Fighting Lassa: Five lessons from three special hospitals managing most cases of Lassa fever in Nigeria
Nigeria is currently witnessing its largest Lassa Fever outbreak in history. Since the first case of the virus was identified in a missionary nurse working in the village of Lassa in Borno State in 1969, cases have continued to increase in Nigeria, mostly in the states of Edo, Ondo, and Ebonyi. The anxiety associated with cases has created panic in many parts of the country and affected hospital operations across the country.
In tackling this Lassa fever outbreak, three specialist hospitals have emerged and grown in capacity and expertise to manage Lassa fever. These hospitals serve as examples to other health facilities in the country as many hospitals in Nigeria still struggle with managing cases of Lassa fever, often leading to panic. While there are plans to add to the number of specialist hospitals with the capacity to effectively manage Lassa fever cases, these three hospitals have shown that it is possible to grow in expertise in the management of Lassa fever in Nigeria through the sheer determination of their leaders, innovation of their staff and involvement of the entire co`mmunity.
Irrua Specialist Teaching Hospital (ISTH), in Edo State, Federal Medical Center Owo (FMC), in Ondo State and the Federal Teaching Hospital in Abakaliki (FETHA), have been remarkable for various reasons. Most importantly, they provide care for over 80% of all Lassa fever cases in Nigeria. These three centres tell an unlikely story of how three hospitals in fairly rural locations have grown to become the frontline of Nigeria’s efforts to curb Lassa Fever. They have risen to the challenge, shown innovation despite limited resources, sustained momentum, created and nurtured new partnerships and risen to be trail blazers.
The following are five lessons that can be learned and adapted from their efforts in controlling the current Lassa fever outbreak in the country and in leadership generally.
Change requires the engagement of all stakeholders
The Irrua Specialist Teaching Hospital ISTH is located 110 km from the historical Benin City, a two-hour drive across the rainforest terrain. Over the past ten years, it has nurtured the development of the Institute of Lassa Fever Research and Control (ILFRC), which now oversees the management of Lassa fever cases. Before its establishment, the number of people that died from Lassa fever when sporadic outbreaks of Lassa fever occurred in the area was quite high, in some cases more than 70%. This was primarily due to late presentation, poor case identification and non-availability of the drug Ribavirin, which is effective in Lassa fever if administered early enough. The centre started as a proactive response to address these issues and over time, the figures have continued to improve remarkably, a reduction of deaths and an accompanying increase in confidence. While ISTH certainly cannot claim to have found all solutions to all the challenges, they have developed unique strengths in the management of Lassa fever and currently set the trail for other health facilities in Nigeria. Irrua Specialist Teaching Hospital will definitely be at the heart of any research planned on Lassa fever and the community will benefit from the innovation and determination of this facility.
Purposeful leadership, systems and structures as drivers of sustainable change
Speaking recently at a panel discussion organised by the Nigeria Centre for Disease Control (NCDC) in Abuja, CMD of ISTH, Okogbenin, a Professor, listed building sustainable systems, structures, and having the right people in place as some of the elements that facilitated the smooth transition of leadership from the time of his predecessors to the current administration that he leads. This has helped ensure that new administrations do not begin brand new projects to duplicate previous ones but focus on scaling up existing systems and interventions. This obvious example is a rare characteristic in our polity in Nigeria, as most new leaders want to gain recognition for new projects. In Irrua, various administrations have built on the Lassa fever control systems in place. What began as a Lassa Fever committee years ago has now grown to become the leading institute for Lassa fever management, detection and research in Nigeria and globally.
Collaboration, collaboration, collaboration
The impact of both local and international partnerships developed over time is evident at both Irrua Specialist Teaching Hospital, Federal Medical Centre Owo and the Virology Centre of the Federal Teaching Hospital Abakiliki, with partners contributing significantly in their areas of strength to help curb the outbreak. ISTH has a long-standing partnership with the Bernhard-Nocht Institute of Tropical Medicine, Hamburg, Germany. This has not only led to contribution of resources for Lassa fever diagnosis and treatment, but also capacity building of local staff who are continuously trained on global best practices. A remarkable feat from this strong collaboration is the ongoing establishment of a state-of-the-art molecular research and diagnostic laboratory within the Lassa fever Institute.
Leaving no one behind
While there is still much that can be done at the Federal Teaching Hospital, Abakaliki, a resident doctor and epidemiologist working in the hospital said the hospital has taken proactive steps following the loss of some colleagues to Lassa in January 2018. These include mandatory health education of all employees on Lassa Fever, revamping of the virology centre, strengthening the activities of the Lassa Fever committee, developing and conspicuously displaying case management protocols, effective collaborations with other treatment centres, State Ministry of Health and other state agencies. Ahmed Adeagbo Liasu, Chief Medical Director of FMC Owo, praised the commitment of his staff working on the Lassa Fever response. “These colleagues are not just government workers, because this is not their usual routine. They volunteered to be part of the Emergency Operations Centre, and they work even in the face of panic and limited resources.”
Taking advantage of the opportunity in crisis situations
In 2017, Nigeria had only three diagnostic centres with the capacity to test for Lassa fever- Lagos University Teaching Hospital (LUTH), ISTH and the NCDC’s National Reference Laboratory, Gaduwa. In Abakaliki, a virology centre had been built but was yet to be operationalised. By the end of January 2018, FETHA had faced a difficult situation as it had not only lost members of its host community to Lassa fever, but health workers had also been infected. The hospital had depended on ISTH, a three-hour drive from Ebonyi for diagnosis which affected early initiation of treatment.
In retrospect, 2018 has seen one of the biggest outbreaks in the history of Lassa fever epidemics in Nigeria and globally.
Chibuike Alagboso