NIGERIA is battling to contain Lassa fever; since an outbreak began in November 2015, more than 100 people have died. Globally, the world is nervous about the mosquito-borne Zika virus that is spreading rapidly in South America, and is linked with increasing cases of microcephaly in children.
It’s part of a growing trend: emerging infectious diseases like these are becoming more and more of a global concern, and in Africa’s case - as the 2014-2015 Ebola crisis showed us - the continent is particularly vulnerable, due to poor health infrastructure in many cases.
But it’s not all doom and gloom; there are lessons to be learned from health emergencies like these, and smart governments never let a good crisis go to waste.
The Ebola outbreak offered many profound – but painful – lessons. The first is that countries with weak health systems and few basic public health infrastructures in place cannot withstand sudden shocks, whether these come from a changing climate or a runaway virus.
As the virus spread, health systems in Guinea, Liberia and Sierra Leone collapsed. People stopped receiving – or stopped seeking – health care for other diseases, like malaria, that cause more annual deaths than Ebola. Maternal mortality soared, and even a simple fall or accident could have deadly consequences.
Stopped in its tracks
But countries like Nigeria, Mali and Senegal, which had good surveillance and laboratory support in place and took swift action were able to defeat the virus before it gained a foothold. They were able to diagnose the disease quickly, trace all the people who had contacts with an Ebola patient, and impose quarantines. That stopped the virus in its tracks.
These are lessons that are coming in handy as Benin also works to put Lassa fever under control. The Benin authorities have taken emergency measures in response to the outbreak, including setting up quarantine units in affected areas to isolate and treat victims; establishing a contact tracing system to find those who might have been exposed to the disease; and making sure the drug Ribavirin, known to be effective against the disease, is widely available.
As of 10 Feb 2016, there had been 52 suspected cases of Lassa fever in Benin, and 17 people have died – two of them health workers.
The second big lesson of Ebola was that community engagement is the one factor that underlies the success of all other control measures.
“It is the linchpin for successful control. Contact tracing, early reporting of symptoms, adherence to recommended protective measures, and safe burials are critically dependent on a cooperative community,” a recent status report from WHO stated.
Control efforts in all three countries were disrupted by community resistance, fuelled by fear and misperceptions about an unfamiliar disease. The control measures imposed were frightening and disruptive – such as disinfecting houses, setting up barriers and fever checks, and the invasion by foreigners dressed in what looked like spacesuits, who took people to hospitals or barricaded them in tent-like wards, from which few returned.
But getting community buy-in, through extensive public health information campaigns, has had much success in Africa’s fight against HIV/AIDS. When the disease first emerged in the 1980s, so high was the fear and stigma that in many places, a diagnosis meant quick ostracisation from the community or even the family home, and one would be left alone to die.
But thanks to the brave campaigns of people like Philly Lutaaya – the first public figure in Africa to come out as HIV positive – the public perception of the disease slowly began to change.
Soon after receiving the news of his status in mid-1989, Lutaaya embarked on a nationwide tour of Uganda to “give a human face” to the disease, even as he grew increasingly frail.
His move to go public – and the airing of documentary “Born in Africa”, that chronicled the last months of his life before he died in December 1989 – probably did more to start reducing the stigma and change attitudes towards the disease than any official campaign ever could.
That shifted the public debate in the direction that forced authorities to confront the reality of the disease, instead of the denialism that had been the case thus far.
Community engagement was also key in Togo’s successful elimination of lymphatic lymphatic filariasis, commonly known as elephantiasis, in 2010, the first country in the WHO African Region to do so. The country conducted at least six consecutive rounds of mass treatments in targeted districts. These mass treatments, conducted door-to-door with the support of community health workers interrupted local transmission of the disease.
The success of the mass treatments was helped along by education and communication campaigns, carried out before and during the medicine distribution; and involvement of community health workers in the distribution of the medicines.
Since being declared free of the disease, the country has been under post-mass drug administration surveillance, which is carried out nationwide through a network of district level laboratories.
Elsewhere in Africa, public health successes of diseases like malaria, polio and cholera has been the result of innovative structuring of the health records and surveillance system.
In Kenya, for example, the Ministry of Health requires all public health centres, even the smallest local dispensary, to file reports to the Ministry of Health on the trends of certain diseases, including malaria, polio, measles, and others that are required to be under surveillance.
Filing these reports on time determines whether the healthcare staff gets will get their salary or not – meaning that the country’s medical data is quite robust, as it is a mandatory requirement to file these reports, or you don’t get paid.
Digitising health records is one popular option for governments to capture, analyse and report healthcare trends. One 2012 study indicated that several African countries, including Kenya, Uganda, South Africa, Tanzania, Ghana, Nigeria, Cameroon and DR Congo are in the process of rolling out electronic medical records, although many are still concentrated at the local and pilot stage.
Adopting digital records in one project in Kenya shortened patient visits by 22%, doctor time per patient was reduced by 58%, and patients spent 38% less time waiting in the clinic.
Ghana is one of the few African countries to attempt to roll out electronic records broadly in the public sector, with a national policy on e-health published in 2012. Zambia, too, is leading the way in digital records, with more than 550 clinics and hospitals around the country now using a pocket-sized chip card that carries an encrypted copy of a patient’s medical history.
But one survey showed that the majority of digital records projects in Africa are concentrated in HIV-related centres, as the shift to digital seems to be driven by donors’ need to report trends and outcomes of their projects.
As they are sustained by funding from international partnerships, it raises questions about the sustainability of these systems by the local healthcare infrastructure.
Still, the progress has been robust, and more importantly, the data captured by these digital records can yield incredible insights when subjected to Big Data analytics and serious number crunching.
In the US, one of the most radical – and insightful – reforms in healthcare President Barack Obama made during his presidency was not the controversial Obamacare; it was an innocuous executive order in his first days in office that required doctors keep digital patient records and abolished hand-written, often illegible scribbling.
The result, a few years later, is that the US has the biggest big data trove of patient records, that researchers are only just starting to analyse – and finding some unexpected insights. For example, the researchers found a link between cognitive decline in old age, and living within a few miles of an airport.
It appears that the background noise from planes landing and taking off as one sleeps at night has a serious impact on mental health – and researchers are now working on preventing that by developing soft earplugs that will not fall out during sleep.