In mid-September, a six-member team from Baylor College of Medicine trained nearly 1,500 healthcare providers and non-medical personnel in the basic facts about Ebola and in the care of people with the disease during four days of training in two Nigerian cities – Lagos, Africa’s most populous city, and Eket, an industrial city in the south. The effort was sponsored by ExxonMobil, which has offices and petroleum operations in the African nation.
Nigeria has had a limited number of cases of the disease in the current outbreak, and the disease has been designated as contained as of early October.
The Baylor training consisted of a presentation for the non-medical public about the disease itself and how best to protect against it. A second, more sophisticated presentation was designed for healthcare providers, describing the best methods to prevent transmission, caring for patients, and protecting against acquiring the infection during care. A third presentation dealt with the appropriate personal protective equipment and how best to put it on and take it off safely.
Dr. Bobby Kapur, physician leader and associate professor of medicine – emergency medicine at Baylor, said it was interesting that Nigeria’s situation was similar to that in the United States. One person traveled from Liberia to Nigeria and then had some contact within the community.
“Nigeria showed that if you respond quickly and begin public health measures, you can limit spread of the disease and its impact. They did a good job of that,” he said.
Despite quick containment, Kapur noted some problems. Some patients who were exposed, including a physician, did not reveal certain risk factors, which led to more spread, he said.
It also emphasizes the importance of health messaging.
“If there is fear or stigma around a disease, patients refuse to reveal symptoms or exposure,” he said. Some Nigerian hospitals were reluctant to admit patients with fever because it would dissuade other patients from going there and ultimately affect their ability to continue to operate.
He pointed out that Nigeria has had a relatively low mortality rate of 36 percent, compared to prior outbreaks and other West African countries involved such as Liberia and Sierra Leone. Nigeria has recorded 19 cases and seven deaths in the current outbreak.
“It is important if you have symptoms to get treatment,” he said. “Self-screening is also important. That includes fever, associated symptoms and a risk factor, such as coming from or having recently visited one of the affected countries.”
Their work was similar to what is being done in the United States, he said. Providing information to reduce fears and concerns is important.
The team began with a strategy meeting at the Lagos Emergency Operations Center on Sept. 15, 2014 and was oriented with the help of local officials. They then participated in a joint training seminar with the US CDC at the University of Lagos Medical School.
Team members included:
- Dr. Olutoyin Asojo, associate professor of pediatrics – tropical medicine, (Team Lagos)
- Dr. Sarah Bezek, assistant professor of medicine – emergency medicine (Team Lagos)
- Dr. Mark Escott, assistant professor of medicine – emergency medicine (Team Eket)
- Dr. Silpa Gadiraju, assistant professor of medicine – emergency medicine (Team Eket)
- Dr. Bobby Kapur (Physician Team Leader)
- Laura Vinas Jahn (Operations Director)
Both teams began work Sept. 16, 2014, when they trained an estimated 1,050 people, covering the non-medical curriculum that explains the spread of the disease, how it is transmitted and treated and how transmission is controlled.
“The audience already had a good understanding of the disease,” said Jahn. “There were few questions about myths or misinformation about the disease.” While the team was in the country, neither the Nigerian Centre for Disease Control nor the U.S. Centers for Disease Control and Prevention reported current cases of Ebola in the nation’s treatment centers.
On Sept. 17, the Lagos team trained community healthcare workers from the municipality – including local officials and physicians who see patients in the poorer parts of the city. That afternoon, the team trained Occupational Health medical staff in patient care and use of personal protective equipment. On the same day, the Eket team trained a mixed group of local officials and healthcare providers in the morning and reviewed evacuation protocols with helicopter transport and occupational health personnel in the afternoon.
Training continued in the two locales on Sept. 18 with the Eket team training a large group in an all-day session and the Lagos team splitting their trainees into two sessions – morning and afternoon. On Sept. 19, there was a dynamic training session in Lagos with providers from multiple industries and hospitals from around the country, as well as consular representatives. The audience, made up mostly of physicians and infection control experts, served as a forum for discussing effectiveness of response and planning for future public health emergencies.
The team left on Sept. 20 and was back in Houston by Sept. 21. They have all been monitoring their health since their return and have passed the 21-day mark for incubation.
Jahn found the activity built on Baylor’s strengths as an educational institution.
“The level of collaboration among the Nigerian Health Ministry, the CDC, and private enterprise was impressive. Their proactive efforts serve as a model for quick containment of a potentially devastating public health emergency. For our part, we were privileged to support broad awareness efforts aimed at promoting prevention and dispelling fear,” she said.Dipali Pathak Office of Communications Baylor College of Medicine 713-798-4710