Two weeks ago, Nigerian Twitter was in uproar over the death of a certain Ahmed Victor Idowu. He was a House Officer (i.e. a qualified doctor practising under supervision in hospital in the first couple of years after graduation) who died from Lassa Fever contracted in the line of duty.
Lassa fever, for the uninitiated among us, is according to the WHO an acute viral haemorrhagic illness that is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, the virus is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Health workers caring for Lassa fever patients are at higher risk of infection, especially if they use improper barrier nursing and infection prevention and control practices.
Dr Idowu’s case is not unique; the Nigerian medical cadre has suffered a spate of losses from Lassa Fever in the past months, however, his death has once again thrown the spotlight on the poor use of Personal Protective Equipment (PPE) by health care professionals in Nigeria. Health workers cite a lack of supplies as a reason for this, while the government blames the workers themselves, for not practising proper infection control.
This article is however not about attributing blame or playing the game blame, and it is not about Lassa Fever or even about Nigeria. Rather, it is about the occupational hazards that (far too many) health workers in low-income and middle-income countries (LMICs) face in the carrying out of their duties.
When I think back to my study abroad elective in Bangladesh, and remember that one of my jobs as a second year nursing student included the cleaning up of theatres post-op (mopping up bodily fluids, etc), and the washing and autoclaving of used gloves, bandages and other (normally single-use) equipment, I cringe at the thought of how I exposed myself to so many risks. I also realise however, that as a British student who was only there for a brief period of time, I was luckier than many of my fellow medical and paramedical colleagues who were exposed to the same risks, day in and day out.
In the global health community, conversations about human resources for health are usually centred around “brain drain”, urban-rural distribution, the quality of training and education, and other such issues.
Yet many health workers are lost, because they must work on the frontlines without the right supplies or equipment, and in so doing, put their own lives at risk in their bid to help others. This is particularly galling, because in many LMICs, the occupational hazards faced by such people are not recognised; in Nigeria for instance, the hazard allowance for a doctor is just N5000, or about £10. It is understandable then that during infectious disease outbreaks, some people simply decide to stay away from work, as was recently the case at the Federal Teaching Hospital Abakaliki, where doctors and nurses fled the hospital over another outbreak of Lassa fever in the state. This of course puts already struggling systems under more pressure, and undermines efforts to contain infections and safeguard the health of the population.
Everyone agrees that promoting and maintaining global health security starts with infection containment within national borders, yet in a globalised world where people are constantly on the move, this is a very lofty goal indeed. To improve the chances of reaching this nigh-impossible goal, health care workers, particularly in LMICs, must be trained in good infection prevention and control practices, supplied with PPE and taught to use them. Hazard allowances should also be increased for workers who must risk their lives, at least during periods of infectious disease outbreaks.
In order to achieve global health security, the global health community should perhaps focus a bit less on the bigger, more “sexy” interventions, and more on less glamorous ones like the provision of gloves and other protective equipment to frontline workers in the remotest corners of the world. After all, a chain is as strong as the weakest link.