Health News of Friday, 29 August 2014

Source: Adjei-Kyeremeh, Nathanael

Ebola: Three factors worsening its spread

Ebola virus disease has been rightly called a devastating killer as it sends up to 90 per cent of its victims to their graves. This recent outbreak is the largest recorded in history.
The first outbreak in 1976 occurred in Zaire where 318 were infected and 280 died. According to WHO, there are 2615 suspected and confirmed cases of Ebola out of which 1427 have died. Though in 1976 little was known of the disease, fewer numbers got infected and fewer died. The reason may be because of little mobility among rural and urban dwellers then, compared to today with very active movements across porous borders.
But there are more factors implicated in this devastation. Three very significant factors that have contributed in worsening the spread of Ebola is the denial of the existence of the disease, gross misinformation even by some health workers and a dysfunctional healthcare system.
Even in this day of technology and advances in scientific knowledge, many in the epidemic zones deny the existence of the virus. For instance a recent survey of 1000 respondents conducted by Samaritan’s purse in the bustling Duala market, Monrovia—Liberia found that 92% of Liberians don’t believe Ebola exists. They believe it is a hoax created by their government to “eat money” from aid donors. Such denials have resulted in the ‘business as usual’ approach to handling of animals both sick and dead, handling of corpses and eating of wild animals. Report confirms how Guineans and Liberians still enjoy their bat meat even in the face of Ebola.
Ebola, like many other deadly diseases have suffered in the hands of conspiracy theorists. In Freetown, capital of Sierra Leone, thousand marched at an Ebola treatment centre following allegations by a former nurse that the deadly virus was invented to conceal “cannibalistic rituals” at the facility. There have been similar attacks on health facilities in Guinea and Liberia.
There are many others, who are spreading false information on the mode of spread and fuelling public fear. Though the strain of Ebola in this outbreak appears to kill 56% of the people it infects, to become infected in the first place, a person’s mucous membranes, or an area of a broken skin must come into contact with the bodily fluids of an infected person such as blood, urine, saliva, semen or stool or materials contaminated with these fluids such as soiled clothing or bed linen. Ebola is not airborne. Dr Peter Piot and many other scientists have consistently spoken against the hysteria we approach Ebola with. The largest outbreak of Ebola before this recent one was in Uganda between 2000 and 2001 in which 425 people were infected and 224 died. Since Ebola first appeared, a total of about 2000 have died from the disease. By comparison, Malaria kills 3,200 people a day and diarrheal diseases some 4,000.

Dysfunctional healthcare systems
This outbreak has exposed the weak healthcare system we have in West Africa. It is a system that hasn’t treated infection prevention and control seriously. Many healthcare workers risk their lives without adequate protection to treat highly infectious people daily. Health facilities are starved of infrastructure, equipment, personnel to run effective disease control. In Liberia, the largest hospital, John Fitzgerald Kennedy Memorial Medical Centre or JFK is seen as a death trap. Locals have nicknamed it “Just For Killing”, because even simple malaria is poorly managed at the facility leading to many avoidable deaths. The hospitals Ebola ward had to be closed down because proper procedures for dealing with the disease were not followed.
People faced with the choice of going to the hospital to die and staying at home then choose the latter. Our health care systems because of such gross inadequacies face stiff competition with traditional and other unorthodox medical practices and in such epidemics; this state of dysfunctional healthcare makes the situation precarious.
The way forward
Ghana has been constantly awakened by these multiple scares. The morbid fear that has engulfed us must be well managed with accurate information on the disease. The need to seek early treatment, the proper handling of dead humans and animals, proper hand washing must be clearly communicated. Healthcare workers must be adequately protected and properly trained on prevention and control of this lethal virus.
Nestor Ndayimirije, WHO representative in Liberia says building trust in communities, including with elders and traditional leaders is the key on the fight against Ebola. Making populations understand the disease in scientific terms according to him is urgent.
The virus gets closer to our borders by day, beyond the assurances by Government; we need to see a readiness at the facility level, and a well-informed populace on Ebola.

Dr Nathanael Adjei-Kyeremeh
Medical Officer
St John of God Hospital, Duayaw Nkwanta