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The two US aid workers infected with the Ebola virus in Liberia have recovered and have been discharged from hospital, medical officials have said. Recovered patient Dr Kent Brantly thanked supporters for their prayers at a news conference. Nancy Writebol was discharged on Tuesday. The two were brought to the US for treatment two weeks ago.The outbreak has killed more than 1,300 people in West Africa, with many of the deaths occurring in Liberia.

"Today is a miraculous day," said Dr Brantly, who appeared healthy if pallid as he addressed reporters on Thursday at Emory University hospital.

"I am thrilled to be alive to be well, and to be reunited with my family. As a medical missionary, I never imagined myself in this position." He said Ebola "was not on the radar" when he and his family moved to Liberia in October.

Dr Bruce Ribner said after rigorous treatment and testing officials were confident Dr Brantly had recovered "and he can return to his family, his community and his life without public health concerns". The group he was working for in Liberia, Samaritan's Purse, said they were celebrating his recovery.

"Today I join all of our Samaritan's Purse team around the world in giving thanks to God as we celebrate Dr Kent Brantly's recovery from Ebola and release from the hospital," Franklin Graham said in a statement.

Details: Ngwa Bertrand; 21.Aug.2014; Hits: 2230

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Details: Health

Sierra Leone’s Ebola crisis has been traced back to a single healer in an isolated border village, who had claimed to be in possession of special powers to cure the deadly disease that started penetrating the border, it has emerged.“She was claiming to have powers to heal Ebola. Cases from Guinea were crossing into Sierra Leone for treatment,” top medical official, Mohamed Vandi, who was based in the crisis-struck Kenema district has revealed.

“She got infected and died. During her funeral, women around the other towns got infected,” he told the agency. The woman was based in the eastern border village of Sokoma.Mourners at the funeral of the healer prompted a chain reaction of sorts, and what was initially a more confined outbreak materialized into a severe epidemic when, in June, the virus struck a city of 190,000 called Kenema.At least 1,350 people have died since the virus spread out of southern Guinea at the beginning of the year. More than 2,200 people have been infected across Guinea, Liberia, Sierra Leone and Nigeria.

The disease spreads through direct contact, for example through broken skin or bodily fluid exposure, and is characterized by fever and bleeding disorders, as well as vomiting, diarrhea and a rash.There is no cure or vaccination for it, and 90 percent of cases result in death. Its severity and destructiveness to organ tissue has earned it the description of “molecular shark”.In part, its rapid transference has been blamed on funeral rites, during which relatives touch their dead. Mourners, family members, and health workers are the most at risk in the event of an outbreak. Twelve nurses out of the 22 infected have died since the virus first hit Kenema.

“The nurses who lost their lives and those who got infected would never have gone in knowing that they would get infected,” Vandi, the district medical officer, told AFP.Nurses have had difficulty securing satisfactory protection from the disease, with 100 nurses in a Sierra Leone hospital striking after complaining of poor management. Some staff told AFP that they had gone for weeks without a day off.Sister Rebecca Lansana told the Guardian newspaper that she had been concerned over high staff deaths. “My family do not want me to come here anymore. They think I will die, they don’t want to be around me in case I give them Ebola,” she said back on August 9. Upon publication she had already been dead for five days.

Liberia has been forced to deploy security forces to contain the disease. Fifty-thousand residents of a Liberian slum were quarantined last night in an attempt to stem the spread of the disease through West Africa.Over the weekend, potential patients fled a similar attempt. Armed soldiers and riot police have begun to block entry and exit points to the West Point neighborhood in Liberia.In a week, Russian virologists will head to the Republic of Guinea to set up and run an Ebola research laboratory.“We agreed with Guinean authorities that our specialists would work in the field and help in the fight against Ebola using special medical diagnostics,” immunology and virology laboratory head at St. Petersburg’s Pasteur Scientific Research Institute, Aleksandr Semyonov, told reporters on Wednesday.

Semyonov added that a vaccine has already been developed in Russia that has proven itself successful in preliminary trials. "We’ll see what happens next," Semyonov said.

Details: Ngwa Bertrand; 21.Aug.2014; Hits: 2078

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Details: Health

Under a scorching sun, with temperatures soaring to over 40 degrees Celsius, Lara Adama’s family is forced to dig for water from a dried-out river bed in Dumai, in northern Cameroon.

This is one of the rivers that used to flow into the shrinking Lake Chad but there is not much water here.

There has been a nine-month-long drought in the region and Adama tells IPS that her family “digs out the sand on this river bed to tap water.”

“We depend on this water for everything in the house,” Adama, a villager in Mokolo in Cameroon’s Far North Region, says.

A cholera outbreak has been declared in Adama’s village. But she and other community members have no choice but to get their water from this river.

The lone borehole in this village of about 1,500 people is out of use due to technical problems.

Every family comes here to retrieve drinking water. Our animals too depend on this water source to survive. When we come after the animals have already polluted a hole, we simply dig another to avoid any health problems,” she says.

This region is threatened by extreme water shortages and climate variability. Barren soils constitute some 25 to 30 percent of the surface area of this region. Lake Chad is rapidly shrinking while Lake Fianga dried up completely in December 1984.

Gregor Binkert, World Bank country director for Cameroon, says that a water-related crisis is prevalent in the north and there is an increased need for protection from floods and drought, which are affecting people more regularly.

“Northern Cameroon is characterised by high poverty levels, and it is also highly vulnerable to natural disasters and climate shocks, including frequent droughts and floods,” Binkert explains.

The protracted droughts in Far North Region have triggered a sharp increase in cholera cases. The outbreak is mainly concentrated in the Mayo-Tsanaga region as all its six health districts have cases of the infectious disease. The current outbreak has already resulted in more than 200 deaths out of the 1,500 cholera cases reported here since June.

According Cameroon’s Minister of Public Health Andre Mama Fouda, “poor sanitation and limited access to good drinking water are the main causes of recurrent outbreak in the Far North. A majority of those infected with the disease are children under the age of five and women.”

Since 2010 three cholera outbreaks have been declared in Far North Region:

In 2010, a cholera outbreak spread to eight of Cameroon’s 10 regions, resulting in 657 deaths – 87 percent of which where were from the Far North Region.
In 2011, 17,121 suspected cholera cases, including 636 deaths, were recorded in Cameroon. Again a majority of those who died were from the Far North.
The latest cholera case in Far North was registered on Apr. 26, when a Nigerian family crossed into Cameroon to receive treatment. Neighbouring Nigeria has reported 24,683 cholera cases since January and the first week of July.
Poor hygiene practices

“Cholera in this region is not only a water scarcity problem, it also aggravated by the poor hygienic practices that are deeply rooted in people’s culture. Water is scarce and considered as a very precious commodity, but handling it is quite unhygienic,” Félicité Tchibindat, the country representative for the United Nations Children’s Fund (UNICEF) Cameroon, tells IPS.

Cultural practices are still primitive in most villages and urban areas.

Northerners have a culture where people publicly share water jars, from which everyone drinks from.

“These practices and many others make them vulnerable to water vector diseases. [It is the] reason why cholera can easily spread to other communities. Cholera outbreaks are a result of inadequate water supplies, sanitation, food safety and hygiene practices,” Tchibindat says.

Open defecation is also common in the region. According Global Atlas of Helminth Infections, 50 to 75 percent of the rural population in Far North Cameroon defecate in the open, compared to 25 to 50 percent of people in urban areas.

Access to good drinking water and sanitation is also very limited. Two out of three people do not have access to proper sanitation and hygiene. While about 40 percent of the population has access to good drinking water, this figure is much lower in rural areas. In rural Cameroon only about 18 percent of people have access to improved drinking water sources, which are on average about over 30 minutes away.

Development challenges

Water sanitation and health (WASH) is vital for development, yet Far North Region has some of the most limited infrastructure in the entire nation, coupled with security challenges as the region is increasily throated by Nigeria’s extremist group Boko Haram.

Poverty is high in the region, UNICEF’s Tchibindat says. And the security issue in neighbouring countries has not helped Cameroon provide proper access to medical services here.

According to UNICEF, major challenges abound in Cameroon. There is a low capacity of coordination for WASH at all levels, and poor institutional leadership of sanitation issues. The decentralisation of the WASH sector means there is no proper support with inequitable distribution of human resources in regions.

“The government and many development partners have provided boreholes to communities and the region counts more than 1,000 boreholes today,” Parfait Ndeme from the Ministry of Mines, Water Resources and Energy says.

But about 30 percent of boreholes are non-functional and need repair, according to UNICEF.

Ndeme explains that, “the cost of providing potable water in the sahelian region might be three times more costly than down south. Distance is one major factor that influences cost and the arid climate in the region makes it difficult to have underground water all year round.”

A borehole in the northern region costs at least eight million Francs (about 16,300 dollars) compared to two million Francs (about 4,000 dollars) in other regions.

Health care challenges are prominent.

“The Far North has limited access development which also has a direct influence of the quality of health care,” Tchibindat says.

The unavailability of basic infrastructure and equipment in health centres makes it difficult to practice in isolated rural areas. Consequently, most rural health centre have a high rate of desertion by staff due to the low level of rural development, she adds.

Most of Cameroon’s health workers, about 59.75 percent, are concentrated in the richest regions; Centre, Littoral and West Region, serving about 42.14 percent of Cameroon’s 21 million people.

According to the World Health Organisation:
- 30.9 percent of health centres in Cameroon do not have a medical analysis laboratory.
- 83 percent of health centres do not have room for minor surgery.
- 45.7 percent of health centres have no access to electricity
- 70 percent of health centres have no tap water.
“Due to lack of equipment in hospitals, the treatment might only start after a couple of hours increasing the probability of it spreading,” Peter Tambe, a health expert based in Maroua, the capital of Far North Region, tells IPS.

“Report of new cholera cases are numerous in isolated villages and the present efforts by the government and development partners are not sufficient to treat and also monitor prevalence,” Tambe says.

Since the discovery of cholera in the region, the government and UNICEF and other partners have doubled their services to these localities to enforce health facilities and provide the population with basic hygiene aid, water treatment tablets and free treatment for patients, regardless of their nationality, along the border with Chad and Nigeria.

“Despite insecurity challenges facing this region, the government and its partners have embarked on information exchanges with Niger, Chad, and Nigeria to avoid further cross-border cases,” Public Health Minister Fouda tells IPS.

Details: Ngwa Bertrand; 19.Aug.2014; Hits: 2242

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Details: Health

The story of Sierra Leone's "hero doctor" does not have a happy ending.

Even though Dr. Sheik Umar Khan was an experienced virus warrior, and hemorrhagic fevers were his specialty, he tested positive for Ebola on July 22 and died in seven terrible days.

His friends and colleagues from around the world are sick with grief, and a haunting question hangs in the air. Did doctors make the right decision in refusing to treat him with an experimental drug?

It was an agonizing ethical drama that literally played out at his bedside, CBC discovered as we pieced this story together.

As the virus ravaged his body, doctors had a choice. Should Dr. Khan become the first human to receive an untested drug with unproven efficacy and unknown risk?

It was a question they could ask because of a simple quirk of fate. A single dose of the treatment happened to be within reach of that remote field hospital in rural Sierra Leone.

It was a lone sample of the drug called ZMapp, one of apparently only five in the world, brought by the Canadian scientists who helped develop it.

The Canadian team was testing the drug at a field laboratory near the border with Guinea simply to see how it would hold up in the African heat, according to a statement released by Doctors Without Borders.

When they offered it to the physicians treating Dr. Khan, they triggered an unprecedented philosophical debate that was argued across continents, as the virus wreaked its havoc on their colleague and friend.

The drug had never been tested on humans. What if it caused an allergic reaction that killed Dr. Khan?

His blood showed antibodies to the virus, evidence that his own immune system was already in full battle. What if the drug got in the way of that immune response?

But what if it worked?

But what if it worked and saved his life? And, what about all those other patients?

Was it ethical to give the drug to one person while so many others were dying without that option?

It was a debate that ricocheted between the bedside at the field hospital in Kailahun, in Sierra Leone's Eastern Province, to the Geneva offices of the World Health Organization, and the Belgium headquarters of Doctors Without Borders, according to Dr. Daniel Bausch, a long-time friend of Dr. Khan and a fellow virus warrior.

Just days earlier the two had been working side by side at the field hospital near the Guinea border, ground zero of the Ebola outbreak. Dr. Bausch left the day before Dr. Khan started feeling sick.

Worried about his friend, he weighed in on the debate from Geneva. "You had a person who was sick, and a drug never used on humans before, it wasn't approved. There were lots of questions to be asked and no easy answers," Dr. Bausch said.

Ultimately, he believes, the final decision was left with the doctors at the field hospital in Sierra Leone, although it was not a unanimous decision.

"There was, I don't want to say dissension," Bausch said. "But there were very definitely differences of opinion, and disagreements about what should happen."

The wrong call?

In the end, Dr. Khan did not get the drug. And for Dr. Bausch it was the wrong decision.

"I disagreed with what ultimately happened," he said. "I do want it to be clear that these were difficult, delicate decisions that people in a stressful situation had to make. But I'm not going to deny that I disagree with the decision they made."

Adding to the anguish, Dr. Khan never knew he had the option. No one told him about the experimental drug. No one asked this specialist for his own opinion about his choices, and whether he was willing to be a test case.

And that, for Dr. Bausch, was the biggest mistake.

"Dr. Khan was the ideal person to make an informed decision on this, and I feel strongly that he should have been asked if he wanted it or not," Dr. Bausch said. "That's one area where, frankly, I am critical."

In its statement about what happened in this case, Doctors Without Borders says Dr. Khan was not consulted about the experimental drug because, "ethically, it would be wrong to inform a patient of a potential course of treatment and then withdraw that option at a later stage."

Late in the night, at the Ebola treatment centre in Kailahun the doctors made the difficult call. The risks outweighed the benefits, at least at that moment.

The treatment, it was felt, if it was to be used at all, would be better attempted at the more sophisticated hospital in Europe where Dr. Khan was about to be moved.

But the next day his condition deteriorated, and he could not be transported after all. He died of Ebola a few days later on July 29.

Shocked the country

The very next day the drug was tried on humans for the first time when two U.S. aid workers infected with Ebola — a doctor, employed by the U.S. Christian charity Samaritan's Purse, and a missionary — were treated in neighbouring Liberia.

The unused Canadian dose that had been offered Dr. Khan was passed on to Samaritan’s Purse, according to a spokesperson from Health Canada on Monday.

They are now recovering in a hospital in Atlanta, Ga. A Spanish priest who also received the experimental treatment later died.

Back in Sierra Leone, Dr. Khan is remembered as a hero. A reporter there told me that Khan's death finally shocked the country into action.

"I personally think that helped to change the minds of the people to believe in the existence of Ebola.

"Before his death there were persistent denials about the existence of the Ebola virus disease," Amara Bangura, of BBC World Action said. "The ministry of health only stepped up the public education after the death of Dr. Khan. In fact that was when our president declared a state of emergency."

A few weeks before his death, Dr. Khan had told one of Bangura's colleagues that it was scary, working on the front lines of the epidemic.

"Yes, I'm afraid for my life. I must say I cherish my life, and if you are afraid of it you will take the maximum precautions," he said.

No one knows how he became infected. But the risk had long worried his brother. C. Ray Khan told CNN he begged Dr. Khan to come home and leave the fight to others.

Asked what he would say to his brother now, Khan replied, "Hey Umar, you didn't die in vain. You died for humanity."