Adeyanju demystifies recent strange deaths in Ondo

Ondo State Commissioner for Health, Dr. Dayo Adeyanju, in an exclusive interview with OLUWASEUN AKINGBOYE in Akure, explains the proactive roles of Ondo state government to control the recent strange endemic disease that killed several indigenes, and the giant stride of the Mother and Child Hospital. Excerpts:

The strange disease
The strange disease, which came up precisely on the 12th of April this year was a disease that was strange to every member of the Irele community and led to the death of about 10 persons. The time our outbreak control team got to know, it had occurred 24 hours because the death was not reported, there were hurried burials of the victims, linking the death to the anger of the Malakun deity.

But when we got to know, we had to quickly dispatch our own State Rapid Response Team to the affected area. When they got there, they promptly swung into action, having three things in mind: firstly, could it be an infectious disease, could it be poisoning because as at time, we were not too sure what we were dealing with.

The State Rapid Response team now met at the emergency operation centre, which we quickly had to put in place and we discussed, and we now had to dispatch them again to go back, get samples, which we then dispatched to Lagos and The Federal University of Technology, Akure (FUTA) for us to ascertain what was going on.

Apparently after the third day, we had a report that ruled out infectious disease, non-viral, not hepatitis, Ebola and all of that. We were quite glad at that, because that means it was not contagious, the containment would not be as much as challenging as when it is infectious.

Of course, I had to lead the entire team on Saturday to see what was actually going on in the community and it was later clear to me during our active case finding that one thing that was peculiar to all of them was the fact that there was consumption of the Ogogoro, which is the locally brewed gin, and samples were then taken of these locally brewed gin where they consumed it; the patients, those survivors were referred to the University College Hospital (UCH), Ibadan.

And about five days later, it was clear to us that there was high concentration of methanol in the blood and samples that we took, which confirmed that it was methanol poisoning we were dealing with and of course then, our strategy changed.

Did the state envisaged such health disaster?
Definitely, you would recall that the whole world just overcome a major health challenge. After the Ebola experience, it was one lesson we learnt was to ever be ready like the Boys Scout, to be able to attack and defend any possible outbreak; so, we already had in place our structures: our Community Outbreak Control team, Facility Case Management and also established an infectious disease hospital.

We also have the State Rapid Response team at the state ministry of health. All of these teams, the Community Outbreak Control team comprises of the community members, the disease notification or surveillance of the local government area, PAC coordinator, health education, the social mobilizer. All of these structure were already in place, we just had to activate, they were deployed instantly and our response was quite prompt. This was why we had the possibility of reducing the high mortality rate that would have occurred in the community.

Related outbreak in other countries was a genocide, but Ondo State only recorded 33 casualties and 23 deaths
It wouldn’t have be as much as 23 if there was no conflicting or confounding traditional belief; they would have definitely reported earlier enough without the secret burial of those victims. Immediately, we had our sensitization programme asking the people to report, as early and promptly as possible; and at that, letting them know how to bury the dead, how to manage the situation and depending on the result that we got, when we realize it wasn’t infectious, we have to let them know and there was effective communication.

The General hospital, Ode Irele, was converted instantly to the case management facility deploying all the volunteers that we had, with all the Personal Protectives Equipment (PPE) and sending in some consumbles like IV Fluids, gloves etc., fortifying what they have there to ensure that thingsactually went fine and respond adequately.
The 10 survivors

Nothing is wrong with their health, the only they lost was their sight. About six of them were the ones who did not really have sight, two of them regained their sight at the UCH and another two at the General Hospital, Ode Irele. It was clear to us how to manage it and we also had to develop the management protocol because we realized that early diagnosis and prompt treatment actually aides the prognosis which is the outcome.

The truth is that, it was neuronal damage, which even depends on the quantity that you consume that would determine the manifestation. If the quantity is so much, the concentration of methanol becomes more and the damage to optic nerve is more.

As regards their well-being, they are absolutely fine. Although, some have blurred vision, their vision is not really clear, some had complete blindness, that was really the situation.

Crusade against substandard drugs and substances to consolidate on healthy living
Of course, by the time we were then rounding up that after 14 days that we realised that we were not having any new case, we had to call it quit and handed them over to National Agency for Food Drug Administration and Control (NAFDAC) as well as the DSS for further investigation. We have been calling meetings to know how far, they have gone because there is need to standard the production of Ogogoro, possibly give them some lable for those who are able to produce and know how to produce, so that they don’t produce the wrong one.

I must tell you that the fight against fake and counterfeit drug is a fight that is essential so that all our investment in health wouldn’t just go down the drain. We were able to put in some all those gigantic facilities, renovate, upgrade and put in personnel. By the time the patience are consuming your drugs and they find out they are fake ones, work done will be zero, because it wouldn’t translate into any improvement in their well-being.

In order for us to completely be assured of quality health care delivery for our good people of Ondo state, there is need again to pay attention to what they consume which informed the establishment of the inauguration of the state task force, where we have the state ministry of health, NAFDAC, the police, National Drug Law Enforcement Agency (NDLEA). After putting all these together, we decided to procure a True-Scan machine, which would enable us scan these drugs at their outlets.

The moment we scan and find out they are fake and counterfeit drugs, such outlets would be shut down. Also, anyone that we scan and we find out they are completely potent and reliable, we would announce to the public that the facility is good and we would put a guarantee-seal on that outlet, people would then know where to buy their dugs, both public and private facility including the government owned facilities.

Mother and child
Mother and Child Hospital is the apex maternal and child health care for the state and the fact that it is actually poised to offer critical emergencies: paediatrics and obstetric emergencies because one of the greatest way to reduce maternal mortality is to attend to the emergencies when there is prompt referral, and that will be saving a whole lot of life.

For us in Ondo state, what we are actually trying to do now is decongesting all our primary health care delivery centres, that is, reducing the complications that will go to the Mother and Child Hospital. And as a result of that, we are just going to have four in the senatorial districts that we have in Ondo state.

The facilities are big and good, the people are there; but what is more about the hospital is the software, which is the service that we provide. The fact that we are able to organise ourselves to have what is called: task shifting, using a clinical guideline and following a protocol management. That is improving greatly the outcome on the output and then impact of Mother and Child Hospital.

We have again be able to ensure using the packing system, a result-based financing so that when we dole out money to them, we give it based on performance. Now have been able to give out average cost for delivery of a pregnant woman, which is N5000. So, when we release N5 million to them, we expect 1000 babies.

These are the things that are promoting efficiency because they too are able to get the pack system, normal delivery pack, caesarean session pack, and the blood donation, which ensures that everybody and patients who need blood are able to get it. All of these software are the things that make the hospital great and very unique.

Another fact is that we have good referral linkage which ensures that: from the primary, secondary to tertiary cases, know those who would need the attention of Mother and Child Hospital, and they give us the best of results.
The rift between the local birth attendant and Mimiko’s overriding Agbebiye initiative

There have been no dispute since we started, no dispute at all, the relationship has been very cordial. They have referred over 2000 deliveries since the programme started, and we in only six local governments. This has greatly affected maternal mortality. Before Agbebiye, we were 317, having dropped from 745, now we have dropped 187 with the Agbebiye because more than 90 percent of the death occurred in their place. So if they cooperate with us, we will definitely crash maternal mortality to zero percent.

On their cooperation, they have been able to hatch a cordial relationship. Here, they refer and we give them coupon, and we redeem the coupon for them. It has been a win-win situation: they are not losing because they have something to take, and we too are gaining because the women are alive because it has great impact on our GDP. The more the women are alive, the more the number of those who are engaged productively in terms of workforce. This has impact on the growth and economy of the nation and continent at large, it has been a win-win situation.