Namibia: The Threat of the Ebola-Like Virus

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Ebola has re-emerged, once again in the Democratic Republic of Congo where it was first discovered in the 1970s.

Save for the Zambezi region, our country lies outside the breeding grounds of the fruit bats that harbour the virus in the wild, and as such, the risk of an Ebola outbreak in Namibia is near zero.

But there is another virus that has killed Namibians in an Ebola-like fashion (profuse bleeding reminiscent of Jesus in the Garden). This is the Crimean Congo haemorrhagic fever Virus (CCHFV), which is not new to Namibia. As in 2017, the Ministry of Health and Social Services declared an outbreak of CCHFV after a man who was quarantined in a state hospital succumbed to the disease (The Namibian, 4 April 2018).

Fortunately, the number of cases of the haemorrhagic fever, the clinical term for the disease these viruses cause, comes nowhere near the 17 deaths and 21 suspected cases due to the Ebola virus in the DRC so far (eCNA 9 May 2018). But CCHFV is transmitted by ticks, which are found all over Namibia.

In turn, these parasites infect livestock - that show no symptoms - but nevertheless pose a risk of infection for farmworkers. Indeed, the sole fatality this year was a farmworker, who presumably contracted CCHFV while slaughtering or butchering an infected animal.

The massive outbreak of Ebola haemorrhagic fever of 2014-15 taught the world about the fragmented healthcare systems of West African countries. Our Congo haemorrhagic fever outbreak, though tiny in comparison, has something to teach us about our health system.

To understand this, imagine you owned a generous (resettlement) farm, complete with cattle. Now, imagine your farm worker had acquired the virus and then you also become infected. You quickly turn to your private hospital for immediate assistance. But once it becomes clear that you have the hallmarks of a disease that spreads and kills like Ebola, the private ward doors will remain stubbornly shut.

For those of you in doubt, I would recommend watching the film "And the Band Played On", which narrates the early years of AIDS. The film depicts Parisian doctor Willy Rozenbaum, as one of the first clinicians to treat patients, who had spent time in central Africa, but suffered from symptoms resembling a fatal disease that was decimating gay men in the United States.

Dr Rozenbaum was forced to leave - with the AIDS patients - because his boss lamented the observation that "normal" patients were avoiding the hospital. In short, stigma surrounding the spread of the causative pathogen - which no one knew as HIV at the time - had cost the hospital many potential patients, who in our setting, are also clients.

Unlike HIV, the Congo-fever virus spreads through close-contact. Yet healthcare workers can protect themselves - by following the protective measures used during the Ebola outbreak of 2014-15. Of the two haemorrhagic fevers, Ebola is by far the deadlier one. This means as a Congo fever patient, the odds are in your favour: your chances of dying range between 10 and 40%, compared to 25-90% for an Ebola patient.

Now, the fancy private hospitals of Windhoek may protest - they may tell you they simply cannot accommodate patients suffering from such a serious tropical disease. But which hospitals in Namibia, then, would be better prepared? Let us not forget private hospitals must have hidden, solitary wards, ready to accommodate VVIP patients.

Surely these wards could be upgraded into isolation units, where you, the haemorrhagic fever patient could rest and hopefully recover. Yet the hospital would fear causing a panic and losing business to a competitor.

And so your hospital turns you away. Then the only place to go to would be the state hospital, who like the mother church, embraces anyone. Now, should that state hospital lack the basic equipment, medication (the antiviral drug ribavirin for instance, work against CCHF infection) and personnel to give you the best possible chance of recovery, who is to blame? We must, quite frankly, blame ourselves; we who never use these facilities but would need to when public health emergencies leave us no choice.

One way to remedy the situation is to foster accountability at state health facilities and so improve the care they offer. We need vocal, educated (and powerful) people to go to our state health facilities and demand better care.

For you, this would be visiting the state hospitals with your farmworker and following up on the care they receive, with more than just an irate SMS to the newspaper.

Yes, when the state hospitals are good enough for you, the weekend farmer, state healthcare in Namibia will be all the better for all people. Besides, you do want to save on that astronomical health insurance premium - emergency access to the high-tech, isolation wards in the USA or UK, where those aid workers recovered from Ebola, does not come cheap.

* Pancho Mulongeni holds a master of public health degree from the University of Cape Town.

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