The dynamics of the disease and its recent epidemic
The RVF (Rift Valley Fever) virus is a viral disease that normally affects sheep, goats and cattle; while uncommon, there are instances where the disease does affect humans and as such due to the infectious nature of this particular type of virus it has actually been classified by the U.S. government as being usable as a potential biological weapon (Hanafi et al., 2011). While in the case of humans the virus normally manifests itself as a mild fever, there are instances where more severe manifestations do take place which result in a subsequently fatal hemorrhagic (internal bleeding or the coughing up of blood) response by the body (Hanafi et al., 2011). Within the latter half of 2006 to the beginning of 2007, the RVF virus affected the horn of Africa (regions encompassing: Somalia, Djibouti, Eritrea, Ethiopia and Kenya) and other regions as well resulting in 300 human deaths and nearly 1,000 reported cases of human infections with thousands of animals infected as well (Rift Valley fever, 2010). This greatly affected the local economy of the regions which, as a result of years of famine, created numerous adverse effects such as an increase in crime, starvation and even mass migrations (Clements et al, 2007).
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The immediate and broader contextual factors that caused the outbreak
From the perspective of De Boer et al. (2010), the main cause of the outbreak was the sudden rise in the mosquito population brought about by the unusually heavy rains from 2006 – 2007 which created ideal breeding conditions however De Boer et al. (2010) goes on to state that even though the ideal conditions were present there were other contributing factors that ensured that the RVF virus ran rampant and caused a subsequent outbreak (De Boer et al., 2010). The first problem is that there were insufficient means of early warning and detecting in place that could have prevented the outbreak from happening in the first place (Sissoko, 2009). The second problem was that the region lacked sufficient resources and facilities in order to employ proper vaccination logistics in areas where they would be necessary the most (Sissoko, 2009). The third problem is the fact that local livestock raising practices are far from western standards resulting in practices that are unsanitary and are the breeding grounds of diseases (Sissoko, 2009). Lastly, the sheer size of the horn of Africa and the various regions it encompasses along with problems regarding proper communication and support between farmers and authorities results in epidemics being well underway when authorities become aware of them resulting in problems during the intervention (Sissoko, 2009).
Public health challenges
As Flick and Bouloy (2005) explain, the main problem in preventing the spread of RVF in the case of the Horn of Africa is the late detection of the disease in animals and humans which results in delays in the proper intervention (Flick and Bouloy, 2005). To better understand why this is such a problem the views of Hall et al. (2011) are going to be explored to show the overall impact of delayed intervention in the case of communicable diseases within specific areas. In their study which explored the spread of communicable diseases and proper means of quarantine and isolation, Hall et al. (2011) state that late detection of any contagion can and will result in it being well established within a local population making it that much harder to resolve the epidemic as compared to situations where viral outbreaks are detected early on resulting in proper measures of mitigation, isolation and treatment (Hall et al, 2011). For example, if five cattle within an open pasture of 100 cows had a variation of the Foot and Mouth disease (Aphtae epizootic), it is very likely that all the cows within the isolated heard could develop the same disease within a month or even less as a result of varying means of transmission (i.e. through shared feed troughs, vehicles, clothing, etc.). This could lead to the culling of not only the heard within the pasture itself but in surrounding pastures as well due to the danger of spreading the disease to other pastures within the region (Law and Mol, 2011). On the other hand, if the disease is detected early on and the infected cattle euthanized before it spreads this saves not only the remaining 95 cattle but also ensures that other pastures will not have to cull their livestock. In their report, Hall et al. (2011) go on to explain that early detection failures also result in the spread of the disease into multiple areas thus stretching available resources such as manpower and vaccination services which actually contributes to the continued spread of the disease making the situation invariably worse (Hall et al, 2011). Evidence of such an occurrence in the 2006/2007 RVF fever outbreak in the Horn of Africa can be seen in the article of Clements et al. (2006) which showed that as a direct result of delays in early detection the RVF virus spread quite quickly in regions such as Kenya and Tanzania with local floods, rusting vehicles and unusable bridges further compounding delays in intervention which lead the disease to spread “more than it should have” in the words of the author (Clements et al. 2006). Another way of looking at this problem is from an economic and regional perspective, as mentioned earlier in this paper the practice of livestock raising in the horn of Africa is drastically different from that of other countries such as the U.S., the U.K. or New Zealand with practices in various African nations being downright unsanitary in terms of the condition of the livestock pens, the areas where they are allowed to graze and the number of flies that surround many of the pastures (Behnke, 2008). The reason behind this is mainly due to lax or altogether absent government regulations meant to ensure that livestock is raised in a clean environment so as to prevent the occurrence of communicable diseases (Behnke, 2008). Unfortunately, since such practices are not in place many farmers utilize age-old methods of raising livestock which has been used in Africa for hundreds of years (Livestock: the Horn of Africa, 2011). This has resulted in many herds of cattle, sheep and goats being susceptible to diseases as a direct result of their exposure to a disease-ridden environment (Livestock: the Horn of Africa, 2011). Chevalier et al. (2004) elaborate that it is the current practices utilized by farmers that contributed to the spread of the RVF virus since not only do they not employ proper methods of sufficient environmental control and sanitation they also neglect to implement proper methods of disease testing and examination which are used regularly in farms in locations such as the U.S., the U.K. and Europe (Chevalier et al., 2004). There are two reasons behind this: the fact that implementing regular methods of animal testing is beyond the economic ability of most farmers within the region and the fact that based on the report of Moritz (2009) farmers within the horn of Africa (particularly those in Kenya) have always relied on visual and cultural traditions regarding disease detection which is a highly inefficient means of disease prevention since this means that the disease has already infected an animal to such an extent that physical symptoms have already manifested themselves (Moritz, 2009). This in itself is a contributing factor to the spread of the RVF virus since without regular checkups and a reliance on a visual means of detecting the virus would of course run rampant. It must also be noted that both Fontenille et al. (1998) and Witt et al.(2011 ) agree that aside from problems related to late detection there are issues related to the current capability of local veterinary and medical facilities within the Horn of Africa that could sufficiently deal with outbreaks as they occur (Fontenille et al., 1998) (Witt et al., 2011). What must be understood is that even if methods of early detection could be put implemented the current state of the region’s facilities in regards to disease prevention are in the words of Chew (2011) “woefully underequipped, undermanned and lacking in the necessary capabilities to deal with the sheer amount of diseases that occur within their jurisdiction on a yearly basis” (Chew, 2011). Various articles explaining the spread of the RVF disease have in fact detailed that several veterinary facilities within key regions in the horn of Africa have outdated equipment in the form of old and barely usable cars and trucks which when combined with the limited resources of such institutions makes disease intervention within the horn of Africa challenging at best nearly impossible at worst (Outbreaks of Rift Valley fever in Kenya, Somalia and the United Republic of Tanzania, December 2006-April – 2007, 2007). There have been accounts of veterinarians having to hitch rides on helicopters with dispatched medical personnel in order to reach regions affected by RVF virus and floods due to impassibility of the terrain which occurs during the unusually high volume of rain which is one of the indicators of the disease as mentioned earlier in this paper. Another factor that should be taken into consideration is the fact that the account of veterinarians hitching rides with medical personnel to affected areas only occurs when there are human cases of RVF infections, this means that the virus has been allowed to spread unchecked into the local animal population base before a proper means of intervention can even arrive which is indicative of a failure insufficient government initiatives and resource allocation in helping various veterinary departments and institutions in properly responding to outbreaks as they occur. That meant that by the time proper vaccination logistics could be implemented in the affected areas there would have already been multiple cases over a widespread area thus resulting in a far more difficult process in isolating, vaccinating and controlling the spread of the virus. Taking all these factors into consideration it becomes quite obvious that proper control methods need to be implemented so as to prevent future problems such as this from occurring.
Based on the presented data regarding challenges to public health, this section will detail the various measures that could be put into effect in order to help prevent the spread of the RVF virus in the future. One of the first challenges that need to be addressed is the issue of early detection and control of outbreaks. As mentioned earlier, the RVF virus usually occurs in seasons of unusually high rainfall which allows stagnant pools of water to create a subsequent boom in the mosquito population within Africa resulting in the spread of the virus. One way of addressing this is a proper means of forecasting when such high rainfalls will occur. It was actually noted in one article that NASA was actually able to predict the occurrence of the RVF virus in 2006/2007 based on atmospheric readings indicating when a substantial amount of rain was going to fall on the horn of Africa. Other methods within the region have at times relied on examining the changes in the local vegetation which coincided with the occurrence of conditions that promote the spread of the RVF virus (Indeje et al., 2006). Unfortunately, such changes only occur after the fact and cannot be considered a reliable means of determining when the correct kind of conditions will occur that will subsequently spread the RVF virus (Indeje et al., 2006). Taking this into consideration a joint partnership program could be established between NASA and local authorities within the horn of Africa in order to create a means of advanced notice regarding weather patterns and possible conditions that NASA has observed which correspond with the indicators of the occurrence of weather conditions that will promote the spread of the RVF virus through mosquito breeding. By implementing this particular method of control not only will local authorities be able to set up proper vaccination logistics before the mosquito population booms but they will be able to ensure that personnel is already in areas where previous “blooms” of the virus started. This would help to institute measures of isolation, vaccination and control before matters reach the proportions seen in 2006/2007 when the virus ran rampant among the local livestock. Another control measure that can be implemented is to utilize the Ushahidi Crowd Map control application available on Ushahidi.com which is already being utilized in Africa to monitor elections and report instances of violence (Ruffer, 2011). The application works by people sending text messages to a specific number that is connected to a web-based application that creates markers indicating where particular reported instances occur (Vericat, 2010). This has been used to great effect in Africa to monitor instances of voter fraud and to indicate where people have been violently attacked in recent days (Vericat, 2010). Concentrations of markers help authorities to determine where to send proper taskforces or intermediaries in order to prevent problems from escalating (Greenwald, 2010). The same application could be utilized in the case of detecting the spread of the RVF virus across vast areas in the horn of Africa. Mobile phones are actually quite ubiquitous among many Africans and in fact, mobile phone top-up cards are at times utilized as an alternative to hard currency. As such, even farmers have easy access to mobile phone technology which can be used in order to send messages to the Crowd Control application in order to alert authorities of sudden occurrences of the disease (Masli, 2011). By utilizing specific keywords and phrases (which farmers can be informed of by distributing pamphlets and fliers), farmers will be able to give updates regarding the number of livestock infected, the spread of the virus within their area and level of help necessary, such a level of community surveillance was put to great effect in Cambodia and proves the viability of its use (Oum, Chandramohan & Cairncross, 2005). This would contribute greatly towards proper vaccination logistics since authorities will not have to investigate for themselves where the greatest numbers of infections are beginning to arise. It is expected that should a combination of such measures arise authorities will be well prepared in being able to deal with the spread of the RVF infection in the future and as such ensure that the number of cases that occur is kept to a minimum.
One of the inherent problems in dealing with an underdeveloped region such as West Africa is the general political and social instability that is rife within the region. For example, Somalia has not had a proper government in years with other areas in the horn of Africa such as Djibouti, Ethiopia and Kenya having to deal with internal unrest as a result of various military factions vying for control of what little power and wealth is left within the country. Further compounding this issue are the severe droughts and famines which have hit the region within the past decade. This has effectively decimated the local population with many adults and children experiencing the effects of malnutrition or death through starvation. All of these problems have placed considerable stress on local authorities resulting in roads and various facilities falling into subsequent disrepair or being considered derelict and unusable. There is also the issue of security due to the surge in crime as a direct result of the aforementioned occurrences. Taking all of this into consideration, any team that would even attempt to endeavor some form of intervention into the horn of Africa would need considerable international financial support as well as military protection in order to assure the safety of its team members. Without such contingencies in place, it would be nearly impossible to even start any operation since the lives of everyone on the team would be in constant danger. From another perspective, other foreseeable challenges in implementing methods of intervention within the region come in the form of changing local cultural perspectives regarding disease perception and control. Many farmers within Africa continue to support various cultural traditions regarding disease prevention and control which are woefully ineffective in actually being able to prevent the spread of disease. Taking this into consideration, proper education regarding sanitary practices and the basics of disease identification and control will be necessary in order to help the local populace understand what needs to be implemented in order to ensure that neither the community nor their livestock will be seriously affected by the outbreak of the RVF virus should it occur again in the immediate future.
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