NAIROBI, KENYA: Leaders in the health sector are blowing hot and cold over Ebola preparations even as the risk of the virus entering the country hits a new high.
Since Wednesday and for the next 16 days, Kenyans will be holding their collective breath over the fate of nine returnees from West African who are under home restriction and being monitored for Ebola.
Another development which puts individual Kenyans in harm’s way are hundreds of health workers preparing for a voluntary mission to the affected countries in coming weeks.
Health authorities are so worried over this, that on Friday, it was a major point of discussion at an East African regional meeting in Nairobi.
It has also become an issue of contention in the United States with politicians wanting returning health workers from Ebola-hit countries to be put under quarantine.
However medical experts are warning that this could discourage other health workers from volunteering to work in the affected countries consequently slowing the fight against the virus.
Worried that poor countries many not send enough volunteers because they lack the capacity to evacuate or treat those who may get infected, the US is considering options which include flying them to American treatment facilities.
“We are discussing a contingency plan for emergency evacuation of health workers in the event of acute illness or Ebola infection,” says Dr Nicholas Muraguri, the Director of Medical Services. “We highly appreciate those who are volunteering. They are now more than 600, and we shall treat them like heroes for sacrificing to go confront the enemy before it can hurt their motherland.”
SIGNIFICANT PROBLEM
While Kenya has the capacity to treat patients with hemorrhagic infections, he says evacuating them safely from abroad could present a significant problem.
As Kenyans pray that those who returned from West Africa remain healthy, there is a sense of a calamity in the eleventh hour. This is made worse by conflicting signals from leaders in the medical sector.
Victor Ngani and Moses Lorre, chairs of the Kenya Medical Practitioners, Pharmacists and Dentist Union and the Association of Kenya Medical Laboratory Scientific Officers, respectively, had until Tuesday repeatedly said Kenya is not prepared to handle the virus.
“Anybody telling you that Kenya is prepared to deal with the virus is deliberately being dishonest or does not understand how the healthcare system works,” Ng’ani had been quoted in the local media two weeks ago.
Among his concerns was inadequacy of isolation wards in Kenya’s medical facilities with Kenyatta National Hospital now putting up a 40 bed unit.
These beds, Mr Ng’ani says are too few in case of an epidemic and wanted to see more.
Similarly, Lorre has also been calling for more specialised laboratories at regional hospitals to deal with the Ebola and such viruses.
They have also been concerned about training and information materials and generally public awareness. But a meeting with the Ministry of Health early in the week seems to have cured these problems. “We are now happy with the measures the government has been taking in the last few weeks and we think this is the right direction,” Ng’ani said on KTN on Tuesday morning. Lorre shared the same sentiments.
“The information we are getting out here is very confusing and we need to separate partisan interests, fear mongering and facts,” says Dr Dominic Karanja, a former chair of the Pharmaceutical Society of Kenya.
When completed, the 40-bed isolation facility will give Kenya a bigger capacity than the US which currently has a 20-bed capacity spread across four institutions. These are National Institutes of Health (7 beds), Emory University Hospital (2 beds), University of Nebraska Medical Centre (10 beds) and Saint Patrick Hospital which has a bed.
The Director of Kenya Medical Research Institute (KEMRI) professor Solomon Mpoke says they have the capacity to deal with any eventuality and to even assist some neighbouring countries.
Between KEMRI and the US Centres for Disease Control and Prevention, they run two of what are called Biosafety Level 4 laboratories at the Nairobi headquarters which handle organisms such as Ebola, anthrax or Marburg.
Mpoke says KEMRI will also be handling possible Ebola samples from Tanzania, Ethiopia and other regional countries which lack the capacity to do so.
According to the head of Centre for Virus Research at KEMRI, Dr George Nakitare, they can now test 30 people in every five hours.
“This includes confirmatory and quality control testing and it would take something much bigger than what is being experienced in West Africa to exhaust our capacity.”
Such facilities which handle highly infectious agents such as Ebola, anthrax and Marburg are expensive to establish.
"Our laboratory cost about Sh200 million and was put up almost 10 years ago," said Dr Nakitare.
But more importantly, such facilities world over are considered high security zones and no government is willing to establish them in every village.
Dangers they pose include the possibility of live viruses accidentally escaping into the environment, infecting workers or getting into the hands of terrorist groups.
In 2010, US Senator Dick Lugar led a delegation to KEMRI and expressed fear that its location is not safe enough to secure deadly biological organisms.
"Al Qaeda and other terrorist groups are active in Africa and it is imperative that deadly pathogens stored in laboratories are secured," he had said and offered US assistance to secure KEMRI further.
But preparations on paper, Dr Benido Impouda of the World Health Organisation says, are not any guarantee because they have seen cases of well-prepared health workers take to their heels when real cases are brought to their hospitals.
At a recent East African Regional meeting in Nairobi, Impouda said good sense is the key in fighting the virus.
"Every health worker, especially in Africa, is well trained in handling infectious organisms because these are numerous in our hospitals, thus there should be be no excuse why we cannot handle Ebola safely," Dr Nakitare told the Sunday Magazine on Thursday.
Absence of good sense is partially being blamed for the entry of the virus in the US after the first patient from Liberia went home from hospital even after shjowing Ebola like symptoms and reporting that he had been in an Ebola-hit country.
CAREFREE ATTITUDE
Nina Pham, the nurse who was treating the Liberian national in a Dallas, Texas hospital was infected despite being fully kitted and the hospital having the official protocol.
It was largely though that happened due to a breach of treatment procedures,
And there lies what could be Kenya's weakest link in stopping the disease once it enters the country.
Last year, researchers from KEMRI published a study showing that a high number of health workers in public facilities were unnecessarily exposing themselves to injuries and contaminated fluids.
The study, led by Everline Muhonja Mbaisi and published in The Pan African Medical Journal, said poor or lack of training, negligence or a carefree attitude was responsible for most of the injuries.
The team studied 246 health workers who included doctors, nurses and laboratory workers at the Rift Valley Provincial Hospital, Nakuru. In a 12 month period, some 81 incidents of injuries or exposure to patients' body fluids were observed.
Contact with contaminated body fluids is the single biggest risk in contracting the Ebola virus.
Even after contact with the patient's blood, the workers are shown to have washed their hands only with running water without disinfection. More than half took no action, not even reporting the accidents as should be the case.
"Only a few of the workers used disinfectants to clean the injured site, while others squeezed the site probably due to lack of knowledge about what immediate action to take," says the study.
While lack of protective gear and other equipment was blamed for this state of events, the researchers says many workers were failing to follow known operational procedures.
It blamed this on ignorance, lack of training and bad attitude.
When it comes to Ebola, some grey areas exist in the information being given out to the public. For instance, it is said Ebola is not airborne and cannot be transmitted through the air like tuberculosis.
However, some animal studies have shown that sneezing could be a possible mode of transmission.
In one of its reports on Ebola, the World Health Organisation says men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery.
