NAIROBI, KENYA: When Liberian-American Diplomat Patrick Sawyer landed in Lagos, Nigeria on July 20, 2014, he was visibly ill, having come from burying his sister who had died of Ebola in Liberia.
He collapsed at the airport and was taken to hospital, where he insisted that he only had malaria. Three days of malaria treatment had no effect and the admitting doctor and the hospital director detained Sawyer, in spite of threats from Liberian authorities, to run Ebola tests. Sawyer was confirmed to have Ebola and died shortly thereafter. The doctor who attended him, Dr Stella Adadavoh, also contracted the disease and died.
Lagos, with a population of 21 million, was poised for unprecedented disaster but three short months later has been declared Ebola free by the World Health Organisation.
Here are the 10 things that helped Nigeria contain Ebola so efficiently.
Early identification: The index patient, aka patient zero, is the first patient in a population to be identified with a disease outbreak. In Nigeria’s case, it was Patrick Sawyer and he was identified and quarantined early. Kenya is equipped to quickly identify its own patient zero through enhanced surveillance across all 34 ports of entry (both land and airports). We are doing 100 per cent screening of passengers at JKIA. Eleven Infra red thermo scanners will be installed in three international airports and major land ports—Namanga, Busia and Malaba to improve surveillance.
Good governance: The Government of Nigeria responded quickly, allocating generous amounts of money and disbursing those funds quickly to deal with the situation. A presidential decree was issued, enabling officials to access mobile phone records and use law enforcement agencies where necessary to track down people at risk. Even the hospital that received Patrick Sawyer was obviously well governed. The admitting doctor and hospital director stood their ground and refused to release Sawyer in spite of alleged pressure from his Government. This helped to confine the spread of the disease. Similarly, the Government of Kenya has released funds to support the ebola preparedness and response plan.
Laboratory facilities: Nigeria has first-rate virology laboratories equipped, and staffed, to quickly and reliably diagnose cases of Ebola. Kenya’s Kemri laboratories are recognised as regional centres of diagnostic excellence. We also have WHO reference laboratories supporting Ebola diagnosis for Kenya and other countries – Southern Sudan, Tanzania, Somalia and Ethiopia.
Outstanding detective work: Nigeria did a world class job of contact tracing, where they tracked down and ISOLATED the 20 people and their families who had been in touch with Patrick Sawyer at First Consultant Hospital. Through this, the Nigerian Government found 898 people that the initial 20 had been in touch with and these 898 were visited EVERY DAY for 21 days to check for the first symptoms of Ebola. Kenya has trained rapid response teams and other trained in contact tracing.
Excellent awareness campaigns: According to WHO, a previously used polio immunisation campaign was repurposed to encourage the early reporting of Ebola symptoms. One of the key messages was that early detection and supportive care greatly increased an Ebola patient’s prospects of survival. They sold hope and it worked. The Government also went door to door and spoke to everyone living within a two kilometer radius of those infected. That was a total of 26,000 families.
Our ministry’s newspaper and television campaign has informed the citizens of the dangers of Ebola, how it is transmitted, how to avoid it and what to do if one suspects they have contracted it. An elaborate public awareness campaign using mass media – radio and print advertisements in English, Swahili and vernacular languages, as well as social mobilisation using faith-based forum will be activated.
A fully functional emergency command centre: When Nigeria was trying to eradicate polio several years ago, the Gates Foundation helped to fund a command centre, fully equipped with GPS tracking equipment to ensure that children were tracked down and given their polio shots. When Ebola made its appearance in Nigeria, that centre was converted to handle the emergency operations of Ebola.
Hydration: Several of the doctors who got the disease say that drinking at least five litres of water/salt and sugar oral rehydration solution was one of the main reasons for their recovery. “You don’t want to drink anything. You are too weak, and with the sore throat it is difficult to swallow, but you know when you have just vomited, you need it,” Survivor Dr Adaora Igonoh told The AP. Ward reconfiguration: When Ebola was first identified, patients were scared to go into the wards because of proximity to infected people. When hospital authorities discovered this, they spaced out the beds in the wards and placed a basin of chlorinated water between beds so that people could disinfect their hands thus minimising their chances of infection.
Nigerians were practical about the reality of Ebola: Citizens did not delude themselves about Ebola. They sought treatment early, in the hospitals, instead of trying to self-medicate. Early intervention ensured a quick recovery rate.
A little luck: Patient Zero had definite symptoms and was very ill at the airport in Lagos so he was easy to identify, whereas other countries have had people who remainasymptomaticfor many days. It was also lucky that none of the other people on the flight got infected even though Sawyer apparently vomited before, during and after the trip. Nigeria was also lucky that there were 10 experts from the Centre for Disease Control (CDC) in Lagos at the time, and that they had access to the fully-equipped command centre donated by the Gates Foundation. Kenya has 150 specialists in infectious diseases control and management. We even sent our team to support capacity building in Liberia in July.
Mr Macharia is the Cabinet Secretary for Health