I find it sad that President Goodluck Jonathan, in his Independence Day speech, appeared to singlehandedly claim the glory for Nigeria’s containment of the Ebola threat, by telling us that his “directives to the Federal Ministry of Health saw the ministry leading the charge in curtailing the spread of this deadly scourge and managing its impact”, and by limiting his acknowledgement of the efforts of others to vague references to “all Nigerians” and “the medical personnel, some of whom made the ultimate sacrifice.”
Many people have since come out angrily questioning the ‘Jonathan-saved-Nigeria-narrative’ suggested by that speech (and now being promoted online and offline by mindless goons and minions of the President and his party); insisting that Governor Babatunde Fashola, not President Jonathan, actually deserves the credit.
That ongoing Ebola credit mêlée is for me is a great opportunity to examine the totality of the Nigerian response to the Ebola Virus Disease, and to advance the argument that Nigeria’s positive Ebola outcome is the result of a multifaceted body of actions and reactions – some of which happened long before Ebola arrived here – that drew in many individual and institutional players, and in which the state and federal governments merely played one of several important roles.
Reducing the Ebola response to a government effort – and that is what the debate about whether it was the federal or the state government that made the difference sadly does – not only completely mischaracterises the situation, but is also very unfair to the several non-government parties who played active roles in the containment response.
In fact, let’s face it, from a certain point of view both governments failed in ways that could have had a far more devastating impact than what eventually played out. The Federal Government failed in not proactively instituting Ebola testing / isolation measures at Nigeria’s international airports, despite the fact that Ebola had already been ravaging Liberia, Ghana and Sierra Leone for three months, and flights were regularly coming into the country from all three countries. And we have since come to learn that there was a memo from the office of the National Security Adviser to the Ministry of Health, 10 days before Patrick Sawyer landed in Lagos, warning of the possibilities of an outbreak in Nigeria. According to media reports, there is no evidence the Federal Health Ministry took any steps to activate a response.
The failing of the Lagos State Government was one that long predated the arrival of Ebola in Nigeria. Here is how Ada Igonoh, a doctor at First Consultants Hospital (she it was who certified Sawyer dead), and an Ebola survivor, describes the “female ward” she was admitted into at the state-government-run Lagos Mainland Hospital – the main infectious diseases facility in a city of more than 15 million persons:
“I was shocked at the environment. It looked like an abandoned building. I suspected it had not been in use for quite a while… The sanitary condition in the ward left much to be desired… The sheets were not changed for days. The floor was stained with greenish vomitus and excrement… Mosquitoes were our roommates until they brought us mosquito nets…”
One doctor who works there shared horror stories with me, of how, long before Ebola, when the hospital focused on managing HIV/AIDS and Tuberculosis patients, longstanding neglect by the government had turned it into a place in which staff sometimes died of infections contracted from patients, and to which doctors did everything to avoid being posted.
The heartwarming sequel is that both governments then quickly moved into action, and worked hard to mitigate the effects of their initial failings. The Lagos State Government assembled teams of volunteers to trace primary and secondary contacts, offered incentives to the volunteers and to medical personnel, and rushed to build a proper and habitable Ebola containment facility.
On its part the Federal Government, through the Ministry of Health, set up an Emergency Operations Centre to bring coordination to all private and public efforts. It also announced a N200m donation to the Lagos State Government.
As important as the actions of the governments are those of a large number of non-governmental players, including but not limited to the following: The Ebola Alert volunteer team (and other groups of volunteers), the World Health Organisation, Medicins Sans Frontieres, and Nigerian philanthropic organisations (the Elumelu, Dangote and Peterside Foundations which all made important donations).
The Ebola Alert team is a group of volunteers who set up an online response centre in the days after Patrick Sawyer’s death. Led by Lawal Bakare, a young Nigerian dentist turned graphic designer, it started on Facebook (assembling tens of specialists from around the world – doctors, epidemiologists, etc – into a virtual advisory council). The volunteers – young Nigerians, working for no remuneration – then moved on to set up a Twitter account, build a website, an online chatroom, and man a toll-free phone line. When I spoke with Bakare early in August he said the helpline – then about a week old – had received about 3,000 phone calls.
It was that set of responses, under the ‘EbolaAlert’ umbrella, that the federal and state ministries of health would go on to adopt as their official messaging platform.
David Brett-Major is a former US military doctor who now works for the World Health Organisation, in the Global Capacities Alert and Response department. He was, from the accounts I have heard, the man who, alongside his colleague Kamal Ait-Ikhlef, a “logistician”, made all the difference in the containment and curative approach to the disease. Dr. Igonoh sats that Brett-Major “would come in once or twice a day and help clean up the ward after chatting with us. He was the only doctor who attended to us. There was no one else at that time.”
“(Brett-Major) built confidence in the Nigerian team,” Bakare told me in August. “He’s doing things nobody else wants to do.”
Also deserving of commendation is Médecins Sans Frontières, which has been involved in the Ebola response across Africa for many years, long before this latest outbreak. It has also been been playing an invisible role in supporting Nigeria’s healthcare system for years. A year ago I visited the Badia East slum settlement in Lagos, which had, months earlier, been demolished by the Lagos State Government, and was told by residents that between 2010 and 2012 MSF ran the community’s only health clinic. It hired and paid the doctors and nurses, and provided an ambulance service. All of this, I am told, was free of charge – MSF covered all the costs. (It becomes even more interesting when you consider the role Nigeria play in the formation of MSF, in 1971, by a group of French doctors who had worked for the Red Cross on the frontlines in Biafra during the Nigerian Civil War. Dismayed by what they saw as the Red Cross’ unsatisfactory handling of the crisis, they founded the MSF).
There are also all the Nigerian physicians and nurses and cleaners who eventually signed up to the effort, no doubt inspired by the example of the WHO staff. The WHO specifically mentions a certain Dr. Bowale as “the first Nigerian physician [to commit] to direct participation in the care team at a time when health worker panic was rife.”
Some gratitude should also go – somewhat perversely, admittedly – to Lassa Fever, a viral hemorrhagic disease like Ebola, also very deadly, but much less contagious. The disease, which was first discovered in north-eastern Nigeria in 1969, and which continues to break out across Nigeria from time to time, somehow unwittingly helped lay the foundation for Nigeria’s diagnostic response. The two laboratories that handled the testing and diagnosis of the Ebola virus – one at the Lagos University Teaching Hospital, and the other at the African Center of Excellence for Genomics of Infectious Diseases (ACEGID) at Redeemer’s University – were originally established to handle Lassa Fever.
The “availability of Lassa fever diagnostics capability … enabled the timely diagnosis of Ebola virus [in Nigeria],” Christian Happi, Cameroonian molecular biologist, and a Professor in the Department of Biological Sciences at Redeemers’ University, told me by email in August.
The list of Ebola heroes is a long one, as it should be. I should also mention the efforts of EbolaFacts.com, another volunteer effort. The website, brainchild of yet another medical doctor turned communications professional, Seyi Taylor (like Bakare an alumnus of the University of Lagos medical school) instantly went viral, and its contents soon showed up on flyers, digital billboards, and in newspapers. It was one of the most successful new media responses to the Ebola threat, providing, amidst all the misinformation, clear and useful and simple information.
Here is what I think: the Ebola containment story deserves a stand-alone presidential speech in which every player is credited in some way or another. In a country that does not do commemoration or celebration of real heroism very well (fat cats being handed undeserving national honours or presidential pardons doesn’t count!), the President would do well to set a refreshingly different example.
Most importantly, now is the time to start talking about how to start the much-needed reform of our public health system. More than 30 years after a certain Brigadier Abacha announced to a longsuffering country that its hospitals were no better than “mere consulting clinics without drugs, water and equipment” – and used that as a justification to seize power – nothing, sadly, has changed.