Lassa fever: ‘No toilet, no marriage’ and other strategies

Greg Odogwu

When I read of the death, last Sunday, of Idowu Ahmad, a medical doctor at the Federal Medical Centre, Lokoja, Kogi State, I was heartbroken. The young man contracted the Lassa fever virus in the line of duty, was transferred to Irrua, Edo State, but lost the battle to the acute viral haemorrhagic pandemic that has been hitting Nigeria on and off for some years now.

The way the disease just comes and goes, cutting short many Nigerians’ lives with each visit, clearly shows that we need to change our overall Lassa fever prevention and containment strategy. It is time we woke up to the reality of the wise saying, popularised by the American politician, Xavier Becerra, “Winning the peace is harder than winning the war.”

We are used to facing emergencies head on, galvanising our human resources, mobilising every material resource, and finally beating whatever the challenge is hands down. Yes, we always win. But the challenge is when we win, we sleep off; waiting for the next enemy to rear its ugly head, then we mobilise afresh. Sadly, we always lose our best soldiers even before the start of each battle. It has almost become like a predictable parabola. A deadly national ritual.

Therefore, what we need now are strategies that can help us win the peace. When Lassa fever is not there, what are we doing to prevent its recurrence? Is it not said that prevention is better than cure? So that even when it shows up, our first salvo hits before it lands. Today, a number of Nigerian states are grappling with Lassa fever: from Ondo to Kogi, to Ebonyi – which had to close down public schools to curb the spread- and now to Imo, where at the last count on Wednesdaythe state government had admitted to the death of three lives.

Surely, these states will come out of their present trouble. But the question is, what will they do after Lassa fever must have left their borders? Will they leave their hospitals without proper equipment to enforce standard precautionary protocol? Or, will they arm the hapless doctors with requisite tools to tackle unforeseen outbreaks?

The World Health Organisation has made it clear that prevention of Lassa fever relies on promoting good community hygiene to discourage rodents from entering homes. In health care settings, staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis.

Ironically, what we find in Nigeria is a governance infrastructure so abysmal that even the number one hospital in Nigeria, may not have the WHO recommended infection prevention and control precautions materials. Of course, this is no exaggeration. Weren’t we told late last year by someone that should know that no single injection syringe was found at the Aso Rock Clinic, notwithstanding the billions of naira inserted in the budget to stock the hospital for the year? It does not, therefore, require any stretch of the imagination to know that those who could overlook the purchase of syringes would naturally feel no compulsion to include hand gloves in their scanty shopping cart for the presidential infirmary.

What then follows is a free-for-all domino effect. The state governors who always look up to the President for inspiration, and sometimes for angelic assistance, would not even conceive upgrading their squalid state clinics. The doctors who work there are at their own mercy. They would even be lucky to get their meagre monthly salaries paid to them promptly. They receive no motivation whatsoever. They console themselves with private practice, which is also another sorry story, because one can imagine the kind of obsolete equipment they can afford to equip their pet-project-and-survival-soiree set up beside their bedrooms.

This is why when we talk about brain drain, it is not only about going for better pay outside Nigeria. It is also about getting off a doomed ride. A 30-year-old doctor like Idowu might still be alive today if there were standard first-contact protocol and equipment in every Nigerian hospital. For all the squalour we see, and the revelations coming from the high and mighty, the young man’s death might have been preventable.

Before I digress, let us look at what it means to have strategies against known epidemics. For Nigeria to tackle seasonal epidemics, we need a total overhaul of our mindset. Our political leaders especially should stop thinking in terms of money and budget. Good governance is about people-oriented ideas, focused, well-researched and trackable. This is how nations grow. It does not take much observation to understand that governance in Nigeria revolves around two words: budget and cash-backing

When there is an emergency, it would immediately seem as if the concerned leaders have been praying for it, because of the way they immediately run to Abuja with cap in hand, literally begging for the almighty Federal Government to disburse “cash” to its “suffering people”. Immediately after the emergency, these leaders retire the remaining money and clean their mouth. Nobody hears about what they learnt from the past challenge, and how they are prepared to tackle another probable future risk. They simply forget the past and pray for a better tomorrow.

Some of the benevolent ones stage religious “thanksgiving” jamborees, and tell the gullible and unfortunate Nigerians that “God has done it again for His people”: the success in defeating the epidemic was actually a miracle!

We need to wake up and tell ourselves the truth. The way we make our bed, we lie on it. Lassa fever is preventable because it has a visible source. The rodent that carries the virus is here with us, all we need to do is think. We need to devise ways to either do away with the rodents or ensure they never breed in our immediate environment, or we create means of putting a boundary between the vectors’ ecosystem and our human abodes. Yes, we can.

Nations around the world are daily devising ways to nip epidemics in the bud. Sometimes, the methods people come up with may be laughable, but at the end of the day, most are practicable and effective. Human society has a way of getting comfortable with anything that works, no matter how ugly. Sometimes, the strategies are not necessarily direct, but roundabout ways to get at the epidemic.

An epidemic like cholera, for instance, is tackled with fighting open defecation especially in urban areas. I was in Ghana recently, and I discovered how a particular local authority deployed such a strategy which they called “No toilet, No marriage”.

Because the government was doing everything to end open defecation, the Komenda- Edina-Eguafo-Abirem Municipal Assembly in the Central Region of the country decreed that marriage certificates of would-be-grooms in the municipality would only be issued to them after providing evidence of them having a toilet facility in their homes.

 Interestingly, when the local government promulgated the new environmental health law, it was described by many as an affront on the rights of the prospective grooms, arguing that the assembly had no right to demand that as a prerequisite in allowing marriages to take place. The local chiefs of the locale however concurred with the government that the decree by the Municipality was a positive step in reducing the high rate of open defecation in the area.

It was during my visit to Ghana that the government announced the success of the policy, prompting other local authorities in the West African country to start working on copying the policy of the KEEA Municipality. In the news item I watched on the country’s prime time news channels, the Sanitation Officer of KEEA, Alex Damptey, indicated that the measure had been hugely successful thus far in the fight against the scourge of open defecation, leading to the declaration of some seven communities in the area open defecation-free.

 Nigeria can adopt such innovative strategies to deal with the Lassa fever scourge

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