After working as an internist in southern Nigeria for six years, Dr. Utibe Effiong, a 2014 alumnus of the University of Michigan’s Master of Public Health program and current U-M SPH research scientist, was inspired to look at the broader determinants of health and health care in the developing world. Dr. Effiong, who now specializes in environmental health and epidemiology, recently applied this lens in investigating the current Ebola crisis in Africa for The Aspen Institute’s New Voices blog.

[Photo: Dr. Utibe Effiong]

In his seven years of medical education and six years working as an internist in southern Nigeria, Dr. Effiong experienced first-hand the true nature of the health system in the world’s most populous Black nation. “In the 250-bed hospital where I worked, as in most Nigerian hospitals, the water was piped almost only into the restrooms. Most patients were cared for in open wards housing up to 20 beds with only one sink at one end of the ward. The few who could afford it received care in private rooms that had no sinks except in the restroom. To make matters worse, water was often not available because of frequent electric power cuts and poor maintenance of the power generators that were required to pump up the water,” he writes in “Ebola: One Treatment, Two Doctors, Two Health Systems, and Two Different Outcomes”.

Dr. Effiong cites other reasons that have contributed to Ebola’s spread, including ineffective barrier nursing, the lack of personal protective equipment, and inadequate patient isolation.

Citing the hospital discharge of American Dr. Kent Brantly, a recovering Ebola patient, Dr. Effiong mentions that “it is likely that the intensive care Dr. Brantly received at Emory University Hospital played a major role in his survival. Certain basic interventions, when used early, can increase the chances of survival for Ebola patients. These include providing intravenous fluids and balancing electrolytes (body salts), maintaining oxygen status, and blood pressure, and treating other infections if they occur. In the intensive care units of most Nigerian hospitals — and likely in Liberia — the gadgetry for properly monitoring a patient’s blood pressure, as well as oxygen, fluid, and electrolyte status are nonexistent.”

“Sadly, the health system in Africa’s largest economy and West Africa’s richest nation is one which promotes the spread of infectious diseases such as Ebola,” Dr. Effiong writes. “If this is the case in Nigeria, it is hard to imagine that that there could be better conditions in the poorer nations of West Africa.”

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