A Big Salute to the Martyrs of Epidemics
On the war front thousands of martyrs die defending a nation. In epidemic outbreaks, the warriors in the front end are the doctors, nurses and nursing assistants. While soldiers and generals get awarded alive or posthumously, the warriors on the epidemic front don't get such gallantry awards although they win the respect and love of people.
The Ebola virus outbreak was first reported in Guinea in end 2013 when it infected a boy. It soon spread across West Africa. In July, 2014, a 40-year old Liberian-American citizen Patrick Sawyer reached Nigeria after taking care of his sister who died after being infected with the virus. On reaching the airport, he collapsed and was taken to a private hospital since the government doctors were on strike. He was attended by a Nigerian doctor, Dr Ameyo Adadevoh, endocrinologist of First Consultant Hospital. She suspected Ebola although he said he was suffering from Malaria. He wanted to go immediately but the doctor refused. The staff had to physically restrain him. In the struggle, his IV popped out and blood was sprayed on Dr Ameyo Adadevoh.
The doctor believed that the only way to contain the spread of the virus in Nigeria was to quarantine him while the influential patient put diplomatic pressure from Liberia to release him. The Nigerian government was also of the view that the nation will be saved if he was allowed to fly back. However, the doctor stood her ground. In October, 2014, three months after Patrick Sawyer landed and passed on the infection to twenty other people, the World Health Organisation (WHO) had declared Nigeria as Ebola free.
However, both Patrick Sawyer and Dr Adadevoh (died August 19) didn't live to hear the victory over epidemic. But her courage and conviction helped Nigeria from a fatal outbreak. Beau Lotto, a neuroscientist and author of Deviate, Seeing Reality Differently (Weidenfeld and Nicolson, 2017) notes that Dr Adadevoh had assumptions that were different from that of Nigerian government and the conviction to stick to it. Their subsequent decision to keep Mr Sawyer in quarantine has become a model for other countries to follow in the outbreak of epidemics. "Despite the pressure from the government, she put the collective well-being of her countrymen ahead of possible damage to her career," writes Beau Lotto.
Salome Karwah, Time Person of the Year 2014
Salome Karwah, a Liberian nursing assistant was in the forefront of dealing with Ebola victims which claimed 11,310 lives in 2014. She lost her mother, father, brother, aunts, uncles and close family members. It was her determination to treat Ebola patients when the whole world dreaded the disease that she was named the Time Magazine's Person of the Year. In 2017, she developed complications after delivering a healthy baby through caesarean section. After discharge from hospital, she developed convulsions and seizures. When she was brought back to hospital by her sister and husband, the staff wouldn't go near her because she was an Ebola survivor. And she succumbed to the disease the very next day. It was a poor healthcare system combined with social stigma attached to patients of communicable diseases that decided the fate of Salome.
Nipah Outbreak and Sister Liny Puthusseri
On May 17, 2018 a 28-year old architect named Mohammed Salih was admitted to Baby Memorial Hospital with high fever and mental agony. He belonged the Perambra town in Kozhikode, northern district in Kerala. Despite good care given to the patient, his condition was not stable and doctors initially suspected Japanese encephalitis. His younger brother Sabith had died 12 days ago with similar symptoms after being treated at Perambra Taluk Hospital. His father and aunt also were infected. The attending physician Dr AS Anoop Kumar and neurologist C Jayakrishnan decided to send samples for testing to Manipal Centre for Virus Research where they diagnosed it as Nipah suspected to have been infected from fruit bats. And in the meantime, Kerala State Health Department officials were alerted and Health Minister KK Shailaja herself reached the place to take leadership of operations to contain the virus.
After Sabith, Salih, their father and aunt succumbed to the virus. Sister Lini who treated Sabith at Perambra hospital also became a martyr. It was her timely alert and tireless work in the hospital that prevented the spread of spread of the disease. She herself told doctors at Kozhikode Medical College to put her on isolation She wrote to her husband from her hospital bed, "I am almost on the way, I don't think that we can meet again.. sorry ...Please take our sons Lavan and Kunju to Gulf . Don't live alone like our father. With lots of love."
Razan al-Najjar, Martyr on the battlefield
Razan al-Najjar, a nursing volunteer from Gaza didn't become a martyr like others while fighting an epidemic. She was shot dead by Israeli soliders on June 1, 2018. The Independent reported that she was often photographed wearing her white medic uniform with colourful headscarves and a determined expression on her face as she entered dangerous terrain inorder to treat the wounded. The photographs often showed blood of her patients spattered on her white coat. She beleived that she was in the front lien as a human shield and rescuer for the injured.
Lessons Learnt in Public Health
In hindsight, the whole world must be thankful to Dr Adadevoh of Nigeria who had as Beau Lotto said, 'medicine in her blood' being the daughter of a renowned pathologist. Her method of quarantine and isolating patients at the start of suspected epidemic outbreak was proven to save invaluable lives. It became an accepted model in public health. The Hindu had reported that within three days of suspicion raised by doctors at Baby Memorial Hospital during the Nipah outbreak of May 2018, an officer trained in Ebola outbreak protocols instructed the state's doctors in infection-control measures-isolating patients, using surgical masks and decontaminating surfaces. "It was an extraordinarily swift response by any measure." A team of casual workers were deployed temporarily to clean the hospitals and surroundings which they took up as a humanitarian cause. But they were later to be abandoned by the state administration after the outbreak was contained. They continued to agitate for months seeking a permanent job as sweepers.
Against all Odds
In India, a Janata curfew was imposed on Sunday, March 22 in view of the Covid-19 outbreak and Prime Minister Narendra Modi appealed to all Indian citizens to stay at home and at 5 pm clap together to express gratitude the medics who are in the forefront fighting the pandemic. Soon the country went for a 21-day lockdown. As I write this piece, we hear reports from the media about nurses struggling in hospitals without sufficient protective masks and gowns.
Several nurses in private hospitals in Mumbai were seen appearing in phone-in programs on channels lamenting about lack of sufficient protective equipment. Some of them have already contracted the virus. A BBC report showed Michelle Wright (37), a nurse who was 29 months pregnant who was tested positive for Covid-19 and working in City Hospital, Birmingham. From her hospital she recorded a video pleading to people in UK to stay at home. Shirley Watts, a nurse in UK appeared on FB after a difficult night shift in ICU saying that they were on their knees and trying all that they can to save lives. She said that they are suffering from 'Rudolph noses' constantly wearing face mask and also away from families and putting themselves in danger.
The martyrs of epidemic outbreaks of the past had only one principle to live by– to use their medical knowledge to treat people with compassion and save lives. Let us give a big salute to them all and all those fighting in the forefront to overcome the Coronavirus now.