‘Is Nepal Ready for Ebola?’
Medical Epidemiologist, USA
I had an opportunity to observe the level of preparedness of Nepal against the possible outbreak of Ebola Virus Disease during my recent personal visit to the country. I was struck by how inadequately Nepal is prepared to handle possible cases of Ebola and to prevent its outbreak.
While I observed few impressive work to manage Ebola in Nepal such as a voluntary reporting desk at airport immigration, a point person in the Ministry of Health and the Nepal office of World Health Organization, temperature check of returning peace keeping military personnel from Liberia and their mandatory quarantine, a wide gap could be observed that needed to be filled if a possible outbreak is to occur and it is to be managed.
Nepal was much better prepared during the pre-pandemic influenza period when the fear of bird flu outbreak with H5N1 was in its height. I had thought similar preparedness measures would have been placed for Ebola, but found only a fraction of for Ebola response.
The lack of preparedness for Ebola could be due to number of reasons. Ebola is still viewed by some countries as a regional problem isolated in west Africa. It has not yet manifested as a global disease. The absence of Ebola cases so far in South Asia (except few suspected cases) has resulted in not triggering a heightened concern. Ebola is not yet a priority as pandemic influenza was back then in 2008. Lack of resources, budget and skilled individuals to handle the cases could be another reason why Ebola is not a priority.
What is mostly lacking for ebola prepraredness is a coordinated national team or central command system comprising of government,
non-government organization, hospitals and all possible stakeholders just like there was one for
pandemic influenza in 2008-2009. Such national team does a series of actions such as the maintenance of an emergency operation centre, meeting regularly to discuss strengths and limitations, identify resources and gaps, and quickly fill them.
Ebola is a disease caused by virus that has a fatality rate of 50-90 percent. This means that up to 90 out of 100 people who are infected with the disease die from it. The process of death is dreadful. First the person has flu like symptoms, followed by diarrhoea, internal and external haemorrhage, failure of organs to function and eventual death. So far as of Jan 19, Ebola has infected more than 21,000 people mostly in Sierra Leone, Liberia, Guinea but some Europe and the United States. Of them more than 8000 have died from the disease.
As we have seen in the United States, Europe and Africa not all hospitals can handle individuals with Ebola. There are few hospitals that are designated as Ebola treatment centre (ETC) where its capacity is scaled up with equipment, resources and expertise to manage patients with Ebola. In the United States hospitals in three places, Atlanta, Nebraska and Bethesda, have been designated as treatment centres where sick individuals are flown in for their treatment. Similar few centres, call them reference hospitals, should be prepared in Nepal and load them with equipment and resources to get it ready to receive sick individuals.
Besides these ‘reference’ hospitals many other hospitals in all the regions of country, should be prepared to provide initial treatment to individuals with Ebola without breaching any safety protocol.
Hospitals need to be provided with the guidances of handling Ebola cases. Not only that. These hospitals should run simulations or drills with a dummy patient to practice how they would follow steps of moving patients from one place to another without breaching safety measure from the point of patient’s arrival to the point of her discharge.
In the United States, one mistaken assumption was that should the disease make landfall in the country most of the hospitals across the country can handle cases of Ebola. This was proven wrong when the first case of diagnosed in the United States. Health personnel working in Dallas hospital made several errors both in identifying the case and in providing proper safety measures to prevent contamination. Another mistaken assumption is that the guidance that was prepared and circulated to hospitals is properly heeded by everyone working in hospitals. It was not. The hospitals should have ran drills to prepare its staff and to realize where they fall short and where they excel.
Public awareness of how Ebola is transmitted, how it is not transmitted, what measures are there to prevent it, and control it should be circulated widely in simple, culturally appropriately language via radio, television, flyers in schools, public places.
I was invited by Norvic Hospital in Kathmandu to share my personal views on the management of Ebola where I got to know first hand how much hospitals are prepared. Talking to the staff, I reckon that a lot of training is warranted for the nurses, doctors and paramedicals working in the hospital if an outbreak is to be prevented from an infected person who land in a hospital.
I was particularly struck by a question ‘can we decline treating a Ebola patient on the grounds that the hospital lacks capacity?’ This shows that the hospital staff need to be trained on the ethical aspect of disease: what protocol to be followed if the hospital lacks capacity of treating patient.
Being ready for an impending outbreak goes a long way in breaking its transmission of infection, reducing its burden, saving lives and reducing costs for the individuals and the nation. It is true for pandemic influenza as it is for Ebola viral disease.
(Dr. Sanjeeb Sapkota is a medical epidemiologist who works for government public health agency in the United States. He could be reached at yessapkota@gmail.com)
