Years after Ebola, where do we go from here?

Fatimatu Gaima, a 25 years old woman in Liberia, is no longer happy with her life. She was one of the few survivors who overcame the deadly Ebola disease that struck the West African sub region in 2014. Her survival was miraculous as she cannot actually understand, but her life has appeared ruined as it looks better to die than live without her children and a beloved husband.

Gaima told her story to officials of the World Health Organisation (WHO) who visited the country to assess the life of the people after months of battling the virus in the most disease prone region of the world. For her, life is no longer worth living as her husband and two children were taken by the angry hands of the Ebola virus.

According to her, “I am learning to live a new life in the home without my husband and my two children. Now there is so much emptiness in the house especially at night,” Fatimata Gaima told the World Health officials with eyes ridden with tears, feeling hopeless, as she sat in a wooden chair in her ram shackled kitchen in a Liberian community.

Her story brought to remembrance another story of a woman, who, though, managed to survive the scourge, her son was also unlucky as he was said to have tested positive to Ebola and died a few days after he was brought to the isolation centre, also in Liberia, the most devastated nation in the African region.

For her, the sweetness of life is gone and is now a bitter pill. Fatoumata Camara, 30 years old, based in Conakry, gave a pathetic story of how she battled with the disease but lost her only child to the virus. Although she is still living in Conakry, she feels lonely because she was a single mother before the cold hands of Ebola took away her son.

Dr Stella Adadevoh (1956 – 2014)

Reports indicate that the disease killed not less than 4,877 people in the West Africa with over 9,936 cases reported between 2014 when it broke out and 2015 when it was finally contained in the region. These figures are said to be official as put together by the World Health Organisation, a body widely regarded as the authority on the Ebola outbreak in the region.

These statistics have been widely circulated, reported, tweeted and retweeted, but the number of deaths related to Ebola is based largely on speculation, not concrete evidence, according to the spokesman for WHO.

“We don’t really know how many deaths there have been, because there are a lot of people who have died alone or out in the bush,” WHO spokesman, Dan Epstein said. Those deaths go unreported, Epstein noted, so the agency uses statistical models to account for what they estimate is the number of unreported cases.

Discovery

Health workers on the ground in Guinea, Liberia and Sierra Leone often rely on anecdotal evidence to estimate the number of Ebola deaths in a particular village or town. During field studies, locals might tell disease trackers that their village has had 20 deaths from Ebola, but “no one is verifying it,” Epstein said.

The disease was first discovered in Zaire, in the Democratic Republic of Congo in 1976. Since the first discovery of the disease, it has affected the West African region three times with the last being the most deadly in the history of disease outbreak in Africa. The first outbreak was in 1976, the second was in few months later in Yambuku Zaire and the highest rate affected four West African countries in 2014 killing all classes of people without consideration for economic or political status.

The disease first appeared in West Africa in Guinea in 2013. Previous outbreaks were confined to countries in Central Africa. In West Africa, it started with the death of a 2 year old boy in December 2013 in Guinea. Researchers believe that the boy identified as Emile Ouamouno who died in the village of Meliandou in Guinea was the index case in West Africa.

His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages. From there, it spread to neighbouring countries of Liberia and Sierra Leone with smaller outbreaks occurring in Senegal and Mali. One factor that led to its spread was that it was not easily diagnosed by medical professionals, the disease had several months to spread before it was recognized as Ebola.

Corpse of Ebola victims carrying by healthcare workers

The virus stealthily entered Nigeria unknown to Nigerian health experts. On July 20, 2014, Patrick Sawyer, a Liberian-America, flew from Liberia to Lagos, Nigeria’s most populous city for Ebola treatment.

That was the index case of Ebola in Nigeria. Sawyer became violently ill upon arriving at the airport and died on July 24 at the First Consultant Hospital in Obalende, Lagos. That was the beginning of Ebola disaster in Nigeria. The first medical doctor, Ameyo Adadevoh, having discovered the disease, prevented other persons from having contact with Sawyer.

On 6 August 2014, the Nigerian health minister, Chukwu Onyebuchi, told reporters, “Yesterday the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward.” On 19 August, it was reported that the doctor who treated Sawyer, Ameyo Adadevoh, also died of the Ebola disease.

From these concerted deaths, the federal government moved into action. It fought the disease from all fronts. That was the first time in the history of Nigeria that the Nigerian government and Nigerians jointly fought an epidemic or a major disaster in a bid to stamp it out of the country.

It was fought with financial contributions from philanthropic Nigerians. It was learnt that Africa’s richest business mogul, Aliko Dangote, donated $1m to the federal government to combat the menace.

State governors, health officers and all well-meaning Nigerians fought the disease with every available resources to bring it under control.

International and national airports were put under 24 hours surveillance and the then minister of health, Chukwu Onyebuchi and former President Goodluck Jonathan, devoted much energy and financial resources in collaboration with the World Health Organisation (WHO) to bring the disease under subjection.

Though it was reported in states like Rivers, Enugu where a person under surveillance traveled to, the efforts of the federal ministry of health in containing the disease cannot be over-emphasised. Special and emergency trainings were organised for health workers, some schools were shut, especially in Lagos to prevent children from contacting the disease.

Stigmatisation

Nigerians avoided shaking hands with friends, neighbours and colleagues at places of work, emergency hand washing was introduced to all public places including schools, even as friendship and closeness got reduced.

Religious gatherings that involved large crowds were curtailed while some were permanently cancelled to avoid body contact with people as every Nigerian became a suspected carrier of the dreaded Ebola virus.

State governors fought in their different states to prevent the disease from entering their states. In all sense of honesty, the fight against Ebola in Nigeria was one of the situations where Nigerians were united in a fight to combat a disease that was at the verge of wiping out the entire nation.

WHO, United States Center for Disease Control and Prevention (CDC), UNICEF and other foreign partners supported the Nigerian government with expertise for outbreak investigation, risk assessment, contact tracing and clinical care.

Strong public awareness campaigns, teamed with early engagement of traditional, religious and community leaders, also played a key role in successful containment of the outbreak.

However, some Nigerians were of the view that the federal government fought the virus because it was affecting majorly the high and the mighty in the country. This is so because it affected medical doctors, senior government officials, highly placed persons without respect for political, economic or religious affiliations.

It dealt a deadly blow on all that had contact with infected persons, hence they argued that the federal government fought the disease to prevent its officers from contacting the virus and eventually dying as no country would admit any patient from any part of West Africa for treatment.

Nigerians were getting stigmatized as most travels to Nigeria were restricted except the WHO officials with heavy protection.

Cure and prompt response

On 9 October 2014, the European Centre for Disease Prevention and Control (ECDC) acknowledged Nigeria’s positive role in its effort to contain the Ebola outbreak. “We wish to thank the Federal Ministry of Health, Abuja, Nigeria, and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria,” the ECDC said.

Nigeria’s quick responses, including intense and rapid contact tracing, surveillance of potential contacts, and isolation of all contacts were of particular importance in controlling and limiting the outbreak, according to the ECDC. Complimenting Nigeria’s successful efforts to control the outbreak, “the usually highly rated WHO declared the feat ‘a piece of world-class epidemiological detective work.”

The WHO’s representative in Nigeria officially declared Nigeria to be Ebola free on 20 October, 2014 after no new active cases were reported in the follow up contacts, stating it was a “spectacular success story for Nigeria”.

The WHO declared the end of Ebola transmission in Guinea on 29 December 2015, in Liberia on 14 January 2016, and in Sierra Leone on 17 March 2016.

Ebola healthcare workers

It must be stressed that in the 2014 Ebola outbreak, Nigeria was the first country to effectively contain and eliminate the Ebola threat that ravaged three other countries in the West African region. The Nigerian unique method of contact tracing became an effective method later used by countries, such as the United States, when Ebola threats were discovered.

But in the midst of the successes recorded, WHO has continued to stress that the countries are still at risk of sporadic transmission of Ebola, largely due to virus persistence in some survivors, and must remain on high alert and ready to respond.

Strong surveillance and emergency response capacity needed to be maintained, while care, screening and counseling also need to be provided for survivors.

Health care delivery in Nigeria is a concurrent responsibility of the three tiers of government in the country, and the private sector. The Nigerian health care system is continuously faced with a shortage of doctors known as ‘brain drain’, because of emigration by skilled Nigerian doctors to North America and Europe.

In 1995, it was estimated that 21,000 Nigerian doctors were practising in the United States alone, which is about the same as the number of doctors working in the Nigerian public service. Retaining these expensively trained professionals has been identified as one of the goals of the government but is yet to come to fruition.

One problem with the Nigerian government is its lackadaisical attitude to issues. When the virus broke out, it went in with all energy and zeal but as soon as the country was declared Ebola free, the government relaxed its surveillance and continuous awareness creation.

The WHO has said that the country remains vulnerable to another imported case. The surveillance and awareness creation must remain high to avoid a more deadly outbreak. However, emerging facts indicate that Nigeria has revised its national preparedness and response plan to ensure that the country is well prepared for other imported cases of the disease.

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