Nigeria

Disease Outbreak, Economic Burden, Government Policy, Healthcare Workforce, Health Systems, Infectious Diseases

Lessons, Impact, and the 'Fearonomics' of the Ebola Outbreak in Nigeria

~Written by Sulzhan Bali, PhD (Contact: sulzhan.bali@twigh.org

Also published on the DGHI Diaries From the Field Blog

Passport Sticker with Ebola Symptoms and National Helpline. Photo Credit: Sulzhan Bali, PhD

24th of July.

The day Macchu Picchu was discovered in 1911.

The day Apollo XI returned to the Earth after the first successful mission of taking humans to the moon in 1969. 

Yet, in Nigeria, that day in 2014 will always be marked as the day Patrick Sawyer—the index patient of Ebola—died and set an outbreak in motion in one of the most populated cities in Africa. Patrick Sawyer was a Liberian-American citizen and a diplomat who violated his Ebola quarantine to travel to Nigeria for an ECOWAS convention. His collapse at the airport, coupled with an ongoing strike by Nigerian doctors in public hospitals, landed him at a private hospital in Obalende, where he infected eight other people. 

Patrick Sawyer’s death marked the beginning of an Ebola epidemic in Lagos, a city of 21 million. Lagos is a major economic hub in Africa and one of its biggest cities. An uncontrolled Ebola epidemic would have a far-reaching economic impact beyond the borders of the city, its country, and even its continent.

A recent study has shown that Ebola virus remains active in a dead body for more than a week. Add to this that the body is most infectious in the hours before death, and it is a "virus bomb" waiting to happen if handled incorrectly. West Africa, especially Nigeria, has a strong funeral culture. This Ebola-infected Liberian diplomat’s body was transported and incinerated in accordance with the WHO and CDC protocol. This feat was achieved despite immense political and diplomatic pressure to return the body for funeral rites. It represents one of the many cases of collaboration and "clinical system governance" that are at the heart of the successful containment of Ebola in Nigeria. It is one of the many stories that I'm hoping to highlight in my research on the role of the private sector in Nigeria’s successful Ebola containment.

One of Many Ebola Information Posters Around Lagos. Photo Credit: Sulzhan Bali, PhD

As part of my research, I am looking at 10 different economic sectors to understand how the Ebola outbreak impacted the private sector and how the private sector dealt with the challenges that the Ebola outbreak posed. My hope is that this research will lead to lessons for the private sector on how, in times of an epidemic, they can help the government to mitigate the disease’s economic impact. I also hope that the resulting report will help governments engage with the private sector more effectively in times of emergencies.

With many outbreaks, especially of highly fatal diseases such as Ebola, fear is the biggest demon. This fear has led to the crippling of economies of Ebola-affected countries. This fear has cost Sierra Leone, Guinea, and Liberia 12 % of their GDP in foregone income and unraveled the years of progress made by these countries. However, this fear is not just a phenomenon limited to West Africa. I had a very personal encounter with this fear recently, when I was quarantined for a few hours in the United States (despite Nigeria being declared Ebola free since October 2014). 

It has been a humbling experience so far, as I try to understand how this fear and the hysteria around Ebola can lead to significant behavioral changes—some of them necessary but some extreme. Everyone I speak to has a story to share. Some people tell of how they bought more than two bus tickets to prevent sitting next to other people. Others tell of hospitals resembling "ghost buildings" as people avoided hospitals and doctors like the plague. Many tell of the "Ebola elbow-shake" that replaced the usual handshake or hug. The reality is that although the Ebola outbreak infected 21 people in Nigeria, it actually affected the lives of 21 million people in Lagos alone, in one way or another. I have come to realize that there is a thin line between precaution and hysteria. Maintaining the equilibrium between the two is the key to controlling the disease and mitigating its economic impact.

As I wrap up my interviews, a few questions resonate with me time and time again from these sessions.

“Are we prepared for the next time?” 

“Ebola is back in Liberia. What can we do to prevent Ebola from coming back to Nigeria?” 

 For the doctors who died in Nigeria’s fight against Ebola:

“Can we truly say our country is a safer place after their sacrifice?” 

And for myself:

“How will your report help Nigeria?”

These are the questions that keep me going. Although my report may not be able to answer all of the aforementioned questions, I do hope it will at least get policy makers, students, and advocacy groups talking about how countries can be better prepared for the next big outbreak and how public-private collaboration can lead a country out of an epidemic and on a path of recovery.

To end on a positive note, 24th July, 2015 also marked one year since the last polio case in Nigeria—an achievement that clearly shows what collaboration in global health can achieve.

(To learn more about my research or to contribute/collaborate in my study, please contact me.)

Innovation, Economic Development

Global Health in a 'Restricted' Country - Breaking the Barrier of Stereotypes

~Written by Dr. Sulzhan Bali, Director of Production and HR, TWiGH (Contact: sulzhan.bali@twigh.org)

*Also published on the Duke Global Health Institute Page "Diaries from the Field Blog"

                                             Lagos, Nigeria - a vibrant city

                                            Lagos, Nigeria - a vibrant city

Let’s play a game. Shall we?  I give a word and you think of the first word that comes to your mind.

Nigeria.

Pat yourself on the back if the word you came up with was NOT ‘scam’, ‘419’, or ‘Boko Haram’. Treat yourself to a chocolate if the word that you came up was a positive word (and if you are not Nigerian).

You see, stereotyping comes naturally to our species. Often, our outlook is dictated by the media, news, and hearsay- which although important, often gives us an incomplete singular dimension of the holistic picture.  Unfortunately more often than not that singular dimension dictates our biases.

 I must admit, before I arrived to Nigeria for field-work, I was afraid. Afraid of what awaited me on the other side. After hearing reactions such as “Why Nigeria out of all places?”, “stay careful in Nigeria, scamming is so common”; “Oh no! Isn’t that where Boko Haram is?”, and tales of evacuation, kidnappings, and even carjackings- I had started really wondering whether I should be excited at all? It didn’t help that my field-work country site was considered entirely restricted for safety purposes. No wonder, I was a little nervous as I disembarked the plane.

After I landed, my first experience of Nigeria was a man offering help at the airport for the cart. I didn’t have local currency yet and I needed a cart for my luggage.  I remembered of the innumerable warnings by friends and family to keep my wits about and to trust no one.  Did I take his help? Yes. Did he run away with my bags? No. Over the course of next 2 weeks, I would discover each and every Nigerian that I met to be warm, friendly, helpful, and yes- trustworthy!  

The risk of being scammed or cheated exists in every big city and Lagos is no different. This city of 21 million people is a melting pot of cultures and like any other metropolitan city in the world is like a coin with 2 sides.  My time in Lagos so far has turned my idea of Nigeria that I had upside down. Yes, there is poverty. Yes, development is an issue. So is corruption, weak health system, malaria, maternal mortality, and infant mortality. Yet, there is also will power.  There is optimism. There is an incredible spirit of entrepreneurship, which I am yet to see in another part of the world. Every Nigerian is an aspirational entrepreneur, hustling to be a successful one. People have a safe job along with an entrepreneurial venture. No wonder, that in Nigeria 41% of women between 18-64 years are entrepreneurs- the highest in the world! Unfortunately, Nigeria also ranks among the worst 20 countries in the world for women entrepreneurs. Many of these entrepreneur women are small traders or market women and entrepreneurship is a by-product of necessity due to lack of opportunities in the formal sector. Yet, despite it all, there is no denying the fact that entrepreneurial energy in Nigeria is on a high. There is an impressive desire in almost all Nigerians that I have interacted with to build something of their own. Optimism and innovation have overshadowed the constraints of red tape and lack of infrastructure. Many entrepreneurs in Nigeria are in it to make an impact and facilitate social change. An apt example is EbolaAlert- an organization that I am collaborating with for my study on 'Role of Private Sector in Ebola Response in Nigeria'. EbolaAlert started as a twitter handle at the peak of Ebola Outbreak in West Africa. People across the world were getting their accurate information on the Ebola Outbreak through it. What started as an information-providing platform turned into a Global health influencer that is now launching multiple public health education campaigns across Nigeria in partnership with CDC, Unicef, MSF, and the private sector.

Global health is about collaboration and coordination. It is about dialogue between sectors, organizations, and cultures. To be able to do that successfully, one has to look beyond the biases. Casting away our lens of bias requires looking beyond what we see and hear in media, news, and hearsay which is only possible with a cultural immersion and an open mind. This is why field-work is such an important component of global health.  Nigeria is not perfect. No country ever is. As the biggest economy in Africa and a country all set to reap its demographic dividend, Nigeria has the means and the will to become a great nation. I recently met a few Nigerian young professionals in Lagos. These were Nigerians from across the world visiting for the Young Nigerian Leaders conference to talk about the future of Nigeria. As it happens, Nigeria's biggest assets are its people. Many of who are using lean entrepreneurship, collaboration and ideation to facilitate change in all spheres.  From my vantage point, the whole world is Nigeria's oyster. Restrictions on the other hand, lie only in our mind set. 

No prize for guessing which is the first word that comes in my mind when someone says Nigeria.  It is 'entrepreneurship'.