LATEST UPDATE: Ebola: Nigeria's Healthcare System Failed Us - Sincere9gerian
Nigeria was free of Ebola until the late Patrick Sawyer, the Liberian-American, imported Ebola into Nigeria on July 20. Mr Sawyer was reported to have been terribly ill on his flight and was rushed to the First Consultant Hospital Obalende, Lagos, where he was diagnosed as having Ebola. He died on July 24.
From that single imported case of Ebola, Nigeria has had, till date, 14 confirmed cases of Ebola (including the 2 cases confirmed today out of the secondary contacts), out of which 5 deaths [including the index (imported) case] was recorded. 5 confirmed cases of Ebola made full recovery and have been discharged while up to 213 contacts are on follow up.
Few days ago, Nigeria’s Health Minister, Prof Onyebuchi Chukwu described the way Nigeria has managed the imported case of Ebola so far as a "success story". With all due respect, I beg to disagree with the Prof. I think we FAILED and I will point out the different levels of failure below.
1. The index case of Ebola was already sick when he arrived the Lagos Airport on July 20. If the Port Health Authorities were alive to their duties on that fateful day, perhaps the late Sawyer would have been quarantined immediately, especially since there was already a widely reported ongoing epidemic of Ebola in Liberia since March this year. Therefore, the Port Health Authority FAILED at this level.
2. Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.
However, the hospital should be commended for making the diagnosis of EVD eventually and alerting the Lagos health authorities. Otherwise, things could have been worse.
3. The failure of the the First Consultant Hospital to make the diagnosis of ebola promptly can also be linked to failure of the state and federal health authorities to sensitize the private and public hospitals on the possibility of ebola outbreak in Nigeria considering the fact that neighbouring west African countries have been battling with ebola epidemic since March this year. The state and federal health authorities FAILED in this respect.
4. The other level of failure is the way we have managed the primary contacts of the index case. I believe that the primary contacts ought to have been categorized into high risk and low risk contacts. The low risk contacts will include, for instance, all those that flew in the same aircraft with Mr Sawyer. The high risk contacts should include the person who sat next to Mr Sawyer in the aircraft, those who helped him all the way to the Lagos hospital and all the health workers that took care of him when his condition was still unknown. All those who fall into the high risk group ought to have been quarantined compulsorily immediately because they are at high risk of EVB. On the other hand, those who fall into the low risk group can be followed up at their homes since they are at low risk of developing EVD.
This strategy has the following benefits:
- since we cannot quarantine all the primary contacts because of logistic challenges, those at high risk, who are few, can be quarantined.
- high risk individuals who develop EVD while on quarantine will not transfer the disease to secondary contacts. That way, secondary contacts will be minimal or zero. If this strategy was adopted, the 213 secondary contacts that are currently on follow up and the 2 confirmed cases of EVD among secondary contacts would not have arisen.
The above suggested strategy is better than the strategy adopted by Nigeria's health authorities, which is simply to follow up all contacts from home. This has led to what looks like a cascade of 213 secondary contacts and 2 confirmed cases of EBV among the secondary contacts. And God forbid, if we continue this way, we will soon be talking of tertiary contacts, quaternary contacts, and so on, with resultant ballooning morbidity and mortality.
In conclusion, if we have this level of mortality and morbidity from a single imported case of Ebola, just imagine what will happen if, God forbid, we have infiltration of several Ebola cases into Nigeria.
Note: this article is a critique of the system, and does not necessarily suggest the author would have done better than the various actors under the same circumstance. from http://ift.tt/19pR9bQ
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