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Liberia health workers fighting unexpected epidemic

02 June 2017
Meningitis outbreak
An unexpected epidemic in Liberia has highlighted the gaps that remain in the country’s capacity to react quickly and effectively. Health workers are demanding access to medical and laboratory equipment to avoid delays in diagnosis.

An “Unexplained Cluster of Health Event”, killing 13 persons in few days, was reported in Greenville City, Sinoe County a few hours after a funeral.

Beginning with an eleven-year-old girl, on 23 April 2017, the J.F. Grant hospital in Greenville admitted the first patient presenting signs and symptoms of headache, vomiting, abdominal pains, diarrhea, weakness and mental confusion. Four hours later, the patient died. The case load accelerated to 26 with 13 deaths by 30 April, representing a fatality rate of 50%, according to the situation report of the ministry of Health.

By 25 April and onwards, the only available medical laboratory investigative result on this crisis declared it negative for Ebola Virus Disease. And with the support of the Center for Disease Control (CDC), some samples were shipped for toxicological analysis.

This situation spread to 11 communities in Greenville City and two other counties in Liberia. According to the Ministry of Health situation report, there were 10 deaths in Sinoe, with 12 survivors; two deaths in Montserrado County without survivors, and one death in Grand Bassa County and one alive. All of these cases are reportedly traced to having taking part in the same funeral, wake keeping, burial and re-pass activities in Greenville, Sinoe County, on 22 April 2017, and they all presented the same signs and symptoms.

The episode claimed the attention of the Liberian people because similarly in 2014, following a funeral activities, strange cluster of deaths over took Dolo Town of Margibi county, killing scores of people. It was later established to be Ebola. One can understand why the Health authorities were quick to announce that this was not Ebola.

On the over all, government and partners did well in putting into place a response mechanism for community engagement: contact tracing, Infection, Protection Control (IPC), house to house visit teams, and surveillance were very timely, while specimens for laboratory investigations were regularly collected.

Disappointingly, it took nearly two weeks for the Ministry of Health to diagnose this episode as meningitis.

Interestingly, the diagnosis only came when there were no new cases and all other patients had either died or survived and were in a stable condition.

This is a classic example of the resilient health setting of the Liberian health worker. Treating patients without knowing their diagnosis due to lack of basic medical equipment and laboratory reagents and other supplies, which is no longer news in Liberia. So, even meningitis could not be diagnosed in the country.

Regrettably, while the rest of the world is treating cause of illness based upon diagnosis, supported by laboratory investigative results in this age, health workers in Liberia are still treating signs and symptoms without proper means. This trial and error method of treatment is unacceptable and must not be allowed to continue. How many victims would have survived had the health workers been able to obtain the correct diagnosis within 24 to 48 hours?

NAHWAL salutes the healthcare providers in Sinoe County and the Sinoe County Health Team. We are grateful to the CDC and the WHO for assisting the Ministry of Health in this crisis. Meanwhile, NAHWAL here by calls upon the National Legislature to see reasons to increase budgetary allotment to the Ministry of Health for infrastructure and human resource development, and ensure that the money is used for the intended purpose of  improving the Liberian health service.

This article is an extract from the “Right to Health” newsletter issue 02/2017. Subscribe to the newsletter. Send us your stories.

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