For months it had been spoken about in hushed tones. Hepatitis E was other people’s reality, and Alfeaus Sheefeni never thought the virus – a nasty newcomer to Namibia – would touch him or his family.
That was until he looked into his wife’s eyes and asked her: “Why are your eyes so yellow?”

“Hepatitis E nearly killed my whole family,” Sheefeni said last week.
His wife, Johanna Imbondi Sheefeni, was six months pregnant when she was diagnosed on 1 February at Katutura Intermediate Hospital.

“They immediately induced labour. The baby girl was born the next day and put in an incubator. I was kept away from her … the only person who could see her was her father. We were later transferred to Windhoek State Hospital,” she said.

The baby died the following month.

Sheefeni, 35, and his family are among 9 000 people living in Brendan Simbwaye location in Havana, one of Windhoek’s most impoverished informal settlements.

Visitors to the settlement are confronted by thousands of corrugated iron shacks on in a dusty wilderness outside the capital.

When The Namibian arrived at Sheefeni’s shack, the Wilson Phillips song Release Me was playing on a small radio inside. Imbondi, 30, was preparing a meal for the family on an open fireplace outside. Sheefeni recalled how his family’s lives were changed by the virus.
“We were so sick that when one came out of the hospital, another went in,” he said. All five family members were infected. At one point, they thought the illness was the result of witchcraft.

“We lost neighbours. A few houses from ours an elderly couple died; just down the road two young women and a child died,” he said.

“Especially in our area, kambashus (shacks) are locked not because people are at work but because they are no more.”

He feels the authorities are not doing enough. “You don’t see toilets or clean water points here,” he complained. Hepatitis E thrives on filth. Sheefeni and his wife are unemployed and find it difficult to buy soap to wash their hands regularly.

“As a mother, I try my best to make sure the water we drink is clean – I get those chemicals at the clinic to put in the water,” Imbondi said.

The government declared hepatitis E a national problem in September last year. By last month, there were 3,835 suspected cases in the country and at least 508 cases confirmed by laboratory test, the health ministry said in a recent statement.

The majority of cases – 2,657 – were reported in the Khomas region, followed by Erongo with 861, Omusati with 127 and Oshana with 77.
The ministry said 33 deaths had been reported since 2017, of which 14 had occurred among pregnant women.

Councillor Fanuel Shivute of the Samora Machel constituency – which includes Havana – said three areas in his constituency were affected. These were the Branden Simbwaye, Peter Nanyemba and Kaxumba Kandola locations.

“Things are not getting better,” Shivute said, warning that urgent official action is needed.

City of Windhoek spokesperson Lydia Amutenya said despite interventions, new cases were still being reported in these areas.
“Reported cases fluctuate from week to week,” Amutenya said.

On the other side of Kaxumba Kandola location, Sophia Sefanya is at home looking for leftover pieces of candle to light her shack, which is across the way from one formerly occupied by her sister, Asteria.
Asteria Sefanya died of hepatitis E after falling ill in February.

“She visited relatives in the north for about two weeks and when she returned she wasn’t feeling well. She was vomiting and had stomach pain. She went to the hospital and was diagnosed with Hepatitis E and died after two weeks,” Sefanya said.
“It was so sad – she was the one who told us about the virus after hearing about it on the radio, and then she died from it.

“We came to Windhoek from the north for a new and better life, and instead we are living in fear of this disease,” she said. “Most of us in this location know it can afflict anyone, any time. We don’t have clean water or toilets here.”

Some Havana residents seem to have given up hope that the epidemic can be defeated. When they hear that someone has died in the neighbourhood, they immediately ask: “Hepati?”

Anna Veiyo, 29, said that in her area shack-dwellers are trying to do things differently, but that not everyone is co-operating. “We have to teach our children the right things,” she said. “We do what we can, like washing our hands with soap. We make sure the water we drink is clean and boiled. But it is difficult because we have no toilets or clean water.”

According to a health ministry report, the City of Windhoek has built only 39 toilets and installed 39 water tanks in the Havana and Goreangab areas. “Water tankers are used to fill the water tanks in the Havana and Goreangab Dam informal settlements, but the City of Windhoek has not adequately maintained this trend,” the report notes.

“However, the World Health Organisation will support the monitoring of the quality of water, in collaboration with the City of Windhoek and the ministry of health.” The report concludes that the outbreak is far from being contained, with most cases still occurring in areas where clean water and toilet facilities are non-existent or limited.

Amutenya added that the Khomas Regional Council had donated four toilets to Havana. Another 16 flush toilets will be handed over to the community soon.

The city had planned install 200 additional toilets in the 2018/19 financial year but because of budget limitations will now only provide 40.

Twenty toilets were donated by the Chinese government through the office of the governor and the Khomas Regional Council. The United States embassy has also provided assistance. DM

What is hepatitis E?

Hepatitis E has only been recently recognised as a threat to global public health, and Africa is among the regions most affected by this dangerous viral liver infection.

According to the World Health Organisation, it causes about 20-million infections worldwide each year, about 3.3-million of them symptomatic,

In 2015 alone, it led to an estimated 44,000 deaths.

A disease of poverty, hepatitis E is transmitted mainly in drinking water contaminated by human faeces.

Settlements that lack proper sanitation and a clean water supply, principally informal settlements and refugee camps, are most at risk.

It is also spread through contaminated blood products and the consumption of undercooked animal meat.

The disease has its highest prevalence in East and South Asia, but 17 outbreaks have been reported in Africa over the past 40 years, causing 35,300 cases and 650 deaths

However, the number of reported outbreaks is likely to be a significant under-estimate. The disease is endemic in at least 20 African countries.

Initial symptoms include mild fever, reduced appetite and nausea. Some sufferers may also experience abdominal pain, itching, a skin rash, joint pain, yellowing of the skin and eye whites, dark urine, pale stools and a tender liver, according to Namibia’s health department.

Often, the infection resolves itself within a fortnight. But it can develop into a condition known as fulminant hepatitis, which can precipitate acute liver failure and death.

Pregnant women with hepatitis E, particularly those in the second or third trimester, are at increased risk of acute liver failure, foetal loss and mortality.

A vaccine has been developed in China, but is not yet available elsewhere. DM

This story was produced by the investigative desk of The Namibian newspaper in Windhoek