The euphoria of Nigeria being Ebola free is yet to subside, despite fears of possible reintroduction of the disease into Nigeria amidst raging infection rates in neighbouring West African countries. The death toll of the present Ebola epidemic is so alarming that there is really little to celebrate, upon consideration that Nigeria’s borders are porous.Already there are fears that vigilance have waned and Nigerians back to old practices which could engender unchecked spread of the disease in the event of an exposure.Going back memory lane, therefore, upon a consideration of a few challenges posed during those dark days of attempting containment of the spread of the virus in Nigeria one suggests the following post Ebola measures:
1. Designation of Isolated Treatment Centers
This need not be a difficult thing to do. There is at least one general hospital in each senatorial zone comprising the country. It does not appear that equipping isolation wards is rocket science. Denoting a ward farthest from the other hospital facilities as isolation wards and equipping them with basic barrier treatment facilities as well as ensuring provision of water/electricity and comfortable toilet facilities, as basic as this may sound, will go a long way in showing preparedness to deal with any unplanned resurgence of the Ebola virus in Nigeria. The idea is that persons who have been exposed to the disease need not see themselves as being taken to some mortuary waiting room to expire. The government would have sent across a strong message to the citizenry that in the unlikely event they are exposed to the disease, there has been prepared a place of healing.
2. Manpower Development
With our abundant schools of nursing and medical schools, this again should pose little difficulty.First, it puts into question the quality of practical training received if it is to be suggested that medical and nursing staff in Nigeria do not know how to treat infectious diseases. All they need would probably be intensive and concentrated practical demonstrations. This can be achieved by setting up centers of excellence in at least one teaching hospital in each geopolitical zone where doctors and nurses and other health personnel from each of the designated isolation centers in the senatorial zones would go for training.
The way to go would be to set up command units in the proposed isolation centers for all the senatorial districts. For instance there would be a consultant specialist doctor, a chief nursing superintendent etc. along with their staff manning the centers. In the meantime there is no immediate threat of the virus, so that anxiety/apprehension would be minimized while they routinely get into the mood of infectious disease experts. Motivation for staff would include new lines of authority for experienced staff who are promoted to the leading hospital positions in the newly created isolation units, employment for newly graduated staff who receive intensive training in the area, specialized insurance for staff and allowances for accommodation/transport/travel/hazard for all.
It is important to mention that in order not to encourage lethargy and a laisser-faire attitude to preparedness to combat any eventual epidemic, routine daily procedures for the isolation unit and their staff ought to be developed and religiously observed, whether there are patients or not. For instance, at every point in time, there should be fully safety gear suited personnel on standby waiting to receive patients. Personnel should with military precision continue to observe all the sanitation/disinfection regimen whether they have patients or not –at least until the risk of reintroduction of the virus into Nigeria subsides.
3. Provision of Specialized Ambulances
Regrettably, the ambulance system in this country is non-existent. Persons infected with the ebola virus are likely to be in self-denial until unmistaken symptoms present. By this time they would be highly infectious. Moving them to the isolation centers could be fatal to the citizenry. Specialized ambulances to curtail the spread of infection during movement of the patient are therefore necessaries. Two for each local government in addition to providing trained staff will build confidence.
4. Media Campaign
The intense media campaign that characterized the heydays of the introduction of ebola within the territory of Nigeria needs to be sustained. The Broadcasting Corporation of Nigeria and other media regulatory agencies may categorize stated periods as public service announcement period for the dissemination of information pertaining to the prevention, management and treatment of Ebola. Highlights of those announcements must include addresses of the designated isolation/treatment centers, contact information for the ambulances, and any progress/developments on preparedness to tackle exposure.
5. Persons endangering public safety
Clearly, one of the major drawbacks to containing spread of the virus during Nigeria’s Ebola crisis was the action of persons exposed to the virus that put others at risk. The diplomat that escaped observation in Lagos and his Port Harcourt doctor and the nurse who fled to Enugu easily come to mind as villains in the events that played out during that anxiety laden period.
Under Nigerian law, knowingly acting in a manner likely to spread dangerous diseases is an offense which attracts six months imprisonment.Those who acted in such a manner as to put the general public, and sadly even family members at risk, should be prosecuted.The Port Harcourt doctor, especially is culpable. The Medical and Dental Practitioners Disciplinary Tribunal is encouraged to convene a seating and make a finding on the matter. Despite the doctor’s death, it is submitted that his name can still be struck out from the register of medical practitioners for infamous conduct as a deterrent to other practitioners. There are provisions in the Criminal Code which read together would penalize similar acts on the part of health practitioners or other persons who presume to administer treatment for instance herbalists or faith healers.There is also the general punishment for reckless and negligent acts which could be up to imprisonment for one year. Emmanuel Onyedi Wingate is a Senior Associate in Sterling Law Partnership, Lagos, Nigeria