Poorly funded, ill-equipped and evidently unreliable, Nigeria’s dysfunctional health delivery system is bracing for a potentially one-sided confrontation with the deadly Ebola virus disease that is steadily sweeping through West Africa. After years of playing havoc with human lives in places such as Congo, Cote d’Ivoire, Sudan and Uganda, the Minister of Health, Onyebuchi Chukwu, admitted the grim reality last week of a possible outbreak of the dreaded disease in the country.
Reports have it that the disease has already claimed 111 lives from about 200 cases recorded since January in Guinea, Sierra Leone, Liberia and Mali, all within the ECOWAS sub-region. Of the known fatalities, 101 came from Guinea, which has recorded 157 cases. While sensitising Nigerians to the impending outbreak, Chukwu said, “Ebola has been moving eastwards towards Nigeria as well, and we are already facing danger…”
Given its nature, the disease presents a formidable challenge, even to the most sophisticated and up-to-date healthcare delivery system. Caused by the virus known as Ebolavirus, which has five known strands, EVD, also known as Ebola haemorrhagic fever, has no known cure; neither have any vaccines been so far developed to effectively ward off the disease. This makes it very dangerous and challenging to medical experts. The World Health Organisation says the mortality rate could be as high as 90 per cent.
According to the WHO, EVD is usually characterised by an onset of fever, intense weakness, muscle joint and abdominal pain, headache and sore throat. These symptoms and signs are followed by vomiting, diarrhoea, rashes, impaired functioning of the kidney and liver which, in some cases, are accompanied by both internal and external bleeding. The span of time between infection and fatality could vary from two to 21 days but, quite often, it is between five and 10 days. Causes of death are usually hypovolemic shock or organ failure.
Although the virus has been traced to wild bats, which are the natural hosts, infection, originally from animal to human, has often been traced to situations where humans handled the carcass of gorillas, duikers (member of the antelope family), monkeys or chimpanzees. Human-to-human infection happens through contact with body fluids such as the blood and saliva of an infected person. Health workers, because of their close contact with patients, unfortunately, are usually at serious risk of infection. But this can be avoided by observing high level hygiene and quarantining the victims. Funeral situations in which contact is freely made with dead infected persons are also another channel for its spread.
Since it is difficult to diagnose EVD through mere observation of symptoms, it is usually preferable to do so through various laboratory tests. This is because EVD presents symptoms similar to such diseases as malaria, typhoid fever, cholera, meningitis, shigellosis, plague, relapsing fever and other diseases. Among tests to diagnose the EVD are both urine and saliva tests.
First discovered in the Democratic Republic of Congo (Zaire) in 1976, where it got its name from the Ebola River Valley in that country, the disease had also been recorded in Sudan, Uganda and Cote d’Ivoire, before the current foray into Guinea, Liberia and Mali. Of the five different strains so far identified, three – Zaire ebolavirus, Bundibugyo ebolavirus and Sudan ebolavirus – have been associated with deadly outbreaks in Africa, while Reston ebolavirus and Tai Forest ebolavirus have been recorded in Philippines and China. The last two, though capable of infecting humans, have not been implicated in any illness or death.
Since that first occurrence that claimed 280 lives, there had been 18 outbreaks before the current ones. The Zaire EVD has proved to be the most deadly, which is why the current outbreaks, said to be caused by this strain, have recorded very high mortality rate. Epidemiologist, Michel Van Herp, of the medical charity, Medecins Sans Frontiers, said, “We are facing the most aggressive strain of ebola, the Zaire strain. It kills more than nine out of 10 people infected.”
Since EVD has neither cure nor vaccine, the need for proper diagnosis and handling by medical experts cannot be overemphasised. What is done generally is the provision of supportive care, using barrier nursing techniques. There is also the need for rehydration, especially in patients who have lost lots of body fluid through vomiting and diarrohea. Isolating the patient will prevent a rapid and wide spread of the disease. Protective equipment used by health personnel will prevent direct contact with blood and body fluids. It is also important to avoid handshakes as it could be an easy way of spread from infected to uninfected people.
For EVD, there is a lot of wisdom in the saying that prevention is better than cure. This is why the Nigerian health authorities should be up and doing to make sure that EVD does not break out in the country. And even when it does, there is adequate preparation to ensure that the damage done is controlled. The minister has already said that jingles and leaflets had been produced in different languages to educate people about what to do and how to avoid infection.
This is however not enough. There is the need for the presence of medical experts at seaports and airports to control the influx of people into the country, especially people from countries where the infection has been reported. Controlling movements of people in a country with borders as porous as Nigeria’s could be taxing, but it will certainly go a long way in reducing the spread of EVD to Nigeria.
