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Five years after Ebola outbreak, still more grounds to cover

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Ebola Virus Isolation Centre at Yaba, Lagos

Five years after the first Ebola virus outbreak was recorded in the country, there are still concerns, given the rampage of the virus in Central Africa. Last week, government had to dispel worries about fresh outbreak. One of the reasons health managers give for their assurances is the deft manner the last episode was contained, which has continued to receive plaudits from around the world.

One of the latest commendations came recently from the Governor-General of Canada, Julie Payette who, while on a visit to the country, commended the Lagos State government for managing and containing the spread of the virus when the index case, the Liberian-American, Patrick Sawyer visited Nigeria in 2014.

According to Payette, if not for the swift action of the government, an outbreak of the dreaded virus in a thickly populated city like Lagos, would have simply spelt doom.

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She expressed delight that should another Ebola outbreak occur, the state was now ready and better equipped to handle such, especially with the launch of the new biosecurity laboratory and bio bank at the Mainland Hospital, Yaba.

“The bio bank will have the capacity to process and rapidly identify samples suspected for Ebola, Lassa fever and other infectious diseases with epidemic potential,” Payette said.

The biosecurity laboratory funded by Canada, through its Global Partnership Programme (GPP) in partnership with Lagos State, will serve as a single repository for all high-concentration pathogens. The lab will also help the state and country to mitigate post-EVD threats, and build capacity for prevention, detection and response to future outbreaks in the country.

After the successful management of the 2014 outbreak, the government took steps to ensure that it is not caught off guard in the event of another outbreak, but sadly, some of those steps were not sustained.

For instance, at many border posts and entry points, the basic screening of travellers, which was the norm during the outbreak of Ebola virus has since come to an end, while safety practices, including the use of hand sanitisers by many have since been jettisoned.

Currently, at the Port Health stand of the Seme border post, medical instruments like the thermometer that were constantly on duty are now perpetually at rest, as no legal or illegal entrants to the country are examined for the deadly Ebola virus.

The scenario is not different at the Muritala Muhammed International Airport, Lagos, where visitors and those returning to the country are having their way without any form of medical screening.

At most inter-state parks, immediately after the outbreak, it was also the norm for passengers about to board vehicles to be screened for increased body temperature. That no longer goes on as things have returned to status quo ante.

Even when The Guardian visited a number of parks around Festac Town and Mazamaza area of the state, where international travellers heading out to West Africa countries embark, the practice of checking passengers body temperature has been abandoned.

It is in the light of this development that many are still of the view that had Sawyer come into the country through any of the land borders, and not through the airport, it would have been disastrous for the country as chances of evacuating him to a first-class medical facility would have been remote, while he would have had contacts with as many people as possible.

Former Head, Department of Primary Healthcare and Disease Control, Badagry Local Council, Dr. Akintayo Adebayo agrees that matters would have been worse if Sawyer ventured into the country by land because of poor medical facilities around those corridors.

“Medical practice is not well regulated in those border communities, including Seme. There are also very porous, legal and illegal entry points across the country, where medical and paramedical practitioners from other West Coast countries take advantage to provide informal medical services. Inadequate knowledge of infection prevention and control also exist in areas like these,” Adebayo said.

He explained that even though Lagos State government has taken some bold steps to ensure proper regulations of medical practice through the Health Facility Monitoring and Accreditation Agency (HEFAMAA), these communities need to complement government’s efforts by prompt patronage of registered medical facilities for the management of medical problems.

“In all fairness, there is a very strong disease surveillance and notification structure in Lagos State. Therefore, I think the state is alert. However, there is need for proper orientation amongst all stakeholders. Currently, there is religious/traditional belief interference in reporting and management of illnesses. This may frustrate government’s efforts to ensure disease conditions are properly identified or evaluated, by trained professionals to reduce spread of infections.

“Continued awareness is necessary, just as capacity building. Adequate funding and deployment of real-time applications gadgets are very essential to capture information on reportable diseases. This will facilitate prompt information sharing for containment of infectious diseases, for research and development,” he said.

On steps that should be taken to ensure that the society is not caught unawares, Adebayo said there is need to activate comprehensive healthcare centres with full complement of medical personnel, appropriate equipment and robust sustainable drug revolving scheme.

He added that continued surveillance of the corridors and border towns for unregistered medical facilities remains critical, aside from promoting community informants’ platforms for disease surveillance and notification, including maintaining intelligence gathering for security threats and bioterrorism potentials.

One of those that took active part in checking the spread of the last Ebola outbreak was Dr. Oridota Sofela, a lecturer at the Lagos University Teaching Hospital (LUTH).

Sharing his experience, he said the process of halting the last Ebola outbreak was great as it provided an opportunity for many things to be put in place.

For instance, “presently, there is coordination between Nigeria and our neighbours, which has been established since last year. There is also surveillance going on at our borders. This is because we have tried to make something out of all the lessons learnt. This is also to make sure that we are better prepared, as health workers in case of another outbreak. The new laboratory that has also been set up in Lagos is part of the response.”

Also, “from that time till now, the National Centre for Disease Control (NCDC) has put in place some laboratories that can actually do a lot different from what we used to have, although we still have some areas of challenge.”

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He disclosed that recently, a simulation exercise was carried out at the Lagos University Teaching Hospital (LUTH) as part of efforts to ascertain trans-border emergency response capacity.

Sofela explained that in addition to this, several trainings on Infection Prevention and Control (IPC), have been scaled up quietly because, “there are diseases that are not here, even though they are rare, but they could still happen anytime. So, surveillance has started on them, with stakeholders meeting to look at how to do something nationally about them.”

He said as a result of the nexus between zoonotic diseases like Ebola fever and Lassa fever, an inter-sectorial collaboration between professionals in agriculture, veterinary doctors and medical doctors is imperative. “We call it One Health. In some countries, they have taken One Health to several levels. We are going to get there soon. because it is not difficult with adequate planning… So there is a strong inter-sectorial collaboration now and I think we are better prepared, but the bulk of the work is with the public, I will love it if the people are hygiene-conscious and take environmental sanitation seriously. With necessary precaution taken, our mind would be at rest that the people are prepared. Once that happens, we in the health sector do not have a choice other than to protect ourselves and brace up because people will come to us when they are sick.”

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