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The VA's Hepatitis C Problem
  Newsweek By Gerard Flynn 5/9/15
Cecil estimates that as many veterans of the Vietnam War will die from hepatitis C infection as were killed in combat. Eleven percent of the veterans of that war are infected, he says, and many are not receiving the treatment they needÉ..."We trusted the VA until 2009, when they knew he was sick but didn't do anything," says Dorothy. "Now we watch them like a hawk."
Martin Dames is a highly decorated veteran of the Vietnam War. He received the Bronze Star for heroism in the combat zone and three Purple Hearts for injuries he suffered while fighting. He made it out alive, only to find out years later that those combat wounds got him infected with the hepatitis C virus (HCV), a deadly blood-borne pathogen discovered in 1989 that claims about 19,000 lives annually, a large number of them veterans. That number is growing every year. A chronic infection in around 80 percent of cases, HCV often shows no signs of its corrosive presence until extensive liver scarring occurs after decades of infection. In some cases, the disease isn't found until it has led to cirrhosis-advanced and potentially lethal amounts of scarring. Infection with the virus is a leading cause of liver cancer and transplants in the U.S.
Some 3.5 million Americans are infected, including an estimated 234,000 veterans. Approximately 174,000 veterans in government care have been diagnosed with hepatitis C, but an additional 50,000 are thought to carry the infection unbeknownst to them. For treatment, those veterans who know they are sick must go to the U.S. Department of Veterans Affairs (VA) and its health care services extension: the Veterans Health Administration (VHA), the largest provider of hepatitis C care in the nation. The VHA serves nearly 9 million patients at over 1,700 sites, but as Dames and many other veterans have found, treatment there is often amiss-especially when it comes to HCV.
Bob, another former U.S. Army soldier, also has HCV. (His name has been changed because he fears jeopardizing his VA treatment.) He thinks he contracted it during an accident in childhood that caused his liver to burst, which required an emergency blood transfusion at a local hospital. Bob's viral infection was discovered by the VA in a routine blood test around 1994, but it took a long time to tell him about it. In 2004, a doctor was looking at Bob's records on a computer screen. "He asked, 'What are you doing about your hepatitis infection?' and I said, 'I didn't know I had it,' and he replied, 'Oh yeah, we have known about it for 10 years.'"
At the time, the only treatment options were the antivirals interferon and ribavirin. Twice, Bob was prescribed a combination therapy of both these drugs and given the maximum dosage, but a debilitating "brain fog" forced him to quit. Had the VA treated him earlier, he has since learned, the outcome might have been much better. The consequences of that delay have been devastating. Advancing liver disease forces him to nap throughout the day, so he can no longer hold a job. And when his legs can no longer carry him, he must crawl up stairs. "They could have and should have done something," he says.
Bob spent the next decade praying for a life-saving organ donation. Getting one isn't easy, particularly inside the VA, which approves only about 100 a year in a nation that performs over 6,000 liver transplants annually. It's so bad that at one point a VA physician urged Bob to obtain private insurance so he could try to get a transplant outside the system. Death seemed imminent for Bob until last year, when a VA doctor gave him the "good news": He had liver cancer. That put him on the fast track for a liver transplant operation.
He's still waiting. In the meanwhile, he's developed a ghoulish condition known as a "variceal hemorrhage"-the blood vessels that line his esophagus

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