The announcement on Monday that Nigeria
has recorded its first set of Ebola survivors was seen as a silver
lining in a dark cloud. According to the World Health Organisation, the
disease has killed more than 1,200 people across four West African
countries in its latest outbreak. The certification of the patients as
free of virus was therefore seen as the first sign of victory over EVD.
A statement signed by the Special
Assistant on Media and Communication to the Minister for Health, Mr. Dan
Nwomeh, revealed that the survivors included, “two male medical doctors
and one female nurse.”
“The three participated in the treatment
of the index case while the fourth person was a female patient at the
time the index was on admission. This brings to five the total number of
patients diagnosed with Ebola Virus Disease who have now been
discharged from hospital, ’’ he said.
However, experts say that the survivors
have a long journey ahead coping with stigma and post treatment health
issues. According to Dr. Dan Onwujekwe, Research Fellow, Nigerian
Institute of Medical Research, it is important to provide psychological
support for the survivors who might be exposed to stigma from friends
and family.
Onwujekwe, who specialises in the
management of people living with HIV/AIDS, told our correspondent that
stigmatisation was inevitable when it comes to infectious diseases. He,
however, attributed it to information mismanagement.
“I call it Ebola hysteria. We should
think about managing that situation now. There is no reason to be afraid
of contact with the survivors. There are criteria for eligibility for
discharges. The stigma is unfounded. A lot of people are reacting with
panic. I remember during the initial outbreak, people in Abuja were
afraid of anyone coming in from Lagos. Ebola is unlike HIV. Once you
test positive for HIV, you remain positive permanently but Ebola is not
like that,’’ he said.
Similarly, a Senior Lecturer at the
Department of Psychology, University of Lagos, Dr. Bamikole Fagboungbe,
counselled the survivors to brace up for tough times as they resume
their normal activities. Fagboungbe further advised them to develop a
thick skin against all forms of negative reactions from the public.
“Even at UNILAG here, we have developed
Ebola greeting, we greet faraway like the Chinese. It is the same with
people who have been released from prison, people avoid them.
Ordinarily, people should show support to them but in this society, our
survival instinct is to sharp. It is better for them to prepare and
condition themselves for what is ahead. Definitely, they will face
stigmatisation but they should develop a thick skin and lead a normal
life,’’ he said.
Besides stigmatisation, experts agreed
that the survivors would also deal with post treatment infections. In
that case, a resident doctor with the Ladoke Akintola University
Teaching Hospital, Dr. Ayodele Falade, urged the survivors to
concentrate on building their immune system against future infections.
“Anything virus inside the body will run
its course. If the patient has a good immune system, the virus will run
its course without killing him. That is why what we do is called
symptomatic treatment. If the person has malaria, it is treated. It is
different when the patient is malnourished. The basic mode of treatment
is to boost the immune system. For a virus like Ebola with a short
course, what the survivors need to focus on is good food, healthy living
and drink water as much as possible. If there is any development, they
should not hesitate before going to the hospital,’’ he said.
Across Africa however, survivors of Ebola
face stigma, suspicion and the potential for side effects as they work
back from the ravages of a deadly disease racing through West Africa.
“Many of our neighbors won’t come to our
house now,” said Fudia Sesay, 49, of Sierra Leone, who was released from
a treatment center last month. “My friends don’t visit, thinking that
if they come near our house, they’ll catch the virus.”
The few who do talk to her, she said, are “in denial,” believing Ebola doesn’t exist.
Sesay was infected when she shared her
niece’s meal, using her spoon. The relative, a nurse who didn’t know she
was infected, later died. The two are among 783 people infected in
Sierra Leone, which recorded 334 deaths as of August 11 since the
outbreak began in January, the World Health Organisation said.
While more than 40 per cent of people
infected in West Africa have survived, their return to normalcy,
physically and mentally, will often be a long journey.
Sesay was isolated for 18 days at a
hospital in Kenema, the country’s third-largest city, before being
cleared. She has been home since July 21, but said she hasn’t yet tried
to reclaim her catering job at a restaurant in town.
‘I don’t even know what the reaction of my boss would be if I show up to start work,’’ she said.
There are other concerns as well. While
only a few researchers have studied survivors from past outbreaks, their
findings suggest that side effects ranging from lingering joint pain to
eye swelling can continue for years.
Limited studies
The evidence comes from four studies
conducted in the Democratic Republic of the Congo and published in the
Journal of Infectious Diseases in 1999. One of the studies identified
uveitis, a swelling of the middle layer of the eye, in about 15 per cent
of survivors following a 1995 outbreak in the Democratic Republic of
the Congo.
In another study, two-thirds of survivors reported joint pain 21 months after recovery.
“Uveitis could eventually lead to
blindness or seriously compromise vision” if untreated, said Amar
Safdar, director of transplant infectious diseases at NYU Langone
Medical Center. “They really shouldn’t use traditional medicines and
shouldn’t wait it out for it to go away on its own.”
The response may be due to an
over-reactive immune response, said Safdar, who wasn’t involved in the
studies. “Once someone has recovered from the infection, the host’s own
inflammatory and immune response takes a life of its own, so to speak,”
he said in a telephone interview.
Knee pain
Sesay said she has experienced knee pain. Other survivors she knows have also been complaining of pain, she said.
At the same time, another survivor,
Sulaiman Kanneh Saidu, a health worker in Koindu, Sierra Leone, said he
has only experienced some dizziness, which stopped after two weeks.
Saidu, 47, who is the supervisor of the
Ebola Management Center in Koindu, said he caught the virus because fear
of Ebola led patients to lie about where they had been and who they had
been in contact with.
“Since we inherited this thing from
Guinea, people were going with the feeling that there is a motive
attached to it,” he said in a phone interview. “There was that kind of
objection to the reality that Ebola is existing.”
People don’t want to be associated with
the health crisis, he said. “When you ask them about their traveling
history they give you false information.”
False news
Such lies led Saidu to contract the
disease himself. He was asked to examine a sick woman, and was told she
had never left Sierra Leone and had not attended any burials, “which was
false news,” he said. Soon after, he was infected.
For 11 nights, Saidu was isolated in a treatment center, praying and focusing on keeping his stress levels low.
When patients hear Ebola has no cure, he
said, “the stress gets intensive and they develop some amount of
depression. Some give up on life.”
He survived, and was discharged on July
15. Saidu was given protein-rich nuts, multivitamins and condoms, and
warned that the virus could linger for as long as three months in his
sperm.
Along with possible physical ailments,
survivors also face psychological after-effects, according to Laurie
Garrett, a senior fellow for global health at the Council on Foreign
Relations in New York.
After the 1995 outbreak in the Democratic
Republic of the Congo, survivors were psychologically traumatized years
later, said Garrett, who covered the outbreak as a reporter for New
York Newsday, and returned three years later to visit survivors.
Sense of betrayal
“Many had seen their own families and
loved ones turn against them” when they caught the virus, “and they have
never recovered from that sense of betrayal,” she said in a telephone
interview.
While Sesay’s neighbors are keeping their distance, she said she is happy because her family accepts her.
“This activity of re-integration of
surviving patients in their villages and communities can take a long
time and sometimes needs a great deal of explanations and several visits
to ensure that the person has been fully accepted into the community,”
Magali Deppen, a spokeswoman for the aid group Doctors Without Borders,
said by e-mail. “For patients, the impact of Ebola doesn’t end when they
are discharged.”
Doctors Without Borders helped Saidu with
his homecoming. The local authorities were told that he was going to be
discharged, and spread the word that he was free of the virus, and
would remain immune to the strain.
Critical gaps
Today, “communities remain fearful of
this ‘new’ disease and do not trust health workers or facilities, which
makes it extremely difficult to contain the epidemic,” Deppen said.
“There are still critical gaps in all aspects — medical care, contact
tracing, epidemiological surveillance, data sharing, effective alert and
referral systems, safe burials and community education and
mobilization.”
Saidu is back to work and is using his
experience to educate his community, spreading the word that even though
there is no cure, one can survive.
He estimates that 205 people have died in the community, which has convinced the majority that Ebola is, in fact, real.
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