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New Liberia Ebola Case: Nigeria Not Keeping A Good Watch

People crossing freely without check of body temperature at the Seme border

People crossing freely without check of body temperature at the Seme border

WHEN the news broke that Ebola Virus Disease (EVD) had entered Nigeria via a Liberian, Patrick Sawyer, and that the health officials, who had contact with him, were infected, negative signals reverberated around the country.

In fact, the news that relatives of infected persons had gone into hiding to evade being quarantined left many panic-stricken. As a result, a lot of measures were put in place, collectively and individually, to ensure that the spread was contained.

Some of the measures included, closing and postponing resumption in schools, use of thermometer to check body temperatures and providing facilities for washing of hands. Nigerians became more hygiene conscious. Some even started wearing hand gloves of all shades, or refusing to shake hands, a natural way of greeting, with sign greetings being introduced.

For three months, the Nigerian government battled to contain the spread. Politics was shunned and all efforts were geared to make Nigeria Ebola free. So when, on October 20, the World Health Organisation (WHO) declared Nigeria Ebola free, it was a great relief for everybody. Ironically, a year after the country recorded its first Ebola case, on July 20, 2014, the country faces another threat, well, may be not.

Only recently, fresh Ebola cases were recorded in Liberia, after the country had been declared Ebola free. This is besides Sierra Leone and Guinea that are still battling to curtail theirs.

The Guardian checks reveal that one of the challenges of preventing the spread of Ebola is the high mobility rate in the sub-Saharan Africa and cross-border movement of infected travelers. It is surprising that the authorities are not taking necessary precautions to ensure that it is not imported, a second time. This is more so, if you take a visit to Seme, the border town between Nigeria and Benin.

At Seme, there was little or no restriction of movement and body temperature measuring instrument like thermometer was not sighted at the Port Health officers’ stand. The ratio of persons crossing legally could be about one to 20, if not more. Unfortunately, those crossing legally were not examined for Ebola, let alone the illegal migrant.

During the visit, this reporter went beyond the Nigerian section of the border to Benin, where he observed government inactions that could trigger another round of Ebola crisis. Although, there were points of stoppage, they were mounted by touts, who were more interested in bargaining and collecting bribe. There were over 20 checkpoints within the less than 500 metre Nigeria-Benin Border posts, and in these points, there were different government agencies, but with touts, as very dominant and visible.

While passing through the Nigeria border, the reporter was stopped for interrogation at two points, one by an immigration officer. After introduction, the immigration officer gave a pass to continue the journey. The second point was by a tout. All efforts and explanations did not make sense to him. What he hammered directly was the bribe he wanted to collect.

When The Guardian sought opinion of Nigerian Port Health officials on how they were coping with the new outbreak of Ebola in Liberia, one of the officials said they were doing their best, as they check every person who decides to legally cross the border by coming to them to stamp their documents. They also told this paper that passengers are told to come down in order to check their body temperature. However, they admitted that there was nothing they could do about those strolling across the border. Surprisingly, while the discussion went on, a passenger car and a rickety tricycle drove pass, but they did not even bother to use them as confirmation of what they had said earlier.

A lady officer confessed that though she had no thermometer to check migrants that day, they usually check travellers’ temperature. A Nigerian student in Benin Republic, Martins Akehre, said the last time he was stopped for temperature check was when Nigeria had not been declared Ebola free. “In recent times, I have not been stopped by any port health officer to check my body temperature.”

Akehre, a computer science student of University, Polytechnic International Benin, revealed that though during the last crisis, there were attempts to check people crossing the border, but days after Nigeria was declared Ebola free, the process stopped.

Another Nigerian, John Bassey, who was in Benin for business, said no health official checked his body temperature, because he was in their stand to get his passport stamped.

Though, there is an improvement at the Murtala Mohammed International Airport, as the management of the airport has responded positively by deploying temperature scanners and getting the health status of those flying, that is not the situation at international motor parks such as Mile 2, Agege and The Young Shall Grow.

In these parks, transporters were more concerned with getting their vehicles filled and hitting the road than taking body temperature of passengers or know their health status.

The Guardian investigations, however, showed that Nigerians are still afraid that the country could witness another Ebola case if the authorities are not alive to their responsibilities.

Ugo Obidegwu, an air hostess, said that Nigeria might witness another case because of the porous nature of the borders. “We have a lot of people passing through our borders who could be coming from anywhere, including Liberia.”

In the words of Stephen Adebisi, “there is a possibility of a new case, since Nigeria is not prepared to protect her borders.”
On her part, Awele Onwuadiamu, went spiritual, saying, “Nigeria cannot witness another case, because believers have prayed and God has answered our prayers.”

On what they have been doing on a personal note to ensure better hygiene, especially, after the new case were reported in Liberia, Adebisi said he did not stop washing his hands and applying sanitisers after the first outbreak. Onwuadiamu also agreed. She said at no time did she stop washing her hands, aside from ensuring her “environment is clean and not shaking hands, carelessly.”

Obidegwu, who confessed that she stopped washing her hands frequently, said she has started applying sanitisers too. “At the office, we are getting back the gloves for crew and sensitising on the correct procedure for handling passengers with infectious diseases on-board.”

A public health expert, Dr. Oridota Sofela, advised that efforts should be directed at containing the new Ebola case at source in Liberia, through using surveillance, making sure that infected people do not move away into other countries, thereby getting other people infected. This, he said, would prevent, what happened to Nigeria the other time happening again, whether to Nigeria or any other country.

“That is very important,” he stressed. “It also means that it is not only the people in Liberia, the international community, everybody, because if it is not contained, it could spread to other parts of the world. All hands should be on deck and everybody involved in the effort to control it.

“It also implies that even in Liberia, it is not only the treatment facilities that should be adequately provided, the protective wears and others, which are important, but also educating the people there, through a lot of aggressive health enlightenment programmes, so that they will know that Ebola is out and take the necessary precautions. Everybody should know that and should be educated about it, which means our hand washing culture should be fully back. We should know that regular hand washing is something that everyone of us needs to imbibe, it is not only for Ebola; but also for cholera and other diseases, even avian flu could be prevented with just hand washing.”

According to the public health expert, the country should not wait until there is another case, like the imported one, before taking the necessary steps. He said that the commitment should be as if there is an epidemic already. “So, we should do all that is possible at those points of entry to make sure that people are screened, even though that may not be hundred per cent effective.”

Sofela advised health workers to have at the back of their mind that the next patient they are going to see might be an Ebola patient, which means taking industrial and other necessary precautions that could prevent them from getting infected.

The Director General, Nigeria Institute of Medical Research (NIMR), Professor Innocent Ujah, said that with the new case in Liberia, Nigeria must be on guard and continue to prepare to tackle any new case.

According to him, the first step is a continuous maintenance of personal and environmental hygiene. “The country needs to continue to create awareness, a lot of awareness through different platforms in order to educate the populace. So we must be very vigilant. I am aware that all the people coming into Nigeria and leaving are made to fill a form besides passing through a temperature scanner or thermometer. It is a way of ensuring that we do not allow anybody who had contacted the disease into Nigeria.”

In his view, the major challenge is the porous borders because along the west coast many come into Nigeria through the unmanned borders. “So the port health officers should be very vigilant. The stakeholders and health workers must continue to educate and inform the public on the need to continue to maintain personal and environmental hygiene. The ports of entry must be man by health officers.”

He maintained that with Nigeria’s commitment there would likely be no new case, but if it comes, the country should deploy its entire arsenal to tackle the crisis. Ujah further said that the Emergency Operation Centre must be put alive and in preparedness for any emergency, in order to be able to respond adequately, while health professionals must continue to build capacity to respond to any emergency.

“One of the things that helped First Consultant Medical Centre that did not make the Patrick Sawyer case to escalate into an epidemic was high index suspicion. So, once doctors see a case, even nurses, they must be suspicious. And it also calls for taking precautions. Fortunately, most of us now wear gloves when examining patients and that is a form of protection before even talking about the personal protection equipment. So the basic protection measures must be observed.”

When he was told that the Treatment and Research Group on Ebola Virus Disease is on recess, he disagreed, saying, “It is not a political party that everybody must know what it is doing or deliberately publicise its activities.

In fact, we have scheduled a meeting for Friday (two days ago) as a result of what happened in Liberia to plan and come up with an action plan. We are not sleeping, because our work and effort is not about noise. What we do is to write our positions to the Honourable Minister or the Permanent Secretary; that is the way we communicate.”

Ujah also said that each state within the federation should have an Emergency Operation Centre and if possible in all the senatorial districts so that any case could be restricted. “It should not just be about the federal government.”

When The Guardian visited the Infection Disease Hospital (IDH), Yaba, Lagos, to see how prepared the hospital is to manage another case or cases, nobody was willing to speak officially.

A senior management staff, who volunteered to comment, but under anonymity, said that more than the first scenario; the centre is better prepared to manage any new case or cases.

He said this is because apart from being more informed about the disease and its management, they have better equipped personnel to drive the process.

According to him, though to successfully tackle the last cases, they got a lot of technical knowhow and input from World Health Organisation (WHO) and other development partners, but with the tutelage they had received, they are really equipped to do the job independently.

He said this was why some Nigerian medical personnel had to travel to Liberia to provide some support. According to him, they are back home and would be available for any cases. This, he also said, makes them to be more experienced in managing Ebola cases.



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