Africa's uneven struggle against Ebola

Nigeria's success against virus cannot be replicated in hardest-hit countries

DAKAR - The disparity in African countries' ability to fight Ebola has left the continent in an uneven struggle against a disease that does not respect borders - yet relatively simple measures could help, experts say.

While countries such as Ivory Coast, Kenya and South Africa have well-equipped hospitals with specialist units and high-tech labs, vast expanses of the continent remain health-care deserts.

But Nigeria, with quick and coordinated action by some of its top doctors, appears to have contained its first Ebola outbreak.

As the epidemic rages out of control in three nations a few hundred kilometres away, Nigeria is the only country to have experienced an outbreak with hundreds of potential victims in a city with vast slums and yet beat it back.

"For those who say it's hopeless, this is an antidote - you can control Ebola," said Dr Thomas Frieden, director of the US Centres for Disease Control and Prevention (CDC).

Although officials are pleased that success was achieved in a country of 177 million that is a major transport and business hub - and whose largest city, Lagos, has 21 million people - the lessons from Nigeria are not easily applicable to the countries at the centre of the Ebola epidemic: Guinea, Liberia and Sierra Leone.

Nigeria's outbreak grew from a single case, while in the other three countries the disease smouldered for months in remote provinces and spread widely before a serious response was mounted.

While the danger in Nigeria is not over, Health Minister Onyebuchi Chukwu said in a telephone interview that his country was now better prepared, with six laboratories able to make diagnoses and response teams and isolation wards ready in every major state.

After the first patient - a dying Liberian-American - flew into Lagos on July 20, Ebola spread to 20 other people there and in a smaller city, Port Harcourt.

They have now all died or recovered, and the cure rate - 60 per cent - was unusually high for an African outbreak. In the meantime, local health workers made 18,500 face-to-face visits to repeatedly take the temperatures of nearly 900 people who had contact with the victims. The last confirmed case was detected on Aug 31, and virtually all contacts have passed the 21-day incubation period without falling ill.

"We don't need large numbers of specialists or expatriate doctor specialists," said Dr Tom Kenyon, director for global health at the CDC. "What we need are those that can provide a basic level of care, meticulous attention to fluid and electrolyte status and these other simple medications."

Yet even this is hard for the three worst-hit countries. They averaged only one doctor per 100,000 inhabitants even before the epidemic claimed the lives of scores of doctors and nurses. Now they face the collapse of their health-care systems.

"Yesterday, we received 60 cases, and they keep coming," said Mr Alfred Gaye, a hospital nurse in the Liberian capital Monrovia.


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