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Ebola: Nigeria's Healthcare System Failed Us by Nobody: 5:15pm On Aug 22, 2014
Nigeria was free of Ebola until the late Patrick Sawyer, the Liberian-American, imported Ebola into Nigeria on July 20. Mr Sawyer was reported to have been terribly ill on his flight and was rushed to the First Consultant Hospital Obalende, Lagos, where he was diagnosed as having Ebola. He died on July 24.

From that single imported case of Ebola, Nigeria has had, till date, 14 confirmed cases of Ebola (including the 2 cases confirmed today out of the secondary contacts), out of which 5 deaths [including the index (imported) case] was recorded. 5 confirmed cases of Ebola made full recovery and have been discharged while up to 213 contacts are on follow up.

Few days ago, Nigeria’s Health Minister, Prof Onyebuchi Chukwu described the way Nigeria has managed the imported case of Ebola so far as a "success story". With all due respect, I beg to disagree with the Prof. I think we FAILED and I will point out the different levels of failure below.

1. The index case of Ebola was already sick when he arrived the Lagos Airport on July 20. If the Port Health Authorities were alive to their duties on that fateful day, perhaps the late Sawyer would have been quarantined immediately, especially since there was already a widely reported ongoing epidemic of Ebola in Liberia since March this year. Therefore, the Port Health Authority FAILED at this level.

2. Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.

However, the hospital should be commended for making the diagnosis of EVD eventually and alerting the Lagos health authorities. Otherwise, things could have been worse.

3. The failure of the the First Consultant Hospital to make the diagnosis of ebola promptly can also be linked to failure of the state and federal health authorities to sensitize the private and public hospitals on the possibility of ebola outbreak in Nigeria considering the fact that neighbouring west African countries have been battling with ebola epidemic since March this year. The state and federal health authorities FAILED in this respect.

4. The other level of failure is the way we have managed the primary contacts of the index case. I believe that the primary contacts ought to have been categorized into high risk and low risk contacts. The low risk contacts will include, for instance, all those that flew in the same aircraft with Mr Sawyer. The high risk contacts should include the person who sat next to Mr Sawyer in the aircraft, those who helped him all the way to the Lagos hospital and all the health workers that took care of him when his condition was still unknown. All those who fall into the high risk group ought to have been quarantined compulsorily immediately because they are at high risk of EVB. On the other hand, those who fall into the low risk group can be followed up at their homes since they are at low risk of developing EVD.

This strategy has the following benefits:
- since we cannot quarantine all the primary contacts because of logistic challenges, those at high risk, who are few, can be quarantined.
- high risk individuals who develop EVD while on quarantine will not transfer the disease to secondary contacts. That way, secondary contacts will be minimal or zero. If this strategy was adopted, the 213 secondary contacts that are currently on follow up and the 2 confirmed cases of EVD among secondary contacts would not have arisen.



The above suggested strategy is better than the strategy adopted by Nigeria's health authorities, which is simply to follow up all contacts from home. This has led to what looks like a cascade of 213 secondary contacts and 2 confirmed cases of EBV among the secondary contacts. And God forbid, if we continue this way, we will soon be talking of tertiary contacts, quaternary contacts, and so on, with resultant ballooning morbidity and mortality.

In conclusion, if we have this level of mortality and morbidity from a single imported case of Ebola, just imagine what will happen if, God forbid, we have infiltration of several Ebola cases into Nigeria.

Note: this article is a critique of the system, and does not necessarily suggest the author would have done better than the various actors under the same circumstance.

62 Likes 6 Shares

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 5:31pm On Aug 22, 2014
They finally succeded in hacking into insincere9igerian's account grin

66 Likes 1 Share

Re: Ebola: Nigeria's Healthcare System Failed Us by SLIDEwaxie(m): 5:45pm On Aug 22, 2014
kolawaxxy: They finally succeded in hacking into insincere9igerian's account grin
I'm also wondering o..
But I think he's trying to alert his paymasters that he hasn't been paid for the month of july grin grin grin

I dnt think u will get paid soon o because dem don pay allowances of russian students? grin grin

Country don go broke

66 Likes 1 Share

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 5:48pm On Aug 22, 2014
SLIDEwaxie: I'm also wondering o..
But I think he's trying to alert his paymasters that he hasn't been paid for the month of july grin grin grin

I dnt think u will get paid soon o because dem don pay allowances of russian students? grin grin

Country don go broke

Bros, this thread suprise me o grin

27 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by phantom(m): 5:52pm On Aug 22, 2014
Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.


with all due respect the above is rubbish

32 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by nigerianvenom(m): 5:52pm On Aug 22, 2014
weldone sincere9gerian.u are one of the few good youths we have in nigeria.the point raised is clear and potent

11 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by naptu2: 5:54pm On Aug 22, 2014
Sincere9gerian: Nigeria was free of Ebola until the late Patrick Sawyer, the Liberian-American, imported Ebola into Nigeria on July 20. Mr Sawyer was reported to have been terribly ill on his flight and was rushed to the First Consultant Hospital Obalende, Lagos, where he was diagnosed as having Ebola. He died on July 24.

From that single imported case of Ebola, Nigeria has had, till date, 14 confirmed cases of Ebola (including the 2 cases confirmed today out of the secondary contacts), out of which 5 deaths [including the index (imported) case] was recorded. 5 confirmed cases of Ebola made full recovery and have been discharged while up to 213 contacts are on follow up.

Few days ago, Nigeria’s Health Minister, Prof Onyebuchi Chukwu described the way Nigeria has managed the imported case of Ebola so far as a "success story". With all due respect, I beg to disagree with the Prof. I think we FAILED and I will point out the different levels of failure below.

1. The index case of Ebola was already sick when he arrived the Lagos Airport on July 20. If the Port Health Authorities were alive to their duties on that fateful day, perhaps the late Sawyer would have been quarantined immediately, especially since there was already a widely reported ongoing epidemic of Ebola in Liberia since March this year. Therefore, the Port Health Authority FAILED at this level.

2. Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.

However, the hospital should be commended for making the diagnosis of EVD eventually and alerting the Lagos health authorities. Otherwise, things could have been worse.

3. The failure of the the First Consultant Hospital to make the diagnosis of ebola promptly can also be linked to failure of the state and federal health authorities to sensitize the private and public hospitals on the possibility of ebola outbreak in Nigeria considering the fact that neighbouring west African countries have been battling with ebola epidemic since March this year. The state and federal health authorities FAILED in this respect.

4. The other level of failure is the way we have managed the primary contacts of the index case. I believe that the primary contacts ought to have been categorized into high risk and low risk contacts. The low risk contacts will include, for instance, all those that flew in the same aircraft with Mr Sawyer. The high risk contacts should include the person who sat next to Mr Sawyer in the aircraft, those who helped him all the way to the Lagos hospital and all the health workers that took care of him when his condition was still unknown. All those who fall into the high risk group ought to have been quarantined compulsorily immediately because they are at high risk of EVB. On the other hand, those who fall into the low risk group can be followed up at their homes since they are at low risk of developing EVD.

This strategy has the following benefits:
- since we cannot quarantine all the primary contacts because of logistic challenges, those at high risk, who are few, can be quarantined.
- high risk individuals who develop EVD while on quarantine will not transfer the disease to secondary contacts. That way, secondary contacts will be minimal or zero. If this strategy was adopted, the 213 secondary contacts that are currently on follow up and the 2 confirmed cases of EVD among secondary contacts would not have arisen.



The above suggested strategy is better than the strategy adopted by Nigeria's health authorities, which is simply to follow up all contacts from home. This has led to what looks like a cascade of 213 secondary contacts and 2 confirmed cases of EBV among the secondary contacts. And God forbid, if we continue this way, we will soon be talking of tertiary contacts, quaternary contacts, and so on, with resultant ballooning morbidity and mortality.

In conclusion, if we have this level of mortality and morbidity from a single imported case of Ebola, just imagine what will happen if, God forbid, we have infiltration of several Ebola cases into Nigeria.

Note: this article is a critique of the system, and does not necessarily suggest the author would have done better than the various actors under the same circumstance.

+100

8 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 6:08pm On Aug 22, 2014
phantom: Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.


with all due respect the above is rubbish
Why?

11 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by eaglechild: 6:18pm On Aug 22, 2014
Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.

ABSOLUTELY NOT

Patrick Sawyer COMPLETELY denied a history of contact with an Ebola patient, the most important lead in clenching the diagnosis in the absence of specific symptoms.

He was NOT showing any SPECIFIC symptoms of Ebola on arrival, irrespective of that, the managing medical team treated him with a high index of suspicion and insisted on testing him based on his travel history, I can tell you that the diagnosis would have been completely missed if he had gone to a less professional place with more catastrophic consequences.

Patrick Sawyer deliberately endangered the lives of the medical personnel by withholding information and spraying them with contaminated body fluids.


The rest of what you wrote is OK.

35 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by eaglechild: 6:20pm On Aug 22, 2014
phantom: Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.


with all due respect the above is rubbish
Thank you.

6 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Mynd44: 6:27pm On Aug 22, 2014
Patrick Sawyer was a medical terrorist, claiming the health officials failed in their jobs is complete silliness.

I took who says he does not intend to make sensible arguments on NL seriously. Therein lies my silliness

11 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by vicadex07(m): 6:28pm On Aug 22, 2014
Wow...all this coming from the same OP that never sees anything wrong with this current administration

Am seriously dumbfounded lipsrsealed

10 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Mynd44: 6:29pm On Aug 22, 2014
The OP actually expected the primary response team at a hospital to start asking for the travel history of a patient?

I find the lack on a reliable chain of reason hilarious

11 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 6:30pm On Aug 22, 2014
eaglechild: Late Patrick Sawyer was rushed to First Consultant Hospital, Lagos, on arrival. It was reported that Sawyer was initially assessed and treated for malaria, hepatitis, etc. The assessment and diagnosis of Ebola came later. The junior and senior doctors that managed Sawyer at the First Consultant Hospital FAILED at this level. With history of acute fever (plus other symptoms) and recent arrival from Liberia, the diagnosis at presentation ought to have been ebola viral disease (EVD) UNTIL PROVEN OTHERWISE.

ABSOLUTELY NOT

Patrick Sawyer COMPLETELY denied a history of contact with an Ebola patient, the most important lead in clenching the diagnosis in the absence of specific symptoms.

He was NOT showing any SPECIFIC symptoms of Ebola on arrival, irrespective of that, the managing medical team treated him with a high index of suspicion and insisted on testing him based on his travel history, I can tell you that the diagnosis would have been completely missed if he had gone to a less professional place with more catastrophic consequences.

Patrick Sawyer deliberately endangered the lives of the medical personnel by withholding information and spraying them with contaminated body fluids.


The rest of what you wrote is OK.
I heard that aspect of the story too (that Mr Sawyer denied having any contact with people with Ebola disease) but I still insist that a history of acute fever PLUS recent arrival from Liberia was sufficient to make a diagnosis of Ebola UNTIL PROVEN OTHERWISE.

15 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Mynd44: 6:31pm On Aug 22, 2014
Sincere9gerian:
I heard that aspect of the story too (that Mr Sawyer denied having any contact with people with Ebola disease) but I still insist that a history of acute fever PLUS recent arrival from Liberia was sufficient to make a diagnosis of Ebola UNTIL PROVEN OTHERWISE.
A man walks into an hospital and you expect them to ask him for his travel history?

what planet do you live?

18 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by redsun(m): 6:33pm On Aug 22, 2014
It was a catastrophic right the plane,because we will assume Liberia is a confirmed failed state. The airline should have been at alert for something like that and should taken measures on the plane to keep him restrained.

I wonder if he was travelling to Europe or America he would have been able to get on the plane like he easily did to nigeria in that condition?

1 Like

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 6:40pm On Aug 22, 2014
Mynd44:
A man walks into an hospital and you expect them to ask him for his travel history?

what planet do you live?
I should know better. Biodata is the first set of information you get from a patient during assessment.

Besides, we heard Sawyer was rushed straight from the Airport to the hospital so it was a pretty straight forward travel history.

17 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Mynd44: 6:45pm On Aug 22, 2014
Sincere9gerian:
I should know better. Biodata is the first set of information you get from a patient during assessment.

Besides, we heard Sawyer was rushed straight from the Airport to the hospital so it was a pretty straight forward travel history.
An bio data includes travel history?

and rushed to the hospital from the airport....the first thing a first responder does is to stabilize the patient. Not ask where he was travelling from.

8 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by vicadex07(m): 6:55pm On Aug 22, 2014
Sincere9gerian:
I should know better. Biodata is the first set of information you get from a patient during assessment.

Besides, we heard Sawyer was rushed straight from the Airport to the hospital so it was a pretty straight forward travel history.

But by that time it will have been too late now. The Doctor would have already did some "feeling" and "touching" in order to access the situation cos of lack of awareness of the said virus at the time.

Besides that, technically speaking the virus would have started spreading from the point of entry i.e. the airport

5 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 6:55pm On Aug 22, 2014
Mynd44:
An bio data includes travel history?

and rushed to the hospital from the airport....the first thing a first responder does is to stabilize the patient. Not ask where he was travelling from.

Biodata includes name, nationality, tribe, place of residence, etc. Before you get all these information it would have been clear that the patient is not a Nigerian, that he is a Liberian, who is in Nigeria on transit to US (according to the reports).

Secondly, you do not spend all day stabilizing the patient. In addition, history taking can continue during patient stabilization and Patrick Sawyer arrived the hospital with aides who could have provided any information in case he was unconscious, which was not the case.

The problem in the case of Sawyer was not that travel history was not known but that he denied any contact with ebola case.

20 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 7:05pm On Aug 22, 2014
vicadex07:

But by that time it will have been too late now. The Doctor would have already did some "feeling" and "touching" in order to access the situation cos of lack of awareness of the said virus at the time.

Besides that, technically speaking the virus would have started spreading from the point of entry i.e. the airport
My point is that the diagnosis from day one would have been Ebola until proven otherwise. If that was done, it would have reduced the number of contacts within the hospital to only healthcare workers who saw him on day one. Those who attended to him on day one would have gone home only after serious de-contamination.

If you still dont agree with me, compare the situation in Nigeria with other countries with similar imported cases of Ebola. How many of such countries have you heard primary contacts, secondary contacts, bla bla bla? Lets stop making excuses for our failures.

20 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 10:37pm On Aug 22, 2014
Can the moderators help move this thread to the health section?

1 Like

Re: Ebola: Nigeria's Healthcare System Failed Us by Sunnybobo3(m): 12:16am On Aug 23, 2014
Mynd44:
A man walks into an hospital and you expect them to ask him for his travel history?

what planet do you live?

Dude that's one of the questions asked when one presents with certain symptoms.

18 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by kayalade123: 8:01am On Aug 23, 2014
The Minister' claim is 100% right and perfect..
I don't see anything wrong with that statement..

2 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by Nobody: 12:01pm On Aug 23, 2014
Sunnybobo3:

Dude that's one of the questions asked when one presents with certain symptoms.
Exactly!

6 Likes

Re: Ebola: Nigeria's Healthcare System Failed Us by bunmioguns(m): 1:38pm On Aug 26, 2014
embarassed embarassed embarassed cry
Re: Ebola: Nigeria's Healthcare System Failed Us by johnwizey: 1:39pm On Aug 26, 2014
.
Re: Ebola: Nigeria's Healthcare System Failed Us by Abbey2sam(m): 1:45pm On Aug 26, 2014
M
Re: Ebola: Nigeria's Healthcare System Failed Us by ayusco85(m): 1:45pm On Aug 26, 2014
am just passing ni o............

Re: Ebola: Nigeria's Healthcare System Failed Us by hotmolo(m): 1:45pm On Aug 26, 2014
We hav always had the problem of addressing issues only when an epidemic stares us in the face. We neva plan ahead. Its a pity

1 Like

Re: Ebola: Nigeria's Healthcare System Failed Us by QMark: 1:46pm On Aug 26, 2014
True
Re: Ebola: Nigeria's Healthcare System Failed Us by Kelvin0(m): 1:46pm On Aug 26, 2014
!

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