f there is anything good that the Ebola Virus Disease outbreak has done for Nigeria, it is bringing out – very strongly – the truth that we have abysmally abused the environmental health sub-sector of this country. Everybody is guilty. From the government that refuses to prioritise and fund it, to the general citizenry that have looked down upon it over the years. But now that Ebola is here, we have all realised its inimitable importance, and are now running helter-skelter to repair the already done damage. So, the good news is that if we keep at the current environmental health-related vigour mustered to halt the Ebola scourge, we could also use the same weapon to eradicate that recalcitrant epidemic, Poliomyelitis, in one fell swoop!
One would ask, “How in the world is Polio related to Ebola?” or more simply, and pragmatically, “How can we do this?” The answer: Just like the Ebola Virus Disease, Polio has a thick connection to environmental health and hygiene. Polio is spread through person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faeces where it can spread rapidly through a community, especially in situations of poor hygiene and sanitation. If a sufficient number of children are fully immunised against polio, the virus is unable to find susceptible children to infect, and dies out.
Similarly, Ebola virus is spread through direct contact with the body fluids of a patient. Once infection is established among humans, as is the case in Nigeria, the management and control of the epidemic becomes majorly an environmental health issue. If the virus could be confined within the boundaries of the contaminated environment only; then there is very high probability of a quick containment of the outbreak, as the virus disappears with the last victim. It is this environmental dynamic that gave birth to the ongoing Ebola-induced love affair between Nigerians and hand sanitisers; which has inspired an overnight market for the product, but also spawned incredibly adulterated brands and half-baked health officers.
It is also important to mention that just like Ebola, most people infected with the polio virus have no signs of illness and are never aware they have been infected. However, in the case of Polio, these symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges. (For this reason, the WHO considers a single confirmed case of Polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.) On the other hand, in the case of Ebola, the carrier transmits the disease only when symptoms are manifested.
But in a positive light, because of Ebola’s vital connection to environmental health, the Federal Government has made a number of strategic moves. According to a recent press statement from the Minister of Environment, “Due to the virulent nature of this disease, Mr President and Commander-in-Chief, Dr Goodluck Jonathan, has ordered us to adopt both clinical and environmental health control measures to curb the likely spread of this deadly disease….The Ministry of Environment is therefore putting in place a robust environmental health management and control programme so that this disease does not become endemic in Nigeria.
“Our Environmental Health Officers working directly in areas of danger, and are responsible for sanitation at the quarantine centres and other areas of direct exposure, to be adequately equipped with Personal Protective Kits: here, I mean clothings, full mask with oxygen supply, gloves and boots. We are also planning to provide on-the-spot screening facilities for house-to-house premises inspection by the EHO…. We are also in touch with the various states of the Federation for the implementation of massive disinfestations of homes, offices, hospitals, hotels and indeed public places infested with bats, rats and other pests….The EVD is real and we are building a robust environmental health response to it to ensure that it is not domesticated in Nigeria.”
It is never helpful to cry over spilt milk. Still, I think it would be instructive to point out that the government erred regarding the EHOs. Last week, it was reported that the government promised to recruit about 490 trained environmental health officers to help tackle the Ebola epidemic at the borders. Ironically, for the past 15 years, the Federal Government had never deemed it necessary to employ even a single EHO, until now!
In fact, it was because of the conspicuous absence of these indispensable officers that I did a piece on this space sometime last year titled, “Where are our sanitary inspectors?” Sadly, it is obvious that issues that border on the environment are taken as unimportant in our clime. This is why the Federal Government and the National Assembly would always carve out large chunks of the nation’s budget for defence, education, etc, but with paltry sums grudgingly apportioned to the environment. But the truth is that the environment has an underpinning connection to almost all the critical sectors; which always manifests, sooner or later.
When the dam bursts, the government is then forced to pay much more than it would have used to shore up the critical environmental support bases. Illustration: The standard international practice is that there should always be a trained environmental health officer at the ports and borders of every nation. Any visitor to a country would first pass through these officers, whose duty is to be the gatekeeper – to detect and instigate response to every roving cross-border fomites, patient, vector, etc. But the Nigerian government did not have them positioned at our ports. Anyway, it is about to deploy 500 of them, after the damage has been done!
Now, back to Polio. Earlier in the year, in a chat with the Registrar of the Environmental Health Officers Registration Council of Nigeria, Augustine Onyekachi Ebisike, my eyes were opened to the not-so-obvious connection between Poliomyelitis and environmental sanitation.
He said, “In our (Nigerian) fight against Polio, we have come to that critical number of recurrence of cases where it continues going up and down without a total eradication; and people wonder why we have not succeeded. The answer lies in our sanitation culture. I say authoritatively that if we stopped public defecation for six months, the Polio Epidemic will disappear. It is a faecal-spread endemic, and could be halted. It is the job of the government to drive public health, and not that of the individual.” Further research on my side confirmed Ebisike’s affirmation.
Therefore, now that Nigerians have become universally conscious of environmental hygiene and the Federal Government seems determined to entrench environmental health infrastructure, let us all go the next yard. Let the government put in stringent sanitary health laws to curb public defecation and related environmental misconduct, and let everybody determine to fight Polio – not only Ebola! – with cleanliness. Among the only three countries in the world (Pakistan, Afghanistan and Nigeria) where Polio has not been eradicated, Nigeria stands with the highest recurring cases – with 94 per cent of the world’s Polio cases. Verily, we need to change our tactics. And, I am convinced that the strategy we need today to totally stamp out Polio comes from the direction of our current Ebola response.