The Ethiopian

The Ethiopian

There was a time that I used to volunteer at a local inner city free clinic. This was a clinic set up to serve people with no insurance and inadequate access to healthcare. This sometimes included recent immigrants.

I found my time at the free clinic very rewarding. The patients were often very appreciative. Most were routine and straight forward primary care patients. There was however one patient I remember that was particularly challenging.

She was a young woman in her twenties. She had immigrated from Ethiopia recently to join her sister in the United States. She herself was divorced and single, but was also a new mom with a six-month old daughter.

She was sick when she saw me. She had tremendous fatigue. She was jaundiced and had a protuberant belly, suggestive of advanced liver disease. She told me that she had developed an acute liver infection in Ethiopia while she was pregnant. She had seen doctors there but told me that they had been unable to come to a diagnosis.

She delivered a healthy daughter and subsequently came to the United States. Unfortunately, she found out that she did not qualify for Medicaid and she was unable to work or get any type of health insurance. She lived with her sister who brought her to the free clinic.

Her case intrigued me as I have an Infectious Disease background and had also grown up in Africa. I took a detailed history on her. It seemed that she had developed some type of a liver infection possibly a viral hepatitis. However, for viral hepatitis to cause liver failure in such a short time was unusual. There were also parasitic infections endemic in that part of Africa such as “Schistosomiasis” of the liver that could over time cause liver failure.

Through the free clinic, I was able to test her for the common viral hepatitis A, B and C. These were all negative. The Schistosomiasis test was a send out test to the CDC which I tried to order, but was unable to do so. I however treated her empirically with an anti-parasitic medication. If this was from a Schistosomiasis infection, there was a possibility that her liver could improve after treatment.

There was another condition that is known as hepatitis E. It is widespread in parts of the third world including southern Asia and parts of Africa. It usually causes a very mild and self-limiting disease in most people.

However, hepatitis E can cause severe liver disease leading to liver failure in two types of people. One, people with immune deficiencies such as cancer, the other – pregnant women!

This was a well described phenomenon. This otherwise mild disease could cause severe liver disease leading to liver failure in pregnant women. Could this young woman have had that? I tried to test her for it, but there was no commercially available test that I could find. I would have to arrange to send the blood to the CDC.

Even if her liver disease was from hepatitis E, there was no specific treatment. Unable to make a diagnosis or offer any treatment, I referred her to our local public University Teaching Hospital, which often provides care for such uninsured patients.

I never saw this young lady again. I often wonder about what happened to her. I hope that this lady is doing well today.