SARS - Ghana's Emergency Preparedness

Could this era be called the Age Of Epidemics in the light of the outbreaks of HIV/AIDS, Ebola Fever, Mad Cow, Anthrax and now Severe Acute Respiratory Syndrome (SARS)?

When the Black Death struck in the 14th Century Africa was spared as it devastated Europe and Asia but because the world has become increasingly compact the new strands of epidemics are having their toll in many more areas.

So far there has not been any confirmed case of SARS on the African Continent but should there be an outbreak would the Continent be able to cope?

Do developing countries have a strong public health system to withstand and endure large-scale epidemics, disasters or any public health crisis?

In the first few weeks after SARS arrived on the scene, the threat of HIV/AIDS infections, terrorists attacks, suicide bombing and the fear of attacks from America's so called "rogue" nations" that had engaged the world's attention paled into insignificance. All eyes were riveted on the ferocious havoc being unleashed by SARS in Asia and North America.

Ghanaians like many others in Africa waited with bated breath silently praying that the disease would spare Africa as it took a toll on human lives, health facilities, air travel and tourism elsewhere.

The World Health Organisation Regional Office for Africa was already in contact with all 46 countries in the Region. Guidelines for preparedness, including case management, have been provided, but there are still apprehensions.

SARS is characterised by symptoms including high fever (over 38 degrees Celsius), cough, shortness of breath and breathing difficulties.

The deadly SARS virus is mostly spread by close person-to-person contact involving exposure to droplets.

For most African countries like Ghana, the arrival of SARS would be devastating considering the existing facilities that could be marshalled to combat it.

The disease has been striking with speed killing hundreds and afflicting thousands beginning in China, its birth-place, and spreading across 26 countries by April this year.

Asian markets, travel and tourism, health facilities were crumbling under the weight of SARS. According to the World Health Organisation (WHO) the global cost of SARS by early May, was approaching 30 billion dollars.

Virologists, epidemiologists and other scientists were up in arms trying to network to find out more about the disease and possibly find a cure or vaccine.

With time more would be learnt about SARS but as yet it remains a threat and a pointer to the fact that Ghana and other developing countries would have to sit up should SARS or any other epidemic make an appearance.

Weak and inefficient health systems, poor surveillance and monitoring structures and non-existing emergency response systems are recipes for disasters.

SARS offers a gloomy picture for African countries. The continent has not majored in preventive medicine.

Factors that would facilitate the spread of SARS include overcrowded and filthy dwelling places in major cities and the ability of the virus to survive outside the human body and become attached to common places like door handles.

United States has put in an advanced party to meet the disease should it make any lethal appearance in that country.

Thousands of Customs and Immigrations Agents and other Federal Homeland Security workers in the US are being trained to spot symptoms of SARS and have orders to detain people, who exhibit them. The training is part of the Federal Government's effort to prevent an outbreak of SARS there.

In the face of emerging global epidemics and public health crisis, it is inconceivable that Ghana would just be waiting unprepared for an epidemic before going into action.

The need for reliable emergency response service and disaster preparedness is critical.

The current poor road and telecommunications networks, poor hospital equipment, vehicles and the mass exodus of health personnel make the situation precarious.

Currently, there is no well-developed ambulance system in the country to take care of victims of epidemics.

Modern health systems in China and sophisticated medical facilities in Hong Kong have buckled under the weight of SARS.

Ghana and other African countries must learn from China and put in more resources to handle infectious diseases.

China, better resourced than most countries in Africa, said they were ill prepared in terms of the ability of doctors and nurses as well as equipment and facilities to deal with the SARS scourge.

Beijing, by April, had recorded 1,440 probable SARS cases, with 75 deaths and because of a shortage of beds at designated hospitals, not all suspected SARS patients could be hospitalised there in a timely manner.

With the soaring cases of SARS, records from Beijing showed that it had 32,000 registered doctors and 34,000 qualified nurses to serve its 13 million people but that less than 3,000 medical staff had specialised in respiratory illnesses to handle the disease.

They said the city had no specialist hospital for respiratory diseases. China's state media had reported that 200 patients were scheduled to be transferred on to a converted hospital in the northern suburb of Xiao Tangshan, which local officials said 7,000 workers were rushing to complete.

The Beijing Municipal Government has mobilised people from all walks of life to build a citywide epidemic prevention network in the battle against SARS.

Acting Mayor Wang Qishan of Beijing was quoted, as saying at a press conference that joint efforts of the whole society for epidemic prevention and control was the key to victory in the battle.

China's battles are certainly lessons for Ghana. One area that needs urgent attention to help Ghana cope with disasters is the brain drain "syndrome" in the health sector.

Inadequate health personnel coupled with the lack of specialists would surely pose a problem in the provision of any meaningful emergency services.

Statistics made available to the GNA from Ghana's Health Ministry show that three years ago, the doctor to patient ratio was 1:22,000 whilst that of the nurses was 1:4,000. These are grossly inadequate numbers to cope with any public health crisis.

The measures instituted when word came around that two Ghanaians, who had contracted SARS were on board an Egypt Air flight due to land in Ghana, was very commendable.

The step by step approach that involved a team getting on board the plane to verify the presence of the supposed SARS sufferers and the subsequent discovery that they were not on board showed that for once Ghana was not going to look on unconcerned to be overwhelmed.

Indeed when the two eventually arrived after the Egyptian Health Authorities had cleared them and that, notwithstanding, their being quarantined and the disinfecting of all the passengers on the tarmac really showed that for once Ghana meant business and was not ready to leave things to chance.

One only hopes that it was not a flash in the saucepan and that more permanent solution would be found to the problems the Health Sector faces.

Government would do well to heed calls of health professionals for better conditions of service so as to stem the brain drain in the sector.

It is heart-warming, therefore, that the Ministry of Health is mapping out strategies to involve the private sector in the provision of health care.

This would be a breather for the public health system in emergency preparedness.

Dr Kwaku Afriyie, the Health Minister at his turn in the meet-the-press series in February this year, stated that the Ministry had developed a strategic plan in response to enhanced private-sector participation in the health sector.

"Currently, we have set a target of increasing participation of the private sector in clinical care from the current level of 35 per cent to 65 per cent in the next 10 years," he said at that meeting.

This arrangement should help in supporting the public health sector in providing wider health care services.

Another issue is the need to establish adequate structures for emergency medical services. Specialised units and blocks should be established within the teaching hospitals for emergency services.

The Korle Bu Teaching Hospital is now undergoing rehabilitation after developing leaky roofs and run-down structures.

Hospitals such as the Police Hospital, which could help in times of public health crisis, are in no better shape either. The Police Hospital with its 100-bed capacity is too small to handle any major public health crisis.

Besides it is also facing a host of problems including the exodus of medical staff and inadequate and run-down equipment.

An effective telecommunications and road network is also needed to facilitate a good emergency response. Possibly, an emergency helicopter services should be introduced to carry trauma victims safely to hospitals.

Ghanaians, in spite of all efforts must also adopt healthy lifestyles and keep clean environments as pre-requisites to avert epidemics.

Maybe it is time for the President to launch a special initiative on disaster preparedness.