Dr. Nick Ngwanyam, MD visited by Dr. Hodel |
Dr. Ngwanyam is proactive educating the population about Ebola via a radio show. Here is the entire transcript which is a brilliant educational tool that will save so many lives if the Cameroon population embraces it and follows what the doctor is saying.
PLEASE READ THE FOLLOWING IN ITS ENTIRELY
Dr. Nick Ngwanyam Throws More Light On
The Mysteries Of Ebola, Typhoid Fever, Other Viral Diseases Courtesy, Highlands Morning Show, CRTV
The Ebola Virus has claimed more than one
thousand five hundred lives in West
Africa. Some pundits say it is even
underestimated. These deaths are notably in Sierra Leone and Liberia. It is spreading rapidly into neighboring Nigeria, carrying with it an aura of overhanging catastrophe. In the desperate
attempt to stop the spread, the World Health Organization has approved the use
of untested drugs. Today we are going to be having an explanation so that
people can understand.
Neighboring West African countries like Cameroon have been taking measures to block the entry of the virus into its
territory. Recently, the Cameroon government suspended the entry of goods and
people to and from countries affected by the Ebola virus into Cameroon.
To get more explanations on the Ebola
Virus, Dr, Nick Ngwayam of St Louis University institute begins by telling us how the Ebola virus is different
from other viruses.
Before I go on, if you are listening I
would like you to wake up your family so that you all listen to this. It is not
for entertainment. We are here to give you information that would help preserve
life. I am so concerned about that because I do not seem to hear a lot in that
light. If we ever had the misfortune of getting it around without knowing what
to do, it will be a real disaster from what I observe and I am really
concerned. I think the technician is taping what we are discussing so that we
can have it on the air now and again to remind people.
You know education; having knowledge is
what would really help us in whatever difficulty we are found in. it is said
that knowledge is power but recently somebody corrected that statement. When
you say knowledge is power it is wrong. It
is tested knowledge which is well understood and which is well applied that is
power. But in Cameroon, we have a lot of knowledge around but we do not apply it. That
is where our problems come from. I am going to show you in what respect we do
not apply knowledge.
This time around if we do not apply
knowledge, Ebola is not going to spare us. We have got to get the knowledge,
understand it and above all apply it. We keep having the issue of cholera
coming round year after year and we keep talking about it and doing nothing. We
go and drink more 33 and more people continue to die, but with Ebola, it is not
going to be like that. It will not give you the chance to go and drink 33. It
is completely different from cholera. It strikes and it kills. I am going to
show you how it kills.
Before we even go into understanding
what happens and the complications of it all, let us remind ourselves again
about germs; this thing that we had learned in primary school called germs. Ebola is
not caused by witchcraft, it is not caused by “musong.” It is caused by a germ.
To refresh our minds again about what
germs are; germs are these very small organisms that we cannot see with our
eyes. You see, if we are talking about a very small particle that we can see,
we might think of very fine dust. We might think of the wheat flour. The one
meant for bread. You might think that is very small but you are seeing that
when put together you have a whole bag. But germs are something that are very
small and to help us understand what germs are, I would just like us to stretch
our imagination and stretch our imagination. The germs that cause diseases are
classified into three groups. We have the viruses that are the smallest and of
course there are some that are even smaller but let me not complicate your mind
with that, then we have bacteria is next in line.
Then after the bacteria we have
protozoa. To give you examples of these, Ebola is a virus and some of the
viruses that you all know very well would be the hepatitis virus. We heard
about hepatitis B, C, A and all that. Therefore, in that class we have Ebola,
hepatitis and our well known HIV. The common cold, the catarrh and cough that
attack children are all viruses. When we leave the class of virus, we would
skip to bacteria.
Bacteria would be your well known
typhoid fever that we all seem to be suffering from which is a lie. We have our
pneumonia, bone infections, skin
infections with boils coming out and so on. Those are caused by bacteria.
The next group would be the protozoa
which is bigger. We are talking of things that cause amoebic dysentery. What we
also know very well is malaria. If we were to try to use a very special
microscope to try to blow up these things to very large sizes so that we can
see them for comparison; let’s say that the amoeba germs that causes amoebic dysentery;
if we were to enlarge it so that it is as big as one of these seventy-seat
buses or a twenty ton truck or something like that, try to use your
imagination. Then the one that causes malaria would be the size of a Toyota cargo
which is also a protozoa. Then though
the bacteria are of different sizes too, it would be like a one
hundred-kilogram bag of potatoes. The virus would be the size of a bean seed.
So you can see the difference. That is why we cannot see the Ebola Germs. We
need special laboratory tests to detect it and there are special ways of doing
it.
Now that we have understood, let us say a
few things about Ebola.
No 1. It exists because
sometimes we suffer from denial.
Something comes and is killing us but we keep denying which is very
unfortunate.
No 2. It is caused by a
germ and not by witchcraft. It is not because your mother hates you or your
grandmother hates you, or a curse or something of the sort.
No 3. It kills like mad.
It kills 60-90% of those that are infected with it.
You do not joke with it. The only way to
stay alive is to stay away from it. When you have it you have a 90% chance that
you would be dead. We are going to discuss how it does that. It is said that it
is a hemorrhagic fever. That is when you have it someway along the line toward
the terminal phases, you start bleeding from everywhere, your nose, mouth and
you have diarrhea. This bleeding is not in all the patients. It is only in
about 60% of the patients who bleed. That is the preliminary.
It
is so frightening. It means that we have danger just around and as I asked
earlier, how is it spread?
Good. I was trying to first tell you
about the germs so that when we are talking about the spreading you would
understand because that is where our “champ
de battaille” is as they say in French. We must know the germ in order to
know how we are going to fight it. we must know how it spreads and we are going
to stop it from spreading. That is the only way we can help ourselves-to stop
it from spreading because when it gets into your camp, it like playing
football. You want the football to stay in the other camp. You do not want the
ball to come to your side. If the ball comes to your side, a goal must be
scored. If it crosses, a goal would be scored. So you want it to stay in the
other side as much as you can. You have to build a very solid fence and keep it
out. I am speaking about it most because this germ is spread by contact.
Let us spell the word CONTACT
in capital. Let us bold it and increase the font. If you can stop contact, you
would stop the disease. For us medical personnel, we are put more at risk than
anyone else because as the patients are sick, they would be brought to the
hospital. We work in hospital 24/24 and the likelihood that doctors, nurses,
laboratory technicians, sweepers, cleaners and everybody working in the
hospital environment would catch the disease is very high. If I am in the radio
talking this morning, it is because I really want to protect myself and others.
If you do not want to protect yourself, I want to stay alive.
We have established the fact that it is
spread by contact and which are the dirtiest part of a human being? The hands
are some of the dirtiest things the human being has got. The mouth, the teeth
are very, very dirty. The mouth is one of the dirtiest places. You know there
are some human beings who bite others like dogs. It is said that the bite of a
human being is more dangerous than one of a dog. It is more dangerous when it
has rabies. You know if a dog that has rabies bites a human being and that
human being bites another, of course he would transmit rabies.
We are saying that the mouth is very
dirty; the hands are very dirty and anus of course is very dirty. So we are
going to watch these places. The hands are the greatest culprit of all of
these. Let me tell you how disease is transmitted. When you wake up from sleep
this morning, take some corn flour or some powder or some dust and sprinkle it
on the table. Put your palm on it. Your palm is going to pick up some of the dust
and then greet a few people. If you used powder, you would actually see it.
Take some powder, spread it on the table or a sheet of paper,
then open your palm, place it on the powder and give five people in your house
a handshake. Let them open their palms and see how much powder is in there.
That is how disease is transmitted.
So when we are coughing or sneezing into our
palms and then giving others a handshake that is exactly what we are doing.
That is exactly why when you have a cold, it easily gets across. We have this
habit of coughing or sneezing into our hands and rubbing them and thinking that
the germs and slim are gone; we start ‘Peace be with you’ in church as we
greet. You enter a “njangi” of about fifty people; you give the fifty people a
handshake. Remember that on giving somebody a handshake, you are transmitting
diseases. Let
us break first this habit of handshaking.
We
are going to look at all ways and means of stopping contact.
The bottom line of stopping Ebola in the community and amongst us is to
stop contact. It is to increase our level of HYGIENE.
That is another word again that we are
going to spell in capital letters and to bold. Remember when there is personal
contact; that thing that leaves from Ngwanyam to Emmanuel or from Ngwanyam to
Pricilla is what would cause the disease. What is it that would leave from me
to you is my body fluid if I am infected. The body fluid would include urine,
diarrhea stools, blood, sperms and might be sweating, saliva and tears.
Everything that might leave my body and get out there would give you the
disease. I can sit on this table and leave my human fluid here. If you get in
contact with it especially if you have a broken skin, wound or something that
is it. You are gone. It is as dangerous as that.
You can begin to now imagine the danger
if let’s say you travel to where ever in our community that is dirty; for
example, when I came into this studio I opened the door. The door handle is
very dirty especially a door handle in public places where a hundred and fifty
people touch every day. The door handle of the toilet is very dirty. These are
some of the things. Imagine when you are entering a seventy-seat bus, there is
that handle that you hold and hitch yourself up is very dirty. So those are places
that we are going to concentrate on cleaning.
Our toilet habits are some of the worst
things that one can think of. Two, three days ago, I was at the Aziri Credit
Union and I was standing up and looking through the window. I was looking
towards the stream that feeds the old fish pond. I was looking back there and
you see that these women selling food and “okrika” just in front of Aziri
Credit Union use those old dilapidated toilets constructed some fifty years
ago. When I was looking at it, I discovered that the toilets were being emptied
into the river.
When they dug the toilets, they were not
deep enough and whatever they do there gets into that stream. What surprised me
as I was looking at that stream was a woman. I think she was selling food or something.
She went to this toilet and I do not know why I kept looking. I realized that
she did not go to pee, she went to make the big thing because she put in quite
some time. I know she did not wash her hands because there was no bucket of
water there. She left; closed the door which has been touch by, I do not know
how many people in the market. She just came back and sat where she was selling
her foodstuff for that matter.
This was just an example of what happens
to all the women who are selling in the market. I understand there are no
toilets in the market, or there is one or two in there that are not good
enough. Our toilet habits are very bad. When you go to the toilet; after that,
you must wash your hands. We shall be talking much more on that.
Before
we go into all those details, the World Health Organization approved the use of
untested drugs. Many people do not understand what it means. Can you throw more
light on that?
We are jumping. We are putting the cart
before the horse in the sense that we are talking treatment even before the
symptoms and how the disease manifests. Can I just talk about the clinical
presentation of the disease so that we are logical?
O.k.
let us have the clinical presentation. I thought you had finished with that.
The thing about the Ebola virus is that
you would not know whether you have it except when you go to a stage where you
are bleeding and that is when people would say “ai this is Ebola.” At that time it is too late because you have
contaminated the people around you already. So it presents just like any viral
disease.
The viral disease that you get; be it
SARS, HIV, whether it be the common cold or whatever; you would have a fever,
joint pains, aching muscles and there would be loss of appetite, headache and
in the next two weeks you might start vomiting and having abdominal pains. As
it progresses, you would start having diarrhea and in the worst case scenario,
you would start bleeding. These are the common trends. Do not forget. When a disease attacks people,
it manifest differently in different people. This is the general trend. In some
people, they might start bleeding earlier or it might just get worse and knock
them out in one week. It depends on the individual. What if it comes when your
immune system is not very good? It takes you.
Once the disease is in you, there is
only one, or two things nurses and doctors can do. I am going to describe
something to you. When you have a water pipe or hose and you connect it to a
tap to collect water in a bucket, you know the tap is sealed and the water
would get into the bucket.
That is how our vascular system is. It is closed. Blood flows in
the vascular circle and goes back. It is a closed circuit. When Ebola attacks
you and is getting into the critical phase, the vessels in your body opens up.
It is like that pipe being burst so that your water begins to leak all over and
that is why patients bleed. Sometimes you also loose water from your vascular
system into the interstitial fluid and so on. That is where the problem is.
When your vessels open up, you start to bleed and loose water. Even when
doctors start replacing that water, if they did not start in time and are
replacing that water; when your vessels had given way, you would still die.
There is no way out and that is why you
have to stay alive at all cost by avoiding CONTACT. If it comes to Cameroon where we do not have a lot of blood around, things like glucose
saline and so on to give you, it becomes very critical. Do not forget that just
because you have been given, you would not necessarily be well.
Let’s
now go to the treatment.
The question you asked; let me make a
statement here. There has been this issue of radio one battery. This radio one
battery is what would kill us Africans and especially Cameroonians. We like to
get information from the street; Information that is not true, information that
has not been tested. You just start a rumor and it grows like wild fire. One of
the rumors that went like wild fire is that bitter kola is a cure. The next had to do with salt. That you have
to put salt in water, drink and bath with it and so on. These are all false.
The only thing that has been shown to have some level of efficacy which is not
a hundred percent because it has not been tested is the drug you are referring
to now. It is called Zmapp. It has been developed in America and so far it was used on those two Americans.
Dr.
what about avoiding bush meat for the moment?
Oh yes, those are preventive measures.
The thing is, the Ebola virus is carried by a lot of bats. I have seen children
shooting bats for food. Stop that. It is also carried by animals especially
monkeys and chimps. Do not eat monkeys and chimps. The other animal that
carries it are pigs. So the people who are growing pigs, sorry. Pork is off
your dinner table. Someone was asking the question here about cooking the meat
well. Remember, the disease is transmitted through contact. That is if you are
touching blood, urine or stool be it from a contaminated animal or human being,
you are dead. So before you even begin to cook or chop the meat, you come into
contact with it and either you eat it or not you are gone.
About medication, there is this medicine
in America called Zmapp. Zmapp is a drug that has been experimented over
the years. It is like things have overtaken the company that is doing the
medication. The scientific companies do not do it as our African panacea people
do it.
The African panacea people just move
around, get the leaves, come around and are deceiving people that they have
been doing research. Those are lies. Before you see a drug come out in the
market, it must have undergone several phases of testing and verification.
First they would find out; in this plant what is that molecule and so on, does
it have some activity against the germ; and so on. There is a way of doing it
in the laboratory.
When there is some relevance to that
statement, they would take the medication and say; we think that this drug can
kill this virus or bacteria. Now if we give it to a living rat or monkey, will
it also kill the germ, if the germ is in the monkey? In the course of killing
the germ, will it kill the monkey or rat? These are tests that they go through.
So when it is tested on the monkey, they come to the understanding that if we
give so much to the monkey it will not kill it; but if we pass this level it
will kill the monkey. So they take a reference from there and try it on human
beings.
It is not just a blind thing.
Once we have established the fact that this molecule is active given at
this doze to a monkey or a rat kills the germs but does not kill the cells, we
are still not safe. How does it work in a human being? How much of it should we
give to a human being? Remember all human beings are not of the same sizes and
race. So you also have to take the drug to all the human beings and play on all
these variables and see what happens. Again when you are taking the drugs to
human beings, it is not a blind study.
When I bring the drug to you, I have to
tell you this drug is called Zmapp. We do not yet know how it works in a human
being. If you are taking it you are taking it with all the risk but I give you
all the information. Because you are found between life and death, you decide
to take it knowing you may still die if you do not take. You then sign a form
to state that you will take it knowing that it might not work or it might hurt
you. The person on which the drug is tested must sign a consent form so that
you may not say tomorrow that you did not know what you were doing. Zmapp was
still on the shelf and they were still working on it and this epidemic just
hit. Everybody is like; bring out that medicine let us use it.
The company is also watching its back.
They are very kind, loving and God fearing but tomorrow when you sue them it
will be a different thing. Since the drug came out with the blessings of W.H.O,
tomorrow you cannot sue them because they would say look, we did it for
humanitarian purposes.
For now the only
cure is prevention by avoiding contact with doubtful persons and wild animals.
Gatherings and hand washing, handshaking are some of the things we must watch
out and know how we go about them.
What
is your appreciation of this decision by government to kind of control if not
limit movement to and from countries affected by Ebola.
You know we are always talking democracy
and human rights. There comes a time when you must curb those rights. There
comes a time when you must be reasonable enough say; they are your rights, too
bad and forgo them for the common good.
Could
we say that it was a problem of mentality that pushed some inhabitants of Monrovia to attack a facility
where some isolated cases of Ebola patients were being treated?
That’s why we talk of informed
knowledge. You have to be informed and so you make informed decisions. Do not
forget Ebola just stroke there. You and I in Cameroon might sit and say those people are foolish, they do not know
Ebola kills. This thing just came like a whirlwind. Even before the education
went through, they were losing people. With that, there was a lot of confusion.
We in Cameroon and others have the advantage. We are seeing what has happened
and we can learn from their mistakes. But the way we are going; that is why I
am on the radio talking about it and informing the public. But we will still
see that kind of thing in Cameroon because people are not informed.
So we should teach people the right thing
and inform them before time so that even if you are faced with the thing, you
already know what it is and what to do and behave differently. It is
true this people in Monrovia; that is exactly what they did due to lack of
knowledge and I do not want Cameroonians to die from lack of knowledge.
In Cameroon when it happens like that especially in the Bamilike country and
some other places, they would go on to operate the corpses.
We
are living in a country where people are so much into auto medication. What
advice do you have to give now that it could be something more dangerous?
Yes it could be something more dangerous.
I am not sure about what to say as far as auto medication is concerned. Know
that each time you are sick and you begin to treat yourself without going to
the hospital it does more harm than good. It is always good to go to the
hospital so that they can put the nail on the coffin and say it is this. Or, I
mean to be more precise about what is going on.
That said, I have also seen we make a
lot mistakes even in our health services. We have been over diagnosing typhoid
fever which is wrong. You know any time you go to the hospital; all of you
check your books; you will see the doctor always treats you for malaria and
typhoid. When you see a doctor
all the time treating for malaria and typhoid, there is a problem there.
The diagnoses of typhoid was wrongly
made and the widal test which we
always use to test for typhoid is a wrong test. We are over treating and over
diagnosing typhoid. That is something that has been with us for so long now;
and if we do not know how to diagnose it, what more of Ebola. Even as we
continue talking of Ebola, the testing kits are not in all hospitals. I think
it’s only now at the borders and probably in some reference hospitals as the
minister said. So this is something that has just come and we could be in a
real mess even before we realize it.
You
certainly have forums like medics that you discuss and share ideas. I know that
those in the lab may not really fall within that but you can do some control if
you have realized that in our different labs the results may not be accurate.
You are referring to typhoid, right? Let
just say something and probably I will tell you how typhoid fever is diagnosed,
then we will realize that all we have been doing is wrong. If you were to take
all medical doctors in Cameroon and put them together and ask them to diagnose typhoid fever, I
think many of them will get it wrong. I will explain to you how it is
diagnosed.
But this is what I wanted to say. With
all the grim pictures that I painted, there is one substance that we can all
use in our homes, in our hospital, in our schools and everywhere to begin to
control most of the infections including Ebola. I am talking of bleach. It is “eau de javel” It is also call “la croix.”
I did not want to just say la croix
because la croix is a commercial
name. People know it as la croix but the generic name would be
bleach or eau de javel as you
understand is the same thing.
I would like to encourage all of us to
have some bleach at home, have bleach in the hospitals and schools. You should
put a little of that bleach in water. Use it to sprinkle the doors of your
toilets, door handles, your toilet seats and floors. Please wash your toilet
with all of that. Wash your cloths with it and try to use as much of it as
possible to keep clean.
The good thing is that it will kill many of the other germs that
give us diseases. If you use it in the toilets it will knock away most of the
toilet smells and all those kind of things. As of now enhance your hygiene by
using la croix.
I had a statement especially for women
who go and attach these nails. You know they look like Dracula. If you do it on
the left hand probably I could forgive you but I see some women, they do it on
both hands. The question is, when you go to the latrine and you do the big
thing and you “shit” as they say, how do you clean those nails? First they have
their original nail and between the flesh and their original nails, there is
dirt. Then when they also stick that thing between their nail and the one they
have fixed, there is also a space, so this “cooky” thing or dirt goes
between and it is terrible. I see some preparing salad and things like that
with those kinds of nails. It gives me goose skin. So you might be passing on a
lot of germs and making people sick.
There
is a caller on the line. [deleted since not relevant to the topic]
Can
we just know why there are differences in the result or it is always typhoid
but not really typhoid?
We are over diagnosing typhoid in our
community and I am aware of it since my days in the medical school. Because I
remember, when we were training as young doctors and we would be going on
rounds, “c’est le paludism, non c’est la fievre typhoid.” This has been
going on and it is a bad habit that we have picked. There is a way of
diagnosing typhoid which will stand the test of time in Cameroon. I meant which would be certified as correct in Cameroon, America and anywhere. You cannot diagnose typhoid in a particular way in
Cameroon and not use that same method in America.
Before I go on, let me just say that
what we know and have for the diagnosis of typhoid fever is the WIDAL test. The
widal test is the wrong method of diagnosing typhoid. And so, how do we
diagnose typhoid?
There is the clinical presentation of
any patient who has typhoid fever and as we saw a moment ago; even with the
clinical presentation; we have to be very sharp. It is not very different from
malaria, and would not be very different from other viral infections. But there
is a key thing about typhoid infections.
When a patient is infected with typhoid
fever; and you happen to see him in the first few days that the disease is starting;
and if this patient were admitted; and you know that in the hospital we have
what we call the temperature chart
where the nurses and doctors take the
temperatures of the patient
and chart with time, it forms a graph.
The longer the patient stays in hospital the longer that graph becomes.
If you look at the graph that comes from
a patient who has typhoid, the way the temperature begins to get up in the
first and second week is like a stair case. It keeps going up every morning and
evening as the temperature is rising. When it hits forty degrees or so, it stays there. But the characteristic thing
is that it is like a staircase and it plateaus and keeps up without deepening.
When you have something like malaria,
you can have a very high temperature which goes from the bottom, shoots to
forty and sometimes crashes back but with typhoid you would see this
plateauing. That is the first thing.
Then the second thing is that when the
temperature of a patient is rising, the pulse also rises. So for a one degree
centigrade rise in temperature the pulse rate increases by ten bits per minute.
But in typhoid fever, you do not have that. So you would have a patient with
typhoid fever, say a fever of forty degrees centigrade, the expected pulse
would be something like one hundred and ten beats/minute or one hundred and
twenty. But in typhoid fever you would have a temperature of about forty
degrees and the pulse would instead be about eighty beats per minute. This is
because the salmonella germ would be poisoning the heart and the heart cannot
keep pace. There is a poison from the typhoid that is doing that and slowing
the heart. These are the two clinical things that you would notice beside
abdominal pain. There might be diarrhea and bloody stools or whatever.
That is the clinical part. In the
laboratory, how do you diagnose typhoid fever? There is only one test that we
do and I would swear that it is hardly ever done around here. It’s culture.
The doctor and the people in the lab will take the urine of the patient and
culture it. They would also take the blood of the patient and culture it and
identify the germ in it. Period.
There
are a lot of misdiagnoses of typhoid in our community. It is true that
typhoid is one of those diseases that is spread because of poor hygiene. We eat
contaminated food and contamination would come from; of course the different
ways we handle our food, water and so on. We do not wash hands; we do not wash
our food. You go to town and the way mangoes, carrots, oranges, tomatoes are
spread on the ground is disheartening.
In 1960, you could not sell food on the
ground because of the sanitary department. But in 2014, we have all the food on
the mat. So it has to do with hygiene as we were talking about the diagnosis of
malaria, typhoid fever and other viral diseases. I was saying that we are over
diagnosing typhoid. In as much it is a problem, we are overseeing the problem
which is not true by using a wrong diagnosis.
DR NICK NGWANYAM, MD
CEO ST LOUIS GROUP
POB 661 BAMENDA
NORTH WEST REGION
REP OF CAMEROON
REP OF CAMEROON
TEL( CELL) 237- 7776 46 74
www.saintlouisgroup.cm
stlouisclinicbamenda@yahoo.co.uk
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