http://www.the-silent-epidemic.com/cover daily 1.0 2014-11-25 http://www.the-silent-epidemic.com/specialized-doctors daily 0.75 2014-12-08 http://www.the-silent-epidemic.com/pndp daily 0.75 2014-11-30 http://www.the-silent-epidemic.com/osf daily 0.75 2014-11-30 http://www.the-silent-epidemic.com/hepatitis-b daily 0.75 2014-12-08 http://www.the-silent-epidemic.com/aminases daily 0.75 2014-12-08 http://www.the-silent-epidemic.com/the-cost-of-a-cure daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419005649086-9SNYWYP31GCVRF0823EN/image-asset.jpeg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419006754570-JOV5MQXB1Q7HYWT0VOL0/JJ001.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419006756139-Y4US9ZQFK4HPOEWPZ8WM/JJ002.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007409018-LUYPT8QDO4HNR0MBI8N6/JJ003.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007412207-9TQOV5CASYOQZ5HH7NOQ/JJ004.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007504434-X1Z48BFR18JDBOFGU1K1/JJ005.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007553914-EVKS9YQ52W5446SBUHA9/JJ006.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007605499-6DOCELWZGTYHNL8LPGYU/JJ007.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007711582-AD6LGFPXO8A8CTVUAOHA/JJ008.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007722540-NY5SDO23Y1WQ70NQVAX2/JJ009.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007830356-ZVSULW3IB79BYJKTTZ7R/JJ010.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007831788-CM0PGUSM0ZTXY5PQG9DB/JJ011.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007919526-GJLEU922V30G8HZKRJZE/JJ012.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419007920789-C8V31J56KOL7MC3TN74U/JJ013.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419008028591-0LL31XKFUSAPKJ1DLDGR/JJ014.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419008027608-ALWDWVNIPRCZL8RRAHAO/JJ015.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419008138954-VMKNIBH54F29YSEFEFWR/JJ016.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419008175464-TXS9ZXPP9GBNKRTW2O48/JJ017.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419008185824-HHGL25J7MLK5JTH7QCC8/JJ018.jpg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1418524927527-CBKW74EJL0O0JEJJZP2K/image-asset.jpeg The Cost of a Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419123421232-X7L5HNMUBJ7CQIE36NN8/JJ011.jpg The Cost of a Cure http://www.the-silent-epidemic.com/nice daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015411433-PRDCYA4M89I99YV9XZ0E/image-asset.jpeg Nice: Misdiagnosed for Twenty Years https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015542504-YWGBMS6LDC0WPKFWMCUU/nice002.jpg Nice: Misdiagnosed for Twenty Years Elenice da Cruz de Castro, age 67, lives in São Gonçalo, Rio de Janeiro. She is a Hepatitis C patient who has chronic liver cirrhosis, only treatable with a liver transplant. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015544809-QC97WOPG7R6UGWCX1F94/nice005.jpg Nice: Misdiagnosed for Twenty Years She has been married to her husband Jayme for 50 years. They have three children and one of the daughters Vera lives with them. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015544203-46NYVV83KG7467XHNLR8/nice004.jpg Nice: Misdiagnosed for Twenty Years In 1990, she started suffering from ascites - her stomach swelled up with fluid for two to three days. This happened to her every year. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015547076-2UQRU0EHA2JZL71KABSJ/nice006.jpg Nice: Misdiagnosed for Twenty Years In 1996, she went to go see a gastroenterologist, who had no solution for her. She changed her diet but the painful ascites still came back every year, making her very weak. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015548732-XJ14DUK4AW50NTJL71A1/nice008.jpg Nice: Misdiagnosed for Twenty Years She became forgetful and confused, walking around her neighborhood without proper consciousness. She was suffering from encephalopathy, a disorder in the brain when the liver cannot function correctly – one of the symptoms of Hepatitis C. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015547352-HGX8TZC1334BT62GV76N/nice007.jpg Nice: Misdiagnosed for Twenty Years At Hospital Antonio Pedro, she received the news that her Hepatitis C was in the chronic stage, and her liver would not be able to take the interferon treatment. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015549517-M5HNXJYIVQGC7XHDBC6A/nice009.jpg Nice: Misdiagnosed for Twenty Years She believes that if the public health doctors had examined her more carefully and diagnosed her much earlier, she would not have developed chronic liver cirrhosis. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015551981-GKRUS12CV3I4129LY5YT/nice011.jpg Nice: Misdiagnosed for Twenty Years She receives most of the information on Hepatitis C from the support group Amarantes. How to live with it on a daily basis and the consequences of the disease. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015553551-UN0Q6CQH410NR3G2EE3I/nice012.jpg Nice: Misdiagnosed for Twenty Years She used to love to go out and be active, but now she feels very limited in her home. She passes the time doing crafts. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015555358-6W6R7QU657L0X33N7Q9F/nice013.jpg Nice: Misdiagnosed for Twenty Years Most of the time, she is overcome by fatigue. She must muster up the strength to wash and cook rice. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419015555529-L10NJHCHXND4HW8FQZ0P/nice014.jpg Nice: Misdiagnosed for Twenty Years Her only option for recovery is a liver transplant at the federal hospital St. Francis Xavier. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419680820925-EMZG9ZZ57V7MGBGP1Z1R/N9.jpg Nice: Misdiagnosed for Twenty Years http://www.the-silent-epidemic.com/meld daily 0.75 2014-12-07 http://www.the-silent-epidemic.com/brazils-family-health-strategy daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419011987950-K5V5DR9OMKOHFZ92Y1Z7/Paulo006.jpg Brazil's Family Health Strategy https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419012215235-222VEO8GICJ5146KXKF7/Paulo011.jpg Brazil's Family Health Strategy Márcia works hard to be an integral part of the patients' everyday life. While her relationship is professional, the care and interaction are key points of primary heath. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419012114537-2DY6BJIWIKZ6AVDUIEW3/Paulo012.jpg Brazil's Family Health Strategy Sandra and Rodrigo, a couple who became stronger in order to overcome the difficulties of treating Sandra's Hepatitis C. They embrace each other in their home at Ladeira dos Tabajaras. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419119388473-XAS6EBGV8MY8D7WS7Y6S/Paulo013.jpg Brazil's Family Health Strategy Tabajaras is a community under development while poverty rate in Brazil is slowly decreasing. Márcia is part of a major point in this change, with the goal to achieve universal health care access. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419119154366-M7YICTUS9571G7GGIL67/Paulo014.jpg Brazil's Family Health Strategy Márcia says that she's a health agent 24 hours a day. The health agents are the face of the health system for the residents. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419119459578-1O80DB4GFZTGUNJ7EDHZ/Paulo015.jpg Brazil's Family Health Strategy https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419011465461-QEHOSPZ3IKZIU0ERXMNO/Paulo008.jpg Brazil's Family Health Strategy Cássia, a new resident of Tabajaras, in her home. She got diagnosed for Hepatitis C 2 years ago. She used to work as a manicurist, manipulating the instruments of several clients - the probable cause of infection. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419011141230-J3TO8YJJE2CFCD6JMU2Q/Paulo009.jpg Brazil's Family Health Strategy Cássia received good news through exams results: the viral load is under the disease standard. She still needs to test again in few months to confirm the regression of the Hepatitis. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419011155981-5RSYO146CL7B36YGB4ZU/Paulo010.jpg Brazil's Family Health Strategy Cássia with her younger son. Pregnancy was a vital point in Cássia's life. She discovered the disease during routine exams and transmitting the virus to her son became the biggest concern. They hope for better days to come. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009109849-FS2XA1KE8IJEY6N791PF/image-asset.jpeg Brazil's Family Health Strategy https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009341705-Y5L89HD49TMTE36I4EQV/Paulo001.jpg Brazil's Family Health Strategy Ladeira dos Tabajaras is an uncommon favela - the disorder and chaotic atmosphere is nothing particular, but it is placed in the heart of Copacabana, one of richest neighborhoods in Rio de Janeiro. The characteristic unfinished houses contrasts with a lot of expensive TV satellite dishes. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009433186-ZG61JBBVQNIY7ZE3RZ2R/Paulo002.jpg Brazil's Family Health Strategy Márcia is the heath agent, responsible for a group of families in Tabajaras. She has been doing this work for years, since the beginning of the health care assistance program. She has a very close relationship with the residents. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419017914376-DXFE3W1TDSHPYMKJQCH9/_PS_2469small.jpg Brazil's Family Health Strategy Rio de Janeiro is a city of contrasts: among photogenic landscapes like the Sugar Loaf, there are hidden areas where poverty and inequalities exist. They are much closer than we can imagine. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009537809-CE4K1O0GJETKLN1KZBT5/Paulo003.jpg Brazil's Family Health Strategy Márcia was born in Tabajaras. She still lives and works in the same area, which makes her very popular among the residents. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009611609-G1FP1VUKUQANF1DSVLB4/Paulo004.jpg Brazil's Family Health Strategy A man looks over the favela. Some of the best views in Rio are located in the higher parts of favelas, and some of them have become tourist attractions. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419009706684-S4Z8TV1RP9MQBYUO6307/Paulo005.jpg Brazil's Family Health Strategy Health agents walk from house to house, collecting and providing informations, delivering supplies and examining patients' health status. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419013357450-UYS3IKYWXBHU5ZCZQYEX/Paulo007.jpg Brazil's Family Health Strategy Cássia, a new resident of Tabajaras at her home. She got a Hepatitis C diagnosis about 2 years ago, she used to work as a manicure and manipulate the instruments of several clients, the probable cause of infection. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419123682610-88SAQ8UWP1SIFIRE21F4/Paulo002.jpg Brazil's Family Health Strategy http://www.the-silent-epidemic.com/jose daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014341769-E94HO8ING1PT4S8WU63Q/jose001.jpg José: The Bitter Remedy José Siquiera, age 64, lives in Niterói, Rio de Janeiro. He is a Hepatitis C patient currently undergoing the interferon treatment for the second time. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014342654-WQDI7O1O1T88EWJXQ34L/jose002.jpg José: The Bitter Remedy José spends his days taking care of the house, looking after his twelve birds, two dogs, and his guava trees. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014344068-AC9PUEPA7ZW4QJ5UZZ9Y/jose003.jpg José: The Bitter Remedy He has been married for over thirty years and has two sons. José worked hard to provide a good life for his family so they did not have to live on the streets as he did as a child. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014343781-BSDOBLUN2QZCP4N36AZB/jose004.jpg José: The Bitter Remedy In 1989, José volunteered to give his blood to a friend injured in an accident, drunkenly forgetting that he had donated earlier the same day. He fainted as he left the hospital and had to receive his own blood transfusion. That transfusion was contaminated with Hepatitis C. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014345164-VXWBAVLJY3CYEG5H3SLS/jose005.jpg José: The Bitter Remedy It was only in 1992 that he discovered the disease, when he tried to donate blood again. Hepatitis C screenings were just becoming mandatory, recently introduced in the medical institution. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014346313-BCG9MWBCU829TJ8YODQ0/jose006.jpg José: The Bitter Remedy For many years, José felt no symptoms of Hepatitis C. He did not find it necessary to seek treatment. He finally decided to start in 2009 when he was pressured from his co-workers who threatened him to take away his job if he didn’t start. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014351998-DZVQYISUKU1P5ZM32X44/jose009.jpg José: The Bitter Remedy He kept his disease a secret from his family to not worry them. He finally broke the news at the beginning of his treatment. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014349463-IKP4HGF047A8KWHGICQT/jose008.jpg José: The Bitter Remedy The interferon treatment took a toll on his body and he could not keep up with his carpentry job anymore. Although he tried to continue working with a less physically demanding job, he had to take time off. Having to stay at home was a drastic change for him. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014353487-6IIGPDY57LF9XOUIAVO1/jose011.jpg José: The Bitter Remedy The side effects of fatigue, constipation, and itchiness led him to permanently leave his job. He became so depressed that during one episode he could not sleep for eight days. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014354802-MXO7K6MH1A91N3L5CEAV/jose012.jpg José: The Bitter Remedy He completed his 48 week treatment, only to find his Hepatitis C was not cured. Now he is on his second treatment. This time he is hopeful because he is convinced the terrible side effects are a sign that the medicine is working. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014352461-6PA51JKIOECFSP7N8080/jose010.jpg José: The Bitter Remedy The only thing that keeps him going is his desire to be with his family and see his grandchildren grow up. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014349302-LT5JITN39PWO4D0Y0R7X/jose007.jpg José: The Bitter Remedy "God gives you food, but He won't put it in your mouth. You have to put in your mouth to live." https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014355511-0PJT1LUJLWPE0IJAGRCJ/jose013.jpg José: The Bitter Remedy TV is not good, music is not good, and nothing feels right, but he is getting used to it. These days, he spends his time walking aimlessly around his house. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014155538-UWFQE9GQZ3RZ3J9KRB3S/image-asset.jpeg José: The Bitter Remedy https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419680576488-E85764TN4OR3JH436D23/J6.jpg José: The Bitter Remedy http://www.the-silent-epidemic.com/paulo daily 0.75 2016-12-01 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016410590-K8KGBPQQRLSX3F8VP7GM/Valda016.jpg Paulo: Two Transplants Later Paulo has some friends over to his home to celebrate his 68th birthday. The Home Care service professionals also shared and enjoyed the moment. In this picture, Paulo’s physical therapist (also named Paulo) talks with the couple and a friend of theirs who lives in the same building. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016403575-PHTF061VSLU6L22B23LS/Valda017.jpg Paulo: Two Transplants Later Paulo is passionate about cars and has a small collection of old car models. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016421054-DNR7Z28JS19GALTW12AV/Valda018.jpg Paulo: Two Transplants Later Paulo has some friends over to his home to celebrate his 68th birthday. His best friend, Geraldo, came all the way to Rio de Janeiro to celebrate his friend's birthday. They have known each other since they were children growing up together in the neighborhood where Paulo currently lives, Todos os Santos, in the north side of Rio de Janeiro. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016417678-B2YWB784ZW7XGYAWYBX9/Valda019.jpg Paulo: Two Transplants Later One of Paulo’s nurses, Helen, puts eye drops in his eyes to lower the eye pressure caused by his glaucoma. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016431328-O8KYGSLLXO2EDJV1W9OY/Valda020.jpg Paulo: Two Transplants Later The couple sings happy birthday. Helen celebrates with them. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016432991-0WSWAQUW7C5RY9YME1L3/Valda021.jpg Paulo: Two Transplants Later The couple kiss each other after everyone has finished singing happy birthday to Paulo. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016195995-NY4IARDDJ4F37423WS4S/Valda001.jpg Paulo: Two Transplants Later Paulo underwent a liver transplant in November 2013 and due to some complications, he then had to go through a new transplant in March 2014. These are the scars from the surgeries https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016044433-APOS5T1T1QEJXPD6EX38/Valda002.jpg Paulo: Two Transplants Later Paulo usually lies down after lunch and he always invites his wife Solange to rest with him. They have been living together since 1989. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016388595-IAIMCQZO1SL45KNHZ93G/Valda003.jpg Paulo: Two Transplants Later Although Paulo has a home nurse for most of the day, Solange is always taking care of him and they are very close. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016201045-X2S4TBQVJNEHGHHELUKZ/Valda004.jpg Paulo: Two Transplants Later https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016211692-TZFNR4Z8WYTMK3QO0XZ4/Valda005.jpg Paulo: Two Transplants Later The nurses organize Paulo’s daily drug regimen. Each bottle is labeled with the name of the pill and correct time for taking. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016210513-LTONU6Z2YSMREYPBG6QH/Valda006.jpg Paulo: Two Transplants Later Solange and Paulo have a maid to help with the housework. At night, they are alone at home and serve their own dinner. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016214828-Q63J5HNB5N7OW7HBF7WT/Valda007.jpg Paulo: Two Transplants Later In fragile health after undergoing two transplants, Paulo needs a bath chair to take a shower safely. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016323058-KNOOZ0OYBF2W21XQZYEW/Valda008.jpg Paulo: Two Transplants Later The laboratory gives Paulo a CD copy of his exams so that he can view them at home. Paulo usually spends his day reading on the computer, analyzing his exams and researching Hepatitis C and other matters relating to the disease. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016319039-0T1X3F2BZ43TIRBMYN5M/Valda009.jpg Paulo: Two Transplants Later Paulo de Carvalho with one of his home nurses, Helen Aguiar. A few nurses, covered by Paulo’s private health insurance, rotate caring for him throughout the week. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016327535-A2G34Q0P1KR5M3GX3GKB/Valda010.jpg Paulo: Two Transplants Later Paulo dries his hair with the help of the nurse “J” (“J” did not want to be featured in this project) before going to Hospital São Francisco de Assis for a medical consultation. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016333727-LD1N9IPUW4M22ABP15X8/Valda011.jpg Paulo: Two Transplants Later In fragile health after undergoing two transplants, Paulo requires the assistance of a walker. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016342488-X5682JFP8J591XWX0WOG/Valda012.jpg Paulo: Two Transplants Later The couple in a taxi on the way to Hospital São Francisco de Assis, located in Tijuca in the north side of Rio de Janeiro. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016343651-2IAAF5AIDL1CDJ85CDHJ/Valda013.jpg Paulo: Two Transplants Later Although Paulo has private health insurance, medical consultations related to his liver transplants must be set up through the public system because surgeries that require donors cannot be granted through the private system. In other words, one cannot “buy” a liver. Paulo asks for information about his medical consultation at the Hepatic Transplant Department of Hospital São Francisco de Assis in Tijuca, Rio de Janeiro. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016354228-OEDANNWIP4QG4BPEUAPZ/Valda014.jpg Paulo: Two Transplants Later Although Paulo has health insurance, medical consultations related to his liver transplant must be set up through the public system because surgeries that require donors cannot be granted through the private system. In other words, one cannot “buy” a liver. Paulo meets the doctor Elizabeth Balbi for his consultation. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016354712-XLEHY37W13VGYL2WUEW5/Valda015.jpg Paulo: Two Transplants Later Solange is Catholic and believes that her faith is a great ally in overcoming the disease of her husband. Here she sits in the church at Hospital Sao Francisco de Assis. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419681029447-6N9WPPAAFCJIETOLH095/Valda010.jpg Paulo: Two Transplants Later http://www.the-silent-epidemic.com/home daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1420285621509-9S7EITOSJQLCSWV5FE34/_MG_6937.jpg Home The First Defense: Interferon and HCV Treatment https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1416978257144-YQI23BCI2I3EHC59W1MZ/image-asset.jpeg Home The Last Resort: Liver Transplantation https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419123021717-Y502PFQ9OAXG3UCL1N33/image-asset.png Home https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1416978339377-MOEJMZW11U0YT6HZ2K9Z/image-asset.jpeg Home The Big Picture: Brazil's Health System https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419122968372-XZJ9MJ3DWH9OF1Z3DQ0R/image-asset.png Home https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1422490037556-92BSCRA7BRDRJ950RE0P/Valda003.jpg Home http://www.the-silent-epidemic.com/the-liver-transplant-unit daily 0.75 2016-12-01 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016896009-BC20SDUZG8YME4RFOGDP/08transplante+de+figado+.jpg The Liver Transplant Unit The anesthesiologist adjusts the anesthesia levels of the patient. He monitors various bodily functions on this machine throughout the transplant. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016895911-QC5GZEYDEVOGST0PBM9H/09transplante+de+figado+.jpg The Liver Transplant Unit The final step, the surgeons stitch the incision. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016899876-27UMR84EBP1GW1W3HCKL/10transplante+de+figado+.jpg The Liver Transplant Unit Exhausted after 8 hours of work during the transplant, Dr. Giuliano, Dr. Lucio and Dr. Lucas rest as they wait for the rest of the team to finish the last steps of the surgery. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016899287-CDPJ61I6YH9DZ10FX2L5/11transplante+de+figado+.jpg The Liver Transplant Unit The infected liver is placed in a side room where it will be taken for examination after the surgery. In the same room is a refrigerator with wheels ready to be used the next day for a new pickup. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016902060-BXGNNURYCQPDDCE0DAVO/12transplante+de+figado+.jpg The Liver Transplant Unit In the early morning after his surgery, Deni Ferreira Ribeiro (59) is brought to his room for recovery. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016816543-TWTAJ7W9I8L4TMHZ5QN9/01transplante+de+figado+.jpg The Liver Transplant Unit Dr. Giuliano (surgeon), who received the liver from Duque de Caxias Hospital (town 30 km from Rio de Janeiro), arrives in the late afternoon to Hospital Sao Francisco de Assis where the transplant will occur. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016816642-ZB3FAQS7BHJ7E3939ED3/02transplante+de+figado+.jpg The Liver Transplant Unit The nursing staff brings the receiving patient, Deni Ferreira Ribeiro (59), to the operating room. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419016817831-NIUWYFHBX7A8H5VIA5MN/03transplante+de+figado+.jpg The Liver Transplant Unit Dr. Giuliano, one of the surgeons in the transplant team takes a break after 8 hours of operation. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419017011212-CAH8J4BCEBHQ0B3DT1NS/04transplante+de+figado+.jpg The Liver Transplant Unit Dr. Lucio Pacheco, chief surgeon, applies iodine to the incision area of the receiving patient Deni Ferreira Ribeiro (59) to avoid possible contamination. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419017009264-MX8HRCIPJMAMGNODA7UM/05transplante+de+figado+.jpg The Liver Transplant Unit Dr. Lucio Pacheco, chief surgeon puts on a new set of clean gloves before beginning the transplant. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419017014797-RQI18WBTI1SGENZ0TUII/06transplante+de+figado+.jpg The Liver Transplant Unit Dr. Lucas washes his hands. Every 2 hours doctors put on new robes and hygiene gloves. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419017014721-CN9GEHI7UQI3IT15HD8M/07transplante+de+figado+.jpg The Liver Transplant Unit A nurse in the transplant team records the medicines and equipment used during the operation. Beside her is the statue of St. Michael the Archangel. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419682989876-FSH9DT3IIPQHGX9X0XBU/05transplante+de+figado+.jpg The Liver Transplant Unit http://www.the-silent-epidemic.com/co-infection-hiv-and-hcv daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419125045215-I6KTUY200Z87CWZOGVV8/image-asset.jpeg Cao: Treating HIV/HCV Co-Infection https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419125209698-0XSHNSDOS0R478WY15AF/image-asset.jpeg Cao: Treating HIV/HCV Co-Infection https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419124576393-MB9KYW4N89OUDC54JPX0/IMG_4751.JPG Cao: Treating HIV/HCV Co-Infection http://www.the-silent-epidemic.com/iara daily 0.75 2016-05-24 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014859623-BZ7MCCY3BLKRODGPSB5Z/IMG_4885.jpg Iara: Recovering from the Cure Iara, age 57, lives in São Gonçalo, Rio de Janeiro. She is a Hepatitis C patient who previously suffered from the side effects of the interferon treatment. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014859579-MSE0JY5JUBVW41IXS77T/IMG_4886.jpg Iara: Recovering from the Cure Iara greets her neighbors from the open air hallway. She keeps her door open, enjoying a quick conversation and joking around with anyone who passes by. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014861477-8NMPYJNHFBGB081X8437/IMG_5039.jpg Iara: Recovering from the Cure She makes a living by cleaning the neighbors' apartments and taking care of the children. Being with children is her biggest joy. She looks after her seven-year-old granddaughter Ketlyn. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014861424-MDQ2Y1DOKY8SIHKZLFXG/IMG_5061.jpg Iara: Recovering from the Cure Iara was diagnosed with Hepatitis C in 1998 when she tried to donate blood for a friend. Iara, like many Hepatitis C patients, had no prior knowledge of the causes or the potential consequences of the disease. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014863517-MJAG28P79AVT7DRO2TRZ/IMG_5204.jpg Iara: Recovering from the Cure Her family, uniformed about the disease, briefly ceased contact with her when she revealed her diagnosis, making Iara feel isolated. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014863582-SRECCKOTTLYL9LFWRAIX/IMG_5245.jpg Iara: Recovering from the Cure She felt no symptoms from Hepatitis C, but her doctors warned her about the potential damages to the liver if left untreated. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014865469-C5SG8WM85HWFGY3V2P0S/IMG_6026.jpg Iara: Recovering from the Cure She fought for four years with the public health system to receive the treatment. Many people give up because of the tiring bureaucratic process. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014865386-2YQ5Z36D3P6PMUCGBQSV/IMG_6056.jpg Iara: Recovering from the Cure The Interferon treatment involved injection under the skin in very high doses once a week. In conjunction with Interferon, she took capsules of Ribavirin orally everyday. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014867386-XBZUUTPT4UNJ8B0UQ2PL/IMG_6119.jpg Iara: Recovering from the Cure The combination of the medicines caused an uncommon number of side effects for Iara. Chest pains, incredible weight loss, terrible rashes were some of the side effects. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014867884-ZEG6BP34OWKO1C5H307G/IMG_6123.jpg Iara: Recovering from the Cure The treatment also made her severely languished. Leaving her home made her feel ashamed. She lost her hair and her eyesight worsened. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014868868-4V0MQOC0XKYHBPQW9B1A/IMG_6141.jpg Iara: Recovering from the Cure She joined a Heptatis C support group called Amarantes where she is a key member, providing life and energy to others. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014870091-GKZC80HS8DRHRW03ALUA/IMG_6239.jpg Iara: Recovering from the Cure She was inspired by another member who defined herself as a full body, not just a liver. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014871028-DF8W27O25FWFYY8CPS6E/IMG_6255.jpg Iara: Recovering from the Cure Iara wanted to continue the treatment but she got so sick that the doctors told her one more dose could kill her. Her Hepatitis C had actually gotten worse. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014871832-L6ZQI29IEB9Y3NWSQ3KL/IMG_6341.jpg Iara: Recovering from the Cure She has temporarily gotten her life back. Although the disease still lives inside her, Iara tries to not let herself live it. Her only hope for cure is the new drug, Sovaldi, which is estimated to take up to six years for it to become available in Brazil. https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419014774794-IDH9KXBUIZRP0WZS7NX2/image-asset.jpeg Iara: Recovering from the Cure https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1419680721411-M6FEKDVE3MDB3XD0QW4A/I25_1.jpg Iara: Recovering from the Cure http://www.the-silent-epidemic.com/dr-lucio daily 0.75 2016-12-01 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1420540830016-Z8WW0AP0DB3JRN2F5IQR/image-asset.jpeg Dr. Lucio: The Surgeon http://www.the-silent-epidemic.com/reperfusion-syndrome daily 0.75 2014-12-07 http://www.the-silent-epidemic.com/new-page-2 daily 0.75 2016-12-01 https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753861253-EHTXPY6DGYPCLO858SC1/image-asset.png Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753225755-HZGTW6L3BV0BR4RPGPIK/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753383512-Z6Y4NEQXW1UNIQF303IC/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753183132-J2HWV0MQ3LSOY64FVXJQ/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753670179-534HSDQQUAKDY4TGZBME/image-asset.png Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753779909-ZSMEMDTODWP6K6H4J4S2/image-asset.png Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425752106918-A2AOJ5U2XUYYWIFH6F09/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425752383911-26D3LB8JB4W6LVG36ZQH/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425752179871-LRO86075HVRL3TF7X86X/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753324399-FQYHC0D2EKYQZ1AEEXE2/image-asset.png Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753749980-7W8US47XJCMMQMAP9LLC/image-asset.png Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425750315093-E4U1BKWY8OKSNXLNDQ61/image-asset.jpeg Participants https://images.squarespace-cdn.com/content/v1/546123d1e4b098772e551a9c/1425753123825-RQZM1J24PYPCDK08QQB0/image-asset.png Participants http://www.the-silent-epidemic.com/new-page-1 daily 0.75 2015-03-07 http://www.the-silent-epidemic.com/iara-1 daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/nice-1 daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/jos daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/surgeon daily 0.75 2016-12-02 http://www.the-silent-epidemic.com/intro daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/liver daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/cao daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/cost daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/paulo-1 daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/new-page daily 0.75 2016-05-24 http://www.the-silent-epidemic.com/take-action-bedford daily 0.75 2025-05-09 https://images.squarespace-cdn.com/content/v1/52a74d9ae4b0253945d2aee9/1390597413198-XUEB2J3138YBEXDCIMC0/tumblr_migjb4LxOB1rkz363o2_1280.jpg Take Action