British doctor's sorrow at losing seven-month-old orphan Mary to Ebola

Writing for ITV News, British doctor Dr Daniel Cooper describes his sorrow at losing the fight to save seven-month-old orphan Mary from Ebola.

A unique phenomenon in the care of Ebola patients is the availability and willingness of disease survivors to assist in patient care.

As far as we know, patients who recover from Ebola are then immune for life.

This was to prove very useful in one particular case that has touched the lives of every volunteer and staff member at Makeni.

Some 11,000 children in West Africa have been orphaned by Ebola alone since the start of the epidemic, and on a very hot afternoon in December, one of these orphans arrived at our triage with her grandmother.

Baby Mary, a seven-month-old girl, had lost her father a few weeks before, and had been breastfed by her mother until she had died three days previously, leaving her in the care of her grandma.

Breastfeeding carries an enormous risk of transmission, especially so close to death, so we initially didn't hold out much hope.

This situation presented us with a difficult ethical dilemma, one of many during the last six weeks, which I was completely unprepared for.

Baby Mary seen being cared for by British NHS staff days before her death. Credit: ITV News

Ethical teaching at medical school hadn’t extended to the care of orphaned babies with Ebola.

Thankfully International Medical Corps, the NGO running Makeni, have a wealth of experience and guided us through these decisions.

The debate centered around the fact that the grandmother did not have symptoms, and therefore was unlikely to be infected at that point, however admitting her to the centre placed her at huge risk.

On the other hand, if baby Mary was left on her own, we couldn’t guarantee the three hourly feeds or round the clock care she would need inside the “red zone”.

We had a very frank and none judgmental discussion with Grandma about the risks to herself compared with the prospect of baby Mary being left alone.

She decided to go home to look after other family members, leaving Mary in our care.

This is probably a decision which many people at home will find difficult to comprehend, however in a country where child death is a fact of life, and with other family members to care for she felt that she couldn't justify the risk to herself.

Despite British workers' best efforts, Baby Mary died from Ebola. Credit: ITV News

In an Ebola Treatment Centre ones priorities have to shift.

The paradigm of patient care in a normal medical setting is changed to prioritise staff, then communities, then individual patient care.

This is the only way this disease will be brought under control, but goes against everything health care professionals stand for.

With this in mind, we embarked on a very difficult nightshift, having to justify every staff entry in to the high-risk zone, whilst fighting every instinct to comfort a crying (and possibly dying) baby.

The next day, Mary was looking much better and we had recruited a survivor who lived locally and was willing to look after her in the high-risk zone.

She was a natural and soon had Mary outside giggling and making everybody coo.

We were delighted when 48 hours later she had two consecutive negative tests and therefore met our discharge criteria.

The rest of the story is one I have yet to come to terms with, and haven’t been able to talk about yet.

We got a call from the orphanage a week later saying Mary had developed symptoms and a fever and would be brought back to us by ambulance.

Despite our best efforts, and some very hard shifts for our survivors, she sadly died two nights ago on the night shift.

Despite our growing survivor wall, and the parties for reach discharge, it’s a hard truth that the social and psychological impact of this epidemic will be felt for many years after our current job in Sierra Leone comes to an end.