Ebola: Fight­ing a deadly virus

Weak na­tional health­care sys­tems and few med­i­cal staff strug­gle to cope

Africa Renewal - - Contents - By Su­laiman Mo­modu

The sight of an Ebola pa­tient is fright­en­ing. Sharon Wash­ing­ton, an em­ployee of Liberia’s for­eign min­istry, got mar­ried in Jan­uary this year at a colour­ful cer­e­mony in the cap­i­tal Mon­rovia. This writer at­tended the wed­ding. Later on, Mrs. Wash­ing­ton nursed her sis­ter who was ill with what started as a mild fever un­til she got weak and started hav­ing se­vere mus­cle pain, chronic headache and sore throat. There­after, it was vom­it­ing, di­ar­rhoea, rash, im­paired kid­ney and liver func­tion, in­ter­nal and ex­ter­nal bleed­ing from all open­ings of the body — the eyes, mouth, and ears and fi­nally, death. It was Ebola. Next, Mrs. Wash­ing­ton tested pos­i­tive for the virus and, trag­i­cally, within a few days, she too passed away.

Long be­fore the cur­rent Ebola virus out­break, af­flu­ent cit­i­zens of the three most af­fected coun­tries of Sierra Leone, Liberia and Guinea of­ten sought med­i­cal at­ten­tion abroad. While some vis­ited premier med­i­cal fa­cil­i­ties in Africa such as the Korle Bu Teach­ing Hos­pi­tal in Ghana and oth­ers in Sene­gal and South Africa, the wealthy trav­elled to Europe or the US where hos­pi­tals are even bet­ter equipped.

Be­cause of se­vere short­ages of doc­tors, nurses, other health work­ers, med­i­cal fa­cil­i­ties and equip­ment, many peo­ple in Africa do not trust their coun­tries’ health sys­tems. For ex­am­ple, with a pop­u­la­tion of about 4.2 mil­lion, Liberia has one doc­tor per 100,000 peo­ple, while Sierra Leone, with six mil­lion peo­ple, has two doc­tors per 100,000, ac­cord­ing to the World Health Or­ga­ni­za­tion ( WHO).

Africa’s health­care sys­tems

To put this into per­spec­tive, con­sider that Cuba, with a pop­u­la­tion of about 11 mil­lion, has about 600 doc­tors per ev­ery 100,000 peo­ple. The dire con­straints of Africa’s health­care sys­tems cou­pled with crowded ur­ban cen­tres, ex­plain why the Ebola virus dis­ease, which first broke out in Guinea’s Guéck­é­dou area in March 2014, quickly spread to Liberia and Sierra Leone.

Ac­cord­ing to the WHO, the mor­tal­ity rate of the cur­rent Ebola out­break is 55% and by early Novem­ber 2014, more than 5,000 had died of the virus. Ebola is spread through hu­man-to-hu­man trans­mis­sion via di­rect con­tact (through bro­ken skin or mu­cous mem­branes) with the blood, se­cre­tions, or­gans or other bod­ily flu­ids of in­fected peo­ple, and with sur­faces and ma­te­ri­als (e.g. bed­ding, cloth­ing) con­tam­i­nated with th­ese flu­ids. The in­cu­ba­tion pe­riod for the virus from in­fec­tion to the on­set of symp­toms is 2 to 21 days. Hu­mans are not in­fec­tious un­til they de­velop symp­toms. Pa­tients can die within days or after a few weeks of symp­toms.

In the three coun­tries se­verely hit by Ebola, masked health work­ers in bio­haz­ard suits can be seen ev­ery­where. Am­bu­lance sirens blare through the main streets, car­ry­ing crit­i­cally ill Ebola pa­tients; news­pa­pers carry banner head­lines on Ebola daily; ra­dio and tele­vi­sion sta­tions and so­cial me­dia fo­cus on the dis­ease. Bill­boards carry mes­sages such as “Ebola is real,” “Don’t eat bush meat,” “Don’t touch the sick,” “Don’t

touch the dead.” No­body trusts any­body. No more hand­shakes, hugs or kisses — even on the cheek. Peo­ple are now get­ting ac­cus­tomed to the rit­ual of hand wash­ing in chlo­rine­treated wa­ter. Most of­fices use ther­mome­ters to check work­ers’ and cus­tomers’ body tem­per­a­tures for fever. And fever th­ese days — any fever — is con­sid­ered Ebola-re­lated.

Why it spread so fast

“The health sys­tems in our coun­tries are very weak,” ad­mit­ted Tol­bert G. Nyenswah, Liberia’s As­sis­tant Min­is­ter for Pre­ven­tive Ser­vices, in an in­ter­view with Africa

Re­newal. Mr. Nyenswah chairs the Na­tional Ebola In­ci­dent Man­age­ment Sys­tem, es­tab­lished by the gov­ern­ment to tackle the dis­ease. Across the bor­der in Sierra Leone, things are the same.

Ebola ex­posed the in­ad­e­qua­cies of the re­gion’s health sys­tems. Med­i­cal ser­vices in Sierra Leone and Liberia lack good lab­o­ra­tory fa­cil­i­ties and can­not de­tect some med­i­cal con­di­tions in their early stages. Of­ten times, di­ag­no­sis is done when it is too late for treat­ment, say med­i­cal au­thor­i­ties. “This dread­ful virus has over­tasked our pub­lic health fa­cil­i­ties and ca­pa­bil­i­ties,” said Liberian Pres­i­dent Ellen John­son Sir­leaf. Good Gov­er­nance Ini­tia­tive, an NGO headed by for­mer Bri­tish Prime Min­is­ter Tony Blair, re­ported in Novem­ber that 12 per­sons were dy­ing from the dis­ease ev­ery day in the af­fected coun­tries.

Sierra Leone and Liberia fought bru­tal civil wars, which ended in 2002 and 2003 re­spec­tively, while Guinea has strug­gled with se­cu­rity is­sues, in­clud­ing mil­i­tary coups. The wars and in­se­cu­ri­ties dec­i­mated so­cial in­fra­struc­ture in th­ese coun­tries. Sierra Leonean Min­is­ter of Health Abubakarr Fo­fana ac­knowl­edges that the re­gion’s health sys­tems need to­tal re­ha­bil­i­ta­tion.

Acute short­age of per­sonal pro­tec­tive equip­ment and lit­tle or no in­cen­tives for front­line health work­ers did not help mat­ters ini­tially. Dozens of health work­ers died after con­tract­ing the virus while treat­ing pa­tients. Some in­fected for­eign doc­tors and other hu­man­i­tar­ian work­ers were flown back to their coun­tries for bet­ter treat­ment. Gov­ern­ment took a few mis­steps such as quar­an­tin­ing the densely pop­u­lated West Point neigh­bour­hood in Mon­rovia, a move protested by angry res­i­dents.

Lack of ba­sic in­for­ma­tion about the virus and preven­tion meth­ods con­trib­uted to its spread. From the out­set, Guineans doubted that the virus ex­isted and even at­tacked Médecins Sans Fron­tières (MSF) work­ers, ac­cus­ing the hu­man­i­tar­ian health aid or­ga­ni­za­tion of bring­ing a strange dis­ease to their coun­try. In Septem­ber, Guineans killed eight jour­nal­ists and aid work­ers in a vil­lage school near Nzérékoré, south-east­ern Guinea, and dumped their bod­ies in a sep­tic tank.

In Liberia, angry youths looted an Ebola cen­tre in Au­gust in Mon­rovia’s West Point, cart­ing away items in­clud­ing blood­stained mat­tresses. With the virus break­ing in Kailahun, in east­ern Sierra Leone that is also an op­po­si­tion strong­hold, Sierra Leoneans ini­tially ac­cused the rul­ing party of at­tempt­ing to dec­i­mate the op­po­si­tion. Also, fear of stigma­ti­za­tion dis­suades many from go­ing to hos­pi­tals and they are also afraid they might con­tract the virus there.

While pre­vi­ous out­breaks in the Demo­cratic Repub­lic of the Congo and Uganda were in ru­ral ar­eas, the cur­rent out­break in West Africa found its way into pop­u­lated ur­ban com­mu­ni­ties. Tra­di­tional prac­tices such as burial rit­u­als and car­ing for the sick at home con­trib­uted to its spread.

Stem­ming the out­break

For their part, the three most stricken coun­tries are mak­ing fran­tic ef­forts to con­tain the virus. They have de­clared states of emer­gency, quar­an­tined towns and vil­lages and im­posed cur­fews. “Any­thing and ev­ery­thing is be­ing done to halt the spread of the virus,” says Liberia’s In­for­ma­tion Min­is­ter Lewis Brown. Sierra Leone’s Pres­i­dent Ernest Bai Koroma adds, “Th­ese are ex­tra­or­di­nary times, and ex­tra­or­di­nary times re­quire ex­tra­or­di­nary mea­sures.”

In­ter­na­tional re­sponse has also been gain­ing strength. The UN es­tab­lished an Ebola Emer­gency Re­sponse Mis­sion based Ac­cra, Ghana, in late Septem­ber – the first such for any dis­ease by the global body. WHO di­rec­tor Mar­garet Chan ap­pealed for greater in­ter­na­tional aid, in­clud­ing US$1 bil­lion to limit its spread. While WHO es­ti­mates that the out­break could po­ten­tially in­fect more than 20,000 peo­ple, the US Cen­ters for Dis­ease Con­trol and Preven­tion warned of a night­mare sce­nario that could re­sult in up to 1.4 mil­lion in­fec­tions by Jan­uary 2015. “This is an epi­demic that is not just a threat to re­gional se­cu­rity, it’s a po­ten­tial threat to global se­cu­rity,” said US Pres­i­dent Barack Obama.

How Nige­ria tamed the virus

Nev­er­the­less, there have been some vic­to­ries in the Ebola bat­tle. Nige­ria and Sene­gal have con­tained the virus. The Wash­ing­ton

Post, a US news­pa­per, re­ferred to Nige­ria’s ef­forts as “an ex­am­ple of hope.”

How did Nige­ria do it? Once Pa­trick Sawyer, a vis­it­ing Liberian-Amer­i­can diplo­mat, was con­firmed as hav­ing the Ebola virus in La­gos, Nige­ria’s city of 17 mil­lion peo­ple, the di­ag­nos­ing doc­tor kept him in the hos­pi­tal de­spite his protests and that of his gov­ern­ment. Of­fi­cials tracked the 281 per­sons with whom he might have had con­tact.

The di­ag­nos­ing doc­tor, Ameyo Adade­voh, later died of the dis­ease her­self. Air­port staff was un­pre­pared and the gov­ern­ment had not set up any hos­pi­tal iso­la­tion unit, so he was able to in­fect sev­eral peo­ple, in­clud­ing health work­ers in the hos­pi­tal where he was taken, some of whom had to re­strain him to keep him there. Even when the virus found its way to the oil hub of Port Har­court in the south­east, au­thor­i­ties were able to quickly con­tain it, an ex­am­ple WHO said oth­ers should be able to follow.

Health au­thor­i­ties in Nige­ria sat­u­rated the me­dia with in­for­ma­tion on Ebola. The coun­try em­ployed a ‘whole com­mu­nity ap­proach,’ in which ev­ery­one, from mil­i­tary per­son­nel to church lead­ers — who had re­ceived de­tailed brief­ing from health of­fi­cials — ed­u­cated grass­roots Nige­ri­ans on the virus. Nige­ri­ans also ac­tively used so­cial me­dia to dis­sem­i­nate Ebola-re­lated mes­sages. Another key strat­egy was that au­thor­i­ties and cit­i­zens cel­e­brated the doc­tors, nurses and oth­ers who gave their lives to the strug­gle

As the Ebola virus con­tin­ues to spark fears glob­ally, the world is hop­ing for a vac­cine and for ag­gres­sive, con­certed ef­forts to con­tain the virus’ spread, as well as im­proved health sys­tems in Africa.

Afreecom/Idrissa Soumaré

A vol­un­teer dis­in­fect­ing the hos­pi­tal of Ta­houay in Con­akry, Guinea.

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