In this interview, Minister of Health, Professor Onyebuchi Chukwu, bares his mind on the deadly ebola virus. He also speaks on the strike by doctors, passionately appealed to them to call it off.
His words: "If doctors are not at their posts, we would have a challenge. And some people have even written that part of the reason the index case was successfully handled was because doctors were on strike and, if not, the index case may have been taken to a public health facility. How true that is I don't know; but as the Minister of Health, I would want the doctors to call off their strike. In the event that we, God forbid, have more cases, we would need the doctors".
But the focus of this interview is the Ebola problem in the country, what government is doing and the challenges ahead. Excerpts:
What is the status of Nigeria regarding Ebola and its possible spread?
You will recall that I informed the nation that altogether we had placed 70 primary contacts of the index case - that is the imported case - under active surveillance.
What we do is that once you begin to show any symptom, no matter how mild, we quarantine you. We now have eight persons under quarantine in Lagos. So, what happened is that based on our report, last week, two of the health workers who came in contact (with the Liberian) were tested for Ebola virus disease and they came out negative. But in the case of the nurse, it has turned out positive and that's why we say we've been able to confirm a first Nigerian with the disease based on contact. Also, some other health workers who are suspected of having symptoms, their results have not been made available because they are not ready yet. We are maintaining that surveillance and, in terms of what we are doing, focus is on the secondary contacts and then the third degree contacts.
There was a meeting of health ministers in the West African sub-region in Ghana once the outbreak was noticed in Guinea. What was the outcome of that meeting regarding possible prevention?
Nigeria participated and one of the outcomes of that meeting was the establishment of a coordinating mechanism in West African countries and some Central African countries on how to share common strategies and common best practices and the sharing of information as we move on.
Let me say that what has happened is unfortunate because this man, who was the index case, was warned by his own country not to travel but how he managed to travel and not disclosing full information to those who asked him remains a mystery. Even while on the hospital bed, he was still denying. It is just unfortunate that he brought the disease into Nigeria and this tells you that every country of the world is at risk.
As the problem goes on we would constantly review out strategies and even the World Health Organisation, WHO, is holding a summit in Geneva, Switzerland, to review all the strategies in place and to see if there is need for a review. In-country here in Nigeria, we are working as a team, all hands are on deck - the Federal Government, Lagos State government and other state governments, WHO, the American CDC - we're working as a team and we'll continue to review the strategy in place. But what is important is that whatever we do, it should enhance the prevention of the disease and it shouldn't be counter-productive!
What is the focus of the strategy because there seems to be too much focus on air travel, whereas our land borders are there and they are porous?
The first one is communication beyond just providing information. We need to communicate effectively. The federal and state governments are doing that. The president has inaugurated an inter-ministerial committee for communication strategy. Eight ministers that are relevant are serving on that committee and they have a mandate to co-opt any other minister that they feel is needed.
Based on that, we are working with the Minister of Information and the Minister of Communication Technology, we are working with the Foreign Affairs Minister, Minister of Interior, Minister of Agriculture, Minister of Aviation, Minister of Science and Technology. Since March, we've had our jingles and adverts on television and even the private broadcast stations are now on board and are ready to sponsor these free of charge. The website is www.ebolaalert.org and information is there; you can make suggestions and make complaints - it is interactive. There are also telephone numbers you can reach the centres on.
Our toll-free helpline is 0800eboolahelp. We have a facebook page; we've opened accounts on Twitter and we have dedicated emails; but the Information Ministry is helping with grassroots communication since the ministry has the structure on ground. The faith-based establishments too will be useful in this regard. We want to be as open as necessary and possible.
We have expanded the facilities for diagnosis in the country. I am in touch with our development partners and they seem to be impressed with what we have in the country but I think we can still improve the scale. Regarding the borders, at Seme, for instance, people are being screened and we are using infrared to detect any rise in temperature; we have reviewed our forms that travelers must fill before they land at our airports and we have temperature screening at the international airports too.
Just two days ago, through the appropriate ministry, we directed the Customs Service to ensure that corpses are not just brought in indiscriminately. What do we mean by this? We are saying that before any corpse is brought into the country, the necessary death certificate must be provided and certified as genuine and true before any such can happened and we would be very stringent with this.
You have to prove the case but we want to maintain a tight control over movement of corpses. In Anambra for instance, we are working with the state government and once the result comes out we will alert members of the public. In Imo State, the corpse issue there has already been decided because they had a proper certificate of death and we are saying the body can be buried because it is not Ebola. On Monday, we sent a team to Akwa Ibom to investigate a case that was brought in from one of these countries that was reported to us. We are working round the clock to tackle the challenge.
What about the infrastructure to manage this problem?
That is one area I must say we are a bit slower than what we anticipated. In Lagos, the state government has done well by providing a place for us to quarantine and treat patients and we are asking for more. Given the way the state government has acted pro-actively, I want to commend the authorities and I believe the state government can do more. On our own part, we want to move ahead and provide isolation tents within our hospitals, so that we can have add-ons. We have trained the workers. Personal protective equipment is being provided through the Federal Government and our development partners, especially WHO. Other states appear slow but with the emergency on our hands, we cannot wait; so the Federal Government is moving ahead, though quite a number of governors are beginning to cooperate and we need to move a lot faster.
But how fast can you move?
It is immediate - very immediate. Once I'm through with you now, I'm off to another meeting. Since this thing started, I've not slept earlier than 4am everyday. But we are all working together.
How much of cooperation are you getting from the local authorities?
We have some challenge there. Once a council chairman, when he heard that we got space for isolation, they began to incite the youth to say 'we don't want Ebola in our community' - this was also a problem in other countries. The people need to understand that all of us are at risk because there is no person on whose passport is written EBOLA CARRIER. People need to understand what we are doing.
The family of the infected nurse, now dead, are they part of those under surveillance?
Yes, they are under surveillance. None of them has been symptomatic yet, but whenever we notice that, we would quarantine such a person. But we are counseling them at this stage and everybody really needs counseling. About delicacies like bats and monkeys. About peoples eating habits, even when you bar people from eating certain things, they go underground and it is even worse because you are not monitoring them. And I know people who have accosted me at the airport or at functions to say since I spoke about bats and monkeys they've stopped. What that tells us is that information is key.
But let me make this point. It is more dangerous for those who are processing the meat and who may have cuts because when it is raw those in contact with it are more in danger. The best thing to do is since we have other forms of protein, we can do without bats and monkeys for God's sake. We have goat meat; we have chicken. Must it be bats? What is needed is enlightenment and appeal. We are at risk and we don't need to mince words about it. How soon do we expect the striking doctors to come back?
We've tried to do our best by addressing almost all they demanded. But that is a question you should ask the Nigeria Medical Association, NMA, because even the Senate and the House of Reps have intervened, and after appearing to have dealt with all the issues, they refused. Elders in the profession have intervened, the governor of Delta State (a medical doctor) intervened; even Mr. President had a one-on-one on two occasions with the leadership of NMA; so I don't know who else to help us appeal to them. I think the strike should be called off; we are appealing to them because we need them to be there, but if they don't, we will take the second best thing.
What level of collaboration exists with the private hospitals as a secondary option for people since the doctors are on strike?
Let me tell you, the index case was discovered at the airport and, because government doctors were on strike, he was taken to a private hospital. I guess if doctors were not on strike, he may have been taken to LASUTH or LUTH. We are engaging them and our people are holding meetings with different groups of private practitioners. We identified that the students need to be enlightened more because of the school environment.
How do we man the illegal entry points?
That is one of the reasons it has been difficult to just close the borders because what it then means is that when you close the designated borders, you leave room for people to use the illegal entry points which are totally off our radar. Mind you, we don't have gates round the country; so it may even be more inimical to close the borders because of those illegal points, so we should encourage people to come in through the 22 designated entry points but once there is a consensus on that, we may then move.
Are we in touch with the American government regarding that serum that was administered on their doctors who got infected with the virus?
Yesterday, I inaugurated the treatment research group and one of its terms is to collaborate with similar such groups all around the world and they are getting in touch with the Americans. They also have the opportunity of looking at their own options and we should not underestimate the intelligence of Nigerians, that's why that committee was inaugurated.
There is no time frame because it is a standing committee on Ebola and possibly other diseases. This is just the beginning. Part of our measures also is to screen in-bound and out-bound passengers just as the passengers too would be screened in their countries of disembarkation. For local flights, internal restriction of movements is counter-productive. What is important is to follow up on contact tracing because there is not enough resources anywhere in the world to do that. But for airports that we know could serve as connection points we are taking care of that.
Now, what about Professor Maurice Iwu's thesis regarding bitter kola and Ebola?
One of the things we decided to focus on by setting up that committee is to streamline claims of possible scientific cure, not a situation where pastors and imams claim they can cure Ebola. We might even go to the extent of making laws to arrest people with such bogus claims. We would take every suggestion seriously. About Professor Iwu, we know that quite a number of Nigerians accessed his article through the internet.
What Professor Iwu and his research team proved in America is that in the laboratory test-tube - not in an animal or a human being - bitter kola extract was able to hinder the growth of Ebola virus, that it was able to slow it down or kill it. That research was not concluded according to Professor Iwu himself and he says he is disappointed that the research was not taken to its logical conclusion.
We need now to work with him and that is why we need him. He is a distinguished world renowned professor of pharmacognosy; and he is someone we value in this country because of his professionalism and working with others; we would be able to put all ideas to the test and see how far we go.
This is a serious business.
By Jide Ajani
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