Dr. Mohammed Salem Noman to the Yemen Times:Pesticides are responsible for 95% of liver diseases [Archives:2008/1119/Reportage]
According to health experts, some foodstuffs, whether imported or locally produced, can cause liver diseases such as hepatitis and cirrhosis. Pesticides used on fruits and vegetables have yet another effect upon the liver, as they contain toxins. What's even more worrying is chewing the mild narcotic qat, whose cultivation requires using dangerous pesticides like dichlorodiphenyltrichloroethane, or DDT.
While some pesticides used on fruits, vegetables and qat are internationally banned, they are smuggled illegally into Yemen.
Khalil Al-Qaheri interviewed liver consultant and assistant professor at Sana'a University's College of Medicine, Mohammed Salem Noman, to obtain more information and details about the causes and symptoms of liver disease in Yemen.
According to Noman, the liver is a refinery that receives all food and liquids coming into the stomach orally. If such intakes are clean, the liver will be clean too; however, if they are unclean, they can cause numerous hepatic infections.
How do liver diseases and infections begin?
Hepatic diseases have many symptoms, the most prominent of which are jaundice of the eye and skin, change of urine color and feeling listless after any effort, in addition to abdominal pain, nausea and skin irritation. All of these are early symptoms of the disease, while later symptoms include vomiting blood, increased gas production or flatulence, foot tumors and hepatic coma.
While some liver patients don't experience such symptoms, they complain of constant listlessness when exerting even simple efforts, with subsequent medical checkups revealing that such individuals suffer hepatic diseases.
Patients with jaundice of the eye are considered to be in the disease's acute phase, meaning the early stage of infection, which should be treated immediately following diagnosis. Those patients experiencing the vomiting of blood, hepatic coma, increased flatulence or severe listlessness seem to be in the late phases of hepatic infection called “cirrhosis.”
Does this mean that late stages of liver infection can't be treated?
Treating liver diseases in the early stages, as mentioned above, is possible; however, if a patient is in the critical stage, he or she requires almost constant medication thereafter, in addition to regular contact with an appropriate physician.
Are there specific causes for such detrimental diseases?
The causes of liver disease differ across countries and areas. For instance, in the Arab region, bilharzias is one primary cause, followed by hepatic viruses, specifically B and C. Such causes are noticeable in Yemen, in addition to the accumulation of alcohol, iron and copper, which also are responsible for liver infections.
Toxins are another primary cause of illness due to the heavy use of pesticides in growing qat and other agricultural crops.
Yemen's environment appears to be responsible for hepatic infections, with bilharzias being a common cause in nearly all governorates.
As long as the environment and pesticides used in growing qat and other crops are responsible for the proliferation of liver diseases in Yemen – where there's no close monitoring of harmful factors to public health – does this mean qat consumers are most likely to experience hepatic infections?
By observing various patients' conditions, I've found that some come to me for an ordinary checkup and complaining of no illness; however, following examination and an ultrasound, their livers appear to be affected by toxins.
While the effect sometimes is clear, at other times it is potential (expected to appear later on), and a patient may come to us very late with cirrhosis, which is disastrous, as the damage from such a deadly disease is impossible to reverse or completely cure without a liver transplant.
Who is accountable for such an unhealthy situation?
The Yemeni government and society both are responsible for the illegal trafficking of chemicals into Yemen without any oversight criteria. Internationally banned pesticides have become commonplace among Yemeni farmers, who use them in cultivating agricultural crops and qat, which Yemenis chew daily. The Yemeni government is supposed to ban the import of such harmful products, in addition to punishing those who bring them into the country.
All those who grow, sell or consume qat know that dangerous and harmful pesticides are used in its cultivation, while the toxins in such pesticides are primarily responsible for hepatic infections and destroying citizens' lives.
Qat growers, sellers and consumers should be aware of the harmful consequences of qat consumption.
A further result of the absence of oversight is that citizens eat and drink expired products, with which Yemeni markets are flooded, while the concerned government authorities pay no attention.
Amid such a dire situation, we seem to be threatened by liver diseases and other illnesses. How can ordinary Yemenis protect themselves from such infections?
Every authority, institution and corporation must play a major role in spreading awareness among the public about the causes of hepatic diseases. Those who sell cooking oil, meat, chicken and qat should have clear consciences when informing consumers about the condition of their commodities.
Additionally, we must be careful when testing any products we consume, whether they are manufactured or agricultural.
Do liver infections affect men and women equally?
Since toxins are the cause, both men and women appear to have similar illness-related symptoms and consequences, with only a slight difference due to the fact that qat consumption is lower among women. Consequently, men are more exposed to liver disease than women due to the high qat consumption rates among Yemeni men.
Are there any statistics regarding current actual or potential liver infections in Yemen?
Based on our observations, we've found that pesticides are responsible for 95 percent of Yemen's hepatitis and cirrhosis cases, with at least 20 percent of Yemenis infected with liver diseases. Such terrible numbers clearly are remarkable, as opposed to just indicating the potential.
What's the difference between liver infections caused by viruses and those caused by toxins?
Hepatic diseases caused by viruses are totally different from infections caused by toxins, as the virus often damages the liver only after dozens of years following the infection's discovery. Such patients sometimes don't develop hepatitis until between the ages of 40 and 60, whereas pesticides destroy the liver within a matter of months up to a maximum of two years.
When pesticides are the cause, patients typically develop hepatitis between the ages of 15 and 20 and find that their livers are terribly damaged. Such patients then find themselves unable to lead happy lives, even at a younger age.
Acute hepatitis brought on by toxins can be treated, with patients gradually returning to normal on condition that they must stop chewing qat. Infections resulting from pesticides can be treated as soon as patients give up chewing qat; however, if they resume, they risk hepatocirrhosis, which doctors may find difficult to treat. In cirrhosis, the liver shrinks over time and becomes unable to perform its job.
What about treatment?
Treating the disease at an early stage is quite feasible, but it becomes more difficult or nearly impossible during the later, critical stages of infection.
Why are there symptoms such as foot tumor flatulence and hepatic coma?
When the liver ails, it leaks water and other fluids into the abdomen and feet, thereby causing swelling and increased gas production, or flatulence. A cirrhosed liver may have tumors, causing the patient to become comatose and maybe transported to the hospital unconscious. In such a condition, 85 percent of cirrhosis cases may risk death.
Are herbs and honey effective in treating cirrhosis and other liver infections?
None of these have anything to do with hepatic diseases. If herbs and honey were effective at treating infections, we wouldn't see hepatocirrhosis patients in those areas famed for their honey production, which means that they ate honey since their early years, but they still suffer liver problems. This further implies that neither honey nor herbs are effective medicines for treating hepatic infections; in fact, honey may be a cause of such diseases.
Known as hijama in Yemen, even blood cupping [extracting blood through a small cut on the skin and then attaching a cup over it that forms a tight seal] has nothing to do with treating hepatic infections and actually may transmit viruses between individuals.
Infections resulting from viruses can be treated with drugs, while those caused by qat consumption are possible to treat after giving up the habit. Had herbs proven effective in treating hepatic infections, the West would have discovered that before us.
While many are hesitant or fearful of medical checkups, it may be good way to discover liver infections at an early stage. Why do people behave this way and what's your advice to them?
Many people fear checkups, however, those living in areas known for the spread of bilharzias or qat consumption are advised to have checkups because the earlier infection is discovered, the easier it can be treated. Patients must search for specialized and experienced doctors in order to diagnose them thoroughly.
There's an effective vaccination for the hepatitis B virus, which may be transmitted via barber's tools or toothbrushes used by more than one individual. Additionally, surgical instruments also may be responsible if not used carefully or in a scientific manner. Vaccination against this B virus provides 100 percent immunity.
Checkups are necessary and citizens are advised to have the required checkups at anytime. Government vaccination campaigns offer immunization and protection from one of the causes of hepatic infection. If bilharzias is the cause of a hepatic disease, medicines to treat bilharzias are available on the market and they are 100 percent effective.
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