I find it sad that President Goodluck
Jonathan, in his Independence Day speech, appeared to singlehandedly
claim the glory for Nigeria’s containment of the Ebola threat, by
telling us that his “directives to the Federal Ministry of Health saw
the ministry leading the charge in curtailing the spread of this deadly
scourge and managing its impact”, and by limiting his acknowledgement of
the efforts of others to vague references to “all Nigerians” and “the
medical personnel, some of whom made the ultimate sacrifice.”
That ongoing Ebola credit mêlée is for me
is a great opportunity to examine the totality of the Nigerian response
to the Ebola Virus Disease, and to advance the argument that Nigeria’s
positive Ebola outcome is the result of a multifaceted body of actions
and reactions – some of which happened long before Ebola arrived here –
that drew in many individual and institutional players, and in which the
state and federal governments merely played one of several important
roles.
Reducing the Ebola response to a
government effort – and that is what the debate about whether it was the
federal or the state government that made the difference sadly does –
not only completely mischaracterises the situation, but is also very
unfair to the several non-government parties who played active roles in
the containment response.
In fact, let’s face it, from a certain
point of view both governments failed in ways that could have had a far
more devastating impact than what eventually played out. The Federal
Government failed in not proactively instituting Ebola testing /
isolation measures at Nigeria’s international airports, despite the fact
that Ebola had already been ravaging Liberia, Ghana and Sierra Leone
for three months, and flights were regularly coming into the country
from all three countries. And we have since come to learn that there was
a memo from the office of the National Security Adviser to the Ministry
of Health, 10 days before Patrick Sawyer landed in Lagos, warning of
the possibilities of an outbreak in Nigeria. According to media reports,
there is no evidence the Federal Health Ministry took any steps to
activate a response.
The failing of the Lagos State Government
was one that long predated the arrival of Ebola in Nigeria. Here is how
Ada Igonoh, a doctor at First Consultants Hospital (she it was who
certified Sawyer dead), and an Ebola survivor, describes the “female
ward” she was admitted into at the state-government-run Lagos Mainland
Hospital – the main infectious diseases facility in a city of more than
15 million persons:
“I was shocked at the environment. It
looked like an abandoned building. I suspected it had not been in use
for quite a while… The sanitary condition in the ward left much to be
desired… The sheets were not changed for days. The floor was stained
with greenish vomitus and excrement… Mosquitoes were our roommates until
they brought us mosquito nets…”
One doctor who works there shared horror
stories with me, of how, long before Ebola, when the hospital focused on
managing HIV/AIDS and Tuberculosis patients, longstanding neglect by
the government had turned it into a place in which staff sometimes died
of infections contracted from patients, and to which doctors did
everything to avoid being posted.
The heartwarming sequel is that both
governments then quickly moved into action, and worked hard to mitigate
the effects of their initial failings. The Lagos State Government
assembled teams of volunteers to trace primary and secondary contacts,
offered incentives to the volunteers and to medical personnel, and
rushed to build a proper and habitable Ebola containment facility.
On its part the Federal Government,
through the Ministry of Health, set up an Emergency Operations Centre to
bring coordination to all private and public efforts. It also announced
a N200m donation to the Lagos State Government.
As important as the actions of the
governments are those of a large number of non-governmental players,
including but not limited to the following: The Ebola Alert volunteer
team (and other groups of volunteers), the World Health Organisation,
Medicins Sans Frontieres, and Nigerian philanthropic organisations (the
Elumelu, Dangote and Peterside Foundations which all made important
donations).
The Ebola Alert team is a group of
volunteers who set up an online response centre in the days after
Patrick Sawyer’s death. Led by Lawal Bakare, a young Nigerian dentist
turned graphic designer, it started on Facebook (assembling tens of
specialists from around the world – doctors, epidemiologists, etc – into
a virtual advisory council). The volunteers – young Nigerians, working
for no remuneration – then moved on to set up a Twitter account, build a
website, an online chatroom, and man a toll-free phone line. When I
spoke with Bakare early in August he said the helpline – then about a
week old – had received about 3,000 phone calls.
It was that set of responses, under the
‘EbolaAlert’ umbrella, that the federal and state ministries of health
would go on to adopt as their official messaging platform.
David Brett-Major is a former US military
doctor who now works for the World Health Organisation, in the Global
Capacities Alert and Response department. He was, from the accounts I
have heard, the man who, alongside his colleague Kamal Ait-Ikhlef, a
“logistician”, made all the difference in the containment and curative
approach to the disease. Dr. Igonoh sats that Brett-Major “would come in
once or twice a day and help clean up the ward after chatting with us.
He was the only doctor who attended to us. There was no one else at that
time.”
“(Brett-Major) built confidence in the Nigerian team,” Bakare told me in August. “He’s doing things nobody else wants to do.”
Also deserving of commendation is
Médecins Sans Frontières, which has been involved in the Ebola response
across Africa for many years, long before this latest outbreak. It has
also been been playing an invisible role in supporting Nigeria’s
healthcare system for years. A year ago I visited the Badia East slum
settlement in Lagos, which had, months earlier, been demolished by the
Lagos State Government, and was told by residents that between 2010 and
2012 MSF ran the community’s only health clinic. It hired and paid the
doctors and nurses, and provided an ambulance service. All of this, I am
told, was free of charge – MSF covered all the costs. (It becomes even
more interesting when you consider the role Nigeria play in the
formation of MSF, in 1971, by a group of French doctors who had worked
for the Red Cross on the frontlines in Biafra during the Nigerian Civil
War. Dismayed by what they saw as the Red Cross’ unsatisfactory handling
of the crisis, they founded the MSF).
There are also all the Nigerian
physicians and nurses and cleaners who eventually signed up to the
effort, no doubt inspired by the example of the WHO staff. The WHO
specifically mentions a certain Dr. Bowale as “the first Nigerian
physician [to commit] to direct participation in the care team at a time
when health worker panic was rife.”
Some gratitude should also go – somewhat
perversely, admittedly – to Lassa Fever, a viral hemorrhagic disease
like Ebola, also very deadly, but much less contagious. The disease,
which was first discovered in north-eastern Nigeria in 1969, and which
continues to break out across Nigeria from time to time, somehow
unwittingly helped lay the foundation for Nigeria’s diagnostic response.
The two laboratories that handled the testing and diagnosis of the
Ebola virus – one at the Lagos University Teaching Hospital, and the
other at the African Center of Excellence for Genomics of Infectious
Diseases (ACEGID) at Redeemer’s University – were originally established
to handle Lassa Fever.
The “availability of Lassa fever
diagnostics capability … enabled the timely diagnosis of Ebola virus [in
Nigeria],” Christian Happi, Cameroonian molecular biologist, and a
Professor in the Department of Biological Sciences at Redeemers’
University, told me by email in August.
The list of Ebola heroes is a long one,
as it should be. I should also mention the efforts of EbolaFacts.com,
another volunteer effort. The website, brainchild of yet another medical
doctor turned communications professional, Seyi Taylor (like Bakare an
alumnus of the University of Lagos medical school) instantly went viral,
and its contents soon showed up on flyers, digital billboards, and in
newspapers. It was one of the most successful new media responses to the
Ebola threat, providing, amidst all the misinformation, clear and
useful and simple information.
Here is what I think: the Ebola
containment story deserves a stand-alone presidential speech in which
every player is credited in some way or another. In a country that does
not do commemoration or celebration of real heroism very well (fat cats
being handed undeserving national honours or presidential pardons
doesn’t count!), the President would do well to set a refreshingly
different example.
Most importantly, now is the time to
start talking about how to start the much-needed reform of our public
health system. More than 30 years after a certain Brigadier Abacha
announced to a longsuffering country that its hospitals were no better
than “mere consulting clinics without drugs, water and equipment” – and
used that as a justification to seize power – nothing, sadly, has
changed.
