Celebrating ‘Heroine’ of Ebola containment in Nigeria

*Dr. Stella Adadevoh’s selfless act integral in country’s quick control of 2014 outbreak
*ECOWAS honoured DRASA with posthumous Award of Excellence for stopping virus

Five years on, Nigeria and indeed rest of the world are still celebrating the heroine of the Ebola Virus Disease (EVD) containment in Nigeria, Dr. Stella Ameyo Adadevoh.

Director General/Chief Executive Officer of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, tweeted on Monday, August 19, 2019: “We celebrate the legacy of Dr. Stella Adadevoh, who died five years ago today (on August 19, 2014). Dr. Adadevoh’s selfless act was integral in Nigeria’s quick control of the 2014 Ebola outbreak. NCDC remains committed to building on her legacy, working with Ministries Departments and Agencies (MDAs), states and partners to prevent epidemics.”

The late Dr. Ameyo Stella Adadevoh worked for the First Consultant Clinic Obalende, Lagos, where she diagnosed the incidence case of EVD in the country and was the first Nigerian to die of the virus.

To immortalise Adadevoh, a Dr. Ameyo Stella Adadevoh Health Trust was established in May 2015.

DRASA is an abbreviation of Dr. Ameyo Stella Adadevoh, the courageous doctor who correctly diagnosed and contained the first case of Ebola in Nigeria though she had never seen an Ebola patient before. When threatened by Liberian officials who wanted the patient to be discharged to attend a conference, she resisted the pressure and said, “for the greater public good” she would not release him. Her efforts prevented a major outbreak in Africa’s most populous country, but as a result she contracted the virus and lost her life.

DRASA Health Trust was established to continue her legacy, promote preparedness for future infectious disease outbreaks, and keep people healthy and safe.

It is a non-profit organisation set up to foster connections and partnerships between key stakeholders to achieve its core objectives in the areas of public awareness, medical education and simulation training, health policy, and medical research.

DRASA Health Trust works with students, community leaders, health workers, and government to improve hygiene and sanitation, reduce the spread of infectious diseases, and strengthen Nigeria’s preparedness for future outbreaks.

According to the DRASA website, https://www.drasatrust.org, “Poor access to clean water, open urination and defecation, and lack of proper hygiene and sanitation are prevalent in many parts of Nigeria and despite the mitigated outcome of Nigeria’s Ebola outbreak in 2014, the country’s health workers are not fully prepared to diagnose and manage deadly infectious diseases. In a country of more than 190 million people and a high volume of travel, this is a recipe for global disaster.

“There is an urgent need to ensure Nigerians can detect and respond quickly and appropriately to outbreaks and public health threats. That is where DRASA comes in.”

To achieve our mission, we work with the government and strategic private and public sector partners at the community, health facility, and state/national levels

Three months after an infected Liberian man, Mr. Patrick Sawyer, arrived by airplane into Lagos, Nigeria was on October 20, 2014 declared free of EVD transmission by the World Health Organisation (WHO).

The man, who died in First Consultants Hospital, Obalende, Lagos, five days later, set off a chain of transmission that infected a total of 19 people, of whom seven died including Dr. Ameyo Stella Adadevoh who diagnosed the index case.

Also, the Economic Community of West African States (ECOWAS), on Saturday June 29, 2019, at its 55th Summit of the Authority of Heads of State and Government of ECOWAS, awarded Dr. Ameyo Stella Adadevoh a posthumous Award of Excellence.

President Muhammadu Buhari, chair of ECOWAS, presented Bankole Cardoso, the only child of Dr. Adadevoh, and the Managing Director, DRASA, Niniola Williams (nee Soleye) with the Award. Niniola is the niece of late Adadevoh.

Williams said: “We are very grateful that West Africa has formally recognized Dr. Adadevoh’s sacrifice and through our work we will continue to push to ensure the devastation of the 2014 Ebola outbreak never happens again.”

DRASA Health Trust, in a press statement, released to mark the fifth anniversary, noted: “…During the second half of 2014 it seemed you could not go anywhere without seeing people washing their hands, using hand sanitizer, and screening people to check their temperatures. Nigerians all over the country were making personal hygiene a priority and health was top of mind.

“Fast forward to today, five years later. The abundance of soap, buckets, and hand sanitizer is gone. These days, if you even see a hand sanitizer dispenser anywhere, it is often broken or empty. We have lost the handwashing and hygiene culture we held on to so tightly in 2014 and screening at our border points is weak, inconsistent, and in some places, non- existent.

“So why did we so quickly abandon these important practices that can protect us all from a massive public health disaster? Because Ebola is ‘gone.’ The fear of contracting the disease has diminished and we feel that we are safe.”

DRASA warned that the on-going Ebola outbreak in Democratic Republic of Congo (DRC) is still a very present threat to Nigeria because as easily as Ebola entered Nigeria via a passenger on a flight in 2014, it could do so again.

The Trust said Nigerians need to remember 2014 and remain aware of the on-going infectious disease threats and must not forget that many people fought very hard to ensure that Ebola did not ravage the country five years ago. DRASA said it was making sure people all over the country understand the importance of handwashing, hygiene, and sanitation and supporting medical personnel with training to ensure they can identify and contain infectious diseases.

The not-for-profit organisation said from medical personnel to community leaders to youth, it is training and educating Nigerians to ensure the country does not rest on its laurels and remain complacent. “To continue the legacy of Dr. Adadevoh, we have trained more than 230 medical personnel on preventing and controlling infections, and engaged more than 23,800 students, 900 teachers, and 300 community leaders in 30 states across the country to improve hygiene and environmental sanitation. We have also trained 460 secondary school students who continue to serve as DRASA’s Health and Hygiene Ambassadors – driving positive health and hygiene behaviours in their schools, families, and wider communities,” it noted.

Williams said the work DRASA is doing is just one component of what is required to prepare Nigeria for future outbreaks. She, however, said other achievements have happened since 2014: Nigeria’s public health institute – NCDC – though in operation since 2011, was finally legally established with the signing of its Act into law in November 2018.

DRASA said, now, NCDC has access to the human and financial resources required to protect a country of over 190 million people from public health threats. Williams said despite the initial limitations, in the last three years alone, NCDC has set up a national emergency call centre, provided outbreak response supplies and materials to every state across the country, and strengthened Nigeria’s network of public health laboratories for diagnosis of infectious diseases, among many other notable achievements.

According to DRASA, globally, the world now have four vaccines and two promising treatments for Ebola – major milestones towards not only preventing but also reducing the fatality rate of this disease. As Jean-Jacques Muyembe-Tamfum, General-Director, DRC Federal Medical Research Institute said, ‘From now on, we will no longer say that Ebola virus disease is not curable.’

Williams said although Nigeria has made progress, in today’s globalised world infectious diseases are a constant threat to personal health, the health of communities, and livelihood, so Nigerians must not forget 2014 and the major social and economic disaster was narrowly averted. “We must work together to ensure that disaster never happens,” she said.

To prevent future outbreak of Ebola in West Africa and to be better prepared for possible epidemics, the World Bank Group (WBG) and the World Economic Forum in collaboration with the Boston Consulting Group (BCG) gathered medical and economic experts on Monday May 4, 2015, at the roundtable in Lagos.

The experts brainstormed on Nigeria’s recent experience with the Ebola epidemic and lessons learned for future national and regional public-private action.

The experts were unanimous that Nigeria was not fully prepared to withstand future outbreak of the deadly EVD because of poor diagnostic capacity and weak health system.

The experts include: Former Commissioner for Health Lagos State, Dr. Jide Idris; a public health consultant and former Chief Medical Director of Lagos University Teaching Hospital (LUTH) Idi Araba; Prof. Akin Osibogun; Chair, Adadevoh Trust and younger sister of the ‘Martyr’ of Ebola fight in Nigeria, Dr. Ameyo Adadevoh, Dr. Ama Adadevoh; Chairman/Chief Executive Officer of Heirs Holdings, Tony Elumelu; Managing Director, GSK, Lekan Asuni.

Others include: Programme Leader WBG, Ayodeji Odutolu; Mayor, Paynesville City, Liberia, Cyvette Gibson; Director PharmAccess, Pieter Walhof; Chief Medical Director of First Consultant Clinic, Dr. Benjamin Ohiaeri.

They recommended among other things: the development of diagnostic capacities in individual countries and establishment of a regional laboratory; continued training and re-training of medical personnel; institutionalizing clinical practice governance in hospitals; setting up legal frameworks to address the challenges; incorporate a wider scope of partnerships, innovations, particularly within the business community and through unprecedented forms of public-private cooperation; and establishment of new platforms of public-private cooperation to manage future outbreaks more effectively and to manage the risk of their occurrence.

The younger sister to Stella Adadevoh, a medical doctor that practices in the United States was one of the panelists at the World Bank Forum.

Ama Adadevoh told the participants: “I believe that the Nigerian government and private sector were not prepared to the Ebola outbreak. We were not prepared. We did not have functional isolation centre.

“Going forward we need to improve in training and preparedness. There should be emphasis on training at all levels of health care. Why Nigeria was successful was the identification of the index case.”

Ama Adadevoh in an exclusive chat with The Guardian had said: “I am currently based in the United States where I practice. I actually came to Lagos to attend this event today because as you know my sister was the doctor who correctly identified and contained the index case of Ebola in Nigeria last year. So it is very important for me to be a part of this Ebola- the lessons learnt event being hosted today.”

On her take regarding how the situation was handled in Nigeria? She said: “Well what I think is that the country as a whole were not prepared for this Ebola outbreak even though it had been going on in West Africa- in Guinea, Liberia and Sierra Leone- for many months.

“Having said that even the United States were not prepared when their index case arrived but what I meant is that we didn’t have even one doctor trained to handle Ebola at the time.

“The first doctor who treated patients in Nigeria was an American doctor working with the WHO. Nobody here was trained; there was no functional isolation facility, and no protective gear as it were.

“We didn’t even have any protocols as to what do you do when an Ebola patient shows up. What is the protocol? Call the government? What do you do with the patient?

“That was why I was saying earlier that in my opinion Patrick Sawyer shouldn’t have been kept at First Consultants because it wasn’t equipped to handle that kind of illness and in him being there and being treated there until he passed away, all the healthcare workers including my sister got exposed.”

Going forward, what should be done in case of future Ebola outbreak? Ama Adadevoh said: “I think we definitely have to be prepared and at the core of our preparedness in my opinion is training.

“Healthcare workers across all levels should be trained very adequately in how to respond when this kind of thing happened. Obviously public health education was also important which was done pretty well. Educating the public as to what the signs and symptoms are and what to do.”

How far with the Dr. Ameyo Stella Adadevoh Health Trust? She said: “The trust was set up in my sisters honour and to continue her legacy of providing first class healthcare to her patients.

“It is a non-profit registered in Nigeria and our main initiative is training for healthcare workers at all levels. We realized that the healthcare workers are the backbone of the healthcare system and the biggest gap in healthcare in Nigeria is in training.

“You may not realize that. We are going to establish a training institute and we are going to use a different kind of training called simulation training, which involves hands-on training not just learning out of the book, which has never been done before in Nigeria. Our vision is to eventually impact healthcare not just in Nigeria but in whole of Africa.”

Meanwhile, as a new Ebola outbreak rages in Congo, some of the first Ebola virus patients to be successfully treated in the United States during the deadliest recorded outbreak five years ago are reuniting with their doctors.

Dr. Kent Brantly, Nancy Writebol and Dr. Ian Crozier were three of four Americans who were treated at Atlanta’s Emory University Hospital in 2014 and recovered.

They plan to join Emory medical staff for a media briefing, the fifth anniversary of Brantly’s arrival. He was the first to come to Emory after being infected while working in Liberia.

But the celebration of their recovery is being undermined by the latest unrelenting outbreak of the virus in Congo that has killed more than 1,800 people, nearly a third of them children, in the year since it was first detected.

On Thursday, last week, the wife and one-year-old daughter of the man who died of Ebola in Goma earlier last week tested positive for the disease, health officials said. It marks the first transmission of the virus inside the densely populated crossroads city on the border with Rwanda, a scenario that health experts have long feared as the virus outbreak enters its second year.

Rwanda briefly closed its border with Congo, a city of more than two million, as the painstaking work of finding, tracking and vaccinating people who had contact with the man — and the contacts of those contacts — continues.

The man died on Wednesday last week after spending several days at home with his large family while showing symptoms. Congo’s presidency said the entire family was at “high risk” and in quarantine.

But many others are at risk of exposure. The man in his 40s was a miner returning from an area of northeastern Ituri province, the WHO has said. It remains unclear where he was exposed to the virus along the 300-mile journey to Goma and whom else he could have infected while taking motor taxis over a number of days through the densely populated region at the heart of the outbreak.

“We’re seeing the first active transmission chain in Goma and expect more to come,” the International Rescue Committee’s Ebola response director, Andre Heller, warned in a statement.

WHO officials have praised African nations for keeping their borders open to date.

WHO has recommended against travel restrictions amid the outbreak but says the risk of regional spread is “very high.” Any border closure is likely to push people to avoid official crossings equipped with hand-washing stations and where people are checked for signs of fever or other Ebola symptoms. In June, three people who crossed on an unguarded footpath into Uganda died there before their family members were taken back to Congo for treatment.

It is now the second-deadliest Ebola outbreak in history, and last month the WHO declared it a rare global emergency. It has brought a surge of millions of dollars in new pledges by international donors, but some health workers say a new approach is needed to combat misunderstandings in a part of Congo that had never experienced Ebola before.

However, the 2014-16 outbreak in West Africa remains the deadliest ever recorded, killing more than 11,300 people.