Tuesday, September 16, 2014

EBOLA: Fighting the Terrorist. This is Guerrilla War fare-Dr Nick Ngwanyam, MD;

Interviewed by the Chronicle News Paper.
Dr Ngwanyam, are you happy and satisfied with the way we are facing up to the Ebola challenges in our country?
Dr. Nick Ngwanyam
  No. We are not doing the right thing. I know the Minister of Health is doing his best the way he understands it but the strategy has to be different and more refined. The emphasis has to be shifted and we need to use a new approach to solving problems otherwise we shall lose against Ebola.

  We have a formula for doing things that work according to our own bench marks. We like to deal with feelings and not facts. This time around, we think we can use our old methods and go at our own pace the way we want. Ebola is like the armed robber who writes a letter to you to inform you that he is coming. What do you do in such cases? Do you continue to drink and pretend he will not show up? Or do you prepare earnestly to challenge him? That is what we are up to. We want to ‘see’ Ebola before we wake up from slumber.
 Ebola does not respect those old management techniques. Ebola does not know presidents, army generals, ministers, cardinals, judges and so on. A whole battalion of soldiers armed to the teeth is of no moment. Ebola is afraid of education, hygiene and the use of common sense even by a primary school child. Someone remarked that if Ebola were to strike any where anytime in Cameroon, it will kill us just in the same way we spray mosquitoes with insecticide.  Our money and wealth cannot help you.
  The Americans have sophisticated armament and technologies for fighting conventional war fare. Dealing with Talibans, Boko Haram and others who use guerrilla tactics and infiltrate into the civilian population is a different ball game all together and fighter jets, warships, atomic bombs are useless. To fight this guerrilla wars, they need a lot of intelligence, small rapidly deployed efficient hit squads. They must understand how the enemy thinks, operates and attacks. Then they have to deploy counter measures to these operation strategies. Short of these, they are wasting time.
  In Cameroon, we are used to doing things in a particular way. We have one strategy and command chain for all. We have just one answer and a one track mind for everything. To us every business is political, then, the administration is heavily implicated in it. The military and intelligence have their say and technology and technicians have no place. The population has an observer status with little or no contribution to make. The reverse is the truth this time around. The power to deal with Ebola is completely in the hands of the communities and health personnel.

These old techniques and strategies would not and will never work for Ebola. They are the same strategies we have used for polio and cholera which have yielded partial fruits. To think that dealing with cholera is so simple and we have not handled it and we convince ourselves that we shall handle Ebola is a dream and a joke in bad taste. Hygiene is about having water everywhere, cleaning our hands after using the toilet along with proper food handling techniques. Handling human and house waste is a real concern. Do you know about the  many schools in the nation that do not have potable running water and functioning toilets? How many markets have these facilities? I know some university professors who do not even wash their hands after using the toilet. What is wrong with us? Would you swear that all ministers wash hands? Fanfare is one thing and doing the right thing is a different cup of tea.

 I understand in the current dispensation, the Head of State is the Chairperson of the fight against Ebola and the Prime Minister is next in command. Thereafter, is the Minister of Health who is assisted by Governors at the Regions. Then the SDOs take the baton at the divisions. Sorry this is all wrong. The fight is led by technicians and the politicians and administration should only lend a helping hand. The army should stand back.
  The minister of health is the head of the team and assisted by Regional delegates for health and divisional medical doctors. This is called taking responsibility, being proactive and accountable. You cannot use a mason to roof a house.
 The whole health structure including all personnel of public and private health institutions should be trained, educated and equipped NOW not TOMORROW. Presently, nothing is happening in this light until a budget is provided. These are the soldiers who face the Ebola daily. Doctors, nurses, lab technicians and cleaners would pay the Ebola  price with their own precious lives if they do the wrong thing in the face of a challenge. Nobody has embarked on a mass training of all these foot soldiers and that is the beginning of the mistake; that is why I am so worried because I do not want to die out of carelessness and neglect.

Doctor, you might be worried but 630,000,000 frs has been set aside for this fight. Is this not enough?

The Ebola fight has nothing to do with money for now. Money is important but even if we have billions of dollars with the wrong attitude, we shall create more problems with people fighting over money that facing Ebola. The thinking should first of all be straight; then, we shall know how to use the money to meet some logistics. When you have a lot of money and do not know what is important, it can only get wasted. We ask for money and a budget and think it is the way. It could become the problem when people refuse to work if someone disappears with the gombo as we a prone to do in Cameroon. Suppose there were no money at all. Are you telling me we will do nothing?

 What the population and health personnel need is mass education which in itself does not need money. The nation is in a crises situation. We have state radio stations and televisions that broadcast naked women dancing, music  from morning till dawn for holiday makers, sex scenes and people drinking beer or better still political party jamborees.  It is time we should use these, for free, to educate. We have a lot of private TV stations, radio stations, community radios and private news papers which will be just too glad to participate in structured educational programs to target Ebola if we take them on board in a participatory approach with a win-win mentality and not a boss-subordinate, top to bottom heavy handed approach.
We have churches, village development organizations, fondoms,  ‘njangis, schools, universities and all these at our disposal and we are not making use of them. Everyone is waiting for a budget as though it were a political campaign where we need to give gifts to unwilling voters. That is not the case. We are all in a sinking boat and we either choose to live together or commit mass suicide. We are also more concerned about what we shall benefit from the exercise. This is wrong and unfortunate.
The President should declare one of these coming days a PUBLIC HOLIDAY FOR EBOLA EDUCATION in the whole nation. All offices and markets should close and everyone should be out on the streets doing something for Ebola. All schools and universities should be involved. All farmers and fishermen and hunters should take the lead.

 For once, we should learn to do the best we can, where we are, with what we have. If you do not know how this works, ask the staff of the University of Buea, who have been on the field doing the best they can in the community with little or no assistance. They have used what they have in the interest of their communities. The mindset is more important that money. ‘ If you no play politics, politics ko play you’. This is an expression we can interpret under any circumstance to mean that someone will lead us to the slaughter house whether we choose to go or not. This happens when we fail to take our responsibilities in society. If you fail to choose, someone will make the bad choice for you and you must bow.
Just before we go Doctor; can you please comment on the quarantine efforts that government is making at the boarders?

 Yes, it is logical to stop people at the boarders and quarantine them for a minimum of fifteen days before you release them to continue into town. The problem is to understand what it means by quarantine and what measures must be put in place to make this exercise palatable and fit for human consumption. The way it is going is a disaster in the making.
 This is the best case scenario. If you have ever been to an operation room in a hospital with surgeons and nurses all dressed up for surgical procedures, you will begin to understand where we stand with managing Ebola. The watch word is ‘non-touch’ technique. If you have also been to a factory that produces IV drugs, you will be speaking the same language. How do we disinfect, clean and sterilize the used equipment? How do we dispose of the human waste, pus, blood, urine, used needles and blades in the hospital? The whole nation needs to rise to this level of understanding though we would be short in practice. Without grasping this need for sterility and non contact as far as Ebola is concerned, we are doomed.
 Let me paint for you what is happening in our borders. First there are no houses to take all the people arriving there. Five, ten or fifteen people are squeezed into whatever space they can afford ‘for observation’ supposedly for fifteen days though in Cameroon, three or five days can easily pass for fifteen days if you know what to do.

If you have 15 persons in one room and assuming that one of them has Ebola. At the end of 15 days, the 14 others who were originally healthy would be contaminated. Do you get the point?
  Now when you release them and keep the single sick individual as he waits for death, you seed the families and communities with the other 14 and so you contributed in making a bad situation worse for your lack of resources and inability to do the right thing. So keeping people without knowing what you are doing could instead be catastrophic.
When you lock them up; tell me, what toilet facilities do they have? Is there running water, soap and ‘la croix’ available? How do they feed themselves? Do they eat from the same dishes with mixed cutlery from the woman who comes to sell food to them? How much contact exists between them? What about some of the women in those places who by chance could be sex workers? What happens with a rising, clientele that sits and counts days with no work to do? Oh, I forgot to find out the place of money in all of this. Can money somehow transmit Ebola? Check out how much ‘33’ would be sold. Are the endless bars functioning?
  I understand that at the border town of Ako in Donga and Mantung Division, one supposedly trained nurse has been deployed out there to detect and handle Ebola cases. What tools has she got to come to that diagnosis? If it is only a thermometer to pick up temperatures; please answer me; are all temperatures caused by Ebola? How would she know the difference?
 If you want to quarantine, you must provide single rooms and toilets for every person and break contact between them at all cost. The rooms must be thoroughly cleaned and disinfected before others are put in them.  Think of how you will feed them and also treat other diseases like malaria and diarrhea not related to Ebola. If we lock up people in cells as it happens in our police custody areas, I am afraid we are doing the wrong thing as we cause more harm than good.
Any last word doctor?

Yes, I will come up in the next issue of the Chronicle with the strategic plan for fighting Ebola. What should each ministry be doing? What do we expect from the President, Prime Minister and other Ministries as their contribution to the fight? We need to come up with action plans as to what we must do at individual and collective levels if the disease were to strike. While we do our best to keep it away, we should also know what to do if it shows up. We must prepare to handle the sick by having in place what we need in sufficient amounts deployed all over the nation. You keep your bullets and guns in wait. You train before time. You do not place an order for stuff
when the enemy is already in. You prepare before hand.

 These action lines or policies and procedures would be built and fashioned on the line up for disaster management. Everybody has to know it and learn it. By preparing and fighting Ebola, this is a good chance and opportunity for Cameroonians to learn and improve on hygiene, food and water preparation and manipulation and we also will create more national unity and love amongst us because we all face the same enemy and the same fate down the road. It shows us that with Ebola, there is no Jew nor Gentile. All the hatred, discrimination, stealing and segregation amount to nothing. Love stands the test of time. Love will win.

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