is also the more expensive of the medicines used most commonly and with good effect.
2.b. Dr. Mangan recommends we ask the doctors in India when to begin and and for how long to treat Assefa for hepatitis B prior to transplant, according to the levels of the infection found in the tests reported by Dr. Alemayehu in his e-mail of May 2.
2.c. Remaining questions of treating Assefa for hepatitis B should be referred to Dr. Kornetsky and then to the physicians who are planning the transplantation.
2.d. Dr. Mangan will confer with Dr. Kornetsky, if he wishes.
3.a Assefa will need to take drugs continuously after the transplant. They will be critical to his recovery & health, and they are expensive. They should be identified before transplant, and a plan to obtain them should be drawn up.
3.b. Dr. Mangan believes that Dr. Kornetsky is able to help to identify those medications.
3.c. And that the Medical Missionaries might be asked to assist in providing them.
4.a. Questions of treating Assefa for *intestinal TB* should be
referred to Dr. Kornetsky and then to the physicians who are planning the transplantation.
4.b. Dr. Mangan suggests we ask about the risks of suppressing the hepatitis B and the intestinal TB, and of reactivating the diseases after transplant.
4.c. Dr. Mangan will confer with Dr. Kornetsky, if he wishes.
5. As per Assefa’s ongoing dialysis, Dr. Mangan suggests we find a way to keep in supply the drugs which bind the phosphates, since those help to alleviate the side effects of the dialysis which Fr. Tesfamariam described as occurring in his nephew, particularly when the hospital ran out of supplies.
II. concerning Robiel Hailu Baraki, the natural (blood) brother of the patient, and the prospective donor of the kidney for transplant
2.a. Dr. Mangan is concerned by the high readings of the test results of *Robiel’s* ALP — the alkaline phosphatase level, 407 — as well as the high level of PT — protime, 15.5 .
2.b. Dr. Mangan asks, why the high levels?, as noted above. The blood chemistry indicates either a liver ailment or a dietary deficiency; usually, a diet of insufficient green, leafy vegetables.
2.c. The prospective donor, Robiel, should be tested again for further readings of ALP and PT.
2.d. We, in the States, should consider either shipping to Robiel a multi-vitamin or asking him to obtain one in Ethiopia, and sending the funds to pay for it.
2.e. We should also ask Za’id to help supply green leafy vegetables in the diet of Robiel, as best as she can.
3. To the question of whether blood types O+ and O- may be mingled in transfusion: yes, but only in emergency, and not without complications. (It is less risky for two men, than a man giving to a women, since there is a danger to mother & fetus during child-bearing, on account of Rh-factor incompatibility.)
END OF SUMMARY
I ask Patrick to study and then to pass along the above summary (with amendments, as needed) as soon as possible to Dr. Kornetsky; then, to phone him immediately to notify of its delivery and to ask him for his assessment.
(Please, call me with any questions before writing to Dr. Kornetsky.)
As soon as we receive word from Dr. Kornetsky we can contact Dr. Mignot and the physicians in India.
cc: Michael J. Mangan, MD
Gregory P. Lloyd, M.A.
National Coalition of Clergy & Laity
621 Jordan Circle, Whitehall PA 18052-7119 USA
Pilgrimage for Restoration
Come to restore. The rest will come.
“Pray, hope, and don’t worry.” St. Padre Pio