This week saw a furious debate around the death of self-taught guitarist and celebrated afro-pop singer Bulelwa Mkutukana, also known as Zahara, supposedly from liver disease for which she was in a Johannesburg hospital for two weeks before her death.
The artist, who featured on the BBC’s 100 Women in 2020 and who had led a turbulent public life, came out to declare her liver troubles two years ago, after a stint in hospital.
She was also known to enjoy drinking alcohol, and, in 2020 the country heard that doctors advised that she either cut down on drinking or die.
But, footage of her allegedly inebriated continued to be shared far and wide, while on podcasts and interviews she spoke about stressors which led her to drink, but denied being an alcoholic.
The death of the Eastern Cape star comes as the world discusses liver diseases, with the Global Liver Institute saying while liver disease was often chronic, it could be avoided, and death prevented.
Saying liver disease continued to pose a heavy burden for the world and its health systems, they said: “Liver disease causes 2 million deaths per year around the globe, and an estimated 1.5 billion have chronic liver disease.”
They added that there were strategies and technologies to prevent liver disease or catch it early, which required financial investment, expert training, “…and often complex execution on a scale that necessitates government support”.
“The best thing one can do is to keep their liver healthy, by treating it well,” the South African Gastreontology society said.
They said the foundation for liver health was avoiding over indulgence in food and alcohol. “Avoid the frequent overconsumption of food and alcohol, maintain a healthy diet, and have an exercise regimen. Get screened if you have liver disease risk factors.”
Alcoholism was only one of the causes, they said. “Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis, and in men, as few as three to four drinks per day.
“Sustained consumption of these quantities over a period of a decade will lead to cirrhosis in susceptible persons. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats and carbohydrates,” they explained.
There were also other causes which led to the development of chronic hepatitis. The hepatitis B virus was the most common cause worldwide. Hepatitis B, like hepatitis C, caused liver inflammation and injury that over several decades could lead to cirrhosis; the hepatitis D virus could also infect the liver, but mostly only in people who already had hepatitis B.
Mediclinin InfoHub said there was also autoimmune hepatitis, which was caused by a problem with the immune system; inherited diseases, among them Wilson’s disease, galactosemia, and glycogen storage diseases that interfered with the way the liver produced, processed, and stored enzymes, proteins, metals, and other substances the body needed to function properly.
Blocked bile ducts were also an issue. “When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue.”
Mediclinic said drugs, toxins, and infections were also responsible for liver disease and cirrhosis of the liver, where the severe reaction to prescription drugs, prolonged exposure to toxins, environmental and chemical, and repeated bouts of heart failure with liver congestion were also causes.
“It is a silent disease, a silent killer, so to speak,” Hepatologist Dr Mandisa Matshili said. There were rarely symptoms during the early stages, but as scar tissue replaced healthy cells, liver function was affected and one could start experiencing symptoms, among them exhaustion, fatigue, loss of appetite, nausea, weakness and weight loss.
“As it progresses complications develop.” And these, Matshili said, was when some experienced the first signs of the disease.
Statistics in South Africa indicate that South Africans brought up in the rural regions of Northern Province, Mpumalanga and KwaZulu-Natal were at higher risk of contracting hepatitis B virus in the first six years of life, leading more often to eventual cirrhosis.
Many types of liver disease were, however, curable. Toxic and alcohol-related liver disease could improve when there was no longer exposure. Diet and lifestyle changes were also prescribed as a means of relieving non-alcohol related fatty liver disease.
Those which were not curable, like liver cancer in some, were more often than not manageable with medication.
The Star