Nigeria’s Ebola Success Story

By FRED ABBA-JORI

On July 20, Liberian-American Patrick Sawyer, became very ill while on a flight from Liberia to Nigeria. On arrival, he was immediately rushed to a private hospital in Lagos where he was initially suspected to have malaria. On further interview however, it was discovered that he had recently been in close contact with a victim of the Ebola virus disease, EVD, then rampaging his home country and had begun to manifest symptoms before boarding a plane at Monrovia airport. His eventual demise four days after arriving in the country notwithstanding; he has been roundly castigated for deliberately and willfully bringing the dreaded pathogen into our shores, creating the potential for an epidemic in Africa’s most populous country.

It was a seminal point in the latest outbreak of the deadly disease, the entry of a highly virulent and incurable virus into a densely populated city with sub-standard public health infrastructure (at a time medical doctors had embarked on industrial action to press home demands for better working conditions). The world waited with bated breath, fearing the worst and expecting a disaster. But once again, Nigeria defied expectations and got it right by responding appropriately and adequately.

It is now nearly six weeks since the infection arrived on our shores and of the 321 already identified persons who had primary or secondary contact with Sawyer, only 12 have been diagnosed with the disease so far, with a prevailing mortality rate of 33 per cent in Nigeria compared with the 60-90 per cent fatality reported elsewhere for the disease.

The recent announcement by Professor Onyebuchi Chukwu, minister of health, that seven persons have been successfully treated for the disease and discharged from hospital, leaving the number of confirmed cases of EVD in Nigeria to stand at just one is both encouraging and surprising. This remarkable success so far recorded in containing the spread and reducing the associated mortality of EVD in Nigeria has shown several positive highlights.
The arrival of EVD in Nigeria was a clear and present danger, which demanded an urgent response and President Goodluck Jonathan seized the bull by the horns when he declared a public health emergency about two weeks into the crisis.

The import of this was the fast-tracking of all official processes involved in responding to this national security threat and priority given to channelling scarce resources towards combating it. Funds running into billions of naira were readily made available. Scanners, thermometers and other equipment needed for screening travellers at airports were quickly deployed. All government officials immediately knew any work related to combating Ebola was top priority. There was no skirting the issue, unnecessary delays or apportioning of blame. An emergency Council of State meeting was summoned. The machinery of government at federal, state and local levels clicked straight into top gear as we confronted the crisis headlong. Isolation centres were set up across the states and the Federal Capital Territory, Abuja. The close collaboration between federal and state governments from across the political divide was particularly commendable and served as a reminder of how we can set aside partisan differences in preserving our collective heritage as a nation.

Another area of significant improvement was the aspect of information dissemination and public enlightenment. Radio, television and newspaper media were inundated with messages on how to prevent contact with and transmission of the disease. Hand washing became a cultural fad and the public was made to understand the necessity of promptly reporting suspected cases via designated phone lines. Churches, schools, mosques, markets and other places of public gathering were made to institute proactive measures against spread. Nearly every Nigerian quickly became sensitised that the threat of EVD was real, potentially deadly but very preventable. The minister of health and the Lagos State commissioner for health held daily briefings to report ongoing progress in efforts at combating the disease.

Furthermore, volunteer health workers were quickly recruited and trained, protective measures put in place and adequate compensation and life insurance arranged for them. Intensive contact tracing of all primary and secondary contacts of the index case (Sawyer) was coupled with a robust surveillance network, which was set up to monitor and periodically test all such contacts suspected of having the disease. Once confirmed to have the virus, such persons were immediately transferred into designated isolation wards and aggressively treated symptomatically, given the unavailability of any known cure for the disease. Such gallant efforts were responsible for the success recorded so far in combating the spread of EVD in Nigeria.

The efforts of the Nigerian government have not gone unacknowledged. The World Health Organization, WHO, and a team of experts from the United States Centre for Disease Control, CDC, recently commended the government’s response, noting that relatively good recovery rates coupled with non-inception of any Ebola case beyond the initial transmission chain from Sawyer are a cause for cautious optimism that the current scourge of EVD may have been checkmated in Nigeria.

Some commentators have pointed out that the fact that public hospitals were closed at the time of Sawyer’s arrival due to an unfortunate doctors’ strike may have been an advantage in limiting disease spread from overcrowding and decrepit infrastructure in public hospitals. It is heart-warming that doctors have since called off their strike and are now actively working together with government to battle the disease. However, their efforts are being hampered by the suspension of over 16,000 resident doctors in the country, ostensibly to enable federal government restructure the residency training programme to make it more relevant and impactful to Nigerians’ health care needs.

But let’s not forget the sacrifice of late Dr Ameyo Stella Adadevoh, the consultant physician who prevented Sawyer from discharging himself from the hospital while highly infective, and instead quarantined him and properly notified health authorities. She contacted the disease and fought gamely for over two weeks, eventually succumbing to it on August 19, 2014. Were it not for her courage and dogged professionalism, the spread of the virus would likely have been more dispersed than it is now.

The role of competent and well-motivated medical personnel in combating the EVD threat cannot be over-emphasised. Hence it is now necessary to recall the suspended residents who constitute the majority of doctors in public hospitals in order to firm up the response to this public health emergency, while the restructuring of their training programme is being worked out. The continued suspension of 70 per cent of the medical workforce despite the declaration of a public health emergency is no longer tenable given that the affected doctors are willing to and capable of returning to their duty posts. Recalling them forthwith will go some way in inspiring confidence in the populace that government can be decisive and resolute in tackling whatever challenges may threaten the health and wellbeing of Nigerians. Let the government keep up the good work.

Abba-Jori writes from Lagos.

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