© 2018 - International Centre for Investigative Reporting
How Ebonyi government virology centre failed ‘Lassa fever’ patients
In the aftermath of the January 2018 outbreak of Lassa fever in Nigeria, PATRICK EGWU travelled to Ebonyi State, one of the states with high incidence of the disease, and reports how the N250 million virology centre in the state – the first and only treatment centre for the disease in the South East – failed patients, leading to the death of seven victims.
This investigation was supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting, ICIR.
ROSEMARY Udoh, 28, sits on a brown leather couch in her living room with her eyes fixed on an artistic drawing of herself and her deceased husband, Abel on their wedding day which was hanging on the yellow wall. She leans back on the couch, placing her right hand on her jaw.
“We had a wonderful discussion the day before he contracted the disease,” Udoh said struggling to control a teary eye. “He came back from work and complained that he was having general malaise. We thought that it was malaria, so we went to buy anti-malaria drugs. He was not showing any symptom or sign of sickness before he left. He was just strong,” she said.
Abel Udoh, 43, was one of the three doctors working at the Federal Teaching Hospital, Abakaliki who lost their lives during the recent Lassa fever outbreak in January in Ebonyi State because the newly constructed virology centre in the hospital was not functioning despite the huge amount of money budgeted for it. Four other patients living in different parts of the state also joined the death toll soon after.
The doctor, alongside other colleagues, had treated a patient with the disease when they contracted it. Draped in green polka dots gown, Udoh continued “But before this, he was hypertensive as well as diabetic. On January 6, my husband, our little daughter and I had an accident so when the whole thing was happening, I thought it was as a result of the shock of the accident. But as time went on, he started jerking and we went to the Federal Teaching Hospital where they admitted us, and they now asked him questions concerning what was happening and when they checked the sugar level, it was very high,” a visibly emotional Udoh said.
Udoh, who is a recent graduate of Nursing from the Ebonyi State University and currently preparing to write the Nursing Council Examination, said she was not sure if her husband died of Lassa fever as she was not allowed to see the medical result of the test conducted on him. When she requested for it, she was told that it was not necessary.
“They ran test on him, but I did not see the results,” she said looking downcast, her face pale and voice, shaky. “I called one of his friends to ask for his (lab) result because I was worried why his samples were not analyzed until he died. We didn’t even see the samples they conducted on us. He told me that it was not necessary because he is dead, but I said I have the right to see it to confirm that he died of Lassa,” she told Orient Daily.
“I was not thinking straight then,” she recalls. “I decided to just finish the funeral then come back for it. Even the family members don’t have it and those who had contact with him do not have the result too. I told them that I have never seen this kind of situation before that if it was Lassa that killed him we have the right to see the result,” Udoh said.
In January this year, Lassa fever broke out in many states in Nigeria with many reported cases. So far, a total of 1,894 suspected cases have been recorded since January 1, 2018 across 21 states, according to a situation report by the Nigeria Centre for Disease Control (NCDC) in May.
“Of these, 423 were confirmed positive, 10 are probable, 1,460 are negative (not a case) and 1 is awaiting laboratory result (pending).
Twenty-one states have recorded at least one confirmed case across 70 local government areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia and Adamawa). Eighteen states have exited the active phase of the outbreak while three states remain active.
A total of 5,012 contacts have been identified from 21 states. Of these 106 (2.1 per cent) are currently being followed up, 4895 (97.7 per cent) have completed 21 days follow up while 11 (0.2 per cent) were lost follow up. Eighty-one symptomatic contacts have been identified, of which 28 (36 per cent) have tested positive from five states (Edo-13, Ondo-8, Ebonyi-3, Kogi -3 and Bauchi-1),” the NCDC said.
The centre said three states carry 81 per cent burden of the disease. Eighty-one per cent of all confirmed cases are from Edo (42 per cent) Ondo (23 per cent) and Ebonyi (16 per cent) states. Seven cases are currently under treatment in treatment centres across nine states – Edo (9), Ondo (5), Ebonyi (5), Bauchi (2), Taraba (3), Plateau (1), Osun (1) and Kogi (1).
Since the onset of the 2018 outbreak, there have been 106 deaths in confirmed cases, 10 in probable cases. Case Fatality Rate in confirmed cases is 25.1 per cent. The NCDC said no new healthcare worker was infected. Thirty-seven healthcare workers have been affected since the onset of the outbreak in eight states –Ebonyi (16), Edo (12), Ondo (3), Kogi (2), Benue (1), Nasarawa (1), Taraba (1), and Abia (1) with eight deaths in Ebonyi (6), Kogi (1) and Abia
Over the years, Lassa fever outbreaks with huge casualties are common in Ebonyi State. In similar cases in the past, schools, markets and public places were shut down and movements restricted as a way of containing the disease.
In this year’s outbreak, seven people – two doctors, one nurse and four patients have died as a result of the disease. According to the University Graduates of Nursing Science Association (UGONSA), no less than 40 health workers have died of Lassa fever in Ebonyi State over the past 13 years. In 2005, an unreported number of staff and patients at the Abakaliki Teaching Hospital died as a result of Lassa fever. Presently, the state has recorded more than 87 cases with 47 confirmed cases and 40 were suspected cases.
N250M NON-FUNCTIONING CENTRE
In 2016, just a year after assumption of office, Ebonyi State Governor, Dave Umahi, rolled out plans to construct a N250 million virology centre in the state to be a rallying point for patients with the disease from the state and neighbouring states. The proposed centre was meant to take care of the diagnosis and treatment of Lassa fever in the state and the entire South East region.
Before now, no South East state has a virology centre and whenever the outbreak occurs, patients embark on a five – six hours’ journey to the virology centre at Irrua Specialist Hospital in Benin, Edo State where samples and diagnosis are conducted, and treatment commenced. Sometimes, patients die on the way even before getting to the hospital to receive treatment.
The governor had said that about N64 million would go into building the mini-hospital and lab while the remaining fund would be used in procuring equipment and for advocacy against the disease in the state.
After the centre was completed under the office of the ministry of health in the state, the contract of equipping the centre was handed to Coscharis medical, for the supply of medical equipment like dialysis machines, Polymerized Chain Reaction machine (PCR), protective kits, among others.
Though some of the equipment for the centre were procured, but they were not activated with chemical agents like reagents and primers thereby making the centre non-functional despite the money that was allocated for it. So, when Lassa fever broke out in the state on January 14, the affected doctors were transported to Irrua Specialist Hospital because the one in Ebonyi was not functioning. Though the building had been completed to standard, investigation showed the centre was not fully equipped. The few equipment that were procured, were not functioning. One of the doctors at the hospital who contracted the disease, Felix Ali, died on the way to Irrua.
The centre, which is situated few meters from the main entrance gate of the Federal Teaching Hospital, Abakaliki, is a well-built structure with spacious compound and 27 bed spaces.
“There was nothing inside it then. Nothing. Even a test tube not to talk of any dialysis machine,” said Timothy Nwakpa, a development consultant who monitored the disease outbreak in the state. “How can they build something like that without equipping it? It’s unbelievable. With that money (N250 million), that Centre can be equipped to standard with every necessary thing in it,” he said.
“It is just a recreational facility,” Charles Otu, a journalist in the state who has reported on the Lassa outbreak extensively said. “Even those who are using it have said these things I’m telling you now. It is more like a monument. Even the ambulance is only one instead of the four they said they would buy,” he said.
As part of the contract agreement for the construction of the centre, provision was made for the purchase of four ambulances to help in evacuating patients during emergency. While one of the ambulances would be stationed at the virology centre, others would be sent to the three senatorial zones of the state; Ebonyi South, Ebonyi North and Ebonyi Central to handle emergency cases in those areas.
But investigations by Orient Daily showed that only one ambulance stationed at the Centre was purchased.
“Who told you that? I don’t know where that information is coming from,” Dr Daniel Umezuruike, the state commissioner for health said when asked for explanation on the state of the centre and the procurement of the ambulance. “Everything was made available. Go there and see for yourself. They are all German products and machines. The only problem then was the primers and the reagents that was not there then and now they are all available.”
Attempts by Orient Daily to speak with the head of the committee in charge of building and supplying equipment for the centre were not successful. However, a member of the committee who doesn’t want his name mentioned in the investigation said the team did what it was required to do in the agreement signed, which included building and equipping the centre. When pressed to show evidence that it fully executed the project, the source got angry and said:” I have told you what I need to tell you.”
But his disclosure was contradicted by Governor Umahi who said the state government did not know that the committee did not complete the job it was given by failing to fully install necessary equipment.
“But why would the state government accept a job that was not fully executed when money had been paid? Neither the government nor the committee has fully come out to account for how the money was spent, especially in procurement of equipment,” queried Otu.
“The controversy here is where is the N250 million? The government has not said how the money was spent. That is what public accountability is all about. If they had come out to say that N50 million is what they used to build the structure and N150 million is for equipping the centre, then we will know who to blame. The government is even shielding the committee because not much is heard from them. It is my wish that the government should wait no further until there is another outbreak before they strictly monitor the execution and completion of this important project,” Otu said.
EBONYI ASSEMBLY PROBE
After the outbreak and reports of the death of the doctors went viral, the Chairman House Committee on Health, Ebonyi State House of Assembly, Oliver Osi, indicted the contractor, Dr Charles Akujiobi of COSCHARIS for his inability to fulfil his end of the contract.
During plenary at the assembly complex, Osi approached the speaker on matter of urgent public importance, praying the house to summon the contractor handling the project on his inability to explain why he could not install all the equipment in the centre as provided in the contract agreement.
“I did raise a motion in that regard and my prayer is that the contractor handling the installation of equipment was supposed to install the Polymerized Chain Reaction (PCR) machine. That system takes care of the analysis and dialysis of the samples that are brought in so that what is wrong with the person can be established,” Osi said.
He continued: “To our knowledge, the contractor is not an expert in that area. He only fixed other areas of the contractual agreement that was why we raised that motion. We are told that the dialysis and the PCR units are not operational despite the money paid to the contractor. Up till now, samples are still being taken to Benin for test.”
Osi asked the House to collaborate with the National Assembly Committee on Health to make budgetary allocation for the centre this year in order to help equip it with modern equipment.
Investigations by Orient Daily showed that despite the summons by the House of Assembly, the contractor or any of his representative is yet to appear before the house to explain their part in fulfilling the terms of agreement.
When Orient Daily visited the contractor’s company office in Enugu, a service engineer of the company who begged not to be named, said the contractor travelled outside the country and won’t be returning soon. When further asked about the contract agreement for the centre, he said “I only deliver equipment I was detailed to deliver to the centre. I don’t know anything other than that. He (the contractor) should be in a better position to say.”
Emails sent to the contractor to get his company’s stand on the investigation were not replied as at the time of publishing this investigation.
SILENCE, SECRECY AT THE CENTRE
Getting information or documents for this investigation from the centre was like a camel passing through the eye of a needle. All attempts made by this reporter to speak or have an audience with the doctor in charge of the centre were unsuccessful as they practically refused to speak.
Inside the compound, some health workers and foreign medical experts were seen moving around – from one building to the other, fully kitted in their decontamination suits and holding medical equipment or kits.
Before now, one of this reporter’s contacts who is familiar with the hospital and their bureaucratic procedures, had given him the contact details of Dr Sylvanus Okoro, one of the doctors in charge of the Centre. When Dr Okoro was contacted, he said he was out of town for a programme and directed this reporter to Dr Damian, another senior doctor at the facility who was in charge at the moment.
After making some enquires, this reporter met Dr Damian while he was coming out of the quarantine section of the building. But efforts to speak with him on the operations at the centre were futile as he refused to say anything in that regard.
“There is nothing to tell you here. I’m not speaking to you or anyone else. Others like you have been here too,” he said removing the gloves he was wearing. “If you want anything, go to the CMD or Deputy CMD. They are the ones who have all the information,” he said while washing his hands with a hand sanitizer positioned in front of the building.
When this reporter visited the Deputy Chief Medical Director (CMD) of the hospital to speak with him about the centre as the public relations officer of the hospital had said the Chief Medical Director (CMD) was away for an official engagement, he said: “You will have to wait for the CMD to return because he should be in a position to know more. He has what you need,” he said entering his car to drive out of the compound after he had enquired where this reporter came from and the purpose of his visit.
When told that access to the centre for confirmation of the claims of procuring the equipment had been denied this reporter, the commissioner for health said he could not facilitate access to the centre as it was not under his jurisdiction. “We all have our area of focus and operation. Mine is the ministry of health while the centre is with the CMD,” he said.
After completing the construction of the virology centre in 2016, the Ebonyi State government reportedly handed it over to the Federal Government. The state government had appealed to the federal government to provide a stabilization fund to fully operationalise the centre. But investigation showed that this never happened. Instead, the centre, though fully completed, was abandoned by the federal government without a full take over which would have also involved equipping and activating the centre to make it functional.
When the Minister of Health, Isaac Adewole, visited the state after the outbreak in January, the state government confronted him over the federal government’s neglect of the centre despite the handover.
The Deputy Governor, Kelechi Igwe, expressed the displeasure of the state government at the refusal of the federal government to make the centre fully functional after the handover. He appealed that experts and experienced personnel be sent to manage the centre.
In response, Adewole said the ministry dispatched a Rapid Response Team and officials of the NCDC to the state to checkmate the spread and promised adequate equipping of the centre to function optimally.
Meanwhile, while commissioning the centre, Adewole turned down demands by the state government for the refund of the money used in the construction of the centre. He, however, assured that the partnership between the federal government and the state government would lead to the provision of more equipment and grants to the centre.
The centre, like any other federal government health facility which is meant to have its own medical staff, managing and attending to patients, instead had to rely on medical personnel from the Federal Teaching Hospital, Abakaliki who swap in between their main jobs to attend to patients at the centre.
“All along we never knew that the structure had deficiency. The government did not say they were unable to equip it. They just said they have handed it to the federal government,” Otu said.
Otu noted that it was embarrassing that the state government that was magnanimous and known for donating money and relief materials to other states in time of need could not make a health facility in the state functional and top priority.
‘MEDICINE AFTER DEATH’
Weeks after the outbreak and death of the health workers and other patients in the state, the state government started frantic efforts to reactivate the centre by equipping and getting it functioning for the treatment of patients with the disease.
First, the governor released N7 million to control the virus by sourcing for foreign medical experts to activate and make the centre functional.
He also released the sum of N2 million for contact tracing of the Lassa fever virus, especially among patients or the deceased and those they have had contact with in the past. The contact tracing was to commence in Ala Awusa in the state where the virus started, and later spread to Macgregor Mater Hospital, Afikpo and Federal Teaching Hospital, Abakaliki,” the governor had said during the outbreak.
“The N5 million is to activate the place fully and get experts to start training because we are committed to releasing more funds as the need arise. In our meeting with NMA and CMD, we agreed to release the sum of N2 million for contact tracing to control the spread of the virus.
“Since we handed over the Lassa Fever Centre to the Federal Government, they have not fully taken it over. It is not fully functional, also very annoying is that the committee we set up to build the place and equip it did not tell us that the supplier of the equipment has not fully installed the equipment, nobody told us and that is very bad,” he added.
When this reporter visited the centre on the first day, a combined team of experts specifically from the Nigerian Centre for Disease Control (NCDC), World Health Organisation (WHO) and Doctors Without Borders, known by its French initials MSF, were seen moving about the premises, putting on their branded logos and protective kits.
An official of NCDC, who does not want his name mentioned, said the intervention was to prevent the disease from spreading to other neighbouring states or areas, adding that the national body deployed the team to assist those already on ground in tackling the outbreak.
In addition to these collaborative roles, the health bodies also provided items like personal protective equipment, kits, eye glasses, boots, gloves and others to local health workers working at the centre.
At the centre, this reporter observed the arrival of two medical machines in a factory truck designated for the diagnosis laboratory.
“All these things are happening now because of the criticisms and what you people (journalists) are doing. Apart from that, this place will be abandoned again,” said Udoh.
Clutching her little daughter, Precious, who is just a year and ten-months old, she said “She still misses her father and wants to see him. Whenever she enters here, she will go and kiss that picture over there,” Udoh said pointing at a picture of her husband placed on the tiled floor.
“She waits for a long time in front of the door when it’s time for him to come back from work. If she doesn’t see him, she goes straight to that picture,” she said, looking depressed.
“I hope they fix the system so people who risk their lives saving patients won’t die again.”