Mongolia's liver cancer crisis: 'No other country has a problem like this'
fDanzan Purev beams as he shows members of a support group photos of his infant nephew on his iPhone. The 68-year-old geologist is charismatic and jokes with the others gathered in the room in Ulan Bator. But his mood changes as he begins to recount his long experience with hepatitis, a disease that has blighted his life.
Purev was diagnosed with hepatitis B and C in the early 1990s. By the end of the decade his health and quality of life had deteriorated, leaving him constantly sick and fatigued. He had to sell his business to finance a trip to Korea to undergo treatment, which was not successful. “Financially, I just went down,” he says.Once back in Mongolia, he was unable to afford hepatitis drugs, and began to lose hope as the disease continued to affect his liver. “I was really scared,” says Purev. “My dad and all the relatives on my dad’s side died of liver cancer and liver disease. I didn’t want to be one of them. I just wanted to keep fighting and cure myself.”Fortunately, he heard about the non-profit Onom Foundation, which offers screening and treatment for hepatitis. Today he is cured of hepatitis C, has low levels of hepatitis B, and the health of his liver, which at one point was two-thirds non-functional, has improved.Purev has been lucky. According to the World Health Organization, Mongolia has the world’s highest rate of liver cancer, as well as the highest mortality rate from the disease. Each year, liver cancer and liver cirrhosis account for 15% of all deaths. Chronic hepatitis is the most common risk factor in developing liver cancer, and 400,000 of Mongolia’s 3 million citizens are diagnosed with a hepatitis virus.
The WHO says hepatitis cases spiked in Mongolia in the 1970s and 80s, when syringes were regularly reused and dental and surgical practices were not always hygienic. Additionally, the country has high rates of “hepatitis B and D super-infection”, which occurs when someone with chronic hepatitis B becomes infected with hepatitis D.
“There is no other country in the world that has a problem like this,” says Dr Naranbaatar Dashdorj, co-founder of the Onom foundation, which runs group therapy sessions for those like Purev living with hepatitis in Mongolia’s capital, as well as providing hepatitis screening and treatment to thousands of people.But the government is waking up to the health crisis, pouring significant money into screening and treatment in an attempt to reduce cases of liver cancer. By 2020, ministers want to eliminate hepatitis C and significantly reduce liver cancer and cirrhosis deaths.
Last year, parliament ploughed 23.4bn Mongolian tugrik (£7m) into the country’s health insurance scheme to subsidise hepatitis medicine. This year, the government allocated MNT 226bn for screening and treatment until 2020. This money also covers free hepatitis testing for those between the ages of 40 and 60, who make up the bulk of liver cancer patients. This will be extended to a younger cohort in 2018.
This cash injection will reduce patient costs drastically. After subsidies, patients pay between $3 (£2.25) and $13 (£9.70) for hepatitis B medicine, and between $65 and $215 for hepatitis C medicine. Before subsidies were introduced, medicines could cost thousands of dollars.“In the area of treatment Mongolia is making really good progress in screening the people, identifying people with chronic hepatitis,” says Narantuya Jadambaa, a technical officer in Mongolia for the WHO. “But we need more work also to stop the transmission within the whole society. It would require more efforts and even more financial support as well.”The National Cancer Centre, a busy hospital where Mongolians from all over the country come for diagnosis and treatment, performs 450 liver surgeries a year. This year, it will start performing liver transplants. Dr Chinburen Jigjidsuren, the centre’s general director, says in the past two years approximately 160 Mongolians have travelled overseas for transplants. He hopes more people will now stay in-country for surgery. About 70 people are on the government waiting list for a liver transplant.
But a major factor in reducing liver cancer deaths is early diagnosis. Many Mongolians are not diagnosed until they are late-stage and inoperable. Jigjidsuren says many people travel from their rural homes to the capital only to be told there is little that can be done. He hopes the centre can establish a system to connect provincial health centres by internet so patients can have online consultations with doctors prior to coming to the city. “We are trying to avoid this problem and trying to establish a good system,” he says. “I hope that Mongolia will be an example to the world [on] how we fight liver cancer.”
Myamjav Jargalsaikhan, 63, is another member of the Onom foundation’s support group. He was diagnosed with hepatitis C and liver cirrhosis 30 years ago, and had been receiving treatment each year. In 2013, after retiring from a 40-year career as a technical engineer at a printing company in Ulan Bator, he was diagnosed with liver cancer. Just as he was ready to enjoy a more carefree life after years of hard work, he was sidelined.“Any plans I had made for the future just all stopped,” he says. But unlike many other patients, Jargalsaikhan’s liver cancer was operable, and he has been cancer-free for three years. Despite all the challenges, he considers himself fortunate. “I really consider myself lucky to have had the disease for so many years and survived it.”