Tackling Borno’s Health Sector

Even before the advent of the Boko Haram insurgency, healthcare in Borno State has been appalling to say the least. In a bid to turn it around, WHO, UNICEF and all other stakeholders in the health sector have swung into action. Michael Olugbode reports

Many preventable diseases have become common in Borno State. The state, even before the insurgency crept in about nine years ago was a permanent feature on the list of states affected by such diseases as poliomyelitis, Cerebrospinal Meningitis (CSM), malaria, measles, cholera. The state even has a permanent name on the disease ladder that it has sold to the rest of the world in Lassa fever as Lassa is a town in Borno State where the deadly disease was first discovered. It was not only this that has made the state notorious but also poliomyelitis, when the world had almost succeeded in finally kicking this disease out, it kept glued to this geographical location and vaccination has to begin all over again and the world has to bear another huge cost of kicking polio out.

Borno has become a familiar name on the list of World Health Organisation (WHO) and all international agencies seeking the well-being of the globe, no wonder when yellow fever epidemic was recorded in Nigeria late last year and early part of this year, though with Borno not having any incident, preventing it in the state could not just be wished away because the world knows if it crept into the state, it may find an abode where it can fester and may not want to leave!

Yellow fever is a deadly disease, it is tropical viral affecting the liver and kidneys, causing fever and jaundice and often fatal. It is transmitted by mosquitoes. It is a viral hemorrhagic infection transmitted by mosquitoes of the Aedes genus.

The yellow fever virus is a single-stranded RNA virus that belongs to the Flavivirus genus. After transmission of the virus occurs, it replicates in regional lymph nodes and subsequently spreads via the bloodstream.

In severe cases yellow fever causes a high fever, bleeding into the skin and the death of cells in the liver and kidneys. Liver damage results in severe jaundice yellowing of the skin hence the name (yellow fever). One can catch this disease if bitten by a mosquito infected with the virus. Anyone can get yellow fever, the elderly have a higher risk of severe infection.

It has the same symptoms as tropical diseases such as malaria and typhoid, it has three stages; infection, acute phase and toxic phase. The first stage has symptoms such as fever, flushing, headache, jaundice, joint aches, loss of appetite, muscle aches and vomiting. In the second stage usually lasting for three and three to four days are such symptoms as backaches, fever, flushing, headaches, joint aches, loss of appetite, muscle aches and shivers. Symptoms in the final stage include abdominal pain, bleeding from the nose, mouth and eyes, decreased urination, delirium, heart rhythm problems, seizures and vomiting sometimes with blood.

Complications of yellow fever includes jaundice, hemorrhage, blood clotting disorders, gastrointestinal bleeding, delirium, nausea and vomiting, sinus bradycardia, headache, convulsions, coma and death.

With the insurgency that has ravaged Borno State and has created camps which have compromised the health of many and a breeding ground for diseases, and with cases of outbreak of yellow fever in some parts of the country like; Kwara, Kogi and Zamfara states, the federal and Borno State governments in conjunction with the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) alongside other partners, put in place plans to ensure preventive mass vaccination campaign across the country in general and in Borno State in particular.

In order not to allow the disease to have a breeding ground in Borno State, a 10-day vaccination campaign was flagged off on 5th February and ended 14th February and over 1.2 million IDPs were vaccinated across 57 wards in 25 local government areas of the troubled state.

The vaccination, exercise led by WHO not only recorded huge success as majority of the IDPs trooped out with their families to be vaccinated, it offered the stakeholders opportunities to have deeper understanding of the other challenges faced by the IDPs, challenges such as hunger and inhabitable living condition.

Narrating what he knew about the disease, Isa Mohammed, 41 years old, an IDP from Baga, said: “I suffered from the ailment for 39 days, it almost blinded my eyes. I was frequently vomiting and I was without strength and was without appetite for food. I was admitted in the hospital for 39 days and when I came back from the hospital I had to use local herbs before I was fully healed. When I was in the hospital I saw a woman die from the ailment and that shook me and made me to abandon the treatment and go for local herbs which helped me to regain full healing. People should embrace vaccination for it is a way of promoting good health and shielding one from suffering.”

Bukar Abba Kaka, 28 years old from Baga, met at one of the IDPs camps in Maiduguri where he queued to be vaccinated, said: “I have seen a patient of yellow fever 16 years ago. He had yellow eyes and was emaciated as if wind would blow him off.”

He said: “We, in this part of the world, only believe that it is herbs that can cure this, the guy was eventually cured with herbs,” but “I will appeal to people to come out for the vaccination so as not to even suffer from the disease in the first place,”

For Falmata Bukar, a 22-year-old, who was employed as a mobiliser by WHO to persuade people to come out and get vaccinated, she said her main words to the people she has spoken to, is that the vaccination “is beneficial to them, even more important than food, and that it is only when they are healthy that they can eat food.”

Dr. Terna Nomhwange, a National Surveillance Officer, World Health Organisation, Country Office Nigeria and the focal person for Accelerated Disease Control, who was on hand to supervise the exercise in Borno, explained that as part of the high strategy, which is basically eliminating yellow fever epidemics globally by the year 2026, the government of Nigeria supported by WHO and other partners has put in place plans to ensure preventive mass vaccination campaign across the country in order for protection and prevent further spread as well.

He said the exercise was targeted at people in age nine months to 45 years, so as to ensure that this persons get the yellow fever vaccination, “this vaccination is given once and provide lifelong protection against the yellow fever virus and the disease. Like you know is most transmitted by the mosquito the aedes eagypti type which we know that within our environment we’ve confirmed that this vector, this mosquito actually is.

He said: “We have discovered this and we did some studies in Zamfara and Kwara states where we actually found these mosquitoes. So we know that the chances of transmission are pretty high and the government of Nigeria is ensuring that all Nigerians are protected by having these vaccines done and of course in the general goal of reducing mortality in women, children and vulnerables.

“We are in Borno, because Borno also comes with its peculiarity and a lot of vulnerability here, for the first phase where we are now, which we are calling phase two, we are targeting the IDPs camps and its host communities and for this particular phase we are targeting 1.2million persons, who will be vaccinated across the 10-day schedule.

“You will find out that we have teams across these LGAs, where we are currently at is the Bakassi camp, it is the camp that many of you know about is a bit easy because we are all in the centre, in the next couple of days, by tomorrow we are hoping to have teams who will be in the Gwoza axis, where it’s a bit more difficult accessing and all of that. But working with the state team and with all the support provided, we are ensuring that all the persons we have targeted within this period will be vaccinated.”

He added that: “We want to use this opportunity to sensitise persons. Any persons that have symptoms of yellowness of the eye within a two-week onset of fever, should present himself or herself to the nearest health facility.

He lamented that: “We have very high mortality rate, for the numbers we have for the current outbreak at the moment we are having mortality rate in the range of about 26 per cent for the cases that we have within this period, but because there is no treatment, this is the disease that actually can kill and this is why the federal government of Nigeria is working with its partners in ensuring that it vaccinate people to protect them from the disease.

“In a situation where we are, what we have as a guide line for a mass vaccination campaign during campaign where you have emergencies, we weigh risk versus benefit. So in an outbreak situation we want to actually vaccinate everybody, but on a routine in places where you don’t have outbreak, you actually say let us weigh those risks, and in outbreak situation, the benefit outweighs the risk,” he said.

Earlier, in a joint statement made available to newsmen in Maiduguri, the Borno State capital, the WHO Health Communication and Promotion Officer, Dr. Chima Onuekwe and the UNICEF Representative in Nigeria, Mohammed Fall said more than 3,000 WHO-trained volunteers, including senior supervisors, monitors, healthcare workers and community leaders including mobilisers were deployed for the exercise.

The statement said to ensure vaccine availability and uptake, UNICEF supported the Borno State Government with logistics for vaccine distribution and social mobilisation, adding that through the deployment of over 2,000 community volunteers and key influencers, UNICEF enhanced community engagement for yellow fever preventive vaccination and ensured that community is aware of the campaign and yellow fever risks.

“If we miss out on children of Borno, often living in very difficult conditions, we deprive large number of children of lifesaving vaccines. It is not only their right but our collective duty to ensure that they survive and thrive,” said Mohammed Fall, UNICEF Nigeria Representative, the statement read.

The statement further said that to ensure a high-quality campaign, WHO worked with the Borno State Ministry of Health to coordinate and facilitate the training of healthcare workers at all levels, arrange logistics for vaccine distribution and deliver messages on health risks to communities.

“Although Borno State has not reported an outbreak of yellow fever this year, vaccinating internally displaced persons is an exercise of high public health importance to protect most-at-risk populations living in high-risk conditions and prevent the spread of yellow fever, if an outbreak occurs,” said Dr. Wondimagegnehu Alemu, WHO Nigeria Representative.

The Borno State Commissioner for Health, Dr. Haruna Mshelia, emphasised the importance of vaccinating IDPs in camps and host communities.

“The vulnerable living conditions of millions of people in Borno State and the tide of outbreaks across 16 states in Nigeria makes it imperative to target the most at-risk people with yellow fever vaccination in the state.

“These efforts are part of a larger yellow fever vaccination campaign that seeks to vaccinate more than 25 million people throughout 2018, in the largest yellow fever vaccination drive in Nigeria’s history. This fits into a wider public health goal to eliminate yellow fever epidemics globally by 2026 through the Eliminate Yellow fever Epidemics (EYE) Strategy, steered by WHO, Gavi and UNICEF,” the statement read.

It would have been a disaster had yellow fever been allowed to berth at IDPs camps in Borno State, as that would have been further disgrace to Nigeria and Nigerians. All thanks to WHO, UNICEF and other stakeholders in the health sector, this was not allowed.