Hats off to Ministry of Health |16 January 2018

It is with great pleasure that the Seychelles Civil Society (SCS) on behalf of the people of Seychelles wishes to pass on our profound congratulations to the health workers, the nurses, doctors and everyone involved in keeping the plague from contaminating our nation. The team who worked at the forefront must receive some kind of award and recognition for their bravery and quick reaction that saved the plague from Madagascar from contaminating our small island state and in particular we wish to thank Dr Meggy Louange and Dr Jude Gedeon for their dedication in making sure the plague that threatened our nation was dealt with appropriately and timely otherwise we could have found ourselves in deep trouble. The plague is more devastating than a swarm of locus.

When things go wrong we are quick to complain but when things go the right way we tend to be complacent and accept it as though it is the norm but believe me, had this crisis not been properly and appropriately handled and dealt with, today we would be going round wondering if anyone in our family and close friends have been contaminated with the disease or not and the fear level to even hug someone, leave aside kiss your close family and relatives, would not have been a pretty situation for us to have found ourselves in. I am not a prophet of doom but I am an advocate that prevention and appropriate action can save lives and property because accidents don’t just happen; usually in 99% of cases of an accident a human being or several or the authority has been negligent and has caused the accident.

The Ministry of Health personnel have risen to the challenge and we have been spared a crisis which could have been on a biblical scale, make no bones about it this is serious my friend. In monetary terms their prompt action and determination has saved our health budget millions of rupees and dollars because if the outbreak had not been contained we would have had to bring in specialists from overseas and they do not come for free especially when such a contagious disease is involved. The Ebola outbreak in West Africa would have paled into insignificance had the plague not been contained by our health workers. Think about the cost in lost tourism revenue this would have caused our nation.

Origin of the plague

Between 1346 and 1353 there was a plague pandemic that killed 200 million people in Europe and Asia, then known as Eurasia. The bacteria Yersinia pestis were carried by people who used the Silk Road to trade and the black rats infested the ships as they ploughed their trade from Crimea to the Mediterranean then on to Europe. They called it the Black Death because once infected the fingers, toes and nose turned black as the gangrene virus starts to multiply and the flesh starts to rot. There were then different varieties of the plague. Elsewhere it is estimated that the plague killed 25 million Chinese and decimated other Asian countries before reaching Constantinople in 1347 and then the disease spread to Venice in Italy and Paris in France.

In England the Black Death was a pneumonic plague pandemic, which reached England in June 1348. It was the first and most severe manifestation of the pandemic which originated from China. The plague was spread by flea-infected rats, Xenopsylla Cheopsis, as well as individuals who had been infected. The rats acted as the reservoir hosts for the bacteria and the Oriental rat flea was the primary vector. The plague killed in the region of 40% of the population of England.

There are two main types of the plague -- bubonic plague and pneumonic plague. The former manifests itself when the contaminated person shows signs of acral gangrene of the extremities such as fingers, toes and nose. The person must be bitten by the flea to be infected, it is not transmitted from person to person. The lymph glands in the inguinal, groin and armpit grow large and ooze out puss and in nearly every case the person so infected died in the old days because there were no antibiotics.  The pneumonic plague on the other hand, like the one in Madagascar, affects the lungs and damage the respiratory system and the sufferer dies within 2 days. The incubation period, that is to say the period when one person can harbour the disease and pass it on to someone else is 7 days which is why the athletes and officials who came back from Madagascar and the relatives they had been in contact with were quarantined just to make absolutely sure they were not infected. Some of them complained on social media that they were unnecessarily quarantined which was not true. The contamination takes place when the person carrying the virus coughs and the droplets from the carrier is inhaled by someone else and the virus is transmitted and starts to infect the respiratory system of the person who has inhaled the droplets. No flea biting is involved.

As soon as anyone is suspected of being in contact with someone else or has visited an infected country or area this person must be quarantined, no ifs and buts about it. The government has the power through its security forces to apprehend and quarantine such a person and this action in no way violates the person’s human rights. In survival terms, which seems unfair and unjust, a few can be sacrificed to save the majority and when this situation arises a decision has to be taken by the “Commander” whoever he or she may be and he/she must take the decision to sacrifice a few in order to save the majority. This is how the cookie crumbles and although it appears harsh it is a Prima Facie consideration under such survival conditions.

Adherence to culture can kill

The Madagascarian culture of digging the graves of the dead relatives and rewrapping the dead body in fresh wraps is the cause of the recurring outbreaks of the plague in Madagascar and yet people keep doing it and we have to be thankful that the Seychellois culture does not call for us to dig up the dead body of our loved ones once they have been buried. It is believed the plague in Madagascar originated from India centuries ago and in India today some people carry their dead loved loves for a trip around the town for the dead person to have a look at the town before they bury him/her. It is bizarre but it takes place. This is in some way analogous to but not as dangerous as the way some Seychellois do not visit you when you are alive but they turn up for your funeral as if your dead body can acknowledge their presence at the funeral. Clearly the person who does this is either looking for spiritual forgiveness for not visiting you while you were alive or it is their way of achieving closure. For whatever reason it is also bizarre but it happens.

In relation to the 49 out of 50 athletes and officials who travelled to Madagascar, upon their return they were quarantined including their relatives they had made contact with upon their return and they were all treated with doxycycline antibiotics as a precaution. Doxycycline is good for treating pneumonia, acne, chlamydia, cholera, syphilis, urinary tract infections, gum disease inter alia. Sadly one of our compatriots who contracted the disease in Madagascar had to be cremated in Madagascar and our prayers and condolences go out to the family. Sadly and unfortunately it was the only way to deal with the matter under the circumstances. Once cremated at 1000 degrees centigrade the ash becomes safe to come home for the appropriate burial ceremony.

We have to take our hats off to our health professionals who insisted that Madagascar carry out an autopsy which they were reluctant to do, they just wanted to airfreight the body to Seychelles which could have created a major catastrophe yet in Madagascar they have the French sponsored DNA analysis and PCR facility to test the DNA because they deal with the plague as a national disease that has not been eradicated and from time to time it flares up due to cultural activities as explained above. We must also thank the World Health Organisation (WHO) who was quick to assist us in our hour of need by providing gowns and masks, inter alia.

What lessons have we learnt if any?

The plague is on our door step in Madagascar and many people from Madagascar work in Seychelles therefore the risk of the plague arriving in Seychelles is high and I would say as high as the arrival of another tsunami, my pet subject. According to our health professionals we need to create a new Isolation Unit and purchase as many of the essential equipment we need to test DNA and carry out other essential tests modern day life has created. The number of flights arriving in Seychelles makes it imperative that we get ourselves prepared for any unforeseen health and other events. If Ebola breaks out again you bet your bottom dollar air travel will be affected and we in Seychelles must have the protection we need. We at Seychelles Civil Society (SCS) will make it a priority to ensure that all facilities and equipment to save our lives are being procured because there are many areas of waste of public money that can be avoided and the money spent on prevention rather than fire-fighting an event when it has happened, usually it is too late and lives are lost unnecessarily.We must remain vigilant because we live in a turbulent world and the next catastrophe is only a stone’s throw away from us therefore our Emergency Services must be co-ordinated and must remain on the alert 24 x 7 and we must provide the necessary funding for this level of security to be afforded to our nation.

Finally we must thank the Integrated Disease Surveillance and Response Committee (IDSR) comprising the Health Ministry, DRDM, Red Cross, Ministry of Tourism and others who responded quickly and positively and delivered their respective diligent contribution as they mapped out the situation and met regularly to monitor the crisis. What we need in Seychelles is a Disaster Control Centre where we can monitor all aspects of civil and military activities including how many fish our licensees are catching from our ocean. We need one Command and Control Centre located on the mountain and connected to all the emergency and security agencies staffed 24 x 7 because we do not know what is round the corner and right now we are very vulnerable because all our essential services, food, electricity, oil, transportation, telecommunications, are at sea level and nothing is being done about it thus putting our lives at risk when appropriate actions can be taken to save our nation from unrecoverable disasters. 

Once again congratulations to our Ministry of Health under the stewardship of Minister Jean-Paul Adam. This is not the end this is only the beginning and we must take this as a warning and a lesson that we are not prepared for catastrophic disasters. Our next move will decide whether we live or die. The choice is ours to make because our future is in our hands.

Contributed by:

Barry Laine FCIM, FInst SMM, MCMI, MBSCH

Seychelles Civil Society