It’s like going through a dark tunnel – but just know that very soon a tiny ray of light will appear – Amaechi-Egemba Emmanuel
During my treatment, I realised that fear will bring you to the ground if you are not courageous. I even thought of committing suicide at one point because of all that I was going through: the injections, the physical pain, depression stigma and loneliness.
I come from a humble family. I grew up in Enugu, and after graduating from university I did my year’s national service; now I’m doing my Master’s degree. I am a musician and also a poet.
I first began feeling sick on 9 February – three days after my birthday. I was preparing for a concert, but in the end I was so sick that I had to cancel the event. When I went to the hospital I was initially placed on anti-malaria drugs as I had all the symptoms of malaria. But the more I took the malaria drugs, the more my condition deteriorated.
I continued to receive treatment for malaria and also typhoid. But then things got a lot worse; I was experiencing pains all over my body and I struggled to breathe – I even had an X-ray, but they found nothing. About a week later, blood started coming out of mouth and nose. People became nervous and didn’t want to come near me. Until that point, I had been going to a private hospital, but then I was taken to a government hospital.
Seeing my condition, the staff at the government hospital did not even want to touch me, and they immediately referred me to Abakaliki.
At the Federal Teaching Hospital in Abakaliki I was taken to the emergency unit where a member of MSF staff asked me some questions. Then they took a blood sample and after 24 hours, I was told I had Lassa fever.
After the diagnosis, I was moved from the emergency unit to the virology unit-where people with Lassa fever are treated. That was when it dawned on me that now I could be a source of infection to others.
When blood started coming out of my mouth and nose, people behaved as though they had seen a dangerous snake. But I thank God that members of my family gave me all the support I needed – none of them deserted me. I also thank God they were not infected.
It was a traumatic period for me and my family because of the psychological effect or trauma I went through. Not many people knew about my condition, but even our family doctor was cautious around me and my family. When my mother visited him for a check-up, he was careful not to get too close.
This situation made me start telling lies to people about my ailment. My family told me I shouldn’t tell people about it – even though I felt that I should have been proud of surviving it. However, people’s reactions showed me that is was wiser not to tell people I was a survivor. During my treatment, the few friends I told avoided me and never visited me. Whenever I called them, they would promise to visit, but it never happened. That was when I realised how it feels to be lonely. But this lonesome feeling ended up being an inspiration for me because I wrote several songs and poems. That was when I approached one member of MSF staff to ask if there is a way I could tell my own side of the story.
There was a night I had this pain in my stomach, it was so severe that I thought I was going to die. I could not sleep as I kept turning and turning on my bed-there was no position that eased the pain. The only thing that made the pain subside was eating bread. It was the next day that I was told that it was ulcer and I was advised to avoid certain foods. Because of that experience, I developed a fear of nights; whenever night was approaching, I became uneasy. So I concentrated on writing songs and poems. There was a particular poem which I wrote and pasted on the wall so that anyone that reads it will know what we were going through.
I tried to make as many friends as I could during that phase; in fact, I made friends in almost every room at the unit where we were admitted. I did all this just to distract myself from the fear of nights. I also had this roommate that made life easy for me because we made our stay in the hospital bearable for both of us as we turned our room into a lively place as we had discussions into late nights. Unfortunately for me, he was discharged before me. During my treatment, my mind became clearer and I planned for the future, I was doing voice warm ups and my voice became clearer.
After my discharge from the hospital, we planned for a thanks giving service in our church where I wanted to give testimony and announce that I survived this dreaded illness, but we had to put it off because of the COVID-19 pandemic.
What I’ll have to tell anyone in this kind of situation is this: you have to be courageous, keep at the back of your mind that you will recover. It’s like going through a dark tunnel – but just know that very soon a tiny ray of light will appear. If you continue walking through that tunnel, you’ll emerge in the sunshine. You should be courageous and not afraid because I’ve come to realise that Lassa fever feeds on our fears and takes advantage of it.
It’s important to talk to people because that takes you away from what you are going through. Following medical advice is essential, because aside from medication, we were advised to drink lots of water and I believe that really helped
I would also like to make an appeal that a platform should be provided for Lassa fever survivors where they’ll let the world know about the disease. I say this because not much is known about Lassa fever and little attention is being given to it because it mostly affects the poor. Those of us that survive the disease have at our own level formed a body and we meet from time to time to share experiences and ideas. For me, the way to express myself is through songs and poetry.
FEARFUL LASSA
It charged against us like a bull
Its horns headed our way
The sounds of the accelerating hoots,
Sent all the birds flying away
Our bodies became weak
Our eyes closed slowly
Our legs knocked against each other
Some of us fell…
It approached our red cloth
Nothing but dust and death came behind
Fiercely, it roared as it came
And we ate; we drank; and we were pierced through
But it still came closer…
But, one by one we began to rise
We stood our grounds
Our positive minds and prayers as our defence
It hit us hard;
Our red cloth is intact and still hanging.
We stood against the FEARFUL LASSA.
Most important thing for patients is to feel understood and have someone to talk to – Chinedu, Mental Health Activity Manager, Abakaliki
The patients we treat are suffering, but its not just physical its also psychological and emotional. The impact of Lassa fever on a patients mental health cannot be overemphasized. Peoples individual beliefs and understanding of Lassa fever, plus the things they hear about it lead to a variety of emotional reactions. Ranging from denial, shock, fear, anxiety, sadness, frustration and anger. Because of this, the mental health team works with each patient right from the time they begin to exhibit symptoms, when their test results come back, up until they are discharged. This is because patients have different needs at each of these stages. Lassa fever patients are isolated, with limited social interaction and waiting for test result for hours and sometimes days can result in significant anxiety, making many patients feel abandoned. Of course this period of isolation lasts even longer if the results come back positive and can make the patient feel further frustrated and sometimes even depressed. This is where we intervene to work on reducing the anxiety and depressive symptoms, to give social support and facilitate coping through difficult times.
The stigma associated with Lassa fever can be very strong. Some people have lost their jobs, been chased out of their own community or even lost a relationship because they were associated with Lassa fever, as a patient or even as a caregiver. Providing support in situations like this is collaborative: the mental health goes with the health promotion team to visit village heads, community chiefs, and family members to assess the perceived or actual stigma. Then, in the presence of the community, we hug, shake hands and interact with the discharged patients. I have visited many homes with the counselors and the health promotion team to sensitize people about how to counter the stigma of Lassa fever. The majority of people who stigmatize others do so out of fear, and often because they have received inaccurate information.
There are difficult moments in this job, but the most rewarding moments come when we see the positive impact of our work on patients. Recently, a survivor of Lassa fever and a former patient delivered a baby, the first person she called to share the good news was Adanna, one of our counselors here; this is because of the rapport they have built over time sometimes the most important thing for patients is to feel understood and to have someone to talk to. Mental health and psychosocial support in Lassa fever context is irreplaceable as reports from both patients and healthcare workers in the field show that it has helped in improving patient wellbeing overall, as well as treatment adherence and recovery.
Dr Precious – Research Medical Doctor, Lassa Fever project, Abakaliki
Now that the world is facing COVID-19, I think there are valuable lessons that we can learn from the experience of treating other diseases, like Lassa fever. Our approach taught me that with good planning and organisation, there is no challenge that lacks a human solution
I’ve been with MSF for two years now. I began working in the Cross River migration project, where MSF was providing treatment for migrants, treating conditions like malaria, malnutrition, sexual and reproductive health and sexual and gender-based violence. I’m a general practitioner by training and a member of the West African College of Surgeons in the Faculty of Obstetrics and Gynaecology; I am also a firm advocate of Gender Equality.
After a year in Cross River, I wanted to explore new areas and face new challenges, so I applied to work with MSF in Abakaliki. My first impression was that this project was specialised – we were very focused on infection prevention measures, preventing the spread of Lassa fever and particularly in protecting healthcare workers.
Our work in Abakaliki combines operational research on Lassa fever, with an active treatment programme for patients. This project began as an emergency response in 2018. Because so many healthcare workers had fallen sick and died, we reached a stage where a lot of healthcare workers didn not want to work in medical facilities. That’s where MSF stepped in. MSF began installing new infection prevention measures in the hospital, and that work had a ripple effect on other hospitals in Ebonyi state, meaning that health facilities were no longer amplifying the infections of Lassa fever.
After reports from the Ministry of Health and the Nigeria Centre for Disease Control (NCDC), and an assessment from MSF, in March 2018, we began working in the Federal Teaching Hospital of Abakaliki (AE-FUTHA) to treat and control the spread of the outbreak, as well as limit the hospital-acquired infections.
In 2018, the situation was extremely difficult – in Ebonyi, ten healthcare workers lost their lives to Lassa fever. However, in 2019 something remarkable happened, we installed a new range of measures and protocols and things began to change. We had six healthcare workers treated in the hospital where we worked, but they survived. Most of them were infected when they were doing their jobs. So to prevent further transmission in the hospital, we set up five separate entry points to the hospital for different services (like paediatric or surgical services); each entry point had a handwashing station for patients and staff to use before entering. We also adapted the triage and patient flow systems, and established clearly marked high-risk and low-risk zones in the hospital – this made it easy for healthcare staff to know the kind of personal protective equipment they should wear, and where they should wear it. The beds in inpatient wards were also set up with at least a two-metre distance between each bed.
To prevent accidental exposure in the high-risk zones, all vials and injectables began being prepared in the low-risk zones beforehand. Everything taken out of the high-risk zone also had to go through a decontamination process. The isolation design and flow was set up in such a way that there are different entry and exits for patients, caretakers, staff and materials, thereby preventing transmission in the hospital. For every risk, we provided both physical (distance, patient flow, and protective equipment) and chemical barriers (Chlorinated water) to reinforce protection.
In addition to preventing further transmission, MSF is actively treating patients with Lassa fever in Ebonyi state. Right now, I’m the doctor who oversees the management of Lassa fever cases; it’s my role to ensure that every patient receives the optimum quality of care.
Apart from the medical effects and treatment of Lassa fever, there are social issues which have a major impact on Lassa fever survivors. Unfortunately this stigma runs through all facets of life – including family, places of religious worship, markets, the workplace and even school. We know that the children of patients who have overcome Lassa fever are sometimes asked to stop attending school; some survivors have been turned away from places of worship; even marriage engagements have been broken because of this stigma.
People need to know that with the early identification of symptoms and prompt treatment, the rate of recovery will increase. The stigmatization of survivors at family and community levels will only discourage patients from coming for lifesaving treatment – and this puts others at risk too. Our health promotion team is working to help communities better understand Lassa fever, and to reduce the stigma that surrounds it. Because of this, there’s light at the end of the tunnel.
Treating patients with Lassa fever isn’t always easy; as medical staff we develop close bonds with our patients, and we share the highs and the lows. But nothing comes close to the happiness of seeing patients go home fully recovered. There have been so many remarkable moments working in this project, but one patient stands out to me in particular. He’s a middle-aged man who was admitted with Lassa fever, and he was suffering from kidney failure and severe anaemia. He suffered from convulsions and had to have dialysis several times. Even his family had lost hope, but the medical team never gave up. Eventually, after several dialysis and transfusion sessions, he recovered and was discharged. I remember about a month after he was discharged, I heard someone scream my name – when I turned around it was his him. He was there with his wife. He came to me and gave me a tight hug, while his wife told their friends “this is the doctor that saved my husband and stopped me from becoming a widow”. I almost cried seeing the joy on their faces, that was worth more than anything to me.
Now that the world is facing COVID-19, I think there are valuable lessons that we can learn from the experience of treating other diseases, like Lassa fever. Our approach taught me that with good planning, tools, and organisation, there is no challenge that lacks a human solution. Prior to our coming into Ebonyi state, no healthcare worker wanted to come near anything linked to Lassa fever; those who still wanted to be involved, faced a terrible stigma. But all that has changed, this hospital is a place where people come to be healed, and to recover. Trust and understanding are replacing that fear now.
I chose to work for MSF because I wanted to give something back and address the needs of the world’s neglected populations. Right from when I was in medical school, I was part of a group of medical students that formed the “I saved A Life” movement, geared towards advancing knowledge, attitude and the practice of voluntary blood donorship to meet rising needs in our hospitals. Our dream led us to build a bank of voluntary donors for both blood and bone marrow from among doctors, nurses, other support staff and even students from the university community; this database was handed over to the haematology department of the teaching hospital for continuity, after we were gone. During my internship days, I heard of MSF’s work in the states of Borno, Adamawa and Yobe, and I was captivated; the Jahun project in Jigawa was also another intervention that piqued my interest in the organisation. So, when the opportunity came in Cross River state, I was happy to apply. As for the journey so far? It’s been a fulfilling one, I must say.
Umonna Ngozi Ogochukwu (Ada)
My advice to those diagnosed with Lassa fever is that they should be brave; they should not panic. Having Lassa fever is not the end of the world because it is curable.
Im from Idemili-North local government area in Anambra state. I just completed my year of national service after graduating from university.
It was on 22 February that I was diagnosed with Lassa fever. Two weeks before that, I was very sick but I was being treated for malaria and typhoid. As there was no improvement, I decided to go to the hospital. I was suffering from headaches, loss of appetite, constant vomiting and heart palpitations.
I was referred to Federal University Teaching Hospital where I was diagnosed. They told me immediately that I had Lassa fever, I started crying and I was wondering if I would survive it because I didnt know much about the sickness. I was thinking: is this the end of the world for me? Later I consoled myself that I would survive it.
Because of Lassa fever, people avoided me. I lost some of my friends because nobody came to visit me while I was undergoing treatment. I was all alone until I called my mother who was in Anambra and she came over to the hospital in Abakaliki where I was being treated. The presence of my mother contributed greatly towards my recovery and I must also add that the MSF personnel attending to us gave us hope. They were constantly consoling and motivating us. They told us that being diagnosed with Lassa fever is not the end of the world. It really helped, having such caring people there.
It was only my mother that knew that I had Lassa fever. I did my national service in Ebonyi state while my family were in Anambra. So no other family member knew about what I went through and some of my friends who knew avoided me. They started visiting me after I recovered but they avoided me when I needed them the most.
My advice to those diagnosed with Lassa fever is that they should be brave; they should not panic. Having Lassa fever is not the end of the world because it is curable. I would also advise people with persistent fever to go for a Lassa fever test.
I want to stress that MSF staff that attended to us during our treatment are wonderful people, they gave us hope. MSF took care of our medical bills and food. I pray that they will be rewarded abundantly.
CONTACTS: Scott Hamilton, Field Communication Manager, Email: [email protected], GSM: +234 906 879 5200
Abdulkareem Yakubu, Field Communication Officer, Email: [email protected], GSM: +234 810 606 6159
