OF the four persons who have so far died from the Ebola Virus Disease in Nigeria, two are health personnel who participated in treating late Patrick Sawyer, who 'imported' the virus into Nigeria. Available information also indicates that the majority of the twelve (12) cases so far confirmed with the ailment in Nigeria were health personnel (doctors and nurses) who were part of the Sawyer treatment team. This development has once again reechoed age long agitation for Nigeria to strengthen its public health systems. Medical personnel are also calling or greater protection.

Vice President of the Commonwealth Medical Association and former President of the Nigeria Medical Association, NMA, Osahon Enabulele in a statement at the weekend was particularly outraged at the fate befalling some doctors who participated in treating Sawyer.

He said: "We have to keep calling on government to provide the needed personal protective equipment to guarantee the safety of health workers. It is not enough to throw workers to manage such public health crisis situations; they also need to guarantee their safety and protection. "Right now there is really nothing on ground to protect health workers and even the hazard allowance of N5,000 per month is so miserable. I can imagine that so far in this crisis since it started in Guinea, a lot of health workers have been consumed; in fact over 60 doctors have lost their lives."

Echoing this call is Public Health Specialist and Consultant of Community Health, University of Benin Teaching Hospital, Dr Kingsley Chinedu Okafor.

In an interview, Dr. Okafor described the development as 'unfortunate'. He said: 'it is unfortunate that this is happening. It is vital that we note that those at risk are health workers, family members or others in close contact with infected people, mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and hunters in the rain forest who come into contact with dead animals found lying in the forest. "The nurse and doctor are already dead as we speak. It is important for life insurance for the health workers and improved hazard allowance for health workers. It is amazing that health workers earn N5, 000 per month as hazard allowance across board. It is difficult to get motivation from such paltry sums. Remember they also have families. Let us take a cue from the American doctors who got infected in Sierra Leone. The government immediately sent a health team with an Air Ambulance to pick them for the best treatment possible at a special facility in Atlanta. The Intensive care Unit where they are currently recuperating is state of the art with negative pressure air sterilization."

He said it was unfortunate and a big challenge to the nation's health system.

His words: "It is a test on our level of preparedness for disease outbreaks and epidemics. The world is a global village and with the growth of international travels and trade, it is difficult to restrict movement, thus disease transmission is swift while its spread is beyond imagination. In the past, seas, high lands, forests separates people and limited the spread of disease, but that is not the case now. "We are well aware that Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. EVD outbreaks have a case fatality rate of up to 90%. EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests. Now, it has been introduced into our population."

On whether government was doing enough to curtail the disease, he stressed: "Government is doing fairly well and I am impressed with the initial response of the Lagos State Government. Instead of denying and wishing it away, they confronted the situation head on. The health facility where the first case occurred also did well by quarantining the Index case and reporting to the public health authorities. But, other aspects of our national response have been below par."

Nigeria, he stressed, does now have the facilities and equipment to manage a case of Ebola. "State governments and Federal Government should immediately start construction of an Incident Center for Ebola management which will have a full complement of medical specialists and other health care workers. It should have public enlightenment unit, research unit, case management unit, diagnostic unit, Infection control unit and other relevant components," he stressed.

On his assessment of awareness among the populace, he stressed: "It has been great. I must commend the members of the Fourth estate of the realm, the press. It has been well covered. The social media, print media and television stations have done well in this regard. It is vital to have continuous sensitization of the populace on Ebola and other disease conditions. We must imbibe good health practices and personal hygiene. "We must warn that people should not take advantage of Ebola to scare the public. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. Only Ebola is introduced into the human population through close contact with and handling of the blood, secretions, organs or other bodily fluids of infected animals like chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. S, it is important to avoid contact with high-risk animals, bush meats including not picking up dead animals found lying in the forest or handling their raw meat. Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human.

"Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient's infectious fluids such as soiled clothing, bed linen, or used needles. "In reality, health workers can be exposed to the virus when caring for Ebola patients. This happens if they are not wearing personal protection equipment, such as gloves, when caring for the patients. Health care providers at all levels of the health system strictly follow recommended infection control precautions. Summarily, the prevention and control of Ebola is a collective responsibility, we can conquer the virus only if we do what is right."

On the short term basis, he said the nation should start putting measures in place to manage cases of Ebola in Nigeria, noting that an infected patient has less than 3 weeks within which to combat the virus.

"So, we must develop the capacity to manage cases properly without increasing transmission locally. No health worker will be willing to attend to an Ebola patient without being well protected. It is not also advisable to manage cases in regular hospital; instead designated areas should be used," Okafor noted. "If patients are well managed, oxygenated hydrated by specialist Consultants in our tertiary hospitals and the medical team, then, there is a chance. Early identification and diagnosis of disease via high index of suspicion and laboratory confirmation should be high priority. Strengthen our surveillance systems for all diseases." He went on: "On the midterm, we should support research on drug treatment and vaccine for Ebola. Improve our capabilities in case management. "On the long term, we should have strong health systems, based on primary health care systems as driven by the NPHCDA, where health care is available to all where they live and work. We should improve access to health care via 100 percent coverage of all citizens in the NHIS or other social health insurance scheme. Generally, there is a need for strong political will on health matters. Eventually, when the disease is put under control, we have to handle the eventual societal stigma that may follow Ebola survivors in developing worlds like ours."

Former Federal Commissioner of the National Human Rights Commission and head of Human Rights Writers Association of Nigeria, Emmanuel Nnadozie Onwubiko appealed to federal and state governments to seriously put effective and workable health measures to stop the Ebola Virus Disease from spreading in rural communities because of the total lack of functional primary health care facilities.

He told The Guardian: "My organization-Human Rights Writers Association of Nigeria has just rounded up a nation wide random opinion sampling from mostly rural dwellers in the six geopolitical areas of Nigeria on the emerging threats to lives of the deadly Ebola Virus Disease which came into Nigeria through a Liberian diplomat, Mr. Patrick Sawyer. "Our findings from what most of those people who responded to our telephone inquiries is that the rural populations will be adversely affected should the affliction of Ebola virus disease be allowed to spread In the 36 states of the federation and their fundamental fear and apprehension is embedded in the fact that the primary healthcare facilities are non-existent in virtually all the rural communities in which we received responses from the six geopolitical zones of the Nigerian state. Their genuine fear is that most of these rural communities do not have functional general hospitals and those that have primary health care centers the state of those facilities are dilapidated and dysfunctional because there is total absence of medical doctors or nurses to cater for their health challenges talk more of if the deadly Ebola virus disease is allowed to spread without effective containment measures by the respective states of the federation and the central government.

"Secondly what we have found out is that , for instance, in Imo state the health ministry officials in Owerri have not really commenced any enlightenment programs in the popular electronic and print media to the residents to warn them on the precautions they need to adopt to reduce and minimize the threats of this deadly health challenge of Ebola Virus Disease. Sadly, because there is no coordinated strategy by the state government to spread the messages to the rural and urban communities in Imo state the majority of the residents have started scouting and searching frantically for any idea on how to cure the disease to an extent that when the rumor started flying about that bathing in salty water and drinking of same will stop it from breaking out the majority of the rural people rushed to comply to this illiterate warning which did not emanate from any health ministry officials whether at the national and/or state levels."

He went on: "From my candid position as a human rights campaigner I am convinced from the rock bottom of my heart that the Federal Ministry of health has tried as much as it can to use the popular media of mass communications to spread messages-in an elitist fashion-to caution Nigerians on how to prevent Ebola Virus Disease from breaking out as a national epidemic and the minister of health Dr. Onyebuchi Chukwu should be commended for heroically briefing Nigerians in the media on what it takes to control the threats of a possible nation wide break out of EVD. But the central government should go a step further by importing in very large quantities preventive/protective kits to be distributed to doctors and medical workers including Nurses who would be designated to handle this emerging national emergency.

"From the experiences of Liberia where the disease was exported into Nigeria by their national and from the experiences of the neighboring countries to Liberia such as Sierra Leone and Guinea where the disease outbreak has reached pandemic dimension, the medical workers are about the first persons and professionals that are exposed to the risks of contracting the disease from the sufferers. They are the nearest people to these people who need medical assistance urgently. The Nigerian Government also needs to on the medium and long terms address comprehensively the urgent national question of the neglect that medical research and science sector has suffered over the years because it is a fact that Nigeria at the federal and state levels pay only lips' service to the critical need of medical researches and science generally.

"The budgetary provisions that have gone on to be distributed to the few medical research institutions that we have at the federal levels are so poor to be able to achieve any sustainable results and sadly the government officials have not fully appreciated the strategic national role that science and medical researches play to the sustenance and survival of the Nigerian populations. Besides, the legislatures have not sufficiently monitored the use to which even the paltry financial provisions and the huge funding assistance from foreign entities that go into the health sector. The Nigerian health sector is sick and grossly underfunded. Why for instance does Nigerian military not have an advanced form of biomedical research institutions to conduct periodic researches on possible use of biological weapons against Nigerians by adversaries?

He lampooned the 36 state houses of assembly for allegedly failing to mobilize their constituents. "The majority of their members are only concerned about retaining their seats in the coming elections than care so much about the health situation of their voters." The Nigerian Government, he stressed, should close its borders and monitor the identified porous entry points to ensure that sufferers of the disease do not sneak into Nigeria to further compound our crisis.

National President, Association of Medical Laboratory scientists of Nigeria (AMLSN), Dr. Godswill Okara, described the situation as a wake up call for Nigeria and Africa. He said: "We cannot continue to behave as if we have not learnt anything from global medical history. Outbreaks of epidemics and pandemics of infectious diseases are not new. National and regional preparedness through a systematic building of personnel and infrastructural capacity remains the only way to effectively combat the challenge of such outbreaks. It was in order to underscore this fact that in 1993, the 43rd session of the World Health Organization (WHO) Regional Committee for Africa, adopted Resolution AFR/RC43/R7, which declared a five-year period for preventing and combating epidemics of communicable diseases through improved epidemiological surveillance at the district level. The resolution further considered that "the frequent occurrence in the African Region of epidemics such as cholera, plague, yellow fever, malaria, cerebrospinal meningitis etc brings untold human suffering and loss of lives", and therefore urged Member States to 'develop well-staffed and properly equipped laboratory services.'

"Again in 1996, the Ministers of Health and Ministers of Interior, from West Africa, Chad and Algeria, met in Ougadougou, to consider ways and means of preventing future epidemics. Their counterparts from countries of the Great Lakes met in Kigali in 1997 to deliberate on the unabated epidemics of infectious diseases. At the conclusion of these meetings the Ministers called for a systematic evaluation of the state of laboratories in their respective countries, and resolved to strengthen laboratory diagnostic capability in member States by providing laboratories at different levels of the health system with basic equipment and standard reagents and means of transportation , based on assessed needs; creating minimum laboratory capability at appropriate levels and organizing the laboratories into a functional network; and training district level personnel in the technique of proper sample collection, preservation and transportation to the laboratory."

He continued: "In 1998, at the 48th session of the WHO Regional Committee for Africa, resolution RC48/008 was adopted by Member States.The resolution titled: "Integrated Surveillance of Diseases in Africa: Regional Strategy" emphasized that 18 communicable diseases be put under integrated surveillance in Africa. The strategy recognized that, 'laboratories are to play a key role in disease diagnosis and control activities by providing prompt and reliable confirmation of suspected cases'. "At the global level, the International Health Regulations (IHR) require all the WHO member countries to establish mechanisms that ensure quality laboratory results. This is to allow reliable and timely laboratory identification of aetiological agents and substances likely to cause public emergencies of national and international concerns. In pursuance of this, Nigeria has a National Medical Laboratory Services Policy which was approved in 2007, with the clear vision of providing all Nigerians with an appropriate, cost-effective and high quality laboratory services as a functional component of a reliable national healthcare delivery system within five years. The long-term goal is to provide a holistic functional laboratory service from primary to tertiary health care level, which also includes the development of public health laboratories at the national, zonal, state and LGA levels.

"The question is what has our Federal Ministry of Health done to implement these resolutions and well-laid out policy? The penchant for making resolutions and policies without implementation and an inability to follow through on implementation is the bane of the Nigerian health system, which has contributed to the very poor state of laboratories in Nigeria.

The Federal Ministry of Health under the Implementation Plan of the Policy was to create a single Department of Medical laboratory services in the Ministry in 2007, to drive, coordinate and oversee the proper translation of the Policy into measurable outcomes. This has not been done up till this moment. It is better late than never, as the saying goes."

Emphasizing the need for Nigerian authorities to learn from the Ebola issue, he stressed: "I pray and hope they will listen and allow medical laboratory scientists and other laboratory experts play their role in winning the fight against diseases through the proper administration and structuring of laboratory services in Nigeria. The inter-professional rivalry in the health sector is not allowing the authorities do things in line with laid down government policies and statutes. A situation where the number one health officer of our nation will publicly say that the health sector is all about the medical doctors, and that all other health professionals in the sector are inconsequential is to undermine the development and stability of the sector."

On the hazards faced by health personnel, he stressed: " The doctor alone cannot diagnose the ailment without laboratory investigations and tests to give a definitive diagnosis. The key role of the laboratory scientists in the effective diagnosis, treatment, control and eventual eradication of the disease cannot be overemphasized. The nursing care and management of the infected patient is also critical.

"Now we have seen that the first Nigerian victim of the Ebola disease is nurse, with other seven health workers infected including only one physician. Does this not underscore the interplay of teamwork and effort in the health care arena. The superiority and ego-tripping of the Nigerian Medical Association (NMA) is certainly utterly misplaced and vexatious. They want to head every imaginable thing in the sector. The vaccine production laboratory in Yaba where medical laboratory scientists produced the smallpox vaccine used in eradicating Smallpox viral disease in the entire West African region in the 1960s/1970s, and Yellow fever vaccine among others has been allowed to fall apart and collapse because of headship and other squabbles over time. Nigeria now spends huge foreign exchange to import Yellow fever vaccine annually."

He went on: " Our heart goes out to the family of our diseased nurse colleague who died in the line of duty. It will be soothing for Government to compensate the family, as it is often done to families of police and military personnel who die in the line of duty. Over and above this, Government should as part of the emergency measures for containing the outbreak purchase the protective clothing needed for barrier nursing and handling of clinical specimens by medical laboratory scientists attending to suspect infected patients. "My view is that the development and production of Vaccine against Ebola virus is the ultimate in the control and eradication of the disease. Medical laboratory scientists under the leadership and direction of Mr. Michael Nwachukwu the first President of the Association of Medical Laboratory scientists of Nigeria produced smallpox and yellow fever vaccines in Yaba, Lagos. We are ready to do same for Ebola and other vaccine-preventable diseases if the enabling environment is provided. The National Medical Laboratory Services Policy should beimplemented without further delay."

Guardian