A chance to survive…… this is what I said we were offering those stricken with Ebola, in this rural area of Sierra Leone, when we opened our Ebola Management Centre about two weeks ago.
Dozens have passed through our doors since the opening. Many have walked in on their own, concerned about suspicious symptoms; still more have arrived by ambulance, referred from other centres. Some have already been confirmed with Ebola; the rest have been assessed, and, if meeting the criteria, admitted as suspected cases while awaiting analysis of a blood test by our laboratory.
With results taking just a few hours, the Canadian Winnipeg laboratory saves days of uncertainty and worry for the lucky ones who can walk out to freedom. Freedom from the dreaded disease, and, carrying with them a certificate proving that they never had Ebola, freedom from the stigma that survivors sadly carry with them.
But survivors……..that’s what we’re waiting for. Too many of our patients are arriving when the disease has already progressed too far for us to be able to save them. We can offer them relief from the pain, good nutrition if they can eat, rehydration if they can’t. We can offer preventative treatment of other illnesses, such as malaria. We can offer psychological counselling from our mental health team, who along with our health promotion team will do everything possible to trace family members, and thus avoid the “disappearances” that have been all too common.
And we can offer them some dignity, both in living and, too often, in dying. It’s this dying that’s getting to me. Every death is a death too many; but one that really hit me was an 18-year old girl, Asata*. One afternoon when I was on duty Puk, the leader of our mental health team, told me that Asata was saying farewell to her mother, aware that she was dying. Asata, her mother and a brother were all in the same tent of Confirmed cases. Her father had already died. This disease is destroying entire families.
The next morning when I came on duty, Fatmata, the mother, was looking tired and subdued. “Asmata died in the night,” I was told. Fatmata must be wondering if her son will be next – or if she herself will succumb. So far they seem to be strong. Let’s hope we can help keep them that way.
But all our efforts could not save Mabinty or Ibrahim. Last night I worked my first 12-hour night shift for many years. I thought it would be tough, that I would struggle to stay awake, even with the stimulation of the cold night air as we sat outside the tents of the High Risk zone between “ward rounds” when we donned our protective equipment – PPE – to monitor and assist patients. But the physical part was easy compared with the emotional struggle. Mabinty and Ibrahim both died in the early hours, just a couple of hours separating their deaths. After more than a decade as a nurse, I ‘ve seen many people die. It’s always, of course, a great sadness. But these deaths from Ebola are uniquely horrid.
When Ibrahim started bleeding from his mouth a couple of days ago, I asked a colleague with a lot of experience with Ebola if people could ever recover once they had started haemorrhaging. “Hardly ever,” she told me. So I knew the end was in sight. Helping him rinse the blood from his mouth, and so make drinking some water a bit more pleasant for him, looking in his eyes as I did so, established a human contact between us. Today his eyes were so distant, his expression so remote, that that contact had already been lost. My mind was more or less attuned to the inevitability of his death, but certifying his dead body a few hours later was still painful.
It was the same with Mabinty, whose death I had to certify just a short while later, when I came in with the team to give out medications, and found her slumped forward from her previously supported position. Mabinty had also been haemorrhaging, and was struggling to breathe. I will always be grateful that my colleague, Marlieke, had gone with one of our national staff to make her more comfortable just an hour or so earlier. With those who are dying, this is all we can do. She died alone, with no family beside her. I hope that we brought her some relief in her dying moments, in spite of being strangers dressed in yellow space suits.
But I don’t want this entry to be all about death and dying, to dwell on the negative. There are happy moments too, like the unexpected reunion between two brothers. Seven-year –old Alie had been admitted a day or so ago into the Suspect tent, along with his uncle. When I came on duty the next morning, Alie was in the tent on his own. “His uncle died last night,” I was told. So little Alie was now alone. But then an eleven-year-old boy, Abdulia, sitting outside the next door tent of Confirmed cases and separated by a barrier, looked across and saw Alie. “That’s my brother!” he said in amazement. So they were able to chat to each other. And when Abdulia was envious of the big shiny radio that his little brother had got, provided by the mental health team, of course Abdulia was given one too. Now we just have to hope that Alie’s test will prove him negative, and that we can help Abdulia fight this Ebola virus and survive.
Then we have a nearly full “convalescent” tent, patients who are not haemorrhaging, who are definitely improving. “I would like to move to the other tent,” Mohammed said to me this morning. “Why is that?” I asked him, thinking most likely it was because he was in the tent with Ibrahim and Mabinty when they died. “Because I am getting better,” he said firmly. I hope we can move him today.
Also on the positive side, the fact that Mabinty and Ibrahim died with us means that many family members, acting as carers, have been saved close contact with a very contagious Ebola sufferer and thus becoming victims in their turn. And although it’s likely the families may not be able to attend the burials, avoiding the dangerous traditional burial practices which lead to dozens more deaths is a public health message we struggle to get across. We will do all we can to let the families know the location of the graves, so that they can visit them and pay their respects.
In the end, this is the most we can do. Just offer a chance to survive; and, if survival cannot be, as compassionate and dignified death as possible.
STOP PRESS!! Our first cured patient was discharged today! She had been admitted the first day we opened, her blood test showing a high viral load. But now, fourteen days later, her blood test is negative and she is ready to go back to her family, friends and community, an Ebola Survivor. We are all celebrating in the Ebola Management Centre of Magburaka!
*All patient names have been changed in the interests of confidentiality.