'Katiada showed extraordinary courage in battling Ebola'

http://www.theguardian.com/global-development/2014/dec/23/courage-ebola-sierra-leone

Version 0 of 1.

Dr Martin Deahl is a consultant psychiatrist from Shropshire in the UK. He works with the aid agency, Goal at its Ebola treatment centre in Port Loko, Sierra Leone. This is his third report for the Guardian.

Katiada is known to practically nobody but God, but she deserves to be known to the world. A little girl who humbled me, showed courage and tenacity of spirit that I, and I suspect many of us, could never match.

Katiada is dead, she “passed” (the local euphemism for death) on Sunday afternoon. I admitted her a week ago, frail and unable to lift a bottle of water to her lips or to sit up without help. Afraid, dehydrated with sunken eyes, barely alive and pathetically vulnerable. She had just lost her mother. I cried at the time, tears of sadness for her, guilt for me (I should be able to do more), and indignation and anger about the unfairness of it all.

In the short time that I knew her, I became very attached. Doctors aren’t supposed to have favourites. Well, I did (as did many of my colleagues, I suspect). I had thought non-verbal communication would be impossible in personal protective equipment (PPE) but was surprised and heartened to find that a hug was a hug despite the PPE. And that two layers of gloves didn’t diminish the emotional impact of the squeeze of a hand.

Over subsequent days she deteriorated, becoming less responsive. No more hand squeezing, and in pain with every attempt to move her or sit her up. Her dehydration worsened, and five agonisingly painful attempts to give her fluids intravenously all ended in failure.

We thought she might have died on at least a couple of occasions in the middle of ward rounds.

Outside the Red Zone, Katiada was the frequent subject of clinical debate. Ethical issues of life and death. The life and fate of a frightened little girl debated in a team discussion. Did we leave little Katiada to her fate or make one last attempt to intravenously hydrate her?

Katadia battled on, defying predictions that each day would be her last. At times she appeared to rally: sit up, take oral fluids and show some awareness of the world around her. At others she was flat, almost lifeless.

While all this was going on, Rugi Conteh, head of our psychosocial team, had located Katadia’s father (a seemingly miraculous development) to try to enable contact between him and his daughter. The psychosocial team have the luxury of actually having the time to talk to patients, while the doctors and nurses can barely complete one single clinical task before having to leave the Red Zone, degraded physically and psychologically by heat, sweat and the sheer exhaustion of working in PPE.

It became clear that geography and her father’s own health would make a visit impossible, but a phone call might be possible. Standard procedure was to hold a phone up to the wire fence separating Red Zone from the outside world, loudspeaker on, and allow the patient to come to the fence and talk through it into the phone.

This wasn’t going to work, as little Katadia couldn’t even sit up unsupported, let alone walk to the fence to use a telephone. After some negotiation it was agreed that a mobile phone could be taken to Katadia’s bedside in the Red Zone (it would never leave; such is the risk of contamination that everything taken into the zone is destroyed).

Rugi arranged for Katadia’s father to phone at a time when she would be in the zone to facilitate and hold the phone to the ear of his frail little daughter. He spoke to Katadia at length, she was barely able to speak but I gather managed a few whispered words. The call ended, and shortly afterwards little Katadia passed, and was finally at peace.

I am not given to superstition, but the timing, the sheer coincidence, appeared extraordinary. It was as if little Katadia had been clinging to life waiting for her father. She had suffered terribly and could, should have died on several occasions.

Katadia was an extraordinary little girl, one of thousands stricken by this terrible disease. She deserves to be remembered, not just by us but by the wider world. She symbolised vulnerability, innocence, suffering, and the sheer randomness of life and death. The life that so many of us take for granted.