What about other Diseases?

THE HORIZON BY KAYODE KOMOLAFE,   kayode.komolafe@thisdaylive.com


The hectic and draining schedules of the medical workforce in this season of gloom can only be imagined by those outside the realm of healthcare.

Like Reverend Father George Ehusani said in a recent homily, medical workers are at risk from infection as they care for patients suffering from a highly infectious disease such as COVID-19.
It’s a risk taken on behalf of our collective humanity.

According to the Catholic priest, the activities of medical personnel in this period of public health emergency amount to a deep expression of the Biblical love for fellow human beings because the risk includes possibly sacrificing their lives. Indeed, some Nigerian health workers were among the hundreds killed by coronavirus since the outbreak of COVID-19.

Ehusani, therefore, suggested that the clergy should also demonstrate this love to members of their congregation who are COVID-19 patients. His compassionate proposition: pastors, prophets and bishops etc. should apply to health authorities to be permitted to wear Protective Personal Equipment (PPE) so that they could have some limited access to members of their congregation and comfort them while in pains.

Although Ehusani is fully conscious of the risk of such access, yet he is not comfortable with just sending prayerful messages to the sick. He wants to visit isolation centres to empathise and show love to the brother or sister on the sick bed. The practicality of this unusual suggestion may be questioned; but the nobility of the spirit behind the thoughts cannot be denied at all.

The health workers surely deserve the resounding applause they have been receiving as they grapple with the extreme demands of this emergency in their various beats.
There should be more of such applause from the high and the low of a grateful public. There can’t be enough moral solidarity with these combatants in the frontline of the COVID-19 war.

This is more so that the jobs of these doctors, pharmacists, nurses, technologists and other members of the medical team have been made more difficult by the complex nature of the coronavirus crisis.

The matter even becomes more complex when you ponder the implications of the toll taken by the COVID-19 on the healthcare delivery system as a whole. Meanwhile, experts say COVID-19 patients with underlying conditions (other diseases) are more vulnerable in their situations.

Some of the conditions often cited include diabetes, high blood pressure, obesity, immune deficiencies as well as the diseases of the liver, lungs, kidney and the heart.
With the enormous professional energy, huge resources and quality time required to prosecute the COVID-19 war effectively, the other diseases are seemingly being neglected to the peril of the health of the affected individuals.

It should be quickly added that this is by no means due to the fault of the medical personnel labouring day and night in the various hospitals and isolation centres. The faulty system and those who run it especially at the policy level should be held squarely responsible for this dangerous trend.
It is undeniable that the burden of the health workforce is compounded by the reality of the patients of other diseases to whom they still have a duty to attend.

In the very unfortunate circumstance, for instance, the case of a patient whose ailment has symptoms similar to those of COVID-19 becomes pathetic. Such a patient may not be given the required attention beyond the immediate suspicion of coronavirus infection. Medical appointments have become more difficult to fix in the age of coronavirus.

What’s more, a patient who sneezes too vigorously could easily be suspected of having been infected with coronavirus. Another patient with persistent dry cough is likely going to be viewed as a candidate for COVID-19 by the laymen in his vicinity. The matter is made worse by the fact of limited capacity to test and confirm the true nature of the individual patient’s problem.

Other diseases should not be ignored while the due priority is given to COVID-19 because of its immense public health effects. The deaths of malaria patients are not reported. Those patients also develop a fever like COVID-19.

Similarly, the story of the victims of Lassa fever is no more hitting the headlines. Yet, this infectious disease still ravages communities in Nigeria. Maybe, the seeming silence on it is because you hardly find a “big name” in the register of Lassa fever victims. Is it a class question again?

As at April 26, Nigeria recorded 987 cases of Lassa fever cumulatively this year in 27 states and 128 local government areas. Out of these cases 188 have died.

Talking about contagious diseases, last year alone 207 patients tested positive for yellow fever. That’s why some countries would insist that travellers from this country should produce evidence of vaccination against yellow fever at the port of entry.

It would ordinarily be expected that in a well- organised setting, Nigeria’s experience of successfully combatting Ebola virus could have been used not only in terms of fortifying the system against epidemics in general, but also in developing the healthcare delivery system and making the services available to all, the poor and the rich alike.

Nothing so far suggests that Nigeria has made use of that experience. This , of course, is far from suggesting that the impact of the Ebola crisis was of the same magnitude as that of the raging devastation of the coronavirus that’s responsible for COVID-19. The index case of Ebola virus was reported on July 20, 2014. By October 20 in the same year, the World Health Organisation (WHO) had declared Nigeria free of Ebola. The well organised operation lasted for three months.

However, one lesson, for instance, that ought to have been learnt is that of bolstering the capacity of the Nigeria Centre for Disease Control (NCDC). Before the coronavirus index case in Lagos, NCDC was busy tracking suspected cases of Lassa fever in local government areas. Tests were carried out and figures of results were announced as part of the sensitisation of the public about Lassa fever. Some activities surely went on the Lassa fever front.

The severe operational limitation of NCDC is, however, put on display by the coronavirus crisis. This federal agency has not been suitably equipped for the crucial job assigned to it. The NCDC has not been sufficiently funded to deal with coronavirus crisis, Lassa fever, yellow fever and other infectious diseases.

The NCDC should be developed to deal with the possibilities of future epidemics. After all, according to virologists, the particular virus causing COVID-19 is just one of the many coronaviruses out there in nature.

By the way, the funding being advocated here is not a case of “throwing money at the problem,” as our neo-liberals are wont to put it in their cliché. There is no running away from the situation. The first step by any government that is serious about disease control would be giving an agency such as NCDC a budgetary priority.

The next step would be for the administration’s project monitors , legislature, civil society and other forces to police the agency’s activities so as to ensure that it is properly structured and that the funds are judiciously used for the defined purpose. There is no evidence from the structure of funding NCDC to show that the institution is taken seriously by the federal government to control diseases including the one having the enormity of COVID-19.

A point of clarification may be apposite to the priority that a disease control agency deserves. Surveillance of the health landscape of the country is part of the duty of NCDC. The organisation should set standards in matters of disease control. In a way, this is a regulatory function necessary in the interest of public health.

That is the point being missed by those clamouring for the decentralisation of the functions of the agency. It would be a terrible policy misstep to leave every state to control diseases in its own way in a country in which some state governors would like to capriciously declare their state coronavirus -free without any scientific test. The same central standards should also be set in combating other diseases including epidemics.

Epidemics do not respect federalist principles just as pandemics don’t recognise national borders. Disease control is one national department that needs a well-developed structure to exercise effective control in the interest of all parts of the country.

At a larger level, the situation with the management of the non-COVID-19 patients should compel policymakers and the public to rethink health economics in Nigeria. It is a great thing that despite the grim mood of the moment, the optimists are projecting into a brighter post-COVID-19 outlook for Nigeria. The centrality of a developed healthcare delivery should be considered as part of that projected future. Otherwise, nothing will have been learnt from this crisis.

There is hardly any point prescribing any rigid model out there in the world to follow in confronting the crisis in the health sector. After all, nationalisation of private health institutions is being contemplated in some climes in the face of emergency.
The thing to do is for Nigeria to structure its own solutions to the problems according to its peculiarities.

One other lesson is that Nigeria should embark on adequate local production of medical equipment, drugs and other needs of the crucial healthcare sector. It seems strange that the federal ministry of science and technology is not quite visible in the task force and committees put together to plot the country’s way out of this crisis. To put it mildly, it is a huge national shame that imported sanitizers from China are on the pharmaceutical shelf during this crisis.

There have been reports of local efforts to manufacture some of the crucial items of equipment and other materials needed in fighting COVID-19. In a regime of all-round development planning, the ministry of science and technology should have a role to play in coordinating and standardising the innovative efforts. It has become a matter of national health safety for Nigeria to manufacture some of its critical needs in the health sector. The science and technology ministry should drive the process and support the various private initiatives in the interest of national development.

In the light of all of the above , the inevitable flux of this crisis period should be taken as a transition to the future. One implication is that a good part of the money being donated to support government’s efforts on COVID-19 out to be used at least in equipping the hospitals and other health institutions appropriately.

The process of a radical change in healthcare delivery system should begin now so that COVID-19 and other diseases could be effectively tackled.

“Other diseases should not be ignored while the due priority is given to COVID-19 because of its immense public health effects”