Nigeria failed Nurse Justina Obioma Ejelonu....and the world didn't care either

By John Okiyi Kalu on

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Nigeria failed Nurse Justina Obioma Ejelonu....and the world didn't care either

 

"I never contacted his fluids. I checked his vitals, helped him with his food, (he was too weak)...I basically touched where his hands touched and thats the only contact. Not directly with his fluids. At a stage, he yanked off his infusion and we had blood everywhere on his bed...but the ward maids took care of that and changed his linens with great precaution"-Nurse Obioma Justina Ejelonu describing the nature of her ill fated contact with American Ebola carrier, Patrick Sawyer, at her place of work in Lagos.

 

A nation state exists primarily to protect the lives and properties of the citizens and in return the citizens pay taxes to the state and generally subject themselves to the rules made by the state. Without being definitive, that should be an elementary explanation of social contract as expounded by John Locke and others. We all know about penalties when citizens fail to keep their part of the bargain but hardly do we make the state suffer penalties for failing to keep her own side of the contract. As a result, the state through it's agents regularly  breach the contract, especially in developing countries, with impunity. And yet life goes on for citizens..... until they drop dead as a result of the non performance of it's existential duties by the state.

 

Nurse Obi Justina Ejelonu died early this morning. Complications associated with Ebola viral disease claimed her life at Mainland hospital Yaba where she was quarantined by the agents of the Nigerian State.

 

May her soul rest in peace.

 

We owe it to her memory and that of others still struggling to stay alive at the Lagos quarantine center to share our thoughts and observations from our interactions with her.  It might help the authorities wake up and keep their social contract with those remaining in quarantine.

 

Most of us didn't meet  Justina in real life (and now will never) but we belong to same online group, Igboville/Oganiru Ndigbo Foundation. While the group was preparing for a free medical service program at Aba in December 2013, Obioma (Justina) volunteered to be among the nurses that will attend to the patients, free of charge. She was really excited about offering her services free, to save lives. It was in the build up and preparation for the event, successfully held at Aba on 27th December 2013, that we got to interact more closely, online. She was always available at the medical service committee thread to make suggestions and liven up the thread with jokes and banters. Naturally, all the members of the team knew this lively nurse working then at Ijebu Ode, Ogun State.

 

Early this year, she moved to Lagos to resume at First Consultant Hospital Obalende. Her excitement was palpable even as she contacted one of our chapter executives to help get her accommodation in Lagos as well as introduce her to some Lagos based Igboville members. As expected, he did his best for her in fulfillment of our slogan "onye aghana nwanne ya" (don't leave your brother/sister behind). She relocated to Lagos and resumed at her new station.

 

Her later posts at the group and  her facebook wall confirmed she was enjoying her new experience at the high brow Lagos hospital. Until the 25th of July when she made this post at Igboville wall:

 

"Friends,

thank God for me o. i had a close contact with the first Ebola case in Nigeria..:.Long story cut short, God saved me dearly. join me in thanking God."

(Jul 25th 2014)

 

And then this comment next day::

 

"Friends,up to our uniforms and all linens were burnt off.  We are on surveillance and off work till 11th.

Our samples have long been taken by WHO and so far we have been fine.

For me,  kudos to my hospital management because we work professionally with every patient considered risk because that's the training. Had it been its a hospital where they manage risky patients with ordinary gloves like Government hospitals and some  Janjaweed private hospital..:lol....wahala for dey o. I must also thank Lagos Govt....infact! Even federal govt self....all have been supportive. I'm good and so are the others in the hospital....."

 

When she made the above posts, I didn't read them, probably because I wasn't online. But a friend of mine who is also a member of the group sent me a message on the 6th of August; "Hmmm make una go look for obi Justina o. She went MIA after her post in Igboville that she was among those that treated the Liberian. One of the nurses whose identity isn't known is dead. I really feel for her. Wahala upon job paying peanuts".  Alarmed, I Immediately contacted the administrators of the group to get updated and learned they were already trying to trace her but can't find her phone number. Messages were sent to her facebook inbox and that of those related to her. With no response, the admin had to mobilize the already anxious more than 18,000 members of the group to look for information on her whereabouts.

 

It was in the midst of that search that my private line rang while I was on a call with a friend who is related to the owner of First Consultant Hospital. Since I didn't pick the waiting unknown call, the caller dropped the call and sent me a short message: "Oga JOK, it is Justina"". I called back promptly and she confirmed to me that she was in quarantine at Mainland Hospital Yaba as she tested positive to Ebola with the symptoms already manifested. What hit me most was the comment that they were "dumped there to die" with little care and separated in two groups with one group in rooms she called "VIP" while she and others were in the "ward". Her voice was weak and labored so I had to ask her what she needed most urgently. She replied "money, we don't have anything here and every money we have is finished because we are the ones taking care of ourselves". She also told me that she was "stooling" (diarrhea) for the past 5 days  with fever.  Finally, she begged me to make sure that she survived from quarantine. It was in the course of our brief discussion that she mentioned that the Minister of Health, Prof Onyebuchi Chukwu, was her Chief Medical Director (CMD) at Ebonyi State University where she trained as a nurse. I assured her we will do the needful and promised to call her the next day at 10am after going to the bank to send some money to her. Sleep was difficult that night as her desperately pleading voice assailed my thoughts..

 

When I reported back to the administrators of Igboville we reviewed the situation and decided that if she can get the same drugs that saved the 2 American medical personnels her chances of making it out alive will improve. Unfortunately, there was also the information that President Barack Obama has rejected Nigeria's request for the experimental  drugs, Zmapp,  to be sold to our medical authorities. The challenge therefore was how to get American public opinion to compel the President to consider the need to save the lives of Nigerian Ebola patients in quarantine and approve release of the drugs. After all it was an American citizen that infected them, delibrately, it seems. It was in consideration of that that we decided to launch a social media campaign using #GiveThemExperimentalDrugs to pressure the leaders of America and Nigeria to respond by urgently sending Zmapp to Nigeria. A petition was also prepared to compel the white house to send the experimental drugs to Africa. We  agreed that we will provide for all she needs at the facility, including cash, oxygen, water for bathing and symptom management drugs that are not available. She has to live long enough to receive the experimental treatment.

 

That same night, we went to the media and appealed for support. Thankfully, Sahara Reporters led the response with other online and mainstream media keying in.

 

The next day, we searched for and bought one canister of oxygen from Lagos and later moved some canisters from Aba where we already had one extra from the medical retreat, to Lagos. (See attached picture). A Nigerian medical expert, Dr Chibueze, who produced a water based elixir for body regeneration was contacted and he donated bottles of  the elixir free. Meanwhile one of our trustees based in US contacted a research institute in a University that has produced experimental treatment for Ebola and it was only yesterday that final approvals were given to release the treatment subject to a formal request from the Nigerian government.

 

To get the Nigerian government to do the needful, we wrote the Minister of Health and copied the President. But in between, the good news came that WHO has approved use of experimental drugs like Zmapp to treat Ebola patients. We celebrated in hope that the drugs will be mobilized shortly to get to Justina and others in quarantine. Even political and community  leaders were contacted to help impress on the government the urgency of the situation with emphasis on the need to make required drugs for management of the patients available at the quarantine location so as to extend the lives of our people pending when the experimental drugs will reach them.

 

At this point let me explain what we knew that guided our choices. From available literature, infection with Ebola is not a death sentence and quarantine is not supposed to be an "awaiting death" prison. If infection is discovered early and the patient managed properly, chances are that he or she will survive. We believe that in cases where EVD infections are discovered early, there is a 60-40 chance of survival without Zmapp and other experimental drugs. Since the virus attacks organs by depleting oxygen available to the organs, one key management tool should be to give the patient oxygen and then lots of intravenous fluids. In addition, you will only need to treat the other symptoms like diarrhea and fever to make the patient more comfortable until her immune system can build up enough anti-bodies to overwhelm or reduce the viral load (quantity of virus) in the patients system. If a patient survives long enough, her immune system will definitely produce enough antibodies to deal with the Ebola pathogens. The challenge therefore, in the absence of Zmapp and other experimental drugs, is to keep the patient alive for as long as possible through a strict management regime that re supplies what the virus is taking from her system while taking care of associated symptoms. Definitely, there is no rocket science involved but strict monitoring and care is required.

 

A quarantine facility is expected to have the capacity and resources to provide all that in addition to keeping the patient away from the general population to avoid spreading the infectious disease. It therefore follows that a quarantine center must have  oxygen canisters to manage those under their care. This much was confirmed by the fact that when we delivered the first oxygen canister to Justina, the expatriate WHO medical personnel was so profuse in his appreciation that we decided to mobilize at least 10 more within 24 hours so that all the patients can have them. We believe that about 10 patients were in critical need at that facility. We also asked the expat to give us a list of urgently needed medical supplies required by the patients so we can approach Lagos State government and the Minister of health to provide them.  President Jonathan has already announced that N1.9b is available for the EVD containment program and the right place to start should be at the quarantine location..

 

The list was supposed to be collected this morning but when our contact, who is related to Justina, arrived at the clinic this morning, he passed this sad message to me: "My brother Obioma is gone". I called back to join in the wailing knowing that Justina could have lived if the state cared. She could have lived if Obama had acted promptly in response to the request by Nigerian government. She could have lived if many Nigerians had joined the cause to demand that she and others be given experimental drugs. She would have lived if their quarantine location was equipped with necessary supplies and the condition made hopeful rather than "awaiting death prison"..

 

To help the world know the true conditions of the quarantines, we arranged for a media practitioner, Kelechi Deca to join the last teleconference we had with Justina. It was in that conference that she said; "we have not had our bathe because there is no water since yesterday......". Wrap that around your head and you know how we felt about our country Nigeria and those responsible for caring for those locked up in quarantine "prison", as Justina told another media person, Prince Charles Dickson, who we also arranged to speak with her independently.

 

This article is not necessarily  to apportion blames. We fully understand that Nigerian leaders were not prepared for this emergency even when our West African neighbors were dropping dead because of Ebola. Probably if the American, Patrick Sawyer, had not visited our country we would have gotten away with another case of national unpreparedness for emergencies. It will also be irresponsible of anyone to start a political blame game in the midst of an unfolding national disaster. Similarly, when we initially raised these issues many social media commentators refused to join the affirmative actions to save lives because they felt remote from the disaster and considered political bickering more worthwhile. We all failed as a nation and a people.

 

But with the announcement we read earlier today that the Presidency have shut down all primary and secondary schools in Nigeria indefinitely, may be it will dawn on every Nigerian that nobody is really safe until this monster called Ebola is contained. It is difficult to remember any infectious disease threat in Nigeria that forced the country to shut down schools indefinitely. We are now in full scale medical emergency situation.

 

Key to containment of Ebola is provision of good and well equipped quarantine facilities pan Nigeria. There are global standards in medical confinement and we must strive to meet and surpass them. As citizens, we should also demand that those we gave power in trust to should do everything to protect every one of us. We don't see how you can convince people to voluntarily go into quarantine when they have no record of someone going in and coming out alive. Still no responsible government will want Ebola patients running round the place like the irresponsible Patrick Sawyer. Confinement is key to containment of EVD but provision of adequate containment facilities is the key to success in a good containment program. Not daily media briefing on how many is infected or  died since the last update. If that is what the N1.9b is meant for, uwa ntooo. 

 

It is on that basis that even as we mourn angel Justina Ejelonu we wish to demand that the concerned authorities immediately provide oxygen canisters to the quarantine location in Lagos and other towns in Nigeria. We demand that alternative power supply be provided with steady water supply. All the required medical supplies including fluid infusion should be supplied without further delay.

 

Announcing another death of a patient in quarantine will almost certainly ensure that most Nigerians will rather bury themselves alive than enter into quarantine. Others will likely show up at religious worship centers and infect more people. Is that what those in authority want?

 

It is time for governments at all levels to get serious about confronting Ebola.  The ongoing social media debates on whether it is a biological weapon or not is distracting because when you are infected and battling for your life the only thing you will care about is staying alive. Even if you establish that EVD is a case of biological warfare gone awry, of what use will that be to you when people around you and even you start bending over clutching their stomach?

 

We have failed Justina. But we must not fail her colleagues and others in quarantine. Earlier today when I told a community leader that was helping to get the attention of those in authorities with regards to improving conditions at Yaba quarantine center that Nurse Justina is dead he responded with one word: "shameful". I know what he meant. You probably also know. But do those in government know?

 

Clock is ticking!

 

JOK 14/8/14

 

Posted on August, 15 2014

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