Ameyo AdadevohBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7558 (Published 16 December 2014) Cite this as: BMJ 2014;349:g7558
All rapid responses
This is a most useful article that emphasizes the essentials in effective management of epidemics of the magnitude we have seen in the Ebola crises. Having followed the story of how Nigeria intervened to contain the epidemic, I have noted, in particular the following that the article also seeks to highlight: Medical professionalism as demonstrated by Dr. Ameyo Adadevoh and her team including Dr. Ada Igonoh; early and rapid response of government with direct involvement of the Minister of Health; effective tracing and monitoring of contacts; effective health education to engage the public in a manner that does not generate panic; availability of resources for management of patients. The saying is always true that "a stitch in time, saves nine". The Nigerian government and the health care team must be commended for the prompt response to the crises. Likely, this saved millions of lives in Nigeria and in other neighboring countries and perhaps in the rest of the world. And Nigeria would not have been this successful in containing the Ebola epidemic without quality leadership demonstrated at all levels.
Other critical point in the article that must not escape attention is the emphasis of Dr. Ada Igonoh on early and continuous rehydration in her management as an Ebola patient. Fluid and electrolyte replacement is key in saving lives in this epidemic. That fact must be stressed. It is a basic public health measure, simple but most effective in management of diarrhea diseases such as in Ebola and cholera.
Reading the original article of Dr. Ignoh, I am impressed by her professional act in isolating herself at home in the prodromal phase of her illness. By this action, she has shown how we as health care professionals should act rationally and selflessly to protect others when we are victims of a contagious disease.
Competing interests: No competing interests
Dr Adadevoh was clearly an autocrat. In infectious disease control, when murderous bacteria or viruses are involved, there is no room for endless discussions. A clear chain of command.
Dr Konotey-Ahulu mentioned Nigeria. Here too it is clear that:
The medically qualified Minister was the " Supreme Commander" with over all control of everything and everybody, needed to extinguish the outbreak.
The second lesson is that foreigners are not needed in epidemic control. Here we need locals held in respect, even awe, by the populace.
Other West African countries might care to study the Nigerian Example. Even the WHO and the Western Public Health Systems might learn from Nigeria.
Competing interests: No competing interests
The impressive account (Feb 7) that Dr Anne Gulland gave of Dr Ameyo Adadevoh contracting Ebola Virus Disease (EVD)  corroborates the very moving account by Dr Ada Igonoh, her Assistant who herself was to be prostrated with the deadly illness before seeing her boss wheeled in later to the same female ward in a coma to die. Dr Igonoh’s blow by blow account of the clinical features of EVD  is the best I have read in any textbook or website be it from WHO, CDC, or NIH .
Dr Ameyo’s amazing account in her own words can be read at http://bit.ly/1oPFf42 but I mention some of the corroborations: Dr Gulland says “Sawyer was desperate to be discharged, and he put a lot of pressure on Dr Adadevoh …but Adadevoh – a formidable doctor who was known among colleagues as ‘first lady’ of the hospital – would not bow to his demands” . Then Dr Ada Igonoh (shown as strikingly beautiful as Dr Ameyo Adadevoh) records: “At about 5.00 pm he requested to see a doctor. I was the doctor on call that night …he had stooled five times that evening and he wanted to use the bathroom again. .. He was acutely ill. Dr Adadevoh told the ECOWAS official the patient could not leave the hospital in his condition” .
Dr Gulland: “Once Ebola was suspected, Adadevoh and her staff were forced to improvise, putting a wooden barrier outside Sawyer’s door.”  Dr Igonoh recounts: “Dr Adadevoh at this time was in a pensive mood. Patrick Sawyer was now a suspected case of Ebola, perhaps the first in the country. He was quarantined, and strict barrier nursing was applied …A wooden barricade was placed at the entrance of the door …vomiting and diarrhoea persisted. The fever escalated from 38c to 40c.” 
Dr Gulland: “Adadevoh went on line to download information to distribute to doctors and nurses.” 
Dr Igonoh: “Dr Adadevoh went on line, downloaded information on Ebola …distributed to the nurses, doctors, and ward maids.”  Dr Gulland: “Sawyer died on 25th July, and Adadevoh was diagnosed as having the disease a few weeks later”.  Dr Igonoh: “At 6.30 am Friday 25th July, I got a call from the nurse that Patrick Sawyer was completely unresponsive. Again I put on the protective gear and headed to his room. I found him slumped in the bathroom. I examined him and observed that there was no respiratory movement. I felt his pulse, it was absent. We had lost him. It was I who certified Patrick Sawyer dead. I informed Dr Adadevoh immediately and she instructed that no one was to be allowed to go into his room for any reason at all. Later that day, officials from W.H.O came and took his body away. The test in Dakar later came out positive for Zaire strain of the Ebola virus. We now had the first official Case of Ebola in Nigeria”.
How Nigerian Government rose to the occasion, how Ada Igonoh herself monitored her symptoms and signs – fever, weakness, anorexia, vomiting, diarrhoea which she described as stooling, the furred white tongue, the skin rash, and describing how colleagues died all around her in the special ward, how Dr Adadevoh was wheeled in in coma to die, how one Caucasian doctor, Dr David from Virginia USA visited her up to twice a day, and how he advised her not to take the Imodium she was swallowing to block stooling but let the virus escape in the stools … And how she drank ORS (Oral Rehydration Solution) 4 to 5 Litres a day “like my life depended on it” – all so well documented that this needs to be a MUST READ for health workers anywhere in the world. “To contain the frequent diarrhoea, I had started wearing adult diapers, as running to the toilet was no longer convenient for me. The indignity was quite overwhelming but I did not have a choice.” 
NIGERIA’S PREPAREDNESS FOR EBOLA VIRUS DISEASE EPIDEMIC
Professor Onyebuchi Chukwu, Nigeria’s Federal Minister of Health “with a crack team, implemented diligent efforts and protocols that halted the disease within three months of Sawyer’s diagnosis. The result: Nigeria reported only 20 cases of the disease, and by 19 October 2014 the WHO declared the country Ebola free” . In the words of Professor Onyebuchi Chukwu, trainer of doctors in a Teaching Hospital in Eastern Nigeria before President Goodluck Jonathan appointed him Federal Minister of Health in June 2011 “Four main factors helped us control the epidemic: (a) Leadership – President Jonathan provided effective Leadership – he got Governors of States involved. (b) Coordination – Ministry of Health working in coordination with the State Governors. You need a Minister of Health who understands his role as the Chief Medical Officer of the country. (c) Thirdly, Infrastructure. Health Infrastructure. When I came into office, for the first time in the history of Nigeria, the government established a Centre for Disease Control. It never existed before I became a Minister. So, that was one infrastructure we lacked in previous epidemics…. (d) The fourth factor was that the state of epidemic is not what you toy with. It should be regarded as war…When the President declared Ebola a National Emergency I had extra powers to exercise full control as a Minister, to be able to control everyone – from Governors, Commissioners of Health, health workers, even ordinary Nigerians – on behalf of the President.”
HELP FROM INTERNATIONAL COMMUNITY ON EBOLA
Asked if he was satisfied with the support the international community has provided? This was what Professor Onyebuchi Chukwu said: “Yes, I am satisfied but I would say the help came late. The world did not respond in time. Again, it seems we don’t learn anything .When we had the genocide in Rwanda, the world reacted late. Now, this is not genocide by human beings. This is genocide in some other form – this time by a virus. We again responded late. But at present we are responding well.” 
Other African countries will do well if their Ministers of Health are as astute as Professor Onyebuchi Chukwu, and their doctors and nurses show as much diligence in caring as the late Dr Ameyo Adadevoh and her able Team some of whom also died did to save lives.
Competing interest: None declared
Felix I D Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool)
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street Ltd, Phoenix Hospital Group, London W1G 9AL
1 Gulland Anne. Ameyo Adadevoh – Physician and Endocrinologist who was instrumental in containing the Ebola epidemic in Nigeria. BMJ 2014; 349:g7558 [February 7 2015]
2 Igonoh Ada. Through the valley of the shadow of death. Bella Naija publishes Ada Igonoh’s story of surviving Ebola http://bit.ly/1oPFf42 December 2014
3 Eze Peter. The man who fought and won the Ebola war in Nigeria – Professor Onyebuchi Chukwu. New African, London, February 2015, No 547, pages 42 - 43.
Dr Ameyo Adadevoh’s Assitant Dr Ada Igonoh survives Ebola Virus Disease
Competing interests: No competing interests