Containing the Ebola Virus Disease (EVD) outbreak is the major challenge both the Federal and the Lagos State governments are grappling with. OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU report.
can Ebola Virus Disease (EVD) be contained in Nigeria? With 139 suspected cases, two deaths and nine confirmed cases, the country seems to be running against time. According to the World Health Organisation (WHO), Ebola outbreaks can devastate families and communities, but the infection can be controlled through the use of recommended protective measures in clinics and hospitals, at community gatherings, or at home.
Nigeria was never proactive in the prevention of the disease.
An outbreak of EVD in West Africa was first reported late March 2014. As of August 4, this year, according to the WHO, 1,711 cases and 932 deaths (case fatality 55-60 per cent) have been reported across the three affected countries. This is the largest outbreak of Ebola ever documented and the first recorded in West Africa.
So far Nigeria’s case fatality rate for Ebola Virus Disease is 28.6 percent. In the ECOWAS region, the case fatality rate stands at 55 percent, which means 45 percent of people who have suffered Ebola are alive and living witnesses.
EVD is one of numerous viral hemorrhagic fevers (VHF). It is a severe, often fatal disease in human and nonhuman primates. EVD is spread by direct contact with the blood or secretions (urine, faeces, semen, breast milk, and possibly others) of an infected person or exposure to objects that have been contaminated with infected secretions. The incubation period is usually eight to 10 days (rarely ranging from two to 21 days).
While neighbouring countries on the Western coast were recording confirmed cases and deaths, Nigeria was paying lip service to precautionary measures and campaigns to sensitise the citizenry on what the disease is; mode of transmission and contraction, among other recommendations by the WHO, inspite of the porous borders.
And with the index case of late Patrick Sawyerr, an American-Liberian, on July 22, in Lagos; the governments are now trying to contain Ebola’s spread. The development is already creating anxiety among the populace.
A nurse and a doctor who attended to the late Sawyer died. Ebola disease has no known cure, for now.
Though at the international scene there are two drugs- TKM-Ebola and ZMAPP with the potentials to treat the disease, the country is yet to access the drugs due to logistics reasons.
President Goodluck Jonathan has declared an emergency over the Ebola outbreak and approved N1.9 billion to contain it. The money is expected to be used in strengthening steps to contain the virus by putting up additional isolation centres, case management, contact tracing, deployment of additional personnel, screening at borders, and the procurement of required items and facilities.
So far, the Federal Government in conjunction with the Lagos State Government has been able to put up some tents at the General Hospital, Mainland, Yaba, former Infectious Disease Hospital, to quarantine suspected cases.
The Management of the University Teaching Hospital (UCH), Ibadan, Oyo State has stated that it can deal with Ebola hemorrhagic fever (Ebola HF) outbreak.
According to the Chief Medical Director (CMD), Prof Temitope Alonge, Ebola belongs to a group of Viral hemorrhagic fevers (VHFs), which refer to a group of illnesses that are caused by several distinct families of viruses.
The CMD said his hospital has the human capacity and facility to detect and manage the Ebola because, “We have been proactive as far back as 2012, by setting up VHF isolation precautions as well as standard precautions, which enabled us to manage Dengue fever and other outbreaks back then. It was later confirmed that no further nosocomial transmission of the virus was documented, indicating that although Dengue is highly infectious, the use of these measures is effective in preventing the spread of disease and other Viral hemorrhagic fevers, such as Ebola.”
According to Alonge, UCH has one of the best virology laboratories in West Africa, with capacity to test hemorrhagic and contagious diseases like Dengue, Lassa fever and Ebola disease.
He said UCH had taken proactive steps since 2012 to prepare for emergencies like this, by setting up the UCH Emergency Response to Disaster Committee, though the concern then was cholera, and Lassa fever last year.
“I’m surprised when people say we cannot make diagnosis of Ebola and that is not true. The Minister of Health has said we can. UCH has the biggest virology lab in terms of clinical care. We look after polio and ours is a place where we would give you all the strains of polio in Nigeria and the Lassa fever detected in Mokola some years ago. We have a lab that is part-funded by the WHO that has the facility to diagnose not only Ebola, but Lassa and Dengue fevers. We have the capacity to do 500 cases as I speak. But on daily basis, we can collect the specimen and run it. With the polymerase chain reaction (PCR), we can do 35 cycles within a day. To say that we cannot make diagnosis in Nigeria is not correct but what we normally do and in line with international standard, we collect another sample for further sampling.”
He said UCH is prepared not only to take care of, “our patients if they come but also to educate the public. We have been doing this before now and have started setting up our tents before any institution in the country starts.
“We are also prepared to assist any state that can bring samples to Ibadan for analysis. The only challenge we have now is having no space for whole cremation, but part-cremation, which we have been doing for the likes of diabetes-foot among others,” he said.
The CMD said the institution would stage an awareness campaign to enlighten members of the public on the disease.
“We have provided simple fliers to tell the public what Ebola is, symptoms and what people can do to prevent it. They are to be distributed in Gbagi market, Dugbe market and Gbagi Titun, so that people can have an idea. We have also gone ahead to translate the language to Yoruba and Hausa,” he said.
He said the major challenge now facing his hospital is how to cremate bodies of Ebola deceased, should there be in his hospital, but, “we have contacted the India communities and other experts in that field and they are ready to collaborate with us should the need arises. We have also printed out pamphlets in English, Yoruba and Hausa languages on what Ebola is, mode of transmission and preventive measures. We have enough Personal Protective Garments (PPG) for the workforce, so UCH is ready and prepared. It will be irresponsible of anybody to say we do not have the capacity in terms of laboratory to diagnose Ebola. The Minister, Prof Onyebuch Chukwu has clearly stated that Nigeria can make accurate diagnoses of Ebola.
“Not only that, we have a bill board that scrolls every five minutes at the main gate, called orita mefa (six-T-junctions), where passers-by stay glued reading the information on Ebola. The important thing now is to prevent contracting same by washing of hands with either soap, ash or use sanitizers.”
Meeanwhile, the government is soliciting for volunteer health workers because medics in its employment are on strike, just as nurses are skeptical of their full service delivery.
The Nigerian Medical Association (NMA), which is the parent body of all doctors association in the country is concerned about the safety of its members, who would treat the Ebola patients. Members want government to stipulate in clear terms the coverage of the insurance policy.
In the wake of this, the 38-day old strike was called off, but the association is divided over whether Nigeria has what it takes to solve the problem.
A faction among the association said the country is ill-equipped to contain the outbreak.
Nurses, too, are against the government for the death of their colleague to Ebola virus disease (EVD).
They said they wont be cajoled into signing their ‘death warrant’.
Past National Deputy President, National Association of Nigerian Nurses and Midwives, (NANNM), Mr Olufemi Tonade, described the death of the nurse as unfortunate, pathetic and painful.
He said it is quiet unfortunate that the Federal Government has not addressed basic needs of healthcare workers, especially nurses.
Tonade said nurses will not be swayed by government’s deceit because there is dearth of equipment.
“We have concluded that we are not going to sign a death warrant. How will the government who cannot resolve basic health needs solve the problem of EVD, which has posed a very serious health hazard. This has shut down Liberia and may shut down other West African countries,” he said.
He said the government did not get its priorities right because EVD is deadly and cannot be politicised.
It should be addressed with all fiat by any serious government, he added.
He said no hospital in Nigeria is prepared to handle the disease.
“They should not politicise it that they have protective equipment. It is no longer preventive in Nigeria rather it is now curative approach,” Tonade noted. The United States, he said, has just tested a drug. “So, all we are saying is that the government should be decisive and tackle the disease headlong.
He said NNMAM is trying to identify the matron who died from the disease.
“For now, we do not know if she is in the private sector or public sector. No amount of money can be given to nurses to attend to an Ebola patient.
This is because nothing is working in Nigeria. The Insurance industry is not effective in Nigeria. The government insurance scheme could be likened to the third party insurance people have on their car. And you know with third party insurance, you do not expect anything when your car gets damaged,” he said.
He said nurses do not have faith in government’s life insurance coverage, saying: “Insurance system in Nigeria is not effective. We cannot promise our members to take such life insurance.”
Besides, we will not allow our members to sign such a death warrant, although it is true we have the man power but no facilities.
He said that is why health workers resisted the government from bringing Ebola patients to the Lagos State University Teaching Hospital (LASUTH) because there are no facilities there.
He said: “In a third party insurance, you don’t have to wait for anybody to repair your car and that is exactly what the government’s life insurance is all about. “What would the government give that could compare to the lives of doctors, nurses and pharmacists, among other health professionals,” he said.
He advised the government to seek help from developed countries, such as the US. “ Let them bring in the drugs that the Americans are currently using for their people. Yes we have quarantined them but we need serious commitment on the part of government,” Tonade stated.
