Ebola is a terrible disease. The pain, fever, exhaustion, confusion, diarrhoea and vomiting creates a carpet bombing attack on the human body.

Our three patients dip in and out of this grim journey, and the unpredictable course of their illness is unsettling. They are all still alive, but demonstrating the rapidly fluctuating symptoms typical of Ebola.

Saffie, the older women with a poor prognosis has, against expectations, improved considerably from her near-moribund state yesterday.

Isatu, the younger woman deteriorated yesterday and we ramped up treatment with some signs of hope. She is well enough to talk and we find out that she is less afraid of dying from Ebola than the consequences of what this will mean for her children. She is separated from her husband and has ten children. Her five-month-old daughter died last month, but the other children are now abandoned at home with no one to support them. She cares little about her suffering and pain, distracted by her concern for her children. Ladybird, ladybird.

Ibrahim, the younger man, was eating and drinking yesterday and the one we were least worried about. However, overnight he has deteriorated rapidly and is now demonstrating neurological symptoms, a bad prognostic sign.

He is confused and almost catatonic, the zombie-like state of late Ebola, and seems to have some symptoms and signs of meningism. It is important that we do not exclude other co-morbidities, though we have little we can do to investigate other causes - our one and only lab test is Ebola PCR.

The three patients have been jostling for position in the critical list, but today it is Ibrahim who is most likely to die.

On the afternoon ward round I find him unresponsive. It is difficult to feel a pulse with the double gloving and difficult to check his pupils with my fogged up goggles, but it doesn’t take long to conclude that he is dead.

Our first Ebola fatality.

I stretch out his arms and legs, and cover him with a blanket. Early signs of rigor mortis are already beginning. He may have been dead for an hour, maybe two, but we are dependent on our smash and grab dashes into the red zone, so it is impossible to be certain of the time of death.

The chlorine sprayer is twitchy as she washes my hands and she drops her sprayer. She knows that Ebola is most dangerous at death, and she is scared of the body, and after my close contact, she is fearful of me.

A sudden sadness descends on the team after a day of joy from the opening. Ibrahim was young and fit and almost symptomless on admission, the clear favourite for survival. One day later he is dead. Ebola is an unpredictable grim reaper.

The rest of the afternoon is spent trying to find out how to get hold of a death certificate and trying to liaise with the safe burial team. We have to contact the family, but they live many miles away and we have no such thing as social services. I quickly appreciate how disconnected our upstart facility is from the community and the established social systems.

The plan for all the Ebola centres is to open with a small number of patients and test the resilience of the facility and the staff routines. 36 hours after admission we are confident about how we are managing and it is time to scale up. Meanwhile, I have my first resident night on call in over 20 years.

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