Death in the afternoon
The deaths are starting to get to me. We’ve had fourteen of these in the last six days and many were children and infants. Our Ebola treatment facility at Prince of Wales (POW) School has become a common referral destination for babies, small children, and pregnant women with Ebola. It seems that the other Ebola centres are uncomfortable dealing with these difficult and very high-risk patients and so they are sending them to POW. I firmly believe that these cases are better off with us, but it increases our workload, our stress level, and ultimately our case fatality rate. Placing intravenous cannulas in tiny infants is intricate and you cannot really get a very good read on the clinical situation. Obviously, they cannot tell you how they are feeling.
MSF staff hand over a body to an IFRC burial team at MSF’s Case Management Centre in Kailahun, Sierra Leone. ©Fabio Basone, MSF
Ebola babies are especially difficult. They can appear quite normal, even chubby, and they seem to feed, cry, cuddle, and move around like a healthy infant for several days. And then, all of a sudden, they just die. Yesterday, a 3-month old girl and a 1-year old boy whose beds were side-by-side died within four hours of each other. The little boy was clearly in bad shape for the entire hospitalization, but the girl looked entirely well. We had even transferred her to the convalescent tent for a while so she could be fed and cared for by two lovely female survivors (a 30-year old lady and her mother-in-law) who extended their stay for this purpose. After they were finally discharged, we moved her into the ICU tent so that she could be better observed and we brought in another female survivor to be her caretaker. All of this was to no avail. She was avidly taking milk one minute and gone the next. I had to pronounce both children dead.
The boy’s father was called and he promptly came to POW for the bad news. I had to tell him that his little boy was another victim of Ebola and he was inconsolable. The boy was so sick for the entire time that the young, well-educated, and obviously caring father could not even visit him. I had dreaded this duty because I had done the same with 9-year old Fatmata’s aunt a few days earlier. Poor thing, she really never had a chance. Her mother had died of Ebola on Boxing Day and the aunt pleaded with me to save her brother Abdulla because he was the only remaining child in the family. But, Abdulla unfortunately had to witness Fatmata’s passing since he was in the adjoining bed. He went rapidly downhill from that point and died a week later. Abdulla and I often joked about football and his favorite player, Lionel Messi. I even thought about sending Messi an email asking for a supportive message to Abdulla. And, now it’s too late. Abdulla is dead.
Ebola is a liar. Unexpected and unexplained deaths in Ebola are not infrequent even in adults. Last week, two men who were being prepared for discharge suddenly gave their last breath. One fell dead to the ground on his way back to his bed after receiving visitors and the other was found in the bathroom. Sometimes, I find it hard to go to work in the morning. I look forward to seeing improvement in my patients and occasionally I see children with happy and grateful smiles on their faces. I know that a select few will survive and live a normal life. But, I also know that 4 out of 10 will end up in a nonporous white body bag with their name and their MSF Ebola number boldly inscribed on the outside by a permanent magic marker. I will never be able to erase this image from my mind and I hope the world remembers too.