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Africa: Ebola Perspectives

AfricaFocus Bulletin
October 7, 2014 (141007)
(Reposted from sources cited below)

Editor's Note

At one level, the challenge posed by Ebola is immediate, direct, and even simple. Health professionals know what needs to be done; the issue is committing enough resources quickly enough to match the pace of the deadly virus. At the same time, the challenge is enormously complex and far-reaching, as the world's failure to mobilize an adequate response poses fundamental questions about past mistakes, future policies, structural inequalities, and persistent stereotypes.

Despite being longer than usual, this AfricaFocus contains only two documents. The first is a statement from the US-Africa Network [Full disclosure: I am a participant in the US-Africa Network and was among the group involved in drafting the statement]. The second contains extended excerpts from a personal account from a Nigerian doctor on her experience with and recovery from Ebola [link to her full account on Bellanaija at http://tinyurl.com/l3l7zkx].

Both documents are from mid-September, but they are still relevant, although the number of deaths cited in the statement have continued to rise rapidly. The Nigerian doctor's story is notable not only for the powerful personal story, but also because Nigerian (and Senegalese) success to date in containing the virus is one of the positive stories that needs to be emphasized.

The format of occasional AfricaFocus Bulletins is not adequate for ongoing or in-depth coverage of this or any other single issue. But there are now abundant good sources of information available on-line. Within the limitations of my time, I am trying to highlight some of the most notable on the AfricaFocus Facebook page (http://www.facebook.com/AfricaFocus) (the same selection is also available on Twitter and Google Plus, for those who prefer those media).

Among many critical points, it is important to highlight positive efforts being made on the ground by local people. Among the most striking is a video of a Liberian nursing student who improvised her own protective equipment and succeeded in saving the lives of three of her relatives. See https://www.facebook.com/video.php?v=463069580500919

For talking points and previous AfricaFocus Bulletins on health issues, visit http://www.africafocus.org/intro-health.php

Additional links from subscribers sent in since publication of this Bulletin:
   "Ebola Response and Resources", Blog from Center for African Studies, University of Illinois, at http://casillinois.blogspot.com/

++++++++++++++++++++++end editor's note+++++++++++++++++

We All Must Respond to Ebola

US-Africa Network (www.usafricanetwork.org)

September 19, 2014

[Plain text: original formatted version available at http://usafricanetwork.org/we-all-must-respond-to-ebola/]

More than 2,400 people have been killed in the largest Ebola outbreak in history. It is spreading fast and threatening the lives of thousands more, including the medical staff and community health workers who are on the front lines. The call for scaled-up international action is growing louder. The U.S. and other governments are stepping up their response, and prominent philanthropists have announced large contributions. But the virus is still outpacing the response.

The US-Africa Network, whose mission is to facilitate communication and solidarity among people and groups in the United States, on the African continent, and in the African diaspora, is calling for an urgent response from all who care about Africa and global health.

There are several ways to take action now.

1. Donate to organizations that have a track record on the ground in Liberia, Sierra Leone, and Guinea.

It is important to verify that the organization has the capacity to reach targeted populations and is responsive to the reality on the ground. The following suggestions are not complete, but include organizations personally known to members of the US-Africa Network:

If you are a trained medical worker and want to volunteer, you can contact Doctors without Borders or fill in a form available to various agencies and organizations ( http://www.usaid.gov/ebola/volunteers).

2. Speak out against panic, prejudice, and stigmatization.

Despite the deadly nature and rapid growth of the disease, exaggerating the danger outside the immediate area is counterproductive. The African Union has called for countries and airlines to reverse hasty measures that have been taken to stop flights or other contact with the affected countries. What can be done to stop the international spread is well known and safety procedures can be put in place. Other countries in West Africa, such as Senegal and Nigeria, have so far succeeded in keeping the spread into their countries to a minimum. Health experts agree that protection for countries not yet affected should be by effective screening of air travel, not by cutting off ties to the affected countries.

Internationally, identifying Ebola with "Africa" generically is factually wrong and reinforces traditional damaging stereotypes of disease, poverty, and conflict. Conversations about Ebola must combat these stereotypes, explaining the size and diversity of Africa and the errors of accepting any simple narrative. And despite the terrible crisis affecting Liberia, Sierra Leone, and Guinea, it is essential to recognize and to highlight the courageous initiatives against the disease being taken by local health workers, community leaders, and common citizens.

3. Put the crisis in context of strengthening local public health systems and their partners.

While there is no cure for Ebola, outbreaks can be stopped and survival rates increased, if standard public health services are in place. According to Adam Levine, Assistant Professor of Emergency Medicine, Brown Medical School, "The best way to help Africa stem the tide of the current Ebola epidemic is by rapidly investing in and deploying basic infectious control measures like gowns, gloves, water, and sterilization tools, coupled with health worker and community health trainings in how to properly use them."

The lack of such capacity in Guinea, Liberia, and Sierra Leone is a direct result of more than a decade of war in both Liberia and Sierra Leone, from which the two countries have not yet fully recovered. It also results from decades of international imposition of budget-cutting ("structural adjustment") and debt repayments, starving health systems across the continent. The global failure to respond to date is also due to massive budget cuts imposed on the World Health Organization in recent years, as well as to U.S. arrears in paying dues to the United Nations.

The world will remain highly vulnerable to this and similar outbreaks unless all countries prioritize the universal right to health, including the international obligation of rich countries to pay their fair share in ensuring that basic health capacity is available everywhere. The failure to do so is a violation of human rights and our common humanity.

4. Demand that all international involvement be coordinated in conjunction with local communities, agencies, and national governments in affected countries.

Local ministries of health must remain the key partners in coordination, working closely with Doctors without Borders, the United Nations, and other stakeholders. In the current circumstances, local agencies and governments agree that massive new international involvement is needed, including military assets for logistics. But all such initiatives must feature coordination and response to local priorities or risk eroding trust which is fundamental to countering the epidemic. Military involvement in quarantines has already had negative effects in Liberia, and involvement of foreign troops in such efforts would be an even larger mistake.

In particular, insist that involvement of the U.S. military not be extended beyond coordination of its own logistical resources to usurping the lead role in broader strategies of response to the epidemic. This risks going beyond the role of support to marginalizing the essential civilian medical response which must remain primary. It is also essential that all efforts to aid the survival of medical personnel, who are essential to the fight against the disease, give attention to local as well as international personnel, including evacuation in cases for which that is indicated.

5. Remember that Ebola can be stopped with actions by local communities and health workers, using standard public health procedures that are well known. What is urgently needed is well-directed and massively scaled up support, including basic supplies such as gloves and disinfectant, as well as basic medical facilities with trained medical workers.


Through the Valley of the Shadow of Death ... Dr. Ada Igonoh survived Ebola - This is her Story

September 15, 2014

http://BellaNaija.com

[Excerpts: Full text available at http://tinyurl.com/l3l7zkx]

As Nigeria battles with the outbreak of Ebola, we consistently commend the dedication and selflessness of the doctors, nurses and other healthcare professionals.

Lives have been lost, and families have had to undergo the trauma of isolation. The fear of the unknown even very crippling. We read about the numbers in the news, but when we put a face to the news reports, it brings it home. Dr. Ada Igonoh of First Consultants Hospital is one of the doctors who attended to Patrick Sawyer. She was infected by the virus and miraculously, she survives to share her story with BellaNaija.

It is a long read but definitely worth reading as Dr. Ada details her experience. It's a really gripping read which shows the story of strength, faith and dedication. We are grateful to Ada for sharing her story with us.

***

On the night of Sunday July 20, 2014, Patrick Sawyer was wheeled into the Emergency Room at First Consultants Medical Centre, Obalende, Lagos, with complaints of fever and body weakness. The male doctor on call admitted him as a case of malaria and took a full history. Knowing that Mr Sawyer had recently arrived from Liberia, the doctor asked if he had been in contact with an Ebola patient in the last couple of weeks, and Mr. Sawyer denied any such contact. He also denied attending any funeral ceremony recently. Blood samples were taken for full blood count, malaria parasites, liver function test and other baseline investigations. He was admitted into a private room and started on antimalarial drugs and analgesics. That night, the full blood count result came back as normal and not indicative of infection.

The following day however, his condition worsened. He barely ate any of his meals. His liver function test result showed his liver enzymes were markedly elevated. We then took samples for HIV and hepatitis screening.

At about 5.00pm, he requested to see a doctor. I was the doctor on call that night so I went in to see him. He was lying in bed with his intravenous (I.V.) fluid bag removed from its metal stand and placed beside him. He complained that he had stooled about five times that evening and that he wanted to use the bathroom again. I picked up the I.V. bag from his bed and hung it back on the stand. I told him I would inform a nurse to come and disconnect the I.V. so he could conveniently go to the bathroom. I walked out of his room and went straight to the nurses' station where I told the nurse on duty to disconnect his I.V. I then informed my Consultant, Dr. Ameyo Adadevoh about the patient's condition and she asked that he be placed on some medications.

The following day, the results for HIV and hepatitis screening came out negative. As we were preparing for the early morning ward rounds, I was approached by an ECOWAS official who informed me that Patrick Sawyer had to catch an 11 o'clock flight to Calabar for a retreat that morning. He wanted to know if it would be possible. I told him it wasn't, as he was acutely ill. Dr. Adadevoh also told him the patient could certainly not leave the hospital in his condition. She then instructed me to write very boldly on his chart that on no account should Patrick Sawyer be allowed out of the hospital premises without the permission of Dr. Ohiaeri, our Chief Medical Consultant. All nurses and doctors were duly informed.

During our early morning ward round with Dr. Adadevoh, we concluded that this was not malaria and that the patient needed to be screened for Ebola Viral Disease. She immediately started calling laboratories to find out where the test could be carried out. She was eventually referred to Professor Omilabu of the LUTH Virology Reference Lab in Idi-Araba whom she called immediately. Prof. Omilabu told her to send blood and urine samples to LUTH straight away. She tried to reach the Lagos State Commissioner for Health but was unable to contact him at the time. She also put calls across to officials of the Federal Ministry of Health and National Centre for Disease Control.

Dr. Adadevoh at this time was in a pensive mood. Patrick Sawyer was now a suspected case of Ebola, perhaps the first in the country. He was quarantined, and strict barrier nursing was applied with all the precautionary measures we could muster. Dr. Adadevoh went online, downloaded information on Ebola and printed copies which were distributed to the nurses, doctors and ward maids. Blood and urine samples were sent to LUTH that morning. Protective gear, gloves, shoe covers and facemasks were provided for the staff. A wooden barricade was placed at the entrance of the door to keep visitors and unauthorized personnel away from the patient. Despite the medications prescribed earlier, the vomiting and diarrhea persisted. The fever escalated from 38c to 40c.

On the morning of Wednesday 23rd July, the tests carried out in LUTH showed a signal for Ebola. Samples were then sent to Dakar, Senegal for a confirmatory test. Dr. Adadevoh went for several meetings with the Lagos State Ministry of Health. Thereafter, officials from Lagos State came to inspect the hospital and the protective measures we had put in place.

The following day, Thursday 24th July, I was again on call. At about 10.00pm Mr. Sawyer requested to see me. I went into the newly created dressing room, donned my protective gear and went in to see him. He had not been cooperating with the nurses and had refused any additional treatment. He sounded confused and said he received a call from Liberia asking for a detailed medical report to be sent to them. He also said he had to travel back to Liberia on a 5.00am flight the following morning and that he didn't want to miss his flight. I told him that I would inform Dr. Adadevoh. As I was leaving the room, I met Dr. Adadevoh dressed in her protective gear along with a nurse and another doctor. They went into his room to have a discussion with him and as I heard later to reset his I.V. line which he had deliberately removed after my visit to his room.

At 6:30am, Friday 25th July, I got a call from the nurse that Patrick Sawyer was completely unresponsive. Again I put on the protective gear and headed to his room. I found him slumped in the bathroom. I examined him and observed that there was no respiratory movement. I felt for his pulse; it was absent. We had lost him. It was I who certified Patrick Sawyer dead. I informed Dr. Adadevoh immediately and she instructed that no one was to be allowed to go into his room for any reason at all. Later that day, officials from W.H.O came and took his body away. The test in Dakar later came out positive for Zaire strain of the Ebola virus. We now had the first official case of Ebola virus disease in Nigeria.

It was a sobering day. We all began to go over all that happened in the last few days, wondering just how much physical contact we had individually made with Patrick Sawyer. Every patient on admission was discharged that day and decontamination began in the hospital. We were now managing a crisis situation. The next day, Saturday 26th July, all staff of First Consultants attended a meeting with Prof. Nasidi of the National Centre for Disease Control, Prof Omilabu of LUTH Virology Reference Lab, and some officials of W.H.O. They congratulated us on the actions we had taken and enlightened us further about the Ebola Virus Disease. They said we were going to be grouped into high risk and low risk categories based on our individual level of exposure to Patrick Sawyer, the 'index' case. Each person would receive a temperature chart and a thermometer to record temperatures in the morning and night for the next 21 days. We were all officially under surveillance. We were asked to report to them at the first sign of a fever for further blood tests to be done. We were reassured that we would all be given adequate care. The anxiety in the air was palpable.

The frenetic pace of life in Lagos, coupled with the demanding nature of my job as a doctor, means that I occasionally need a change of environment. As such, one week before Patrick Sawyer died, I had gone to my parents' home for a retreat. I was still staying with them when I received my temperature chart and thermometer on Tuesday 29th of July. I could not contain my anxiety. People were talking Ebola everywhere - on television, online, everywhere. I soon started experiencing joint and muscle aches and a sore throat, which I quickly attributed to stress and anxiety. I decided to take malaria tablets. I also started taking antibiotics for the sore throat. The first couple of temperature readings were normal. Every day I would attempt to recall the period Patrick Sawyer was on admission - just how much direct and indirect contact did I have with him? I reassured myself that my contact with him was quite minimal. I completed the anti-malarials but the aches and pains persisted. I had loss of appetite and felt very tired.

On Friday 1st of August, my temperature read a high 38.7c. As I type this, I recall the anxiety I felt that morning. I could not believe what I saw on the thermometer. I ran to my mother's room and told her. I did not go to work that day. I cautiously started using a separate set of utensils and cups from the ones my family members were using.

On Saturday 2nd of August, the fever worsened. It was now at 39c and would not be reduced by taking paracetamol. This was now my second day of fever. I couldn't eat. The sore throat was getting worse. That was when I called the helpline and an ambulance was sent with W.H.O doctors who came and took a sample of my blood. Later that day, I started stooling and vomiting. I stayed away from my family. I started washing my plates and spoons myself. My parents meanwhile, were convinced that I could not have Ebola.

...

The ambulance door opened and a Caucasian gentleman approached me but kept a little distance. He said to me, "I have to inform you that your blood tested positive for Ebola. I am sorry." I had no reaction. I think I must have been in shock. He then told me to open my mouth and he looked at my tongue. He said it was the typical Ebola tongue. I took out my mirror from my bag and took a look and I was shocked at what I saw. My whole tongue had a white coating, looked furry and had a long, deep ridge right in the middle. I then started to look at my whole body, searching for Ebola rashes and other signs as we had been recently instructed. I called my mother immediately and said, "Mummy, they said I have Ebola, but don't worry, I will survive it. Please, go and lock my room now; don't let anyone inside and don't touch anything." She was silent. I cut the line.

...

Dr. David, the Caucasian man who had met me at the ambulance on my arrival, came in wearing his full protective 'hazmat' suit and goggles. It was fascinating seeing one live. I had only seen them online. He brought bottles of water and ORS, the oral fluid therapy which he dropped by my bedside. He told me that 90 percent of the treatment depended on me. He said I had to drink at least 4.5 litres of ORS daily to replace fluids lost in stooling and vomiting. I told him I had stooled three times earlier and taken Imodium tablets to stop the stooling. He said it was not advisable, as the virus would replicate the more inside of me. It was better he said to let it out. He said good night and left.

My parents called. My uncle called. My husband called crying. He could not believe the news. My parents had informed him, as I didn't even know how to break the news to him. As I lay on my bed in that isolation ward, strangely, I did not fear for my life. I was confident that I would leave that ward some day. There was an inner sense of calm. I did not for a second think I would be consumed by the disease. That evening, the symptoms fully kicked in. I was stooling almost every two hours. The toilets did not flush so I had to fetch water in a bucket from the bathroom each time I used the toilet. I then placed another bucket beneath my bed for the vomiting. On occasion I would run to the toilet with a bottle of ORS, so that as I was stooling, I was drinking.

...

My husband started visiting but was not allowed to come close to me. He could only see me from a window at a distance. He visited so many times. It was he who brought me a change of clothes and toiletries and other things I needed because I had not even packed a bag. I was grateful I was not with him at home when I fell ill or he would most certainly have contracted the disease. My retreat at my parents' home turned out to be the instrumentality God used to shield and save him.

...

I kept encouraging myself. This could not be the end for me. Five days after I was admitted, the vomiting stopped. A day after that, the diarrhea ceased. I was overwhelmed with joy. It happened at a time I thought I could no longer stand the ORS. Drinking that fluid had stretched my endurance greatly.

...

I began to think about my mother. She was under surveillance along with my other family members. I was worried. She had touched my sweat. I couldn't get the thought off my mind. I prayed for her. Hours later on Twitter I came across a tweet by W.H.O saying that the sweat of an Ebola patient cannot transmit the virus at the early stage of the infection. The sweat could only transmit it at the late stage. That settled it for me. It calmed the storms that were raging within me concerning my parents. I knew right away it was divine guidance that caused me to see that tweet. I could cope with having Ebola, but I was not prepared to deal with a member of my family contracting it from me.

Soon, volunteer doctors started coming to help Dr. David take care of us. They had learned how to protect themselves. Among the volunteer doctors was Dr. Badmus, my consultant in LUTH during my housemanship days. It was good to see a familiar face among the care-givers. I soon understood the important role these brave volunteers were playing. As they increased in number, so did the number of shifts increase and subsequently the number of times the patients could access a doctor in one day. This allowed for more frequent patient monitoring and treatment. It also reduced care-giver fatigue. It was clear that Lagos State was working hard to contain the crisis

...

On my 10th day in the ward, the doctors having noted that I had stopped vomiting and stooling and was no longer running a fever, decided it was time to take my blood sample to test if the virus had cleared from my system. They took the sample and told me that I shouldn't be worried if it comes out positive as the virus takes a while before it is cleared completely. I prayed that I didn't want any more samples collected from me. I wanted that to be the first and last sample to be tested for the absence of the virus in my system. I called my pastor. He encouraged me and we prayed again about the test.

On the evening of the day Justina passed on, we were moved to the new isolation centre. We felt like we were leaving hell and going to heaven. We were conveyed to the new place in an ambulance. It was just behind the old building. Time would not permit me to recount the drama involved with the dynamics of our relocation. It was like a script from a science fiction movie. The new building was cleaner and much better than the old building. Towels and nightwear were provided on each bed. The environment was serene.

The following night, Dr. Adadevoh was moved to our isolation ward from her private room where she had previously been receiving treatment. She had also tested positive for Ebola and was now in a coma. She was receiving I.V. fluids and oxygen support and was being monitored closely by the W.H.O doctors. We all hoped and prayed that she would come out of it. It was so difficult seeing her in that state. I could not bear it. She was my consultant, my boss, my teacher and my mentor. She was the imperial lady of First Consultants, full of passion, energy and competence. I imagined she would wake up soon and see that she was surrounded by her First Consultants family but sadly it was not to be.

I continued listening to my healing messages. They gave me life. I literarily played them hours on end. Two days later, on Saturday the 16th of August, the W.H.O doctors came with some papers. I was informed that the result of my blood test was negative for Ebola virus. If I could somersault, I would have but my joints were still slightly painful. I was free to go home after being in isolation for exactly 14 days. I was so full of thanks and praise to God. I called my mother to get fresh clothes and slippers and come pick me. My husband couldn't stop shouting when I called him. He was completely overwhelmed with joy.

I was told however that I could not leave the ward with anything I came in with. I glanced one last time at my cd player, my valuable messages, my research assistant a.k.a my iPad, my phones and other items. I remember saying to myself, "I have life; I can always replace these items."

...

We had to pass through several stations of disinfection before we reached the car. Bleach and chlorinated water were sprayed on everyone's legs at each station. As we made our way to the car, we walked past the old isolation building. I could hardly recognize it. I could not believe I slept in that building for 10 days. I was free! Free of Ebola. Free to live again. Free to interact with humanity again. Free from the sentence of death.

My parents and two brothers were under surveillance for 21 days and they completed the surveillance successfully. None of them came down with a fever. The house had been disinfected by Lagos State Ministry of Health soon after I was taken to the isolation centre. I thank God for shielding them from the plague.

My recovery after discharge has been gradual but progressive. I thank God for the support of family and friends. I remember my colleagues who we lost in this battle. Dr. Adadevoh my boss, Nurse Justina Ejelonu, and the ward maid, Mrs. Ukoh were heroines who lost their lives in the cause to protect Nigeria. They will never be forgotten.

...


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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