When Nigeria was hit by its first outbreak of the Ebola virus, health workers monitoring suspected cases armed themselves with mobile phones and an Android app that cut the time it took to report the onset of symptoms.
The app and most of the phones were provided by eHealth & Information Systems Nigeria, a Santa Ana, California-based non-profit research company that operates in the northern city of Kano. Ebola Alert, a group of volunteers, used Facebook and Twitter to educate Nigerians about the illness. Google Inc.’s Nigerian unit organized training sessions for journalists on how to use Google Trends to identify top questions most people wanted answered about the disease.
The phone app helped reduce reporting times that would normally take 12 hours by half initially, then 75 percent, before becoming almost real time, according to Daniel Tom-Aba, senior data manager at the Ebola Emergency Operation Centre in Lagos. Information previously written on forms by hand before being sent to databases could be updated immediately, he said.
“With Ebola, time is very important,” Adam Thompson, the chief executive officer of eHealth & Information Systems, an organization that had gained experience fighting the polio virus in northern Nigeria, said by phone from Kano. “If there’s a two or three-day lag in order to get a contact to the list, this could be a problem. The person could be in a different country by that point.”
After a two-month campaign, during which more than 800 people who came into contact with infected persons were placed under surveillance, Nigerian officials are confident the outbreak has been contained. The Health Ministry isn’t monitoring anyone at the moment and expects Nigeria to be declared Ebola-free by the World Health Organization about Oct. 20, spokesman Daniel Nwomeh said by phone on Oct. 3 from Abuja, the capital.
Nigeria, Africa’s most populous nation with about 170 million people and the continent’s biggest economy, recorded 19 cases, with seven confirmed deaths and 12 recoveries, according to the Health Ministry. That’s a 40 percent fatality rate for a disease that could kill as much as 90 percent of those infected.
The latest Ebola outbreak in West Africa has killed more than 3,400 people, according to the WHO, making it the worst in history.
eHealth is exporting its app-loaded mobile phones and other tech-based tools to Sierra Leone, Guinea and Liberia, the three worst-hit countries in West Africa.
“We’ve established three operations in Sierra Leone, Liberia and Guinea,” Thompson said in an Oct. 4 e-mailed response to questions from Freetown, the capital of Sierra Leone. “We’re managing about $14 million of private foundation funds to support emergency operations.”
The main lessons in Nigeria were the importance of fast communication and instant tracking.
“One of the key things that worked for Nigeria was the fact that we knew the index case and we were able to trace all the contacts back to him,” Tom-Aba said. “Every contact tracer had a GPS incorporated in their phones so we knew that they had gone to the contact’s house. That built accountability.”
Liberian civil servant Patrick Sawyer introduced the virus into Nigeria when he arrived on July 20. Sawyer and four of the health workers who treated him also died of Ebola. Contact tracers made 18,500 home visits to check on people who may have been exposed, according to a Sept. 30 report on the website of the Centers for Diseases Control and Prevention.
Laboratory technicians conducting tests were given tablets to scan and upload results to the emergency center data base. Field teams in turn got text-message alerts on their phones informing them of the results, he said.
Journalists were also shown how to create visuals using Google Maps and Google Earth to better tell the story.
“From the beginning of August to mid-September, about two terms in the top five searches were Ebola-related,” Taiwo Kola-Ogunlade, Google’s communications manager for West Africa, said in a phone interview from Lagos on Oct. 6. “We noticed journalists were missing the story because people were asking questions as simple as, what is quarantine?”
Lawal Bakare, a 31-year-old dentist, corralled Facebook friends at home and abroad to create Ebola Alert, which educated Nigerians about the disease online.
Within a week, they formed a partnership with the government to operate a helpline that took 600 calls a day. The group’s Facebook and Twitter accounts have more than 30,000 followers combined as of Oct. 6, and its website, www.ebolaalert.org, had 4 million hits in August alone, Bakare said.
As Nigerians’ interest in Ebola wanes, a growing amount of traffic is now coming from the U.S., which diagnosed its first case of the disease in Dallas last week. The patient, who is in critical condition at Texas Health Presbyterian Hospital Dallas, had traveled from Liberia. Bakare estimates that about 21 percent of the group’s followers are now from the U.S.
Fast communication in a country where they are 130 million mobile-phone users had its downside: unsubstantiated rumors.
Some text messages circulated saying that drinking a salt solution would prevent the infection. At least two people were confirmed dead from drinking too much salt by the Health Ministry.
“As the rumor mongers are generating their rumors, we are countering almost real-time on Twitter especially to manage panic,” Bakare said.
He cited the example of a Lagos church that put up a poster advertising “free immunization” from the virus.
For Nigeria, the next target in the fight against Ebola is to halt its spread in Liberia, Sierra Leone and Guinea, according to Alex Okoh, the director of Port Health Services in Lagos.
“We may be Ebola free, but as long as there’s still an outbreak in the sub-region, we’re still at risk,” she said in an interview. “We can’t let our guard down because we still have people criss-crossing the continent.”