Since September (2016), more than 600 MSF staff in Am Timan in Chad have been working to provide care to hundreds of patients with Hepatitis E, while improving the supply of water and sanitation in the area.

In the past four months, 320 potential cases of Hepatitis E have been identified in Chad and 44 patients with the disease have been hospitalized in Am Timan.

The first cases of Hepatitis E were discovered in late August in Am Timan Hospital, where MSF provides HIV and tuberculosis (TB) care and is working in the paediatric and maternity departments. Like cholera, it is transmitted from one person to another, mainly through contaminated drinking water, and rapidly spreads in places where hygiene and sanitary conditions are poor.

It is estimated that one in 25 patients with Hepatitis E is at risk of death, but for pregnant women in their third trimester, the risks of maternal and fetal mortality are higher. Among the nine patients who have died in the past few months, three were pregnant women with jaundice.

Along with the urgent medical response to Hepatitis E, MSF’s Community Health Workers are raising awareness about the early signs and symptoms of Hepatitis E and sharing information about hygiene practices. This includes meeting with local Chiefs, leaders and officials, to hear their concerns, identify needs and encourage them to talk to their community about the urgency of the Hepatitis E response. In the last three weeks (as of 6 December 2016), they have also distributed 773 hygiene kits containing bars of soap and buckets. Most people in Am Timan had not previously heard of Hepatitis E, and as a result, staff are working to address fear and suspicion about the ‘sick people with yellow eyes’, as a major symptom of the disease can include jaundice, or the yellowing of the eyes and skin . In many cases, Hepatitis E patients have been seen as a threat to the community, leading to both stigmatisation and shame for those who are diagnosed. But with support from Community Outreach Workers, this is changing.