Thursday, September 11, 2014

How to survive the arrival of Ebola in Cameroon, by Dr. Ngwanyam

Dr. Nick Ngwanyam, MD visited by Dr. Hodel
The St. Louis University Institute of Health and Biomedical Sciences in Bamenda is a wonderful school successfully training nurses, medical technicians and more. AIDSfreeAFRICA has recruited nurses and technicians for the Faith Health Center that we are supporting in Esu/Menchum Division.
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.


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.

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