By Kemo Cham
From the word go it was obvious that there was something fundamentally wrong about how governments of the three countries affected by Ebola - Guinea, Liberia and Sierra Leone - were handling the outbreak in the sub-region. If anything, the speed and vigour with which the epidemic subsequently overwhelmed their health systems is proof of this.
But a more concise explanation has now emerged from authoritative people. Four researchers working in Sierra Leone have faulted "ineffective" surveillance systems and policies for the worsening situation.
Writing on the prestigious medical journal, the Lancet, the scientists who are based in Bo and work at the Mercy Hospital Research Laboratory (MHRL) there, said priority actions were needed to tackle the Ebola crisis and called for more focus on providing healthcare resources. They specifically called for improvement in access to diagnostic technologies as well as improved disease surveillance and health communication.
These grassroots medical doctors cite Bo town, where they say the over 150, 000 population depend on less than 15 medical doctors, as a reflection of the reality across the sub region.
They fear that due to ineffective healthcare systems, many cases of the Ebola epidemic may be going undetected.
Medical experts have maintained that the earlier patients with symptoms of Ebola report to a health facility the greater their chances of getting life-saving treatment if they turn out positive for the virus. But the Lancet article published on Saturday, July 5, argues that because of a poor communication strategy, this has not been the case in Sierra Leone and its neighbouring countries.
They cite poor diagnostic facilities, expensive and insufficient laboratory testing, and shortage of medical personnel as key factors.
"Many cases meeting the case definition for suspected Ebola might be going undetected and unreported because ill people and their families are opting for self-treatment with over-the-counter drugs or traditional medicine," they wrote.
The group is headed by a US-based specialist, Karen Jacobs of the George Mason University in Fair Fax, Virginia. Their statement almost coincided with the Accra Ministerial conference last week convened by the World Health Organisation (WHO) which has also warned that the Ebola outbreak is likely to persist for several months.
The UN health agency which had earlier declared the "out-of-control" West Africa outbreak as the worst ever since the virus was first reported in the former Zaire (now Democratic Republic of Congo) about 40 years ago, cautioned other West African countries of a possible spill over, hence the Accra meeting to discuss a common agenda to tackle it.
Widespread distrust
As of its last regional update on last week, WHO put the total death toll for the three countries at 467, with 756 laboratory confirmed cases.
In Sierra Leone, the latest figures from the Ministry of Health and Sanitation released on Sunday indicate 80 deaths and a total of 270 confirmed cases. But the MHRL scientists believe the true extent of the outbreak will be difficult to determine and they blame the situation on lack of incentive for patients to seek professional diagnosis. They say most people prefer taking treatment at home even when they display symptoms attributed to the sickness. It follows reports of widespread distrust within the public towards health personnel. Many Sierra Leoneans have come to believe that going to hospital increases their chance of contracting the Ebola virus.
"Even when you vomit and you report to the hospital, the nurses will say it's Ebola and they will detain you among Ebola victims," a young man recently said on the Poda Poda (commercial transport van) the other day, vowing never to report to a hospital amidst this talk of Ebola.
A young lady in the same vehicle believed the nurses inject Ebola into patients.
"The problem is that the people who are treating us are foreigners. They are strangers and they are disguised," added yet another man, referring to the appearance of medical personnel in protective gears.
All these suggest a daunting task facing the government in terms of public awareness. But it gets worst, according to the MHRL scientists. Already, there has been a growing concern about the safety of health personnel, with some reports indicating a number of deaths among nurses who contracted the virus from infected patients.
Regrettably, the Ministry of Health and Sanitation doesn't seem to feel accountable as far as the death toll among its personnel is concerned.
Government ridicule
After a long denial following the debacle around the death of the young lady nurse in Kailahun, which infamous episode exposed the government to ridicule, the ministry last week tacitly admitted the desperation of the situation through deputy health minister Dr Abubakarr Fofanah.
He was sighted in a Reuters Health report on the fringes of the Accra summit appealing for cash for drugs, basic protective gears and staff pay.
The MHRL scientists say the few healthcare providers attending to underserved populations often have poor access to basic personal protective equipment, and therefore might be understandably unwilling to provide direct care for patients suspected to have Ebola.
"There is an urgent need to provide reliable and constant access to personal protective equipment in healthcare centres across the region," they say.
When the Ebola outbreak was first confirmed in Guinea, the focus of health officials was containment and they directed their attention on restriction of cross border movements within the three neighbouring countries.
There was also so much talk about the role bush meat plays that the authorities sought to discourage their consumption. But theses scientists say the policies around those measures failed because of how they were implemented.
This, they claim, raised anxiety and, in some places, fuelled rumours that led to counterproductive behaviours.
"Improved communication by health officials with the media, community leaders and health professionals, and the general public is necessary to reduce misinformation and improve compliance and prevention and control measures that have been proven effective," they conclude.
(C) Politico 08/07/14
