Fr Paterne Mombe SJ, AJAN Director, AJANews 132 July-August 2014
“Madame, I congratulate you and the Kenyan government for doing this,” I said while returning the form I was requested to fill on arrival at the airport. “Thank you,” she replied. “I wish I could record this statement and share with some people around here. They don’t understand the sense of what we are doing and think we are bothering passengers for nothing.”
Public health measures are crucial
I had this conversation a month ago with a health professional officer at the Jomo Kenyatta International Airport (JKIA) as I was coming back from a trip to some Central African countries. Her team was distributing a form to any passenger from Central and West Africa regardless of rank.
The easy-to-fill form is a series of questions. The first part covers background information on the traveller, including countries visited in the past two or three weeks; the second asks whether the traveller has experienced any of the dozen symptoms listed in the form; the last is about contacts and addresses in Kenya and abroad. Questions flitted through my mind as I filled the form: should I tell the truth and say I had flu last week, with fever and headache? Would they put me in quarantine and waste my time for nothing? And so on…
I congratulated the healthcare team at the airport for taking this basic public health measure because it is the kind of action that should be taken by the airport authorities and health ministries of all African countries. But from the six airports and borders I crossed within ten days, only JKIA took the right measures. It is crucial – and in the interest of all – that travellers and others comply with public measures to monitor and control the risk of transmission in places where Ebola infection may occur. Gathering this data makes it easier for health professionals to swiftly track down anyone who might have been in contact with a passenger who turns out to be infected.
The worst-ever Ebola outbreak
This worst-ever outbreak of the deadly Ebola virus started in Guinea (Conakry) in February 2014. By 23 April, 242 people were allegedly infected and 142 had died from the Ebola haemorrhagic fever (EHF) or Ebola virus disease (EVD). The virus was then observed in patients in Liberia between the end of March and mid-April, and in Sierra Leone where the first case was officially documented on 25 May. Two months later, a new case was reported in Nigeria. On 15 August, the death toll stood at 1,145 out of 2,127 cases reported.
The situation is serious: the World Health Organisation (WHO) recently declared a public health emergency – something it has done only twice before in its 66-year history – and called for “extraordinary measures”. Medecins Sans Frontieres (MSF) said the scale of the epidemic had been “vastly underestimated” and that the situation was “deteriorating faster, and moving faster, than we can respond to”.
A lethal disease
Ebola stands out as one of the most lethal infectious diseases in human history, with a fatality rate of up to 90% (although it is around 55 to 60% in the current epidemic so far). It is a virus that causes first fever, headaches, muscle pain and conjunctivitis, then moves to a more severe phase which include vomiting, diarrhoea, and haemorrhage (internal and external bleeding). Severely ill patients or people at advanced stages of infection are highly contagious.
Although we don’t know yet which wild animal (‘reservoir’ of the virus) transmits the Ebola virus to the human community, provoking here and there a new epidemic, we know it is transmitted and spread among humans through person-to-person contact, or through contact with or consumption of bush meat (primates). More specifically, Ebola is transmitted through direct or close contact with blood, body fluids, and tissues or cadavers of infected animals or persons.
Peter Piot, who co-discovered Ebola with his team in late 1976 when a mysterious pathogen was killing people in then Zaire, told Reuters he’s saddened and frustrated by this and other outbreaks – partly because they should be easy to prevent, or at least to contain. “What we’re seeing is a pattern that’s been repeated in nearly every single Ebola outbreak,” the former UNAIDS director told Reuters. “It started in people who live in the forest, or in close contact with it, and it’s then transmitted around hospitals… and then spreads further either at funerals or in households though close contact.”
Most cases of fatal exposure reportedly take place when medical staff or family members are caring for the afflicted or when families are preparing deceased patients for burial. It can travel from one country to another via travel, as symptoms of Ebola infection can take two to 21 days to manifest. However the virus is not airborne and WHO has said the risk of transmission of Ebola during air travel is low.
Containing the epidemic
As of now, there is neither treatment nor vaccine. Still Ebola can be contained. As Dr Piot said: “It’s about respecting the basics of hygiene, and about isolation, quarantine and protecting yourself – in particular protecting healthcare workers, because they are very exposed.”
At the level of public health in African countries, effective surveillance mechanisms are a must to contain and control the current outbreak. It’s also a question of resources or rather of lack of resources. According to an article penned by Jim Yong Kim, president of the World Bank Group, and Nkosazana Dlamini Zuma, chairperson of the African Union Commission, Liberia has one physician for every 70,000 people, Sierra Leone one for every 45,000. More healthcare workers need to be deployed, more clinics opened, and more equipment put in place.
At the individual, family or community level, revising aspects of life, relationships, reactions and interactions, especially around caregiving and mourning/burial practices, is important. Measures to contain the epidemic hinge upon widespread information-sharing, communication, sensitization and education in hospitals, at home and in any community gathering.
So far, in a context where the epidemic is moving faster than efforts to contain it, the response has been too little, too late. We can only hope that urgent calls for action are heeded and that international and domestic actors make up for lost time to contain Ebola before it gets completely out of hand.