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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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