Plague, cholera, Lassa fever, Ebola, SARS, these are a few of the infectious disease outbreaks the world has seen occur in the last decade, the spread of which can be greatly limited through the implementation of stringent infection control measures, including the appropriate use of personal protective equipment. This is however, not always possible in low resource settings.
In 2018, there was an uproar among Nigerians on social media, over the premature death of yet another health care professional – Ahmed Victor Idowu, a young doctor, had died from Lassa Fever contracted in the line of duty.
According to the WHO, Lassa fever is 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 and paramedical cadres have suffered a spate of losses from Lassa Fever, Ebola and other infectious diseases in the past few years, however, his death once again put the spotlight on the poor use of Personal Protective Equipment (PPE) among 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- resource settings, often in low- 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, greatly increasing their chance of infection.
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. These are worthy topics, but in order to have a more holistic discussion, it is important to talk about the many health workers that are lost because they work on the frontlines without the right supplies or equipment.
Health care workers effectively put their own lives at risk in their bid to help others, and 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 and since social security systems are deficient in many cases, death or disability in the line of duty has far-reaching repercussions for families and other dependents who may become destitute. It is understandable then, that during infectious disease outbreaks, some people simply decide to stay away from work, as was 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 health 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, armed 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 its weakest link.
About the author
Clara has a nursing background and is currently a health systems and policy researcher at the Institute of Tropical Medicine in Belgium. Her interests and focus areas of work are: health systems strengthening, particularly in fragile and conflict-affected settings; gender; health governance and sustainable development