With the Ebola virus in Nigeria, people expect doctors to confront it. Even those who are struggling for leadership role with the doctor now want the doctor to be in front! The Minister of Health, Prof. Onyebuchi Chukwu, says the doctors’ strike puts Nigeria at a “disadvantage.”
The Ebola outbreak in West Africa has killed more than 900 people across four countries and it includes many health workers who contract the disease. In Sierra Leone, where the disease has killed at least 572 people, 50 of those were hospital workers.
Thirty two have died in Liberia alone. The Voice of America reported that, “Many of that country’s health clinics and hospitals have shut down as nurses and doctors refuse to risk being exposed.”
It said, “Dr. Melvin Korkor said he has a pretty good idea how he got Ebola, though it’s impossible to know for sure.”
A woman came into his facility, Phebe Hospital in Bong County in central Liberia. The patient didn’t have fever, but she was vomiting.
“She said she was from Bangha instead of Lofa, but the next day, I was a little bit suspicious. I said, ‘Well, I hope you are not from Lofa because there is every indication that you are suspect.’”
They later found out the woman lied. She had come from Lofa, an area at the Sierra Leone and Guinea borders that is at the centre of this regional Ebola outbreak.
Five nurses from Korkor’s hospital have since died of Ebola. When he tested positive, he was taken to Monrovia and then to Lofa to an isolation ward.
“One of the patients had just died. They prepared the bed and I went in… my heart became hardened, and I said to myself, I was going to make it and I said to my wife, ‘Bring me my Bible’ and that is that, I’m going to go by,” said Korkor.
The VOA further narrated, “Korkor forced himself to eat even though he did not want food. It was lonely. He tried to stay calm. He saw other patients growing despondent, hopeless and passing away.”
But he survived. “It was like being reborn,” he said. His is one of those rare survival cases of Ebola.
In Liberia, health workers who continue to work say they are terrified and that even people outside the clinic are afraid of them.
It is also reported that many of the health care workers who were killed during this Ebola outbreak include those who had had access to protective gear. Though it could also be because they were undertrained and overworked which could make them let their guard down.
Doctors through the Nigerian Medical Association and nurses through the National Association of Nigerian Nurses and Midwives have come out to voice their concern of government’s ability to put things in place to protect them while they are working.
In Nigeria, hardly any health care worker has been given personal protective equipment (PPE). In one hospital, there are three PPEs to go round, but not being used. The PPEs may not be quality ones as I gather they are already shredding. They are the ones given during the Bird Flu scare. The PPEs are better discarded than reused. Trying to reuse them even if they will be disinfected carries a potential risk.
In addition to the absence of PPE, there are also inadequate infrastructure and no proper training of all health care workers.
In West Africa, Ebola victims are packed in one space. But the Centre for Disease Control recommends that they must be isolated in a proper facility, which is a single patient room (containing a private bathroom) with the door closed. The CDC says all persons entering the patient room should wear at least: gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and facemask.
It also adds that additional PPEs might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or faeces present in the environment), including but not limited to: Double gloving, disposable shoe covers, and leg coverings.
If doctors call off their ongoing strike, there may not be adequate facilities to work with even in normal times, how much more now that there is Ebola.
In a typical public hospital, the facilities are stretched; the Outpatient Department is jam packed. The casualty wards are full, some patients may be admitted at the corridor, some lie on the floor, with blood, stool and vomitus on the floor. One woman who came for a minor procedure ran away when she could not stomach what she saw.
The public hospitals where patients and their relatives move from one paying point to another are a potential way of spreading the virus. No one knows who had contact with those at the airport who handled Mr. Patrick Sawyer, the Liberian who brought the first case of Ebola into Nigeria.
Perhaps, the doctors strike may be a blessing in disguise, what The New York Times called “a strange twist” that may “have saved lives” as Sawyer was initially planned to be brought to a major public hospital like the teaching hospitals, a crowded place, before they realised that doctors were on strike. The nation was not prepared. By now doctors, medical students, nurses, student nurses and laboratory staff, patients and their relatives would have contracted the virus and spread it to their family members, and beyond, as the Liberian had initially lied about his health status.
We feel bad that a doctor already has the virus. No one can imagine the trauma she and others who now have the virus could be going through, with a nurse already dead, while taking care of a sick person. N5,000 is doctors’ hazard allowance. We pray God heals all of them like the Liberian doctor.
Meanwhile, since the strike, people have been more proactive about their health avoiding behaviours that could lead to hospital visitation. If nothing has been achieved during this strike, it is that at least the saying that prevention is better than cure has had a better meaning among Nigerians.
As a start, every emergency room medical personnel, including doctors, nurses, and cleaners must wear PPEs. All medical staff should wear scrubs that are long sleeves with boots, not ward coats. After work, they are dropped for laundry staff to properly disinfect and wash. It is not proper for medical staff, especially nurses to go back home in the white dress to meet their families.
Even doctors and nurses working in private hospitals must also observe this. Government must provide all private hospitals with the PPEs, they have proved their mettle in this case.
The PPEs should not only be for isolated cases of Ebola. They should be from point of first contact, which is the primary health care level, private hospitals and emergency and casualty wards. In an epidemic, every patient that walks in to see the doctor should be seen to have Ebola till proven otherwise, until the situation changes.
Let us thank God schoolchildren are on holidays, further reducing movements. I suggest school resumption may be extended until we think it safe to reopen them.
It is hoped that the doctors’ strike makes government do the needful. You might be wondering. I am one of a few doctors who have offered to give emergency services during the strike.
Dr. Cosmas Odoemena
With the Ebola virus in Nigeria, people expect doctors to confront it. Even those who are struggling for leadership role with the doctor now want the doctor to be in front! The Minister of Health, Prof. Onyebuchi Chukwu, says the doctors’ strike puts Nigeria at a “disadvantage.”
The Ebola outbreak in West Africa has killed more than 900 people across four countries and it includes many health workers who contract the disease. In Sierra Leone, where the disease has killed at least 572 people, 50 of those were hospital workers.
Thirty two have died in Liberia alone. The Voice of America reported that, “Many of that country’s health clinics and hospitals have shut down as nurses and doctors refuse to risk being exposed.”
It said, “Dr. Melvin Korkor said he has a pretty good idea how he got Ebola, though it’s impossible to know for sure.”
A woman came into his facility, Phebe Hospital in Bong County in central Liberia. The patient didn’t have fever, but she was vomiting.
“She said she was from Bangha instead of Lofa, but the next day, I was a little bit suspicious. I said, ‘Well, I hope you are not from Lofa because there is every indication that you are suspect.’”
They later found out the woman lied. She had come from Lofa, an area at the Sierra Leone and Guinea borders that is at the centre of this regional Ebola outbreak.
Five nurses from Korkor’s hospital have since died of Ebola. When he tested positive, he was taken to Monrovia and then to Lofa to an isolation ward.
“One of the patients had just died. They prepared the bed and I went in… my heart became hardened, and I said to myself, I was going to make it and I said to my wife, ‘Bring me my Bible’ and that is that, I’m going to go by,” said Korkor.
The VOA further narrated, “Korkor forced himself to eat even though he did not want food. It was lonely. He tried to stay calm. He saw other patients growing despondent, hopeless and passing away.”
But he survived. “It was like being reborn,” he said. His is one of those rare survival cases of Ebola.
In Liberia, health workers who continue to work say they are terrified and that even people outside the clinic are afraid of them.
It is also reported that many of the health care workers who were killed during this Ebola outbreak include those who had had access to protective gear. Though it could also be because they were undertrained and overworked which could make them let their guard down.
Doctors through the Nigerian Medical Association and nurses through the National Association of Nigerian Nurses and Midwives have come out to voice their concern of government’s ability to put things in place to protect them while they are working.
In Nigeria, hardly any health care worker has been given personal protective equipment (PPE). In one hospital, there are three PPEs to go round, but not being used. The PPEs may not be quality ones as I gather they are already shredding. They are the ones given during the Bird Flu scare. The PPEs are better discarded than reused. Trying to reuse them even if they will be disinfected carries a potential risk.
In addition to the absence of PPE, there are also inadequate infrastructure and no proper training of all health care workers.
In West Africa, Ebola victims are packed in one space. But the Centre for Disease Control recommends that they must be isolated in a proper facility, which is a single patient room (containing a private bathroom) with the door closed. The CDC says all persons entering the patient room should wear at least: gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and facemask.
It also adds that additional PPEs might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or faeces present in the environment), including but not limited to: Double gloving, disposable shoe covers, and leg coverings.
If doctors call off their ongoing strike, there may not be adequate facilities to work with even in normal times, how much more now that there is Ebola.
In a typical public hospital, the facilities are stretched; the Outpatient Department is jam packed. The casualty wards are full, some patients may be admitted at the corridor, some lie on the floor, with blood, stool and vomitus on the floor. One woman who came for a minor procedure ran away when she could not stomach what she saw.
The public hospitals where patients and their relatives move from one paying point to another are a potential way of spreading the virus. No one knows who had contact with those at the airport who handled Mr. Patrick Sawyer, the Liberian who brought the first case of Ebola into Nigeria.
Perhaps, the doctors strike may be a blessing in disguise, what The New York Times called “a strange twist” that may “have saved lives” as Sawyer was initially planned to be brought to a major public hospital like the teaching hospitals, a crowded place, before they realised that doctors were on strike. The nation was not prepared. By now doctors, medical students, nurses, student nurses and laboratory staff, patients and their relatives would have contracted the virus and spread it to their family members, and beyond, as the Liberian had initially lied about his health status.
We feel bad that a doctor already has the virus. No one can imagine the trauma she and others who now have the virus could be going through, with a nurse already dead, while taking care of a sick person. N5,000 is doctors’ hazard allowance. We pray God heals all of them like the Liberian doctor.
Meanwhile, since the strike, people have been more proactive about their health avoiding behaviours that could lead to hospital visitation. If nothing has been achieved during this strike, it is that at least the saying that prevention is better than cure has had a better meaning among Nigerians.
As a start, every emergency room medical personnel, including doctors, nurses, and cleaners must wear PPEs. All medical staff should wear scrubs that are long sleeves with boots, not ward coats. After work, they are dropped for laundry staff to properly disinfect and wash. It is not proper for medical staff, especially nurses to go back home in the white dress to meet their families.
Even doctors and nurses working in private hospitals must also observe this. Government must provide all private hospitals with the PPEs, they have proved their mettle in this case.
The PPEs should not only be for isolated cases of Ebola. They should be from point of first contact, which is the primary health care level, private hospitals and emergency and casualty wards. In an epidemic, every patient that walks in to see the doctor should be seen to have Ebola till proven otherwise, until the situation changes.
Let us thank God schoolchildren are on holidays, further reducing movements. I suggest school resumption may be extended until we think it safe to reopen them.
It is hoped that the doctors’ strike makes government do the needful. You might be wondering. I am one of a few doctors who have offered to give emergency services during the strike.
Dr. Cosmas Odoemena
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