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Adadevoh: An alternative perspective of ‘the Victim and the Visitor’ – 1

Adedavoh: An alternative perspective of ‘the Victim and the Visitor’ -II

Knowing for certain, adamant, recalcitrant and resolute in her decision to do what was required, what ought to be done – in the face of doubt and utter disbelief and in the absence of the gold standard, she stood alone and unmoved – a victim of the consequences of corruption, disparate treatment, double standards, corner-cutting, flagrant disregard for due process, abuse of positional power, privilege and authority; abrogation of responsibility, leakages, deficiencies, consistent accommodation of unethical practices and procedures, as well as the enduring violations that have permeated and remained pervasive in virtually every industry and system in many African countries.

She would have turned 63 today but was deprived of the privilege of a milestone – attending the graduation of her only son. ‘How can an endocrinologist know so much about public health matters? How can she be so sure? What is the basis of her assurance? What does she know? Has she ever practised public health? were some of the questions asked by and discussed among some eminent and experienced public health physicians. ‘Yes, we know she identified the first case of H1NI virus but does that mean this is a case of Ebola? We cannot risk a national chaos. Not only is it unlikely, what is the basis?’ The reported signs and symptoms are inconclusive and we cannot make a definite diagnosis based on what she said! Nigeria’s health system will become the global laughing stock! We must have proof before we take any action! There must be proof before we contact the World Health Organisation!

Displaying characteristics that were evident before adolescence, he was compelled to retain the ‘the Visitor’ at the First Consultants Medical Centre, until ‘proof could be produced’.

She had always wanted to be doctor – this desire was expressed from earliest conversations during the five-day interview that was a pre-requisite for admission into ‘best-in-class’ secondary boarding schools at the time. Not only did her classmates know she wanted to become a medical doctor, it was evident from Form 1 that she would not only become one but also one of the best! Queen’s School is where it began, the earnest quest, the dream, the focus, the charted course and where she distinguished herself, consistently!

Many of her classmates variously at the Mainland Preparatory School, Yaba, Corona School Yaba, Queen’s School Ibadan, Queen’s College Lagos (a few weeks), University of Lagos, Akoka, College of Medicine, Idi-Araba, residency colleagues from various medical schools, professional colleagues at the Hammersmith Hospital and First Consultants Medical Centre attest to her diligence, commitment, attention to details and mindfulness.

Queen’s School, where the foundational values instilled by her parents were consolidated – personality development, high-level personal discipline, lifelong influences, study patterns, subject choices as well as the attributes, attitudes, behaviour and conduct that are key to entering the medical profession – is where we first met. The sensitivity and sensibilities required to practise the ‘art and science of medicine’ were visible throughout adolescence. Excellence has always been her personal best and professional best. Why then would she behave differently on this occasion?

The eldest of four siblings and the oldest grandchild from both sides of her family, one cannot help believing that she had an innate sense of responsibility. Consistently cited as someone who had a sense of purpose, did worthwhile work and made a difference, Ameyo was indisputably a ‘Blue Ocean’ in medicine. Her intelligence, ability to think outside of the box, thought-leadership on many matters, emotional quotient, character, upbringing and most importantly her choice (based on her values and belief) – cost her, her life!

She was certain it was Ebola (not because she was a public health expert) and she went to all extents possible – the same day she saw ‘Patient Zero’, to convince the policymakers, and those in authority to take necessary and immediate action while awaiting the test results. She went to ‘fight’, to argue her case, to insist but was greeted by ‘fear of the unknown, denial and some scepticism’. She weighed the cost and benefits of ‘false positive’ and ‘false negative’; she argued the impacts of both outcomes with several colleagues. Routine protocol dictated that an authorised government official representing the national public health interest should communicate formally with the WHO – accompanied by proof – not an endocrinologist without formal training or certification in public health! But, Ameyo knew for certain – a ‘knowing’ beyond competence, a ‘knowing’ beyond experience, a ‘knowing’ beyond the familiar, a ‘knowing’ beyond all she had been taught, all she had learnt’. She strung everything together in a few minutes – and she was sure. Her verdict was unequivocal and indisputable! Evidence was nonetheless necessary to support this stance – a test undertaken in a reference laboratory of the appropriate Biosafety Level for the ‘suspected diagnosis’; a test undertaken with internal controls (pre-analytical, analytical and post-analytical) and independent external quality assessment – evidence-based and scientifically proven. The WHO was officially informed by the Lagos State epidemiologist. The cost implications and logistics involved in containment of a true-positive result could swallow the national healthcare budget! However, there was no time to wait and no time to waste.

Unable to access care at the Lagos State University Teaching Hospital and Lagos University Teaching Hospital due to the industrial action, one of the hospitals designated by the Liberian consulate was the next stop. This was a major blessing from God – a miracle recognised only by a few and for which we must remain eternally grateful.

Having been accorded special treatment fit for a president, the highest level of security, protection, due protocols selectively suspended, shrouded medical condition, the ‘high-risk, high-alert visitor’ was allowed to travel in open and confined spaces – with over 200 persons (ground staff, cabin crew, airline pilots, passengers (babies, infants, toddlers, children, teenagers, adults, pregnant women and elderly) along with accompanying friends and family milling around the Monrovia Airport. With the rules bent, protocols breached, understood handshakes, falsified documentation, sanitised health records and pristinely declared fit-to-fly, the ‘visitor’ arrived in Lagos after making a brief stop and possibly exposing more persons to risk.

Upon arrival at the First Consultants, the attending physician after noting the signs and clinical appearance, commenced treatment for malaria but was concerned. In keeping with the hospital protocol, ‘The Chief must be informed about this case…and provide further insight to his management’, the game-changing call was made – to the person who would subsequently make the decision that would avert an epidemic of indescribable magnitude.

As soon as she saw ‘the Visitor’ on Monday morning, she raised a flag. After further examination and pertinent questioning, she knew something was not right. This is definitely not malaria! There was a mismatch between the presenting complaint, history and clinical findings – a vital link was missing. Blood samples would be required…but there was a nagging feeling. Did he just arrive from Monrovia? And by what route? Could this line of thought make sense, could it be remotely possible? More questions…and then entered the consulate staff to take him away – to a hospital with better facilities as it was perceived that not much could be done here! By then, her research had been completed, her hunch was right, the highly improbable had happened – there was absolutely no way these ‘president’s envoys’ would remove him from under her watch – not until all protocols were observed and adherence to due process confirmed. She was ready for battle but neither sufficiently armed nor protected!

She did not take the path of least resistance, she stuck her neck out, she took full responsibility, she made herself accountable as Chief Physician. She did not have to if she did not want to, she was not expected to, but she needed to and wanted to. She could have allowed ‘Patient Zero to walk away, she could have acceded to the request of the staff of the Liberian consulate, but she did not. She restrained the ‘the visitor’ (funny as I recall her stature in comparison). She co-opted the pertinent hospital staff as she activated the process of containment in an inappropriate and unprepared environment. The First Consultants had become an unwilling but a necessary host for the Index Case.

She knew what she was dealing with, she understood the risks that had been taken and would need to be taken, she understood the consequences of exposure, shared space, direct exposure, in close proximity, direct contact with skin, blood and body fluids – not splashes, not drops but copious volumes – repeatedly within a short period and without the necessary and adequate protection! She murdered sleep for the next two nights researching the visitor – Ebola – and how to contain it.

Dancing to a different drum, the drum of professionalism, the drum of ethics, the drum of selflessness, the drum of the ‘art and science’ of medicine, the drum of the humanitarian call, the drum of the noble profession (or should one state erstwhile noble profession?), she had a husband, she had a son, she had siblings, she had a mother, she had a host of cousins as well as nieces and nephews who looked up to her as their mentor. At that moment, they did not matter! At that moment, nothing else mattered! At that moment, humanity mattered! At that moment, thousands of lives mattered!

To be concluded

By Dr. Adenike Adewakun is a healthcare quality improvement consultant based in Lagos

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