On the Ground in Nigeria: Ebola Response

By Lisa Esapa, CDC-Nigeria

For the last few months, there has been a constant buzz about Ebola among my friends and colleagues in Abuja, the capital of Nigeria. Everyone had a theory about if, when, or how Ebola would come to Nigeria. When we heard about a probable case in Lagos, my heart sank. Lagos is one of the most densely populated cities in the world, with a population of 15 to 20 million people. Lagos is crowded and loud, with sprawling slum areas that occupy the spaces between the river banks, markets, and developed areas. The stakes for stopping this outbreak from spreading are incredibly high.

For the past 17 months, I’ve been stationed in Abuja, Nigeria, with the Global Immunization Division, working on polio eradication and routine immunizations as part of CDC’s emergency response efforts. I was deployed from Abuja to Lagos just over a week ago to work on setting up Nigeria’s own Emergency Operations Center (EOC) for Ebola. I’m a public health advisor, which I have learned in my 6 years at CDC means I have to be a jack-of-all-trades. This is certainly true for this response. Nine CDC staff in Lagos are working with Nigeria and non-governmental organizations (NGOs) on infection control, airport screening, contact tracing, epidemiology and surveillance, communications, and management. I fit into the last category, but really my job is to be sure that all the different pieces are coming together and working. Our days start around 7:30 am with discussions over breakfast at the hotel. We then move to the Ebola EOC, temporarily located in a psychiatric hospital.

The drive to the EOC is the first adventure of the day. Traffic in Lagos can be quite challenging; lanes are congested with cars, while street venders move between the lanes of traffic at intersections selling daily papers—Ebola is the headline in 80 point font in all of them.

Talking to people, you can tell they are nervous and scared. Part of the work of the EOC is to put out accurate messages on prevention and counter the misinformation about Ebola that circulates. For example, the current rumor is that drinking salt water can prevent Ebola. There is a lot of stigma around Ebola and anyone associated with the disease. Many of the people who had contact with Ebola patients have been shunned by their communities. We are working with UNICEF and the U.S. Consulate to determine ways to support this group of people.

During the course of the day, some team members go to an isolation ward (which houses the current patients), the airport, the lab, or the U.S. Consulate. In a “typical” day, I may work on a number of varying tasks, such as finalizing guidance documents that can be shared with states or healthcare workers, meeting with teams leads and partners, drafting a budget for specific activities, and explaining Nigerian culture to the team members. Luckily, this is part of my toolkit—being able to work in a different culture and help ensure my team doesn’t run into problems. Even a job like coordinating the motor pool is no small task, since security is always a concern in Nigeria and we have to travel in armored vehicles around the city. Connectivity has also been a major challenge this week. Sometimes the simplest tasks, like sending an email, can be the hardest to achieve!

The days are long; the team arrives back at the hotel between 9pm – 10pm each night. As we eat dinner, we discuss the events of the day and plan for the next day. The pace is extremely hectic, but, we all understand the urgency of the situation. We are all tired and at times frustrated when things don’t happen as quickly as we might like. In this type of environment, patience can sometimes wear thin.

Yesterday, we got word from the hospital that another one of the patients with Ebola had died. This was the fourth death from Ebola in Nigeria. I might not have known the patient personally, but I’m still deeply saddened by the news. We’re all a part of the response and working as hard as we can to ensure that no one else will become infected. With the bad news, there was also good news from the hospital that other patients are recovering and may be ready for discharge in the coming days. Compared to other countries in the West Africa Ebola outbreak, case numbers in Nigeria are low and we’re all holding our breath hoping that we’ve done enough to prevent any further spread of the disease.

For more on the Ebola outbreak in West Africa, visit www.cdc.gov/ebola.