Doctors Without Borders/Médecins Sans Frontières (MSF) psychiatrist Frédéric Gelly describes how, with the help of her granddaughter, one Liberian Ebola survivor, a woman named Massa, came to terms with the trauma of her daughter’s death.
All Massa could talk about was the death of her daughter.
Massa’s daughter had fallen sick with Ebola after she was infected by someone in the community. She came to her mother for help, and Massa took care of her, until she and her husband caught the disease too. All three were taken to an Ebola treatment unit in the Liberian capital, Monrovia.
A lot of rumors were circulating during the peak of the Ebola outbreak. One was that the government was killing patients in Ebola treatment units in order to steal and sell their internal organs. Another was that the drugs given to patients and the chlorine used to disinfect clothes and bodies were being used to kill people. After Massa’s husband died in the treatment unit, she advised her daughter not to take any of the drugs she was given.
After bribing a watchman, Massa managed to escape from the unit, leaving her daughter behind. Back at home, she took care of her five grandchildren, despite her fears of infecting them.
It was at this time that Massa’s nightmares began. Every night she dreamed of her daughter in the Ebola treatment unit, weak and at the point of death, calling out her name. As is usual with post-traumatic stress disorder, her nightmares recalled her actual experiences, and summoned the same emotions and fears on waking up.
At home, Massa began slowly to recover from Ebola. One of her granddaughters, Helena, was infected, but survived without being referred to an Ebola treatment unit.
One day, Massa was told that her daughter had died in the Ebola treatment unit. Having lost the people she most trusted—her husband and now her daughter—Massa was alone with her grandchildren.
This situation was obviously traumatic. Massa had faced death in a direct way, by being sick herself, and by having lost two of the people who were most important to her. Ebola seemed to have distorted the normal order of things. First, her daughter had come for protection, but had infected her parents with the deadly virus. Then Massa, in a bid to protect her daughter, had advised her to refuse the drugs that might have saved her life. Wracked with guilt, Massa felt she had lost trust in everything she knew.
Massa came to MSF’s survivors’ clinic one year after the death of her daughter because of her nightmares. Exhausted by sleepless nights, she was trying to cope with everyday life and looking after her grandchildren. She never spoke to the children about their mother.
During the first sessions at the clinic, Massa talked about the traumatic experiences she’d been through, and soon started feeling better. She agreed to take antidepressants to help her sleep. Her nightmares became less frequent. But it was still impossible for Massa to talk to her grandchildren about what had happened to their mother.
After she had been coming to the clinic for four months, Massa brought along her eight-year-old granddaughter, Helena. Massa said the girl always seemed to be sad, sitting alone in the yard, not playing with other children.
We saw Helena twice in individual sessions. She was aware of what had happened to her mother, and she seemed to understand that we were trying to help her grandmother. But she didn’t want to talk about any of her feelings, as if talking about her mother would signify that she was really dead.
Finally, we organized a joint session with Massa and Helena. During this session, for the first time, Massa was able to talk about her daughter. At the end, she cried. When we asked Helena what she was thinking, she answered: "She should not cry, my mother will never come back."
In that session, Massa told us what she couldn’t say to her grandchildren. And Helena told us what she had to say to her grandmother. In some way, she was asking her grandmother to accept the reality of her mother’s death, and to join the children in their new life. She also let her grandmother know that she shared her pain, and that neither was alone.
For Massa and Helena, sharing their story was the first step towards accepting reality: words can be used to define things and to put them away. Our presence, as witnesses, allowed Massa and Helena to talk together without being completely alone. And our presence as providers of care represented the possibility to continue to live and to have trust, after a trauma which had made them believe that it was impossible to trust anyone.
We hope to make it possible for our patients to leave their traumatic experiences in the past, and to live in the present, without trying to forget the unforgettable.
Patient names changed to protect anonymity.