The Response to Ebola in Nigeria

I participated in an intervention organised by Doctors Without Borders (MSF) that helped the Nigerian Ministry of Health to deal with the management of Ebola cases in two Nigerian citiesWhen asked to write a post for this blog about my experience in Nigeria as part of a team responding to an Ebola outbreak, I could not help but feel a little disconcerted. Impossible for me to tell the story of despair and helplessness experienced by my colleagues in Sierra Leone and Liberia. Nor can I give an account of the huge impact of the disease on those fragile countries and their already precarious health systems. I cannot even provide the clinical insights that could be offered by a physician who has seen many patients. My experience was so different from what is happening in the areas where the epidemic is out of control. In August and September of this year, I was lucky enough to participate in an intervention organised by Doctors Without Borders (MSF) that helped the Nigerian Ministry of Health to deal with the management of Ebola cases in two Nigerian cities.

We had to evaluate the first suspected case (later confirmed) within 24 hours of our arrivalNigeria is a middle income country, which depends largely on the export of natural resources and has the problems typical of such countries: high social and regional inequality, as well as a degree of political instability and corruption. The country has a population of over 170 million, with cities of up to 20 million inhabitants, such as Lagos. In mid-July, a patient with Ebola flew into Lagos from Liberia. His diagnosis was delayed and 13 more people were infected, mostly health care staff. The teams monitoring the outbreak lost track of one of the people who had been in contact with the first patient. That person travelled to Port Harcourt in Rivers State, where he infected a doctor, leading to the infection of three more people.

The MSF response team I was part of was involved in the care of the cases in Port Harcourt. Five of us, all foreigners, had arrived in Port Harcourt when a report was received of a secondary infection from the case imported from Lagos. We had to evaluate the first suspected case (later confirmed) within 24 hours of our arrival. We were assigned a hospital on the outskirts of the city, which served as a treatment centre for patients with suspected Ebola. It was a centre that functioned primarily as a maternity hospital so the first task was to clear the facility of patients and refurbish it before starting operations. The Ministry of Health had recruited a group of doctors, nurses and hygienists, who formed the bulk of the staff. Our first tasks were the medical care of the first cases and training the local personnel to the point that they were conversant with and could independently implement the many protection protocols involved in the care of Ebola patients. The MSF response within the treatment centre was complemented by the coordination of an integrated response that included epidemiological surveillance, community mobilisation and disinfection, contact tracing, and counselling. These were the components of the response that resulted in effective control of the epidemic at an early stage. On 19 October, Nigeria declared the epidemic to be at an end.

A valid question is to ask whether the outbreak would have been controlled with the same success if the affected person had arrived by another means or if those affected had come from a different social class If the situation in the epicentre of the current epidemic does not improve, Nigeria still has a moderate to high risk of receiving new imported cases. The response to this outbreak has shown that a country with an intermediate level health system can respond in a coordinated manner to an imported outbreak, even in an urban setting. However, I wonder whether the success in this case might not also be attributed to the point of entry of the disease. The index patient was a diplomat who arrived by plane and infected the staff of a private clinic; almost all of the patients belonged to the upper classes. A valid question, I think, is to ask whether—in such a fragmented and unequal country—the outbreak would have been controlled with the same success if the affected person had arrived by another means or if those affected had come from a different social class. Now it is imporssible to know the answer to that question and, in the case of Nigeria, I hope we never find out.

Seminar: Fighting the Ebola Outbreak in the Front Line

Victor Illanes is a staff member of the Department of Internal Medicine, Faculty of Medicine, University of Chile. He is currently completing his Masters in advanced medical skills at the University of Barcelona. In 2014 he completed the ISGlobal-UB Diploma of Global Health

On Friday 31 October 2014 Víctor Illanes will talk about his experience in Nigeria on the open access seminar "Fighting the Ebola Outbreak in the Front Line". The event will take place at the University of Barcelona (Faculty of Medicine, Seminar 8) at 9:00 a.M.