The Nigerian Ebola Story: The victors, villains and the victims.

The Nigerian Ebola Story: The victors, the villains and the victims.

“In the midst of this apprehension however, a woman displayed bravery. Dr Adedevoh discharged her duties without fear or favor. She defied the odds, upheld standard practice, spurned intimidation and threats from various powers and put her life on the line just to save Nigeria from an impending catastrophe! She and her team remained undaunted as they fight to contain a likely infectious disease!”

           Sometimes in July when Ebola Viral Disease (EVD) had taken virtually all attention and discussions of the World Health Organization (WHO), about the same time the world most populous black nation was about to be hit by this deadly and highly contagious virus. The good news however, was that the virus is not airborne and the disease cannot be transmitted during incubation period. As good as that sounds, palpable fear, trepidation and paranoia accompanies the mention of Ebola. In the wake of the epidemic in the region, somehow Nigeria was able to keep its own despite lack of a formidable frontier surveillance and weak port health vigilance, but this was not going to last forever, as a villain was about to capitalize on these inadequacies.

           The news of a sick Liberian diplomat –Patrick Sawyer, being admitted in a top-notch private hospital in Lagos sends shivers down the spine of all Nigerians. Both the poor and the rich were concerned; the leaders and the governed were terrified as that would be the first case of the disease in Nigeria since almost 38years of its existence. There was paranoia all over the landscape not only because of the untold physical, social and emotional hardship Ebola was causing in countries where the epidemic was ongoing but also questions about the disease presents a rather scary answers. The case fatality is very high, treatment options is only palliative, progress in the current epidemic was minimal and worst still, the possibility of Ebola in this diplomat was very likely with positive travel history to Ebola infested country, history of close contact with Ebola patient and manifestation of classical symptoms and signs of Ebola. 

              In the midst of this apprehension however, a woman displayed bravery. Dr Adedevoh discharged her duties without fear or favor. She defied the odds, upheld standard practice, spurned intimidations and threats from various powers and put her life on the line just to save Nigeria from an impending catastrophe! She and her team remained undaunted as they fight to contain a likely infectious disease! After few days, Sawyer’s blood sample sent to Senegal came back positive for Ebola virus, some days later he died. The doctors and other health care workers who attended to him became infected and the reality was dawn on all Nigerians –Ebola is here!

              Nigerians were disappointed. They blamed Sawyer for being callous and wittingly spreading the virus. The health sector got its share of the rage because doctors in all public health facilities nationwide were on strike and as such public health hospitals were not functioning optimally in the wake of the epidemic. Airport and port health officers were not excused also, they were practically uninformed and not sensitive enough to detect and prevent Sawyer from entering Lagos. No infectious disease expert, no quarantine stations and worst still no infra-red thermometers to detect high temperature amongst travelers. As it were, the port health service was incapacitated! Ignorance of the disease was widespread, fear was in abundance and logical reasoning became impossible for most folks. Before long, Nigerians became trapped in mediocrity, as some villains had hijacked the panic to dispel false and unfounded myth on prevention and cure of Ebola. The “salt and water” hoax and the bitter kola ‘magic’ were cases in point. Sadly, quite a number of people lost their lives in the process and became victims of ‘fear of the unknown’.

              The singular act of Dr Adedevoh had limited spread of the virus only to primary contacts of the index patient and coupled with world class epidemiological intelligence, efficient contact tracing and painstaking surveillance put up by the leadership of the former Governor of Lagos State; Babatunde Fashola, Ebola was not going to breathe in Nigeria for too long. Suddenly Nigerians began to align. Public Health advocates started using social media to provide accurate information on Ebola, toll-free number were made available to report any suspected case, banks and hotels started using infrared thermometers to screen for fever, orderliness returned to crowded bus stops and shopping malls and President’s display of hand sanitization  technique on National Television leaves Nigerians with no doubt about the importance of hygiene in the fight against the disease.

          Sooner than we thought, some contacts (mainly health care workers) began to succumb to the disease. Quite pathetic was the newly employed, pregnant nurse who just resumed at the hospital. She contracts the disease and died in the process. Nigeria’s heroine was also caught in this Ebola web. This was well captured by Dr Ada Igonoh in her story “she was in coma, receiving IV fluids and oxygen support and closely monitored by WHO doctors. It was difficult seeing in that state. I could not bear it. She was my consultant, my boss, my teacher and my mentor. She was the imperial lady of First Consultant, full of passion, energy and competence. I imagine she would wake up and see that she was surrounded by First Consultant family but sadly it was not to be”¹. It was a national tragedy and the country mourned her demise.

          While Nigeria was on track as regards Ebola containment, certain unscrupulous doctor in Port Harcourt was incubating another Ebola infected diplomat in a hotel. His motive for doing this was not clear but what was obvious was that, the action could start another cascade of the dwindling epidemic and sabotage the combined heroism of First Consultant Hospital and Lagos State Government. That did not happen though, as the brewing ‘fire’ was duly nip in the bud.

            At exactly three months after the invasion in July, Nigeria was declared Ebola free on 20th October 2014. Here we are, one year down the line and it seems we haven’t learnt much. What structures do we have in place to prevent a repeat of that Ebola experience? Have we strengthened our health system in anyway? How many indigenous Ebola vaccine trials are currently on-going in Nigeria? Are public health hospitals free from incessant strikes? Until we get the basis right, an efficient and effective health system will continue to elude us.

Guinea and Sierra Leone are yet to record zero Ebola case in over 20months of this epidemic. Liberia was declared Ebola free in May but is now experiencing ‘resurgence’ after a lucid period of about 2months. The risk seems to be mounting; building a resilient health system is a must if the region wants to prevent future epidemics and the time to begin is now!

                                                                                                                                    -   @Chartol1

1.      Through the valley of the shadow of death by Dr Ada Igonoh http:// www.bellanaija.com/2014/09/15/must-read-through-the-valley-of-the-shadow

COMBATING TOBACCO USE IN NIGERIA

COMBATING TOBACCO USE IN NIGERIA

"A wise king will prepare for war in the time of peace" – Horace

This truism is fitting for man’s experience with disease on this side of the divide. Right from the time man is born into this battlefield called EARTH; he is constantly in a supremacy battle with disease. The best time to engage in this inevitable war however, is the period of calm when he is at peace with his health. Medically, activities to checkmate diseases at this period is otherwise called primary level of prevention. There are other times in  disease spectrum when man can equally fight against diseases and this includes:

§  When he is sick with disease but the toll of this can still be reversed. This is called secondary level of prevention

§  When he is sick with disease but the toll of this cannot be reversed, with palliation offering the best case scenario. This is called tertiary level of prevention.

These two domains belong to clinical medicine and rehabilitative medicine respectively and tend to offer little or no chance at prevention in the strict sense of the word. However, primary prevention which is the domain of public health offers the best result as far as health and disease prevention is concerned. Useful tools to achieve this are health Information, health promotion, health advocacy, health policy, behavior change and lifestyle modification like physical activity, healthy eating, tobacco and alcohol control.

            Smoking is a dysfunctional health behavior that is associated with a lot of health and health-related complications; hence there is need for us to be aware and position ourselves appropriately to win this all-important battle against indiscriminate tobacco use. It should be noted however that it is the behavior of the users that is dysfunctional and not the person, because issues have to be separated from persons. Again, this is not a stigma placing venture but a behavior change adventure! Be that as it may, why do we need to control tobacco use in our community?

            Tobacco use is the single greatest preventable cause of death worldwide. It kills about 5.4Millon persons per year from lung cancer, cardio respiratory diseases and other illnesses like mental disorder. Smokers are 25times more at risk of dying from lung cancer- a disease which is simply preventable but largely untreatable. Interestingly, second hand smokers who by CHOICE (hangs around smokers) or CIRCUMSTANCE (environment where smoking is not regulated e.g. Motor parks, Prisons, Airports) inhale the smoke from tobacco users are equally at risk of lung cancer.

Moreover, tobacco smoke contains carbon dioxide and methane which are potent greenhouse gases (GHG). Also, tobacco farming requires a lot of wood for drying and as such more trees are chopped down causing Eco-system imbalance and acting synergistically with the greenhouse gases to cause climate change. This we must note however, regardless of our smoking status we all have to face the consequence of climate change. So a stitch in time saves nine!

Adaptive behavior change like quitting cigarette smoking may be difficult but it is very desirable for everyone and not just the smoker. Different mechanisms have been put forward to checkmate smoking tendencies amongst the populace and this has been conceptualized by WHO as MPOWER:

M- Monitor tobacco use and prevention policies

P- Protect people from tobacco smoke

O- Offer help to quit tobacco use

W- Warn about the dangers of tobacco use

E- Enforce bans on tobacco adverting, promotion and sponsorship

R-Raise taxes on tobacco

The Nigerian tobacco control bill has all these dimensions plus ban on sale of cigarette to minors. The benefits of this BILL is passed into LAW are immense and I think some are worthy of mention.

MEDICAL BENEFITS

1.      Reduced risk of dying from lung cancer and cardiovascular diseases.

2.      Acute exacerbations of chronic respiratory diseases like Asthma, Emphysema and Bronchitis will also reduce

3.      The risk of dependence, substance abuse and the attendant mental illnesses become infinitesimal.

SOCIOECONOMIC BENEFITS

1.      No risk of stigmatization

2.      Healthful participation with no discrimination

3.      Some broken homes will be averted

4.      Some orphans and juvenile delinquents will be prevented

5.      Extra cost on tobacco purchase will be saved

ENVIRONMENTAL BENEFITS

1.      Additional threat to climate change from GHG resulting from tobacco use will be removed

2.      Increased deforestation from tobacco farming will be no more.

Combating tobacco use is a collective effort; we all must stand together as the negative effects leaves no one without a mark. We need to arm ourselves with sufficient health information and must be ready to change our behavior to suit the life style of a warrior. Prevention is KEY, Behavior change is CRITICAL and Tobacco control law is ALL IMPORTANT!

This sums it all

Smoking might seem pleasant. Its produce leads straight to death.

However, its victim signs the contract.

They get trapped wanting to stop but the addition won’t let go!

When pain comes and anguish multiplies they cry for help.

Then it will be too late as the lungs cannot be salvaged.

Slowly but progressively life eases out of them.

Others watch in panic, desirous of a genuine succor.

Indeed, there is no help in any other except a Tobacco Control Law.

This is it! Lets us support the passage of Tobacco Control Bill.

          
Your health and behavior change advocate,  
 @Chartol1 

HIV/AIDS AND THE TETRAD SOCIAL EVIL

              HIV/AIDS AND THE TETRAD SOCIAL EVIL

     Sarah has been having fever for some months, regular antibiotics and antimalarials seem not to produce any remarkable improvement. Occasional diarrhea makes her weak and feeble. She daily longs to be with her husband, Abubakar, a military man who was recently posted to Mubi (Adamawa, Nigeria) because of the activities of BokoHaram (BH). Sarah, mother of two, will not visit the hospital, let alone have a test done. Her reason she says was personal! Days glided into weeks, weeks to months but her symptoms would not abate. A local Nurse who is also a friend broke her obstinacy and brought her to the hospital. History taking revealed husband’s occupation as military officer with over 10years of service; one who visits his family once in six months and had a history of multiple sexual partners.

   

      Thereafter, the doctor counseled her and requested for a HIV test.  Immediately, the atmosphere became quiet and Sarah’s fear became palpable. She looked towards the Nurse and like a sheep to the slaughter, she was dumb! She tried to pull herself together but tears failed her. She knew she is HIV positive but the social implication of her status threatens her to the marrow. With tears she retorted, "Doctor, I cannot stand the shame and the rejection that my children and I will go through, my husband will obviously take another wife and my children will probably be forced out of school.” She cried and cried…

                                            *********

     Another world HIV/AIDS day is here and I think we need to spare some thoughts for innocent women like Sarah as they battle stigmatization, discrimination, neglect and ostracism alongside a positive HIV status. I need not tell you how HIV is transmitted because you know! I need not bother you on how the virus ruins the immune system because you are aware! I need not emphasize that AIDS has no cure because you are well informed! But I must bother you on behavior change towards victims of HIV/AIDS because it is a threat to pleasant relationships, economic privileges and social order!

     Stigmatization is an act of putting negative distinguishing mark on people because of their experience. Just when you start referring to someone whose name you know as “HIV patient”, there and then you have started stigmatizing. It may be subtle at first but the societal implication is deep seated. It is a name no one wants to bear for obvious reasons. So when next you come in contact with people with HIV; give them a handshake, hug and reassure them, it will go a long way. The virus is not spread through casual contact!

     Discrimination on the other hand is a social disadvantage placed on people with HIV. This is moving a step further; it puts a restriction on patients’ social participation and interaction. However, we need to be aware that, this action is capable of preventing voluntary disclosure of status. Loss of Job, employment difficulties, limitation of participation, restriction of travel, are possible channels of discrimination. That young qualified graduate that was refused an employment because of his HIV status is being discriminated against. That middle age woman whose visa will not be processed because she is living with the virus is being discriminated against.

     Neglect by family and community members also constitute a social evil imposed on People Living with HIV and AIDS (PLHA). We've heard stories of husbands neglecting their spouse because of HIV and vice versa. Stories of extended family members denying bereaved mothers and children a living and livelihood because the breadwinner died of AIDS are common around us. Unavailability of antiretroviral drugs, lack of care and social support for AIDS orphan, PLHA, People Affected By AIDS (PABA) cannot be overemphasized.

      The last strike and definitely the most severe is ostracism. Countless number of people have been sent out of their communities and abandoned in various leprosariums all over the country. This punitive measure meted against leprosy patients is gradually creeping into the way HIV/AIDS patients are being handled. Contrary to widespread myth however, HIV/AIDS is not ‘special’ because:

1. It is a chronic, incurable disease like cancer, hypertension and diabetes
2. It is blood borne like Hepatitis B and C  virus
3. Sexually transmitted like Gonorrhea, Syphilis and Herpes
4. Preventable  like every other diseases of public health importance

Therefore, the paranoia and disgust associated with HIV/AIDS is baseless and unfounded. Truth be told, we will be doing ourselves a great deal of favor if we change our behavior towards HIV/AIDS victims. If we stigmatize them, they won’t own up to their status, this will lead to concealment of cases and ultimately to clandestine spread of the virus. If we discriminate against them, they will be furious and this can lead to vengeful spread of the virus. Whichever way, more people will become infected, the burden of the disease multiplies and more deaths ensue.

      The UN secretary general Ban KI Moon says “stigma is a chief reason why AIDS epidemic continues to devastate societies around the world”. 

     

     Lets us not forget the increasing spate of insurgency around the world and its effects on HIV/AIDS ; Al-Qaeda, Al-Shabaab, Islamic State of Iraq and Syria (ISIS), BokoHaram etc, all tend to increase the number of internally displaced persons and refugees with disruption of family lives and homes, consequent upon this can be spread of diseases like HIV/AIDS. 

      The abduction of over 200 school girls in Nigeria over 7months ago with theories of them being married off to unknown men or the possibility of them being used as sex slaves is not only heart breaking but pathetic especially if HIV transmission is found in the mix.

      Time will fail me to talk about rape and forced marriages, whose victims are now suffering from HIV/AIDS. The sad episode may get worse, the frustration may escalates and the hopelessness may become irretrievable if we continue to stigmatize, discriminate, neglect or worse still ostracize these innocent souls. Our behavior must change and the time to start is now! Stop the Stigma, Don’t Discriminate, No to Neglect, Oppose Ostracism and End this social Evil. 

 




N.B- The names in this article are fictitious-any coincidence is not intended.

REJECTING HEALTH, PROCLAIMING IGNORANCE

               REJECTING HEALTH, PROCLAIMING IGNORANCE
   

    Health status remains one of the determinants of wellbeing that is often underestimated, taken for granted and least appreciated; nevertheless it remains core to our continued existence on this side of the world. It should be clear to us that, not even our occupation, belief, social status, educational attainment on their own can bail us out when our health fails. A patient with serious debilitating disease will probably not go to work, neither will he attend functions, nor remember his beliefs but his only desire will be to get healed. Furthermore, quality of life of the citizens of a country is no longer dependent solely on the Gross Domestic Product (GDP) of such nation, but also on life expectancy at birth (which is a health status indicator) and literacy level of the populace. If not, how do you relate a country with the largest GDP in a continent yet majority of its citizen struggle daily to meet their basic physiological needs of food, shelter and clothing? A nation where achieving security needs is practically impossible. A land where meeting one's social need is considered out of place and aspiring to attain one's esteemed need would mean asking for too much. In this part of the world, the vicious cycle of poverty, ignorance and disease is inseparable!

   

     Learning from the foregoing, health status is not only a determinant of an individual’s wellbeing but it is also an economic parameter that measures the wellbeing of a country. If our health status is so sacrosanct to our general wellbeing, why are some folks handling it with so much levity and triviality? Truth be told, if health is not lost there is no point trying to restore it. Staying healthy like I always say is cheaper than getting treated, it however requires some commitment like searching for correct health information, sustaining healthy lifestyle through discipline and psychological training and re-training. The recent “Ebola and salt water hoax” however shows how far we are lagging behind. Why do we discard sound health information and keep proclaiming ignorance despite the resources at our diaposal? Here are some reasons:

     Firstly, people are most times lazy and tend to respond only to easy solutions. Getting things done fast, easy and at practically no cost has blinded us to the most obvious facts of life. Sadly, this mindset has invaded not only the way we handle our health or information related to health but other facets of our lives has also suffered.If salt and water could cure Ebola why would United States be spending so much to manufacture a vaccine? Why would grants be given solely to develop a drug, if common table salt and water at any random concentration was equally effective? Health Information is everywhere, yes; on Google world, Twitter street, Facebook domain etc, but always check with a medical professional, you might just save yourself from a catastrophic health event! Information is power but negative information is paralysis in itself.

     Moreover, terms like health risk, risky behavior and relative risk seems intangible and distant to most people. The notion that, if it is not happening to me now, it can never happen to me should be very well considered. Hypertension for example is primarily a hereditary disease; also men with hypertensive parents have over four-fold increase in risk (chances) of developing Hypertension after the age of 30-35years. This risk can be increased further by indulging in risky behaviors like smoking, drinking alcohol, increased stress and increased salt intake. In other to reduce the risk of hypertension in such people, we do advise them to quit smoking, stop drinking, reduce salt in diet, avoid too much stress, exercise more and take more fruits. These are scientific facts which holds true in most cases. My sincere appeal is that if you are at risk of hypertension, do not wait till stroke sets in and you can't move your limbs. Consult your physician for check up and begin those lifestyle modification stated above in earnest.

     Lastly, people’s priority and problems also cloud their sense of judgment and affect their disposition towards sourcing or using health information at their disposal. Truly if one can’t figure where the next meal is coming from, one might probably not be bothered if the food one gets after waiting for two days or more was prepared in the toilet. This cycle of poverty, ignorance and disease has to broken at some point. The preponderance of poverty in this country is only a pointer that our government really needs to do more. Be that as it may, ignorance which is the next culprit is a choice we have to make. If we choose information we get good health in return but if we choose ignorance we get disease and as such perpetuate the vicious cycle. For so many people, health information is still regarded as intangible and should not compete with more tangible realities in their lives, but is that position safe? Remember if one's health falters, life may crumble. Maintaining healthy status is an end, getting sound health information and implementing it through a positive behavior change is a means to this end. Health they say is wealth, but shall we continue in ignorance and expect our health to blossom?

 
                                                                     

BRIDGING BEHAVIORAL CHANGE AND DISEASE PREVENTION

BRIDGING BEHAVIORAL CHANGE AND DISEASE PREVENTION

        It is often said that the world is changing and as such the inhabitants. However, the point I think should be stressed is that man’s expectations in life, disposition to issues, response to setbacks and yearning for discovery has changed over the years and this had affected his world. Therefore, man is the variable factor and the effect of his variability is now reflected on his world.  The fluidity of this generation and the desire to get all things done at the snap of the finger has lured us into breaking health frontiers without knowing.  Man’s ignorance of the limit of his ability and over-exploitation of his constitutional make-up has opened up a floodgate of diseases for which he lacks economic, scientific, emotional and spiritual reserves to deal with. The upsurge of new diseases coupled with old ones changing form and character which was  conceptualized as Emerging and Re-emerging disease is now a menace to man’s survival.

         In elementary science “a matter will continue in its state of REST or UNIFORM MOTION unless acted upon by a force”. Sadly, the “motion” of Emerging and Re-emerging of diseases has started and unless a suitable and sustainable “force” is put in place by people and community at least to slow down the progression and if possible halt it, we may continue to have Ebola outbreaks, Middle East Respiratory Syndrome (MERS), Double burden of disease and Environmental and Climatic Emergencies. The good news however, is that Disease Prevention offers a safe haven! The ideals of disease prevention are simple and practicable in most settings provided the principles are well understood. What then is Disease Prevention? What are the ideals?

         Disease Prevention can be defined as actions aimed at eradicating, eliminating or minimizing of disease and disability and if none of these are feasible, retard the progress of disease and disability. The concept of disease prevention is gaining more prominence now than ever before because man is becoming increasingly aware that he cannot keep pace with the rate at which new diseases are springing up and old diseases becoming more lethal. Dr Chan (DG World Health Organization) said recently that, public health must shift its focus from cure to prevention, from short term to long term. Why spend fortune to cure a disease (which in itself cannot guarantee cure) when it is possible to prevent it? How then do we prevent disease?

        Disease prevention don’t exist in isolation, like most concept it requires a medium through which its values can be communicated, learnt and implemented, this is what Health Information and Behavioral change represents. Health Information simply deals with acquisition facts concerning a disease condition while Behavioral change involves application of these facts in the prevention of disease. Behavior change may involve lifestyle modification such as smoking, drunk driving, unprotected sexual intercourse, exercising, feeding etc. Health Information is of little account and significance without a corresponding Behavior change. Therefore, Health Information couple with Behavioral change is the necessary bridge to Disease prevention! 

Consider this for example:

“Smoking cigarette causes lung cancer”- Health fact/Information

“Staying in company of smokers even if you don’t smoke also put at risk of lung cancer”- More fact

The behavior change to avoid lung cancer is to quit smoking and stop hanging around smokers if you don’t smoke.  Lagos State (South-West, Nigeria) has even gone a step further by banning smoking in public places. All these are geared towards preventing lung cancer and other respiratory disease in the population by enforcing a behavior change.

Again:

“Cervical cancer is caused by Human papilloma virus HPV”- Health fact/Information

“People with multiple sexual partners are at risk of contracting and transmitting the virus”- More fact

The behavioral change dimension to this involves; restricting yourself sexually to a single uninfected partner, going for screening test (pap smears) against cervical cancer once you are sexually active and getting children especially girls between 10-12years immunized against HPV. Behavioral change is applicable to other non-communicable disease like hypertension, diabetes and other health-related events like climate change.

            We need not remind ourselves of notable people that have departed from diseases which are amenable to behavioral adjustment. The time to begin is now, delay might be dangerous. Unhealthy lifestyle has a way of provoking a ripple effect. Let us live but live right, eat but eat healthy, change but positively!