‘Why Lassa fever may never be eradicated in Nigeria’

Dr. Talemoh Wycliffe Dah is the Director of Soteria-Afrique Rural Health Initiative and Consultant Gynaecologist and Obstetrician at Angelic Care Hospital and Maternity. In this interview with EMEKA ANUFORO in Abuja, Dah, who survived a bout of Lassa fever in his younger days, speaks on Nigeria disease surveillance system, the ongoing Lassa fever outbreak and other topical issues.

What is your view about the current Lassa fever outbreak?
Lassa fever has been with us since 1969, well, before 1969 when some missionaries contracted it and it was discovered. From time to time, there would be some resurgence and people will discover Lassa fever here and there. You will agree with me that it appears in many places and people die and are buried. You know how we bury people in some places. We don’t waste time. We don’t even want to do post mortem. Even in my clinic if somebody dies and I try to suggest post mortem, it would be resisted. For them, since it won’t bring back the dead so why bother.

Currently, some person’s die in some places and reports of Lassa fever are in many places now. My thinking is that it has always been there, and if you raise people’s awareness about a particular thing, it would look as if the incidence of that particular thing is rising.

Why would you get Lassa fever in Taraba, and then the next place you hear of is Ondo or Cross River or somewhere else? It is not as if it is a completely airborne thing and if it were airborne; it is going to cross over somewhere. Why would it take a long time before you see it in Adamawa, for instance, when it was there in Taraba? Could it be that it is because of the incident in Niger that we talk of Lassa fever? Places are beginning to report it in places where it was not reported?

There is greater awareness about it. Because of that, it is looking as if we are having an epidemic. It is not necessarily that. It may mean that this is an epidemic thing and people are beginning to be very careful about Lassa fever. They are beginning to associate certain symptoms to Lassa fever. Some people will die even before they get to the hospital and they won’t do post mortem and post mortem is going to cost more money. It needs experts, so it is not done.

It is an endemic disease and we have not been making enough noise to sound like people who want to stop it. If you are travelling anywhere in Nigeria, you will see either cassava is dried along the road. Corn and different other things are also dried along the road.

In our houses, we need to cover edible things. Rats roam around in the house mostly when people are asleep. People keep things uncovered for long. When we change our behaviour, the situation will improve tremendously. But since we have it endemic among us, it will take some time. It will take some effort. It will take a lot of communication to change their behaviour. Incidentally, it is behaviour that relates to our food. We still have cravings for Amala and other things and we will look for them. We don’t respect our commons. Those things we share are our commons.

We need a lot of work. Most of the work is communicative.

Is it possible that what we witness currently is under reportage?

In terms of the real incidence, yes we are under reporting it. Many people die and before any health person gets to them, they are buried. Even when it happens in the towns and people are asking questions, because of our religious beliefs, people will say no. We have been under reporting it and it has gotten to a point that it just happening by itself and increasing in number. I still want to reiterate that the current seeming epidemic is such that it is beginning to be reported with a little bit of seriousness, not necessarily that the incidence is increasing. The incidence is not increasing. That is what I believe. It is just that somebody makes noise and somebody says: ‘is that, we have it also’.

That is the situation, I think. Basically, I think that it has been under reported over a long time.

In terms of cure and vaccines, are there initiatives that you think we could adopt to hasten containment. Since it was first ‘discovered’ and given a name in Nigeria, so to say, what can we do?

There is medicine that if given to a patient early, he could pull through. Fatality is not 100 per cent. Also, if we get those who survived Lassa fever and take his or her serum and give somebody suffering it; the person is going to survive. But that is not common now because we have the drug. If you give the drug early, the patient will survive. But if you are late, you may not be successful. That is on the medical side. But like I said, our behaviour must change. We should change the way we do things. We have the ability to change this.

I will give you an example. I don’t eat kilishi. I don’t eat it because I know the way it is prepared. You get meat, cut it and put it in the sun. While it dries, flies come and perch. You then add seasoning and take it back in the sun. This doesn’t go down well with me. So, I don’t eat Kilishi. Now, I have discovered that when it is time to do the drying, the people making it now put it in wire gauze. While it is in the wire gauze enclosure, flies don’t perch and lizards don’t run across it. When they add seasoning, they put the meat back into the wire gauze; and they are making more sales now. With this, it is safe and no longer as dangerous as before.

It is possible to construct things where rural people can dry their stuff in something that is covered in a way that rats do not have access? This idea of rats dropping faeces and running across food that is dried on the roadside is dangerous. If we are able to change that behaviour, we can, to a great extent, reduce the problem.

You will agree with me that this is less in the township, because the rats are less. People eat packaged food much more than eating those things that are dried. So, you see that it is the rural people that are suffering it more. With time, perhaps our life style would change and the situation would improve.

If we want to aggressively stop Lassa fever, we need to adopt the public health approach. We need to speak to people and ask them to behave this way or that way. We need to constantly remind them to wash fruits before they eat. Don’t dry your stuffs around the road. Cook your food very well before you eat and all those kinds of messages. When people imbibe things, and I think Nigerians have the ability to imbibe things quickly, a lot will change. You saw the way people restrained from handshakes during the Ebola outbreak? That is the attitude. These will reduce Lassa fever drastically.

The Ministry of Health seems to have given a deadline to stop Lassa fever. Do you think the ailment could be stopped that suddenly?

It is very easy to do things that are seemingly more difficult than to change human behaviour even though with Ebola experience, I thought it was difficult. But I think I was proven wrong. I was proven wrong because Nigerians love life. If it has to do with lives, they are going to be more obedient. When Ebola came, I projected that we had two scenarios. Either Nigerians were going to escape it because they love life or it is going to be worse. If you say people should not board a certain flight because somebody on board has a fever that we are suspecting, somebody would bribe officials and board it.

A patient escaped to Port Harcourt. His doctor knew he had Ebola and went ahead to treat him. He didn’t tell his wife. He brought it home to them. They got infected and all died, including himself. You can imagine this kind of thing. We are very bold at the things we do. Based on that, one would think it would have been difficult. But Ebola proved us wrong. People just obeyed and Ebola stopped.