Connecting local responses around the world
Permit me to pay my condolences to the families who have lost their loved ones to the pandemic.
Ebola Virus is strange to Nigeria and many Nigerian medical workers including physicians, laboratorians, nurses are just fiercely empowering themselves with information about it. The outbreak caught many medical experts in the country unawares as they may have never encountered such cases before. Moreover, since it’s a fever, the initial symptoms such as sore throat, headaches and muscle pains are similar to other fevers such as malaria and typhoid that they deal with frequently, and can be confused with them initially. However, it should be noted that Ebola Virus Disease (also known as Ebola Haemorrhagic Fever) is not new in the field International Health. After the first outbreak occurred in Zaire (Now Democratic Republic of Congo) in 1976, there had been about twenty four other outbreaks. There are five species of ebola virus namely Zaire Ebola Virus (occurred first in Zaire, now Democratic Republic of Congo), Sudan Ebola Virus (Occurred in Sudan), Reston Ebola Virus (USA), Tai Forest Ebola Virus (Cote d’Ivoire), Bundibugyo Ebola Virus (Uganda). They were named after the geographical locations of the outbreaks. Ebola virus causes a severe haemorrhagic fever in humans and other primates.
According to the World Health Organization, “Ebola is introduced into the human population through close contact with the blood, secretions, organs or other body fluids of infected animals. In Africa, infection has been documented through handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelopes and porcupines found ill or dead or in the forest”. Further reports from the WHO says ebola spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs and bodily fluid of infected people, and indirect contact with environments contaminated with such fluids.
There are suggestions that male survivors may be able to transmit the disease via semen for nearly two months and that burial ceremonies in which mourners have direct contact with the body of the deceased person can play a role in the transmission of Ebola.
Nigeria seems to have an early warning system and preparedness for the disease. Apparently, this was why the Federal Ministry of Health (FMoH) swung into action immediately after the national index case was announced. Due to its fever symptoms, the disease probably deceived the staff of the clinic that attended to Mr Sawyer from Liberia who eventually died. It was a similar story in the first recorded case of Zaire Ebola Virus on 26 August 1976 when Mabalo Lokela, a 44-year old school teacher showed symptoms confused with Malaria. I am impressed at the good national response to the outbreak from the Nigerian government.
The Ebola Virus Disease seems to be a bit controllable as most of the previous outbreaks lasted for two months to less than a year. For example, Bundibugyo Ebola Virus outbreak started on November 24 2007 and the Ugandan Ministry officially announced an end to the epidemic on 20 February 2008, with the last infected person discharged on 8 January 2008. Likewise, an outbreak of Zaire Ebola Virus lasted from November to December 2003 (About 2 months). If efforts are intensified in Nigeria and other countries battling with the pandemic, it can be controlled early.
One concern I have is that staffs of Primary, Secondary and Tertiary Health Care facilities may require quick capacity building to make them aware of the disease and as well begin to adopt preventive practices such as barrier nursing. The Nigeria Medical Association should give guidelines about handling of fever-related cases such as adoption of barrier nursing at least for the next few months until the disease is declared controlled. In the outbreak of Sudan Ebola Virus of 1976, the lack of barrier nursing allegedly facilitated the spread of the virus and the disease.
The recent development has caused many to start spreading different unconfirmed and mythical reports. These reports are already influencing the behaviours of the general public, especially the greetings and what they eat. I like to shake hands and hug people but I was warned severely by a friend to stop doing that. Earlier, there was a report that bitter kola was an antidote to ebola virus infection but we are still waiting for stronger statements regarding this. I was not surprised to see that bitter kola was packaged differently by road-side sellers on my way to Lagos about two days ago (Aug 8 2014). You now find large quantities of the commodity at high prices. Expectedly, there are indications that the sale of bush meat is nose-diving as we know that animals such as bats and monkeys are reservoirs for the virus. Although many Nigerians enjoy eating bush meat, many have been discouraged from eating it. It is a good preventive measure but the Health ministry has yet to issue any statement regarding this. During Sudan Ebola Virus outbreak in 1976, the disease was believed to have broken out among cotton factory workers and the first case was believed to have been exposed to a natural reservoir. In response, many local animals and insects were tested but none was found to be carrying the virus. In this recent circumstance, the late Mr Sawyer from Liberia (index case) was not reported to have visited any forest in Nigeria and there has been no confirmed report of any hunter or forest worker coming down with the fever. Therefore, there is no official ban on the consumption of bush meat. However, abstinence from bush meat for this period may be sensible.
The WHO says no licensed vaccine for Ebola Virus Disease is available, although several vaccines are being tested. None is available for clinical use. No specific treatment is available too but new drugs are being evaluated.
The civil society should rise up to the occasion through awareness creation and proper information dissemination and helping to debunk emerging myths. The recent development has given opportunities for rumour-mongers to share unconfirmed reports via the social media. Some of the recent rumours were that the disease can be prevented by washing with warm salt solution; and drinking same. It is the responsibility of health-focused Civil Society Organizations to debunk these myths as well those that will soon emerge in their communities. It is worthy of note that some Nigeria telecommunication companies are really assisting by providing updates about the disease. They send unsolicited messages regarding preventive measures against ebola virus. The messages I’ve got on my phone were in English but there may be need to translate them to other local languages so that everyone (not only elites) will benefit from this support. Similarly, media organizations (Prints, Radio and Television) are providing updates about the disease. The people depend on them to provide us assist in create awareness, allay fears, and educate all Nigerians.
The disease may be prevented by reducing contact with infected animal, properly cooking meat before consumption, good hand-washing practices and barrier nursing, especially by medical workers. Also, fluids and tissues from people with the disease should be handled with special caution.
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Taiwo Adesoba is a Microbiologist, Social Worker, Evaluation Professional and Public Health worker from Nigeria