The Ebola experience- What can Nigeria teach the world?

What can Nigeria’s Ebola
experience teach the world?
My country made mistakes during its outbreak and it is
crucial that others learn from this when devising emergency
plans
A Nigerian port health official uses a thermometer
to screen Muslim pilgrims for Ebola.Photograph:
Sunday Alamba/AP
Ebola Polio Health Nigeria Africa
Sponsored by:
Bill and Melinda Gates Foundation
Oyewale Tomori in Lagos
Tuesday 7 October 2014 07.00 BST
As the US confirmed the first case of Ebola outside Africa,
world leaders and public health specialists are desperately
scrambling to control the west African outbreak. One of the
few bright spots is the success of Nigeria in controlling the
disease, which could have spiralled out of control in Africa’s
most populous country.
Ebola surfaced in Nigeria in July, but with the final patients
under observation given the all-clear, the country is now
officially Ebola-free. Nigeria was able to respond relatively
quickly, and use its experience in tackling polio to do so. As
we have seen in the US, all countries need to be better
prepared, with plans in place in case Ebola is imported.
Nigeria’s outbreak started when Patrick Sawyer, a Liberian-
American, flew into Lagos on 20 July. He was already
seriously ill and later died. In total there were 19 confirmed
cases and one probable case that stemmed from Sawyer’s.
Eight of these cases resulted in death and the last case was
officially detected on 31 August. Since then, no further cases
have been detected.
Nigeria had a head start over other west African countries. As
one of the last countries to still be polio-endemic, Nigeria has
been waging a war against the disease. A strong polio
surveillance system backed by an emergency command
centre, which was built in 2012 by the Bill & Melinda Gates
Foundation, has ensured agency coordination so that polio
outbreaks can be identified quickly and stopped. A cadre of
100 Nigerian doctors trained in epidemiology by
international experts, who have helped end polio in countries
such as India, makes up the backbone of the rapid disease
response team.
Pilgrims wait to be screened for Ebola before
boarding a plane for Saudi Arabia at Murtala
Muhammed airport in Lagos. Photograph: Sunday
Alamba/AP
With only six cases of polio this year, Nigeria is tantalisingly
close to ending polio and moving the world one step closer to
global eradication. But as soon as the Ebola outbreak
happened, it was imperative that Nigeria utilised the aces it
had up its sleeve.
Before Sawyer was identified as having Ebola, he had already
infected several people while travelling from the plane to the
hospital. Having denied being in contact with Ebola, he was
treated initially for malaria in a hospital with no infection
control. A nurse treating him later died and it was only when
malaria treatment failed that Nigeria’s first case of Ebola was
identified.
Once that diagnosis had been made, Nigeria mimicked its own
polio response and an Ebola emergency operation centre in
Lagos was set up. From the polio response team, 40 of the
Nigerian doctors trained in epidemiology were reassigned.
This centralised hub coordinated the Nigerian health ministry,
the World Health Organisation, Unicef, the US Centers for
Disease Control and Prevention, Médecins sans Frontières
and the International Committee of the Red Cross.
The response was flawed, it took two weeks for the first
isolation ward to open and health workers were initially
reluctant to work in it. However, 1,800 health workers were
eventually trained, protective gear was provided, and safe
wards with enough beds and access to chlorinated water were
set up so that patients could be treated safely. In total, health
workers made 18,000 visits to 900 people to check the
temperatures of possible contacts. As with polio eradication,
this wasn’t easy but it was imperative to stopping the disease
in its tracks.
Nigeria and the US both made mistakes when Ebola first hit. It
is important other countries learn from this and develop
emergency plans to respond quickly to stop it spreading.
Nigeria’s health system is fragile but the country is lucky to
have a comparatively high number of specially trained health
workers and a polio surveillance system, which helped
prevent an exponential spread. Sierra Leone, Guinea and
Liberia were less fortunate, the disease was allowed to get a
head start and prosper in the remotest rural villages that had
poor health infrastructure. But there is hope in all three
countries.
Teachers at Tundunwada secondary school in
Abuja warn students about Ebola during an
assembly. Photograph: AFP/Getty Images
As world leaders begin to break from their collective apathy,
the lessons from Nigeria are clear. There needs to be enough
trained health workers, equipment and facilities available to
isolate those showing Ebola symptoms in well-equipped
treatment centres. Accelerated action in west Africa,
specifically educating communities about the disease,
symptoms, treatment, contact tracing and how to bury the
dead, can end this virus. There are no short cuts, and urgent
international support is critical to building treatment centres
and stopping Ebola.
Nigeria cannot afford to declare Ebola over. The first
outbreak is but others may come. As with polio, until there are
no cases of Ebola, no one is safe from the virus.

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