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Ebola Outbreak: Anger in Lagos Infectious Diseases Hospital

Ebola outbreak: Anger in Lagos infectious diseases hospital
Jide Idris, Lagos State Commissioner for health


Members of staff of the Infectious Disease Hospital, Yaba, Lagos, have expressed anger over the impending removal of the hazard allowance component of their September salary. Sources within the hospital told The Punch that the Lagos State government has excised the allowance, which has been paid for years in the September payroll.

“We have sighted the payroll for September already and there is no provision for this allowance which has been paid to us for more than four years. This is really terrible. If government wants to remove anybody’s allowance, should it be from us workers at the IDH? What kind of problem is this?” one of the workers of the hospital lamented.

Earlier, volunteers at the isolation ward had protested the non-payment of their daily allowance since August 30.

“We learnt they want to send us away because there are no cases of Ebola again. But they should at least pay us our entitlements even if they will do that,” a volunteer confided in our correspondent on Thursday.

While the Lagos State Government has not disclosed the cost it has incurred in containing the Ebola Virus Disease so far, it has received cash donations from some sources, including the Federal Government.

Governor Babatunde Fashola recently confirmed the receipt of a N200m assistance from the Federal Government, while officials of Seplat company also donated N20m to the state to help contain the virus, among other material and financial donations.

In the wake of the outbreak, which occurred during the nationwide strike of the Nigerian Medical Association, the state government had called for volunteers. It paid daily allowance of N30, 000, N40, 000 and N50, 000 respectively to attendants, nurses and doctors working at the isolation unit but the payment of the allowances had been stopped since August 29.

While the volunteers still report to the isolation centres daily, many of them said they were aware that the government would soon ask them to go away “because there are no more cases of Ebola in the state.”

As of Thursday, only the female student of the Obafemi Awolowo University, who was brought to the centre late on Tuesday, remained in the Lagos Ebola isolation ward. The student was said to have confessed that she had contact with the late Port Harcourt doctor, Iyke Enemuo, who died of the EVD after treating an ECOWAS diplomat in a hotel.

The student, who was rushed to the centre from Ile Ife after she fell ill and manifested symptoms similar to EVD, however, has tested negative to the Ebola virus, the OAU authorities said on Thursday.

The Lagos State Commissioner for Health, Dr. Jide Idris, did not answer his call when our correspondent called for his confirmation of situation at the IDH.

Meanwhile, in a paper released Wednesday afternoon titled “Ebola Then and Now”, two doctors on the frontlines of the 1976 outbreak in Zaire recall the meticulous procedures that kept the climax of the outbreak to 318 people. While the piece offers valuable information for those fighting the current Ebola outbreak, it underscores just how dangerous it has become. That was then, this is now. Here, juxtaposed with the New England Journal of Medicine’s report, is today’s response.

Delayed Response Time

1976

The study’s authors, Dr. Joel G. Breman and Karl M. Johnson, arrived in Zaire in 1976 equipped with new virologic and immunologic tests that helped them immediately identify the (then new) agent. “In Zaire, we became, respectively, the chief of surveillance, epidemiology, and control and the scientific director of the International Commission for the Investigation and Control of Ebola Hemorrhagic Fever in Zaire,” they write. Immediately upon arrival, five commission members were sent to the village of Yambuku—the original site of the outbreak—to map the extent of the outbreak. The other 70 members remained at the hospital base.

Now

On March 23, 2014, the World Health Organisation (WHO) reported what they called a “rapidly evolving outbreak” of Ebola in West Africa, where 49 cases and 39 deaths had been recorded. One month later, the number of cases had quadrupled, with WHO showing more than 208 cases and 130 deaths. It wasn’t until August 6, with 1,779 cases and close to 1,000 deaths, that WHO began discussing whether or not the outbreak constituted an international health emergency. By the time it did a few days later, which made it nearly six months after the initial outbreak, it was too late.

Infective Quarantine

1976

When Breman and Johnson arrived on the scene, the government had already quarantined 275,000 people in the Bumba Zone. Planes, boats, cars, strangers—all were banned from entering the cordoned off area. At first, the doctors write, the villagers were “fearful and agitated,” lacking the basic necessities needed to survive. When members of the International Commission arrived to help, the community was wary. But with an electron micgrograph to illustrate what was fueling the outbreak, they were able to gain the trust of the people. “People along the road from the town …were relieved when we said we’d come to stop the disease’s spread, treat patients, and meet their families,” the paper reads. Inside the quarantine zone, even more specific procedures were outlined to keep those within the bounds of it safe.

Now

Attempts to quarantine during the current outbreak, led by the local armies and police, have been catastrophic. When the Liberian government attempted to contain the outbreak in Liberia through a quarantine in West Point—an exceptionally impoverished area near Monrovia — they did the opposite. With anywhere from 70K to 120K residents living in tiny shacks without running water, sanitation, or electricity, they left a struggling demographic without the means to protect themselves— many, without knowledge of what it was that necessitated protection. With people fighting for food, violent outbreaks between Liberians and the army began to heat up at the 10-day mark. When four were injured and one killed, President Ellen Johnson Sirleaf officially lifted the quarantine.

Mistrust from Communities

1976

For those outside of the quarantine zones, Drs. Breman and Johnson laid out specific guidelines to community members to help reduce the risk of the infection’s spread. Family members who became infected with the disease were placed in “huts outside their villages,” a procedure that allowed victims to be isolated outside of a hospital. The doctors then suggested one family member, “preferably someone who had recovered from the illness,” deliver food, water, and medicine to the patient each day until a medical professional could arrive on the scene. With the help of other community members, the doctors successfully educated the families of those who died about the dangers of handling the body in typical ritual fashion. “Credibility was gradually restored, especially when we began visiting villages accompanied by the three remaining nuns,” the authors write.

Bodies were covered with bleach and buried, and isolation huts burned. An already-local tradition of shaving one’s head in mourning for a lost family member became dual purpose—used to flag potential carriers of the disease.

Now

With the virus already widespread when international relief began pouring into West Africa, spending individual time in affected communities was not an option. Without this crucial period of trust building, many in the communities spent months under the impression that Ebola was either a hoax or a disease brought to West Africa by American nurses and doctors. The fallout of this loss of trust has had an enormous impact on the outbreak. Without a clear understanding of how Ebola is spread and when it is contagious, family members continued to bury their loved ones—who, at that point, are the most contagious—with typical burial rites such as washing, touching, and even kissing the corpses. While doctors in West Africa now report success educating the communities and persuading them not to perform burials, the amount of burials already performed have infected hundreds, if not thousands of people.

At the end of the report, which highlights stirring images from the original 1976 outbreak, the authors offer suggestions for where the international community should focus their support. “We believe the main priorities should be adequate staff for rigorous identification, surveillance, and care of patients and primary contacts. Strict isolation of patients, good clinical care, and rapid, culturally-sensitive disposal of infectious cadavers,” they write. “Breman, who got wind of the current outbreak when a CDC officer stationed in Guinea called him for advice in March, is still optimistic. Most of his positivity rests on the news that people in the villages have finally begun to trust that the outbreak is real, and that the health workers are there to stop it. And with the announcement that the U.S. plans to send a “surge” of workers into West Africa armed with $22 million from the Pentagon, America now looks poised to fight back against Ebola.

“These are the darkest days, they know what they’re doing,” Breman tells the health care workers in the field. “They know the dangers. There are dangers at the front lines. It’s a war zone, and Ebola is the enemy.”





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