Living with hepatitis B: Without detection 'it is a silent killer'
For newcomers from endemic areas who are not vaccinated, hepatitis B can be a serious liver infection caused by the hepatitis B virus (HBV).
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The routine bloodwork and tests that Biniam Soquar received when he first came to Canada as a refugee likely saved his life. He was diagnosed with hepatitis B, a prevalent global health concern that affects millions every year, especially in Africa, where the incidence rates are high. Just recently, in his homeland of Eritrea, healthcare providers from different communities were trained to administer the hepatitis B vaccine.
In Canada, where we don’t hear a lot about hepatitis B, infants typically receive the pre-exposure vaccination at birth and in their first year. However, dosing schedules vary across the country. But for newcomers from endemic areas who are not vaccinated, hepatitis B can be a severe liver infection caused by the hepatitis B virus (HBV). Acute hepatitis B lasts less than six months, but for many, the infection becomes chronic, raising the risk of liver failure, liver cancer, and scarring of the liver known as cirrhosis. Detection is imperative.
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“The woman at the front desk called me, and she said a doctor would like to talk to you tomorrow. Can you come tomorrow?” Biniam recalls of the news of his health screenings, which were done soon after he arrived in Canada in 2010. Scared of what he might hear, he had a sleepless night before meeting with the doctor.
“She told me that I had hepatitis B, but I was much relieved because I was expecting something much worse. It could have been HIV. In Africa, that was like a death sentence.”
Symptoms can be non-existent with hepatitis B
He admits it was a blessing to have it detected because he didn’t know anything was wrong. He hadn’t experienced any symptoms, which often don’t appear until liver damage becomes worse. The doctor advised him to avoid alcohol and make sure to attend the regular monitoring appointments. He did, and when a later ultrasound revealed some liver scarring, his doctor prescribed medication.
It worked well for several years, until one of the side effects of the drug—diminished bone density—flagged the need to be moved to another antiviral medication. This one has continued to be effective. With chronic hepatitis B, he explains, “Once they put you on medication, it is long-term. I cannot stop the medication.”
Giving back to the community after diagnosis
Biniam is no stranger to adversity. He fled war-torn Eritrea when he was 29, avoiding the mandatory military training and service prohibited by his religion. He went with two younger cousins to Sudan for refuge. They joined a growing Eritrean refugee community that had a school where he taught subjects including science (Biniam was a marine biologist). And finally, after 11 years of waiting and hoping, his sponsorship by Canada’s federal government came through for resettlement, and he was flown to Calgary. He’s now 55, enjoying quieter days at home with his wife and two boys.
His life has come full circle in many ways, he says, putting his personal experience in the forefront. He works as an outreach facilitator at the Calgary Refugee Clinic to help newcomers access healthcare support—a job that is critically important for individuals who may not be familiar with the culture, language, or steps to obtain coverage for medication.
“Because I work in a refugee setting, they find somebody who identifies with them and understands what they are going through. And sometimes I’m also someone who speaks their own language and understands their culture,” he says. “There’s an instant connection and as a result, whatever advice they’re given, they heed the advice and they make changes.”
When those changes make a difference in their lives, it’s one of the most rewarding things about the work he does.
Appreciating Canada’s healthcare from a different perspective
He also understands the true benefits of Canada’s healthcare, given his knowledge and experience in Africa, where customs are very different. For example, people see a doctor only when they are very sick, which sometimes is too late. So, doing health tests when they are resettling in Canada or for routine monitoring when they’re feeling well is an unexpected approach to care.
“When we are sick and they do some tests and find you have malaria, they give you tablets,” he says of treatment in Africa. “But here you go to your doctor, and you do all these tests. You don’t know what is going on. Why are they not treating you?”
For people with a diagnosis of hepatitis B, detection can be lifesaving. Biniam has been there, and his advice is not to panic, learn about hepatitis B and follow through on monitoring appointments. If they’re on medication, never stop taking it until they’re advised to do so. “The virus might come back, and you might have some resistance to the medication, and it could be even fatal,” he says of hepatitis B.
“There is a reason to be grateful. Because they are in Canada, they will be taken care of. There is treatment for it. If it was discovered while they were, let’s say, in Africa, it is a silent killer.”
World Hepatitis Day takes place on July 28 each year and aims to raise global awareness about hepatitis and its impact.
