On September 13th, Ibrahim came to us in the arms of his mother, his older brother Lamin walking at her side. He was a little more than a year old on arrival. We couldn’t be sure of his age exactly and his mother did not know. His mother told us her husband, Ibrahim’s father, had died less than a month ago.
We tested all three, mother and two children and, while they stayed with us awaiting test results, Ibrahim’s bright little spirit crept into the hearts of many of our staff. On September 14, Mother was confirmed positive, but the two boys were both negative. They could not stay with their mother, who, after her positive test, was moved from our “suspect” wards to our “confirmed” wards to be cared for separately from those who only might have Ebola.
In order to remove the boys from risk, they were taken to a small orphanage here in Kailahun that is run by the Ministry of Social Services, and with regular contact with our Health Promoters (HP). The orphanage was started in order to make some provision for exactly such cases as Ibrahim and his brother, with the hope that they may be returned to a parent or parents if they survive, and also to care for “Ebola orphans” - children who suffer the loss of both parents - until the Ministry of Social Services, stretched-thin by the so-far endless litany of loss generated by this epidemic, can make other provisions for placement.
Our HPs tell me the orphanage is staffed by a dedicated Sierra Leone woman who stays with the children full-time, provides for their feeding, care and nurturing, assisted by two or three others who work part-time. They have all been trained carefully in techniques to prevent disease transmission. I am told they do a wonderful job.
In the treatment center, Ibrahim’s mother fought for her life but grew weaker day by day. On September 16 both Ibrahim and his brother were brought back to the treatment center because orphanage caregivers feared they were not well. However, they both seemed quite robust and on the 17th, both test results returned negative for the second time.
Their mother in the meantime seemed to turn a corner; she began to gain strength. Although she could not be allowed to leave the confirmed area of the treatment center to be with her children, we made her completely aware of the children’s readmission and their second negative tests. We can only imagine her relief. For our part, we were thrilled to send these endearing fellows back to the orphanage together for safe-keeping, anticipating now their reunion w/their recuperating mother once her viral load subsided.
Then on the 23rd Ibrahim was returned to us for the third time. His sweet, cheerful spirit persisted, but we have trust in the orphanage caregivers and admitted him immediately for testing - again. His Ebola test result returned positive on the 24th. Now known to be infected, Ibrahim could be transferred to the confirmed ward to be reunited with and cared for by his own, steadily improving mother.
Ibrahim deteriorated over three days and died in the treatment center in the care of his mother last Saturday, September 27. His mother was discharged cured to join her remaining son, to return to a home empty of husband and second child.
We in the meantime, while we do not believe this transmission of infection occurred in the orphanage, hope constantly for the well-being of the other 10 or 12 children there. Their temperatures are taken twice daily and they are monitored by their conscientious caregivers for all other symptoms of Ebola. We have tested one other febrile child in the orphanage since Ibrahim’s death and that child was negative.
These impossible stories are right now the daily stuff of the lives of our friends here in Sierra Leone. Who knows why Ibrahim died and his brother lived? They say this disease is most cruel because it attacks those to whom we are closest, those who need us or whom we need the most. Perhaps it was because he was younger, carried close to the warmth of his mother more often. Perhaps at the onset of his mother’s illness he was still breast feeding. Perhaps, being a smaller child, he just did not have as strong or developed an immune system.
The reason doesn’t matter now. He is gone and she must live with constant terror for the well-being of her only remaining son and the gift and guilt of her own survival.
Patricia wrote this post on 29th September 2014 in Kailahun, Sierra Leone. For more information about MSF's work on the Ebola outbreak in West Africa please visit msf.org.uk/ebola