While anxieties about Ebola have taken flight globally, it is particularly important in a small economy like ours with definite health challenges and ringed by porous borders that levelheaded approaches utilizing government and non-government resources be deftly and swiftly applied. The public also has to be kept fully apprised of all developments and provided with information on prevention and treatment so as to avert irrational fears.
Before one considers Ebola it is perhaps instructive to examine the country’s experience with Chikungunya (ChikV). A mosquito-borne virus which is not fatal in healthy people, ChikV was first detected in the Caribbean in December 2013 in St Martin, the French half of the island shared with Dutch St Maarten. When one considers the thousands of Guyanese who live on the island and the high volume of traffic between the two countries, it was inevitable that the disease would migrate here rather quickly as it began jumping from island to island and ever closer to the South American mainland. All it would have taken would have been for an infected traveller to be bitten by the vector here and transferral of the virus to others.
Guyana’s first cases were reported in late May at a press conference called by Minister of Health Dr Bheri Ramsaran. While it is likely that the virus was present here even before this announcement, the government essentially had about five months to limit the impact of this disease which has struck down many with debilitating joint pains and recurrences of the symptoms. The government’s main options were two-fold: a massive fogging exercise along the coast accompanied by the clearing of stagnant drains and their aggressive maintenance and an inundation of the coast with public service messages on maintaining a healthy environment.
Unfortunately, none of this happened. The fogging programme when it started late in the day was beset by problems about the chemical being used and concerns among the sprayers about their health. As the virus erupted across the region, the Pan American Health Organisation warned last month that Caribbean countries had to take aggressive steps to eliminate the vector. Unfortunately, this is a message that the government has not acted on. Further, its education programme was limp and there was no sense of urgency. Not surprisingly, thousands of Guyanese have come down with the disease and are still coming down with it. The government has no answer to this burgeoning morbidity, the solution as far as one can tell is for the populace to develop immunity to ChikV and bear what has been reported all round to be excruciating pains and other trials. It was not until very late after the first series of infections that the public was told that infected persons should isolate themselves until the infectious phase was over. As an aside, it should be noted that no steps were taken to have the much vaunted national reference laboratory be capable of testing for ChikV until PAHO intervened.
Lost productivity calculated in places like Jamaica has been staggering. If these things were properly recorded here it would be a similarly high figure for Guyana as householders, businesses both big and small and the public sector have been severely affected. While Guyana is not singular in suffering this affliction, the pivotal concern surrounds the lack of planning to counter a debilitating disease that was on the way.
Those missteps can certainly not be countenanced with the virulent Ebola. Luckily for Guyana, it will be shielded from a direct threat at formal ports of entry by the evaluations that would have been done at various points on the journey. Non formal ports of entry pose a clear threat which has to be addressed.
While the President’s statement to the nation and a meeting with public sector stakeholders last week on Ebola are welcome, the government has not been sure-footed and is yet to provide a detailed public plan to assuage public concerns about preparedness. It was not until earlier this month that the public’s attention was drawn by the Minister of Foreign Affairs Carolyn Rodrigues-Birkett to a September 9, 2014 post on her Facebook page about restrictions on travellers from West Africa to Guyana. As deficient as the advisory was, it could hardly suffice as a medium through which the public could be assured of steps to insulate then from the threat of this disease. Where was the government and the Ministry of Health in taking charge of this vital public information campaign and disseminating information on travel restrictions?
Signs have only recently emerged of more coordinated activity with the disclosure on Friday that a person who travelled from West Africa was being monitored at the GPHC. Having claimed nearly 5,000 lives in West Africa and still out of control in some areas, there needs to be a steep learning curve for all involved. The protocols have to be clear and followed rigorously. The first real test of the response system clearly shows that there are big holes. The person from West Africa who is being evaluated at the GPHC apparently entered the country without the relevant questions being asked of her and there was no attempt to follow up on her condition. She presented herself to a private physician and out of an abundance of caution the physician referred her to the Georgetown Hospital.
One cannot be too hard on the government and its public health agencies considering the breakneck speed with which Ebola has surfaced and the limited resources. The US itself has suffered the acute embarrassment of hospitals not being prepared to receive patients, health care providers admitting that they had not been trained, worries about the disposing of contaminated materials and shocking misinformation on the disease and its dangers from the Head of the Centers for Disease Control. However, the government here must now show greater coordination and urgency.
The government must now set out in great detail its plans on Ebola and address the following, among other concerns.
1) Have immigration officers at ports of entry been rigorously trained to interview and evaluate travellers to determine whether there is a credible threat? The officers must be knowledgeable about the geography of West Africa and be particularly interested in the recent travel history of the person seeking admission.
2) Are there secure facilities at ports of entry for persons who may pose a threat to be kept?
3) Is it the policy of the government to quarantine citizens and others who have visited affected areas? 4) What plans are in place for aggressive contract tracing should the need arise?
5) Does the country and its ports of entry have adequate supplies of non-contact infrared thermometers and bio-hazard suits?
6) Are there adequate medical supplies dispersed across all areas of need?
7) What is the policy for the porous borders to the east, north and south? This is an enormously complex proposition but the government has to show that it is thinking on its feet and is aware of the dangerous challenge that backtracking routes can pose to public health.
These and many related matters require clear statements and planning from the government. This is yet to be seen.
