The panic associated with the spread of the dreadful virus Ebola grabbed headlines in the media in the recent past as six passengers of Bangladeshi origin (from Ebola-affected Liberia), entered the country through Shahjalal International Airport without proper health screening. Fortunately, it was later ascertained that they were not infected with the virus. Nevertheless, the absence of rigorous monitoring at the airport has been a wake-up call for the relevant authorities.
The incident exposed the lack of necessary coordination between the officials of the health ministry, the immigration department, civil aviation ministry and the different airlines using Dhaka and Chittagong airports. What was also disturbing was the report received from one of the above six passengers that some other Bangladeshis had already returned from Liberia and Sierra Leone before them and had passed through the Shahjalal International Airport without proper health screening.
Considering the seriousness of this issue, it has been good of the Health Minister to have assured the people that steps to keep the global pandemic out of Bangladesh were being taken with great seriousness. In this context, the media was asked to play a responsible role about spreading the message regarding possible symptoms associated with the virus, and the cautionary and preventive measures that need to be taken. It has been clarified that contrary to some media reports, 126 passengers coming into Bangladesh from West African countries had been screened during the month of August.
The Director of the Institute of Epidemiology, Disease Control and Research has mentioned that a total of 25 medical teams are now working at 20 land ports, three international airports and two seaports across the country. These teams have already trained about 3,000 other doctors on how to handle the Ebola virus. One can only hope that what is being claimed by the authorities is implemented with caution and care. It might be useful in this context to seek technical advice from experts in the USA and the UK.
FIRST IDENTIFIED IN 1976: Ebola as a disease was first identified in 1976 in Zaire, in the middle of the Congo River basin in Africa. Scientists examining the infected blood (taken from a sick Belgian nun in Zaire) in Antwerp discovered a totally new virus within the family of filovirus and named it after the Ebola River not far from the dying nun's mission station. The scientists researching the disease agreed that fruit bats were the most likely natural 'reservoir' for the Ebola virus and that it travelled from them through their saliva or through their excreta deposited on fruits. Once inside the body in humans, this virus tends to spread around the body contaminating other cells and destroying the immune system. This eventually leads to fever and heavy bleeding, sometimes from the nose, fingernails or anus. Consequently Ebola is also categorised as a hemorrhagic fever. Victims eventually die from multiple organ failure. The infection chain is taken forward through the body fluids of the sick person.
OFFICIAL GUIDELINES FOR SURGICAL TREATMENT: The World Health Organisation (WHO) in their statement issued in the second week of October indicated that out of a total of about 8,400 registered Ebola cases in seven countries, 4,033 people had died. The vast majority of those deaths have been in Guinea, Liberia and Sierra Leone. The Center of Disease Control and Prevention (CDC) indicated in September that between 550,000 and 1.4 million people might be infected in the region by January, 2015. Those already infected included at least 416 health care workers who contracted Ebola while providing healthcare to patients affected by the virus. Of them, 233 have already died, according to the WHO. In Liberia, the worst-affected country, the virus has killed more than 100 medical workers. This has led to an invisible crisis as medical staff have been expressing their dissatisfaction about the inordinate risk they are to undertake and the lack of medical resources.
This emergency situation and growing fear among the medical personnel have persuaded the American College of Surgeons and the Association for Academic Surgery and the United States Centers for Disease Control and Prevention (CDC) to prepare official guidelines for the surgical treatment of suspected or confirmed Ebola patients needing emergency care. They are hoping that the new guidelines will serve as a starting point to help health care providers in Ebola-stricken countries perform surgical interventions more safely. It is also expected that this guideline will serve as an advocacy tool to prepare others to stock up on the appropriate protection materials, including double gloves, leg coverings with a full plastic film coating, full face shields, and masks, surgical gowns made of a hi-tech fabric, hoods and goggles- to stave off virus infection.
The draft protocol sets forth instructions on how to handle needles and sharp surgical tools, as well as what to do when skin is exposed to blood of the patient during the procedure. By doing so, they have fulfilled their Hippocratic Oath.
One hopes that the responsible authorities in our country will take pre-emptive measures and stock up on the required items and practice their use through emergency drills.
It is disappointing to find that coordinated international help to fight this serious disease has been less than desired. Doctors without Borders (MSF) has drawn world attention in its website to this by pointing out that it sought help from the international community but "to this date, very little has materialised in concrete action on the ground." The organisation's teams, composed of 3,058 staff working in Guinea, Liberia, Nigeria, Sierra Leone and Senegal, are seeing "critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems and community education and mobilization." This sort of inaction is totally unacceptable.
To this has been added media reports which have highlighted abject circumstances in the affected areas in West African countries. The Washington Post has detailed horrific conditions at a Monrovia Ebola facility where one doctor died from Ebola and another tested positive for the virus. The Post reported: "Doctors put on their protective gear in the kitchen. There is no incinerator, so a 10-foot pile of Ebola-laced garbage and excrement sits in the back yard. There is no morgue, so bodies sometimes decay outside, next to where patients sit in white lawn chairs. There are no protective hoods for the full-body medical suits."
Questions have been raised about security arrangement at the healthcare centres. In August, CNN reported that an Ebola treatment facility in Monrovia was attacked by an armed mob who stole mattresses and equipment. Ebola patients fled, local authorities said. Matters have turned for the worse, particularly in Guinea and Sierra Leone where healthcare workers have been mostly unable to track and monitor the contacts of infected people because of poor road conditions. Crowded housing in other parts of the affected areas has also made healthcare extension efforts more difficult.
Establishing calm and assurance is a vital and human part of being a caregiver. Ebola is, however, taking that away from nurses and doctors who are afraid while continuing their work out of their practical necessity and also sometimes because of their commitment and passion.
THE ROLE OF THE WORLD POWERS: The world powers appear to be busy with their own prioritised political agenda. They express their concern about human rights and yet fail to raise the requisite contribution required to help the stricken African countries overcome their health travails. They seem to be forgetting that this health implosion, the biggest since the AIDS epidemic will not respect borders or sovereign rights of nations. It will not remain as a localised West African problem but will march through other countries leaving behind a trail of death.
It would be useful at this point to refer here to the recent comments made by Amara Konneh, the Finance Minister of Ebola-affected Liberia. He has pointed out that the entire globalised economic system has a stake in this fight against Ebola and this has been proven with travel firms' shares diving with fears of further air-travel restrictions for holidaymakers and businesses and international financial institutions, resources companies and other large corporations anticipating an impact on international trade in cashews, cocoa, iron ore and oil.
The world has to be pro-active. A strategy needs to be worked out to support the re-building of community infrastructure and promoting economic livelihood projects in Ebola-affected countries.
We have to understand that terrorism is a threat but so is Ebola - particularly in densely populated South Asia. One hopes that the next SAARC Summit in Kathmandu will address this issue.
The writer, a former Ambassador, is an analyst specialised in foreign affairs, right to information and good governance.
mzamir@dhaka.net