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Jane Greig – Australian Epidemiologist in Lagos, Nigeria Jane Greig is an epidemiologist from Victoria, currently on her first mission with Médecins Sans Frontières (MSF). Jane is working as Epidemiologist & Coordinator of Operational Research for MSF in Lagos, Nigeria, and here she describes the unique experience of Meningitis case-finding in the arid northern states of Nigeria.
Flexibility is crucial in working with MSF. I came to Nigeria to do Operational Research in MSFs HIV Treatment project in Lagos, a city of 12-15 million people. I arrived in late March, expecting to see very little of Lagos in my first month due to planned movement restrictions as a precaution during national elections in April. Now, it is the second election weekend, and the second 3-day weekend I’ve been restricted to a hotel in Sokoto – hundreds of kilometres to the north east of Lagos. This part of Nigeria is affected by the dusty Harmattan winds from the Sahara, a land of camels, goats and donkeys, of small villages that can be hard to find, and heat… dry heat that is waiting for the rains to come. The rains also signal the end of the risk period for cerebrospinal meningitis (CSM) outbreaks. CSM is why I am here. In 1996 there was a massive (300,000 cases) outbreak of CSM in this part of Africa, and based on a roughly 10-year cycle for epidemics, it is now a risky time. MSF has an Emergency Preparedness (EPREP) team in Nigeria that does surveillance and case management of epidemic prone diseases, including CSM. For many weeks they have been based in Sokoto, a state in the far north of Nigeria.
The 2 international staff who were with the team (EPREP team leader and Medical Coordinator) needed to return to Abuja, and the replacements temporarily transferred from the Lagos HIV project are an experienced nurse/coordinator from Kenya and myself, an epidemiologist from Australia. The others in the team are national staff – a doctor, a nurse and 2 drivers (who can also service the Landcruisers, fix the radios, speak the local language, and remember a remote turn off to a village we went to once!). My role has been to monitor the epidemiology of the CSM cases – standard information to use is time, person and place, which sounds simple enough. However, working out when the first case probably was (and therefore when the peak of the outbreak is likely to be/have been and whether a vaccination campaign is worthwhile) is difficult when diagnostic capacity is limited, records are incomplete, and many clinics are non-existent or non-functional. The EPREP team involvement dramatically improved diagnosis, records and treatment, and with it my ability to interpret the outbreak pattern. Deciding where to do surveillance for additional cases was another challenge – asking in nearby villages is easy, but working out where a list of patients came from without a map is a little harder. Planning surveillance with a hand drawn map that turns out to be highly inaccurate is also difficult. A satellite phone with GPS was a great help in working out the geographical area where cases were occurring. Without some of the things we take for granted in more resourced places, flexibility to find alternatives is important. Case-finding
Local people are also usually very helpful if you ask for directions to another village, even if it is many kilometres away – they may not be able to tell you where it is on a map, but they will definitely point you in the right direction. Maps are necessary for those who are foreign to the area, not for the locals. Visiting some of the villages for case finding has been probably as interesting for the people in the village as for me – I don’t think too many white females are seen here, in fact in some villages adult women rarely go out. Covering my head/hair is not required here, but I think is more acceptable and respectful. Even if I could speak the local language it would probably not be appropriate for me to ask questions of the village head – our national staff doctor speaks Hausa and he has been doing a great job seeking information in the villages. Whether I speak or not, the village children will stare in fascination/fear until we depart. If I smile, some smile shyly back, others just stare. Our visit will have added some excitement to their day; fortunately in many villages there have been no cases of CSM to add excitement to our day. Read other articles on Nigeria
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