Tim Cunningham – Sierra Leone – December 2014
My Christmas present this year came in the form of an amazing patient called Fatima. Fatima is not her real name so I will use it to honor her privacy in light of both the relentless stigma towards Ebola patients here in Sierra Leone right now and also in to respect her rights as a patient. She is around 10 years old and spent nearly a week with us in our confirmed ward at our ETU. Although she tested positive for Ebola, she never got sick. This disease is strange — it kills many people and others have a fever and perhaps some diarrhea for a day or two, then they rapidly recover. Some show no symptoms at all even though they cared for and lived with parents, brothers and sisters who succumbed to the disease. (I don’t know the sensitivity and specificity of our Ebola PCR test; maybe that plays a part in this mystery of the symptomatic and non-symptomatic cases too.)
Fatima witnessed much suffering and countless deaths at home and during the nights at the ETU when there were no nurses in the wards to provide comfort.
She mixed innocent compassion with a dark sense of humor. At times, the most healthy patient in the pediatric ward, she would ask for a lappa from us (a traditional cloth/covering), collect it, and then hide it so that when the next team came through a few hours later, she would ask for another. She played this game daily with much success. And in the evening time, during our last shift of the day, we could come into the pediatric ward and each sleeping child would have a lappa covering them, keeping them warm.
We also use the lappas to cover bodies of patients who die. It is not uncommon to walk into a room and see multiple patients covered completely. All of us on our team have laid too many lappas across our deceased patients. Fatima saw this everyday too.
One day her “gallows humor” came out full force. I walked into the pediatric ward to do one last check on some malnourished children before doffing my PPE and leaving for the day. When I entered the room Fatima said something to me and pointed at a covered body on the bed next to her. I jumped, startled because just earlier this child was alive and well. She saw my reaction and started laughing, quickly pulling back the sheet revealing a well child and her twisted prank.
She was “queen of the ward.” I asked her one day if she was the ward’s doctor and she said “no.” I then asked if she was the ward’s nurse, “no” again. So then I asked if she was more of the queen of the ward and her eyes and smile lit up. She would collect soap and cups for the younger kids, lead the healthy kids in card games and other activities out in the sunshine by the wards… and most importantly, make her friends drink. At one point a few days ago 1/3 of the patients in our ETU were younger than 18 years old. Fatima was their matron, supporting them and keeping the energy positive and playful. The pediatric ward is right near the doffing area, so while we were waiting in line to doff, she would dance with us. Her dancing soon became fits of laughter at me and my colleagues showcasing our lack of rhythm and finesse as we moved around like goofballs in our white “space suits.”
Four days ago Fatima tested negative for Ebola and we discharged her home!
We said goodbye to her in front of our ETU by our tree of hope. On the tree of hope each survivor is given a piece of lappa that they tie around. Recently we topped 100 survivors; we are sending survivors home now almost daily. Fatima sat with the largest smile I think I’ve ever seen after tying her ribbon. Then she sat and waited for her ride home from the Red Cross. Fatima beat this disease. Many have, and many more will.