Dear Editor,
The announcement on Friday that a Guyanese woman had been tested for the suspected ebola virus following closely on Thursday’s discovery in the USA that a Doctors without Borders (MSF) doctor had been confirmed with the virus surely caused a heightened level of alarm in this country. The Cabinet’s prompt press release was helpful but I am left with a feeling that our approach leaves something to be desired especially as regards avoiding public panic.
I have had the opportunity to see incidents of such panic in two of the affected countries. It does nor bear repetition.
That spectacle makes imperative precautions that should be properly devised, elaborated and discussed both for completeness to ensure adequacy of policy response and to assist the very critical public information campaign.
The most glaring inadequacy is evident right at our doorstep and has nothing to do with foreigners. Friday’s suspected case arrived in Guyana without any acceptable entry protocol. It was not a West African. The immigration form asks travellers to specify from where they had travelled on the current trip but without a time reference. In spite of this the authorities neither knew nor were alerted to the fact that the visitor had been to West Africa. Which probably means that the forms are neither analysed nor supplemented by questions by the health authorities at the airport. It may also mean that some of our immigration officials do not know the countries of West Africa. I shall return to that matter. I am not suggesting that the authorities should have stopped the returning passenger but that they should have known and should have had arrangements made to alert all visitors from all the affected countries to contact a designated set of medical clinics or Doctors in the event of any problems. The Ministry or the crisis response teams should then keep a track of the developments at the clinics.
It goes without saying that some basic medical capacity should be provided at the airport but I shall return to this.
Let me turn to the irrelevance of the de facto West Africa visa ban. Foreign Affairs Minister Carolyn Rodrigues-Birkett is reported to have posted this statement on Facebook, “On September 9, 2014 all of our embassies and consulates abroad have been instructed by me not to issue visas to nationals from West African countries for the time being. The consulates and embassies have not issued any visas since ……. While this does not constitute a travel ban for persons from African countries, it is one measure aimed at dealing with this deadly virus….”.
The announced action and the similarity of its assumptions to that made by the MPs who had declined an invitation to attend a Commonwealth Parliamentary Association meeting in Central Africa seem more relevant to policy panic than a rational and careful and careful policy.
I am challenged to understand the relevance of the proposed action and the meaning of the Minister’s comment – it is not a ban, it is a measure! It is not even clear that only those West Africans already in possession of visas will be permitted to enter Guyana.
Those analysts who are looking at the current ebola crisis that erupted in March and now appears to be out of control in Liberia, Sierra Leone and Guinea are agreed on six points:
i. The epidemic is not restricted to any particular national or race of persons. Ebola/ebola Reston and the Sudan virus have appeared outside of Africa in the past – the US Centers for Disease Control has pointed out that Italy, the Philippines, Russia, UK and the USA have had the Sudan virus appear in the past. In these cases only in Russia was there a loss of life.
ii. The virus is transmitted by physical contact and bodily fluids and secretions including sweat, presumably faeces and mucus. That means that in Guyana the annual jamboree of flooding needs to be prevented at all costs. The same applies to the daily over-crowding in mini-buses.
iii. Since the disease is only contagious when the symptoms are visible, which seems to occur within 8-10 days of infection and, one of the earliest symptoms of the infection is exceptionally high body or elevated body temperature in the region of 103.5 degrees F, the Government should invest urgently in the special non-contact thermometers for use at all the ports of entry and, the placement of Health Staff familiar with the symptoms of both ebola and an illness with similar symptoms, malaria. I should not need to mention the need for protective gear at the ports and in the ambulances serving those places.
iv. The enforcement of our public health regulations and the quality of medical services and health systems – trained nurses, qualified Doctors, availability of beds, protective material and drugs will determine our ability to control the spread of the outbreak. There is a consensus except, dare I say, among the Government MPs that these systems need urgent attention. The Ministers of Finance and Health, Works and Local Government should ensure that funds are available to urgently upgrade the status in these.
v. The daily toll of persons dying of ebola across the globe has been accelerating but there is a need to keep it in perspective – it is currently 14 persons per day compared with 110 who die of TB, 552 who die of malaria and 685 who die of HIV/AIDS daily.
vi. The disease has triggered public alarm and sometimes panic but effective containment requires systematic and relevant action. On Friday the Head of the Red Cross pointed out that travel bans of the type that target Africa are irrational and unhelpful. The World Health Organisation is of the same view.
Whilst it would therefore be entirely prudent and understandable to try to isolate or exclude persons who may have been in physical contact with those infected or at risk, since the infection does not respect nationalities or race Minister Rodrigues’ statement to the effect that only persons of a particular nationality or cluster of nationalities are to be denied visas to visit Guyana is inappropriate, at best.
Is the implication of the restriction that a Russian or Indian national travelling through Guinea cannot be infected or that they cannot in turn infect Guyanese? The logical reaction to the findings I have mentioned above is that if a state believes that it does not have the capacity to diagnose or treat ebola victims, exclusion of those at risk should mean applying visa restrictions or refusing entry to all persons travelling from or through the three countries in West Africa within a specified time period, whether they are nationals or not!! The WHO and most states are now restricting their measures to the affected states. Some also extend the restrictions to the immediate neighbours.
Earlier this year a charming clerk at a Scotia Bank office in GT looked at a Senegalese passport and asked the holder where this country was located. When invited to guess she enquired, “in Europe?“ I know that the Consular staff abroad are better educated but it does cause one to pause for thought! Are the immigration officers any better? Are they being trained and will they be asking?. Have additional health officials been posted at the airport and ports since the Minister’s announcement?
In declaring the de facto ban, I wonder whether the Ministry bore in mind that there are 15 countries in West Africa including Cape Verde which is an island some 700 miles from the nearest affected regional state. Mauritania (1.03mn sq km) is a few miles less (766 in a straight line) but is separated from Sierra Leone by some 750,000 square km of the dreaded Sahara desert and Mali (1.2mn sq km). To get this in perspective Guyana’s area is 0.2mn km. Does a ban which includes such a massive state as Mauritania and an island, both far from the crisis area, make sense? The WHO recommends no such ban and Guyana should be careful about blind and firm sounding reactions which are not even in place in the main Caribbean states some of which have recognized the need to deal with all travellers rather than just West Africans. In fact Jamaica does not allow in even Jamaicans who have visited the affected states!
The first point is that this is not solely or primarily a visa problem because Guyanese and Commonwealth citizens can contract and bring the virus into Guyana. The exaggerated emphasis on a de facto visa ban is misconceived and gives false comfort to the public. The arrival of a Guyanese without the authorities being aware at the time of her entry of where she had travelled attests to my point. Whatever the nationality or race of travellers they should be specifically asked where they have been in the last month and all tested for fever.
Like Guyanese, West Africans, are currently living all over the world, in and out of Africa. Some Guineans, for example, are born of Guinean parents but may have never been to Africa or lived there. Under our regulations those persons would be denied a visa to Guyana. So would a Liberian student or Diplomat who left Liberia in May 2012 for studies or work in the USA. However, an Indian national who left Sierra Leone last week after living there for two months and who has been in contact with infected persons would be granted a visa! This is dangerous, to put it mildly.
Second, one cannot harbour the virus in its infectious stage without a high fever. Guyana has no arrangement in place to run a check for fever on all passengers entering and leaving Guyana. There is a relatively costless, quick, and effective test. It is not a guarantee but a necessary precaution. All travellers leaving and entering West African States have to undergo this. Entry to the USA requires it too.
I would like to pose the following questions and comments for the authorities.
On October 10th Brazil is reported to have had a suspected case of Ebola. It shares a border with Guyana and no obstacle by way of desert or sea separates us like they do many countries in West Africa. If that suspected ebola case had proven to be positive the adoption of the Guyana restrictions by other countries would see all Guyanese being denied visas to travel anywhere in the world. That has implications for commerce and services as a direct consequence of the cancellation of flights. The ban would adversely affect our exports via stopping business travel and limit individual’s ability to access advanced medical attention abroad. In Sierra Leone and Liberia in particular, a ban has affected investment and the ability of foreign investors, managers and finance staff to travel. New projects are delayed and jobs lost. Not surprisingly, their exchange rates have declined and imports have become more expensive at precisely the time when they can least afford it. It is having a drastic effect on incomes, individual well-being and national welfare.
Why should our Government compound the parlous situation of already poor countries by thoughtless and careless policy?
The World Bank has estimated that this year the loss in GDP likely to be suffered by Guinea, Sierra Leone and Liberia are over 2%, 8% and 12%, respectively. That is a disaster by any measure.
If the problem were to arise in Brazil I am sure that the Guyana Government and public would argue that being a neighbour is not so relevant because travel between Brazil and Guyana is limited and less than that to the USA. That is precisely the point.
Would Guyanese resident in Guyana willingly accept the arrangements announced by Guyana? Would Guyanese abroad?
What is good for Peter is good for Paul.
A more defensible and acceptable set of restrictions consistent with the recommendations of the WHO and elsewhere other than in the Caribbean, would be to deny visas to travellers who have been to any of the affected West African states within the last say, week or 41 days. Travellers would include both Africans and non-Africans.
It is instructive to note that the Dominican Republic for example has directed its restrictions only to foreigners who have visited the affected states within the last month.
So apart from the much vaunted visa and entry restrictions, there should be more meaningful checks on travellers, a basic medical test, the placement of more and specifically trained health officials and protective equipment at the airport and ports.
Additionally, the Ministry of Health and the authorities in general should now pay urgent attention to basic hygiene and public health issues. All the states in West Africa have begun campaigns to encourage citizens to wash their hands with anti-bacterial soap after contact and to take special care to wash food before its preparation. The easy availability of clean water would therefore be an issue. Both water and soap are being supplied to those in need. There is no reason why we should not be doing the same.
In a country where the disposal of waste, solid and liquid, can only be described as medieval, the authorities would also be well advised to devote significant additional resources to urgently putting in place acceptable facilities for the disposal of contaminated material as well as medical waste. We have to be also concerned about the entire chain of ‘handling’ and burial of infected bodies, in particular. This latter question of disposal of a large volume of contaminated material is currently challenging the US authorities. In Guyana, we already have a problem with the security of relatively small quantities of such hospital waste and the recycling of what are supposed to be disposable tools and gear.
The rainy season is not far off and the inevitable flooding of Georgetown in particular would heighten citizens‘ exposure to the spread of all viruses via the flooding of yards and their accessories such as septic tanks, latrines and the like, to which we are routinely subject during the rainy season. Even if the ebola virus never reaches Guyana, those facilities need to be urgently improved because with such terrible waste disposal we are fortunate to only have leptospirosis and gastro to deal with rather than cholera so far. For once the administration should resist the temptation to wait until the rains start by handing out last minute contracts without tendering. Safeguarding public health requires timely cleaning of drains and gutters, canals, servicing of pumps, and disposal of rubbish that would normally find its way into the waterways, well before the onset of the rains.
We should not continue to tempt fate.
Low pay and skewed distribution of protective gear for gravediggers has led to one major strike in Sierra Leone by the grave diggers. Infected corpses have been left in the streets at times, an unimaginable horror.
If the Government has completed the preparation of a plan to deal with ebola, its main elements should be made public, if only because the announcements so far by the Minister show a degree of inadequate action and incomplete analysis.
We all need to know and to have an opportunity to determine how this grave matter is being handled at this worrying time.
Yours faithfully,
Carl Greenidge
