Health-care workers and everyday heroism: A case study in curbing disease
In 2014, staff at a Nigerian hospital faced a situation that would determine the fate of their country
Health-care workers shoulder some of a pandemic's greatest burdens. Their hands-on work with patients increases their risk of contracting a contagious illness and of bringing it home to their families.
At the same time, they are often the bulwark that prevents disease from escaping into the general population. The accuracy of their diagnoses and timeliness of their interventions can make the difference between a small outbreak and a massive epidemic.
Six years ago, the staff at one hospital were faced with a situation that would determine the fate of a country.
On July 20, 2014, an American-Liberian lawyer boarded a commercial flight in Monrovia, Liberia, on his way to an economic conference in Nigeria. According to witnesses, he began vomiting en route, and when he arrived at Murtala Muhammed International Airport in Lagos, Nigeria's capital city, he collapsed and was rushed to First Consultants Hospital.
Given the traveller's symptoms — fever, vomiting, and diarrhea — doctors immediately started him on a course of anti-malaria drugs, but his condition only worsened. The hospital's chief physician, Dr. Ameyo Stella Adadevoh, began to suspect a different, and much more fearsome, diagnosis: Ebola.
An outbreak of the deadly virus was burgeoning in the lawyer's home country, but it hadn't yet turned into the massive epidemic it would become in the months to follow. The patient himself was adamant he hadn't come into contact with any of Liberia's relatively few Ebola cases, and, since Ebola can only spread through a symptomatic person's body fluids, it seemed impossible that he could have the disease. He began to demand to be discharged from the hospital.
Nigeria had never had a case of Ebola before, so neither Adadevoh nor any of her colleagues had experience identifying it. After more than 30 years in medicine, though, Adadevoh trusted her own diagnostic judgment. She had a history of recognizing and containing new contagious illnesses: in 2012, she had been the first doctor to alert Nigerian authorities to an outbreak of H1N1 (swine flu) in the country.
Adadevoh ordered an Ebola test and confined her patient to his hospital room while awaiting the results.
As she rushed to create a makeshift quarantine zone and obtain personal protective equipment for her staff, Adadevoh began fielding phone calls from the Liberian ambassador to Nigeria. He accused First Consultant Hospital of kidnapping a Liberian national and threatened them with legal action if they didn't release their patient immediately.
Deadly consequences
Adadevoh stood firm, knowing the wrong decision could have deadly consequences.
Lagos is the largest city in Africa, with 21 million residents and a high population density. That month, its public hospitals were critically understaffed due to a doctors' strike. If this really was Ebola and the virus escaped into the city, the outcome would be catastrophic.
When the lab results returned, they confirmed Adadevoh's Ebola diagnosis. Despite his protests to the contrary, the lawyer had been exposed to Ebola while helping to care for his sister, who had died of the virus less than two weeks before. He had even been hospitalized back in Liberia for suspected Ebola but had left against medical advice.
LISTEN | Ainsley Hawthorn and Andrew Hawthorn look at the recent lessons of an Ebola outbreak in the latest episode of Apocalypse Then:
The same day the test came back positive, Nigerian health officials launched a massive contact-tracing effort. They rapidly located 898 people who might have contracted the disease and set about monitoring them.
On July 25, the Liberian patient died at First Consultant, just five days after he arrived in Lagos.
The next day, hospital employees were called to a meeting. Each person who had had close exposure to the patient was given a thermometer and a chart so they could track their own temperature for the next 21 days.
An unused building was repurposed as a small quarantine facility. Conditions were rough, with stained floors and toilets that didn't flush. Still, as doctors, nurses, and other hospital staff developed symptoms, they identified themselves to authorities and were transported to the quarantine unit.
In the end, 19 people were infected in Nigeria's Ebola outbreak, most of them health-care workers, and seven people died. Adadevoh herself succumbed to the illness on Aug. 19, 2014, after slipping into a coma.
The outbreak is a case study of how wise decision-making at all levels of the health-care system can quash an epidemic before it begins.
Adadevoh's astute diagnosis identified a terrible health threat to the people of Nigeria, and her resolve kept a contagious patient in hospital where he couldn't infect anyone else.
WATCH | From October 2014, a report on how Nigeria was declared free of Ebola:
The large-scale contact-tracing program that was swiftly mounted by health officials detected the handful of other Ebola infections as they emerged so patients could be quarantined.
The bravery of hospital staff who sent themselves into quarantine despite their own fears prevented the virus from spreading into the community.
Thanks to the professionalism, quick-thinking, and integrity of these health-care workers, the World Health Organization declared Nigeria Ebola-free on Oct. 20, 2014, and the country avoided a devastating epidemic like the ones that claimed thousands of lives in nearby Guinea, Liberia and Sierra Leone.
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