Leveraging on Nigeria’s Ebola epidemic to manage future events
NIGERIA was on October 20, 2014, declared free of the Ebola Virus Disease (EVD) transmission by the World Health Organisation (WHO), three months after an infected Liberian man, Mr. Patrick Sawyer, arrived by airplane into Lagos, Africa’s most populous city.
The man, who died in First Consultants Hospital, Obalende, Lagos, five days later, set off a chain of transmission that infected a total of 19 people, of whom seven died including Dr. Ameyo Stella Adadevoh who diagnosed the index case.
Seven months on, to prevent future outbreak of Ebola in West Africa and to be better prepared for possible epidemics, the World Bank Group (WBG) and the World Economic Forum in collaboration with the Boston Consulting Group (BCG) gathered medical and economic experts on Monday May 4, 2015, at the roundtable in Lagos.
The experts brainstormed on Nigeria’s recent experience with the Ebola epidemic and lessons learned for future national and regional public-private action.
The experts were unanimous that Nigeria is not fully prepared to withstand future outbreak of the deadly Ebola Virus Disease (EVD) because of poor diagnostic capacity and weak health system.
The experts include: Commissioner for Health Lagos State, Dr. Jide Idris; a public health consultant and former Chief Medical Director of Lagos University Teaching Hospital (LUTH) Idi Araba; Prof. Akin Osibogun; Chair, Adadevoh Trust and younger sister of the ‘Martyr’ of Ebola fight in Nigeria, Dr. Ameyo Adadevoh, Dr. Ama Adadevoh; Chairman/Chief Executive Officer of Heirs Holdings, Tony Elumelu; Managing Director, GSK, Lekan Asuni.
Others include: Programme Leader WBG, Ayodeji Odutolu; Mayor, Paynesville City, Liberia, Cyvette Gibson; Director PharmAccess, Pieter Walhof; Chief Medical Director of First Consultant Clinic, Dr. Benjamin Ohiaeri.
They recommended among other things: the development of diagnostic capacities in individual countries and establishment of a regional laboratory; continued training and re-training of medical personnel; institutionalizing clinical practice governance in hospitals; setting up legal frameworks to address the challenges; incorporate a wider scope of partnerships, innovations, particularly within the business community and through unprecedented forms of public-private cooperation; and establishment of new platforms of public-private cooperation to manage future outbreaks more effectively and to manage the risk of their occurrence.
The experts also eulogized late Dr. Ameyo Stella Adadevoh of First Consultant Clinic Obalende, Lagos, who diagnosed the incidence case of EVD and first Nigerian to die of the virus.
They also promised to support the Dr. Ameyo Stella Adadevoh Health Trust, a non-profit organization set up to foster connections and partnerships between key stakeholders to achieve its core objectives in the areas of public awareness, medical education and simulation training, health policy, and medical research.
Dr. Stella Ameyo Adadevoh raised a red flag when attending to a Liberian patient at the First Consultant Hospital. Patrick Sawyer had just flown into the country, already sick – he should never have been allowed on the plane.
Nigeria had never had an Ebola case before so it was an impressive piece of diagnostic work. Whilst caring for Mr. Sawyer and protecting the nation from the virus, Adadevoh and her colleagues were themselves at great risk.
Mr. Sawyer died in the hospital from Ebola. Adadevoh and eleven of her colleagues caught the virus. The younger sister to Stella Adadevoh, a medical doctor that practices in the United States was one of the panelists at the World Bank Forum.
Ama Adadevoh told the participants: “I believe that the Nigerian government and private sector were not prepared to the Ebola outbreak. We were not prepared. We did not have functional isolation centre.
Going forward we need to improve in training and preparedness. There should be emphasis on training at all levels of health care. Why Nigeria was successful was the identification of the index case.”
Ama Adadevoh in an exclusive chat with The Guardian said: “I am currently based in the United States where I practice. I actually came to Lagos to attend this event today because as you know my sister was the doctor who correctly identified and contained the index case of Ebola in Nigeria last year.
So it is very important for me to be a part of this Ebola- the lessons learnt event being hosted today.” On her take regarding how the situation was handled in Nigeria? She said: “Well what I think is that the country as a whole were not prepared for this Ebola outbreak even though it had been going on in West Africa- in Guinea, Liberia and Sierra Leone- for many months.
Having said that even the United States were not prepared when their index case arrived but what I meant is that we didn’t have even one doctor trained to handle Ebola at the time.
“ The first doctor who treated patients in Nigeria was an American doctor working with the WHO. Nobody here was trained; there was no functional isolation facility, and no protective gear as it were.
We didn’t even have any protocols as to what do you do when an Ebola patient shows up. What is the protocol? Call the government? What do you do with the patient?
That was why I was saying earlier that in my opinion Patrick Sawyer shouldn’t have been kept at First Consultants because it wasn’t equipped to handle that kind of illness and in him being there and being treated there until he passed away, all the healthcare workers including my sister got exposed.”
Going forward, what should be done in case of future Ebola outbreak? Ama Adadevoh said: “I think we definitely have to be prepared and at the core of our preparedness in my opinion is training.
Healthcare workers across all levels should be trained very adequately in how to respond when this kind of thing happened. Obviously public health education was also important which was done pretty well.
Educating the public as to what the signs and symptoms are and what to do.” How far with the Dr. Ameyo Stella Adadevoh Health Trust? She said: “The trust was set up in my sisters honour and to continue her legacy of providing first class healthcare to her patients.
It is a non-profit registered in Nigeria and our main initiative is training for healthcare workers at all levels. We realized that the healthcare workers are the backbone of the healthcare system and the biggest gap in healthcare in Nigeria is in training.
You may not realize that. We are going to establish a training institute and we are going to use a different kind of training called simulation training, which involves hands-on training not just learning out of the book, which has never been done before in Nigeria.
Our vision is to eventually impact healthcare not just in Nigeria but in whole of Africa.” Has it been launched officially? Ama Adadevoh said: “We haven’t had a formal launch.
We have had a soft launch but the formal launch has been scheduled for October this year.” Are you comfortable with what the government has done as regards to immortalizing your sister? “I am fine with what has been done so far,’ she said.
Idris said: “Are we prepared to handle another Ebola outbreak? My answer is that we are better off compared to where we were before the first situation.
Are we fully prepared? No. We have started testing at the point of entry and other measures we have introduced at state and national levels. But we are not yet there.
Our diagnostic capabilities are not there. Apart from Lagos we do not have laboratories that can diagnose Ebola in other states. We need to build those capabilities.”
On how Lagos was able to contain the Ebola outbreak, Idris said: “The main thing was leadership. We have a Governor that has a vision and did not hesitate to do what he had to do. Six years ago we sat down to look at possible emergency situations…
We had established the disease surveillance unit and a unit that was picking up dead bodies on Lagos streets, which we employed for contact tracing during Ebola outbreak.
We now call it incidence management structure.” Osibogun said training of the medical personnel and the quick diagnosis of the incident case were key to the containment of the EVD. He explained: “Training was very important.
The people at the First Consultant Clinic were able to contain the virus because they were trained. You cannot contain what you do not know. We had equipment for avian influenza containment that is PCR to characterize the virus.
So the training to be able to diagnose the case was there. We are fortunate that the virus came through Lagos. We got all the support from the Governor of Lagos State.
The Lagos State government did not have to wait for anybody and was able to enforce leadership. “So leadership is very critical as well as development of diagnostic capacity. These diseases will come in the near future.
These are mutants that will come. We need to develop a public health system to be able to respond on time. It is not yet over.” Osibogun added: “It is very important for us to make diagnosis. We need a regional laboratory that is capable of making EVD diagnosis.
Shortly before the incidence case of Ebola we got some support from Chevron to be able to set up Molecular Laboratory. If you have genomic laboratory you will be able to go to Deoxy ribonucleic Acid (DNA)/genetic material level to identify the strain of the virus.
“It is good for us to have one or two countries in the region with capability to make that diagnosis. Other laboratories should be able to have PCR. We should be able to go into the level of gene banking.”
“Although technology is necessary, it is not the solution. You could have all the resources and if your training is not good enough technology will fail. We should organize the private sector to buy into this, buy Chairs in universities and sponsor researches. I think it is a question of value systems.
I look into the National Honours and I don’t see any scientist. We need to change our value system maybe give tax reprieve to companies that support research.” Ohiaeri said all medical institution must put in place clinical practice governance.
He said it was during such meeting with late Adadevoh that the team made the prognosis that the index case, Mr. Patrick Sawyer, had EVD. Gibson, who narrated Liberia’s experience in tackling the virus, said the country “would be declared Ebola free by the World Health Organisation (WHO) in six days.”
Odutolu said the Forum, with the support of the Boston Consulting Group, will consult stakeholders from both the private and public sectors, including the United Nations, the World Bank Group, the African Development Bank and the Centers for Disease Control and Prevention.
The private-sector stakeholders include a wide range of companies and industries such as mining, healthcare and consumer goods. He said the effort will culminate with a short report and recommendations presented at the World Economic Forum on Africa on June 3 to 5 in Cape Town, South Africa, to support a high-level session on managing future epidemics through public-private cooperation.