Pakistan: Occupational hazards and hepatitis C risk in Machar Colony

Hepatitis C can be life-threatening, but many people don’t know they have the virus. MSF health promoter Tassawar Ali explains how his team is aiming to change that in a slum community in Karachi…

Machar colony is an urban slum area in Karachi, the largest city in Pakistan.

The residents are largely involved in the local fish industry – the industry provides both formal and informal means of employment. The formal fish factories are considered the safer option – relatively –  as they tend to incorporate safety measures with access to first aid equipment.

Workers doing jobs that are traditionally considered “unskilled” are especially at risk as they remain largely unaware of their hepatitis C status and ways to protect themselves from the virus

Informal fish factories are normally set up within the community. In these make-shift settings, workers often peel shrimp with razor-sharp blades which are then reused and shared.

They also work at times during the dark hours of the evenings and before sunrise.

All these working conditions are risk factors for hepatitis C, because a minor cut with a blade that already has traces of an infected person’s blood on it can be all it takes to transmit the virus.

Hepatitis C in Machar Colony

Hepatitis C is a blood-born virus which affects the liver. Most people don’t have symptoms until the liver damage is already significant, so early diagnosis is key to saving lives.

Our Médecins Sans Frontières / Doctors Without Borders (MSF) team has been conducting ad hoc screenings among the people of Machar Colony. According to the initial findings, the prevalence of hepatitis C appears to be significantly higher here than the national average.

These initial findings, however, still have to be confirmed through more in-depth research methods.

Groups at risk

Our health promotion team in Machar is committed to identifying specific groups of people who are more at risk for hepatitis C transmission as a result of their work environments.

To address this, our team is involved in mapping out several occupational and traditional practices that might contribute to hepatitis C transmission.

Workers doing jobs that are traditionally considered “unskilled” are especially at risk as they remain largely unaware of their hepatitis C status and ways to protect themselves from the virus.

Our model

In 2015 MSF first established its hepatitis C programme using what’s known as a “decentralized” model of care. This means our team is treating hepatitis C in a primary health care set-up (i.e. local health clinics) instead of specialist units at hospitals. We wanted to show it could be done – bringing healthcare closer to the people who need it.

In 2018, we redesigned a decentralized model of care for chronic hepatitis C management. Our health promotion strategy is to reach out to the people at higher risk of hepatitis C infection within the Machar colony.

Local health practitioners

Aside from those involved in the fisheries, another key occupational group for us is what we call “non-formalized” local health practitioners. These practitioners work in the community but but don’t have formal medical qualifications or registration.

From our discussions with them, we discovered they generally lack knowledge about the transmission of the hepatitis C virus.

This is significant for our team of health promoters as we at times have to reach out to the community through this important group in order to raise awareness and decrease the risk of hepatitis transmission.

This informal network of practitioners are also a potential transmission risk. Some offer treatments by injection, on demand, and these syringes could transmit the virus if proper hygiene practices are not followed.

Our goals

The objectives of our work in health promotion are to increase knowledge of hepatitis C in the higher-risk populations and to stop the avenues of reinfection by urging the Machar Colony residents to adopt healthier work and lifestyle practices.

In an attempt to achieve this objective, we are reaching out to groups such as barbers, lady health workers, and traditional healers, amongst others, to raise awareness of hepatitis C prevention.

As health promoters, we normally base our health information, education and communication interventions on findings within the community that highlight to us lack of knowledge or practice related to a specific health topic.

Within Machar Colony, we are trying to understand more and more about how the hepatitis C virus spreads via occupational hazards.

Hopefully, more information will help us plan our health activities like population mapping, focus group discussions, hepatitis C screenings and workplace monitoring in a more efficient way.

The information gained from these activities should help us to develop strategies which will encourage positive change in health behaviors to reduced hepatitis C transmission within Machar Colony.

I am motivated that in the future our behaviour change strategy will bring forth sustainable results for a significant reduction of hepatitis C in the local community.


Read more: Stories about health promotion in Pakistan

Health promotion in Karachi: how a visit to a fish factory is helping to fight hepatitis C

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