No Time to Lose: A Life in Pursuit of Deadly Viruses (6 page)

All of us were aware of the many exceptions to this in real life—the unexpected outliers, the blips and lags, the complications of propagated epidemics with secondary and tertiary infections. But night by night, as we jotted down data and sketched out a picture from our interviews and notes, it appeared that although people were still dying (and dying horribly), the peak number of new infections around the Yambuku mission might be, at least provisionally, behind us.

This was a huge relief. But another conclusion also began to take shape, and it was a great deal more uncomfortable to deal with. Two elements linked almost every victim of the mystery epidemic. One factor was funerals: many of the dead had been present at the funeral of a sick person or had close contact with someone who had. The other factor was presence at the Yambuku Mission Hospital. Just about every early victim of the virus had attended the outpatient clinic a few days before falling ill.

We developed near-certitude about the mode of transmission one evening, when Joel and I were drawing curves showing the number of cases by location, age, and gender. (Working with Joel was a real education, like a terrific crash course in epidemiology.) It seemed likely by this point that aerosol contact was not enough to transmit the disease. But particularly in the eighteen- to twenty-five-year age group, at least twice as many women had died as men. We knew that there was something fishy about the hospital, and about funerals, but this was the real clue. What’s different in men and women at that age?

Being a bunch of men, it took us a little time to figure out the answer. Women get pregnant. And indeed, almost all of the women who had died
had
been pregnant, particularly in that age-group, and they had attended the antenatal clinic at the Yambuku mission.

Masamba and Ruppol were the first to figure out the picture. Vitamin shots. They were usually completely pointless, but many African villagers considered them vital: to them the act of injection with a syringe was emblematic of Western medicine. Thus there were two words for Western medicine in the region. Anything you ingested orally was
aspirin
, and it was hopelessly weak. An injection was
dawa
, proper medicine—something strong and effective.

We needed to take another tour of the Yambuku hospital.

Knowing what we now did, the empty rooms and bare metal bed frames of the mission hospital seemed more disturbing—grim killers of the joyful young mothers who had come there to be cared for but left with a lethal disease. When we reached the stockroom, we hunted through the large multidose jars of antibiotics and other medications. Their rubber bungs had been perforated multiple times by syringes. In some cases the bung had been removed and was stuck down with a simple bandage. Nearby were a few large glass syringes, five or six.

We politely interviewed the nuns. Sister Genoveva told us quite freely that the few glass syringes were reused for every patient; every morning, she told us, they were quickly (and far too summarily) boiled, like the obstetric instruments employed in the maternity room. Then all day long they were employed and re-employed; they were simply rinsed out with sterile water.

She confirmed that the nuns dosed all the pregnant women in their care with injections of vitamin B and calcium gluconate. Calcium gluconate is a salt of calcium and gluconic acid; it has basically no medical value in pregnancy, but it delivers a shot of energy, and this temporary “high” made it very popular among patients.

In other words, the nurses were systematically injecting a useless product to every woman in antenatal care, as well as to many of the other patients who came to them for help. To do so, they used unsterilized syringes that freely passed on infection. Thus, almost certainly, they had unwittingly killed large numbers of people. It looked as though the only obstacle to the epidemic had been the natural intelligence of the villagers, who saw that many of the sick came from the hospital, and thus fled it; who knew to set up at least some barriers to travel, thus creating a semblance of quarantine.

The nuns were totally committed women. They were brave. They faced an incredibly difficult environment and they dealt with it as best they could. They meant well. We had shared their table and their lives for what seemed like far longer than four days, and every evening, as they sipped their little tots of vermouth, they had told us about the villages of their childhoods. Every evening the discussion had ended up circling around and around the same subject—the epidemic. Who had fallen ill first, when it had happened and how. The dread of infection, the horrible deaths of their patients and colleagues. They had been trying to map out the frightening terrain until, I suppose, it would seem more manageable, less horrific. It was a narrative in which they had felt like heroes of a sort, and certainly martyrs.

Now it appeared that they were in some sense villains as well. It was very hard to formulate the words that would inform the sisters that the virus had in all likelihood been amplified and spread by their own practices and lack of proper training. In the end I think we were far too polite about it: I’m not certain at all that it really sank in when we told them our preliminary conclusions.

OUR THERMOSES WERE
full of blood samples that we needed to deliver to a lab for detailed analysis. After great persuasion, the two survivors, Sophie and Sukato, agreed to come with us to Kinshasa for further testing and, assuming that their blood did indeed have antibodies to the virus, plasmapheresis. It was time to head back to Bumba for our rendezvous with the pilots who had agreed to return us to Kinshasa.

Pierre Sureau and I argued that there was no need for
all
of us to leave. We felt that a continued presence could be useful, if only as a placebo—a totem that could relieve the sisters (and to some extent, also the villagers) of their fear of being alone with the epidemic. There were still some active cases of the virus around Yambuku, and no way of knowing whether the epidemic would flare up again to full strength. However, although Pierre radioed Karl Johnson his most strenuous recommendation, our orders were to return.

But when we got to Bumba no plane came. A day went by and an airplane engine rumbled the sky, but when we scrambled out to the airfield it circled overhead and flew off without landing. Another day went by, and another. We were told there was no fuel for the airplane. Then it was a national holiday. Then the weather was not good. Meanwhile we were running out of carbon dioxide canisters to manufacture the dry ice that we had packed around our blood samples. We had to drive over to Ebonda from the mission in Bumba, where we were staying, to persuade the Unilever plantation officials to accept these small potential bombs of contagion into their freezer and then hope against hope that their generator wouldn’t fail.

You learn to wait for things in Africa. Initially you are overcome by a swell of irritation, but after a few days it wears off, as most things do. You learn to sit on a veranda or under a tree and talk, or nod in silence, knowing that when the plane comes, you will hear it. It’s a good life lesson.

I spent quite a lot of time with our convalescent Sukato, who spoke some French and could translate, too, for Sophie, who was already missing the children she had left behind in Yambuku. Neither of them had ever been to Bumba. Sophie in particular was a deeply modest and devout Christian, and to both of them this ramshackle townlet seemed to represent the fearful temptations and corruptions of the big city. They felt humiliated by the knowing sneers of the locals, who looked down at them as primitive forest folk, and Pierre and I bought them clothes from Noguera so they would feel more at ease. I was a bit anxious when I thought of how they would react to the truly chaotic metropolis of Kinshasa.

I also spent time with Father Carlos, who really was a most curious character. (He still lives in Bumba, and we correspond, now by e-mail!) He must have been in his early thirties—slightly older than I—but though he drank beer and wore Jesus sandals and colorful short-sleeved shirts made of local cloth, he seemed from an entirely different generation. He had inherited money from his family in West Flanders (I gathered that his father had been a banker) and he spread it around Bumba, paying for projects, helping people out. He was totally acclimatized to his environment, preaching in what seemed like fluent Lingala, deploying skills of diplomacy and negotiation that were truly admirable; he was a figure of authority almost equal to the local
Commissaire
.

With Carlos, as with the sisters of Yambuku, I perceived aspects of my own Belgian culture far more clearly than when I was actually living it. The dialect they spoke; the heavy, traditional winter food they enjoyed despite the sweltering heat: all of it seemed so confined, so tightly wound, and redolent of the 1950s. Every day, once work was over, they ate together, prayed, and then they sat, sipping old Flemish liqueurs such as Elixir d’Anvers, and talked, conjuring up a fantasy of an old Flemish village. For them the motherland was frozen in time that was situated somewhere between their own childhoods and those of their parents. I knew this country was partly imaginary, but it was also partly where I came from too. This was how my people used to think and see the world.

I saw then that I had left my tribe. I had far less in common with the sisters than I did with the piebald, random team of scientists that chance had cobbled together to fight a virus that none of us yet understood.

WHEN THE PLANE
finally came to pick us up after four days of waiting, the pilots refused to load our two convalescents or our samples of virus. They had arrived with a load of construction material for a villa that General Bumba was building in a nearby hamlet, and they planned to take off with a load of local produce, breaking the quarantine embargo. Thankfully it seemed there was no logistical problem that Jean-François Ruppol could not solve. The aircraft finally took off, in pouring rain with all of us on board as it lurched and hiccupped perilously across the tree line.

We arrived in Kinshasa and escorted Sophie and Sukato to the Clinique Ngaliema. None of the people quarantined there had developed symptoms. But that also meant that so far, no antibodies had been found in any blood samples. The blood Sophie and Sukato would give—like the vials we had brought with us—was crucially important.

There was still a high degree of panic among the medical staff at Ngaliema. Perhaps intensifying the sense of gloom, a negative-pressure isolation bed, one of only two or three in the world, had arrived from Johannesburg. It is a kind of hermetic tent that basically prevents viruses from leaving the space because of the negative pressure in it. It stood grimly in a special room in Ngaliema, to be used in case one of the international team fell ill. Basically, if one of us caught the virus, we would be entombed inside this contraption for the duration of our treatment, or our few remaining days alive. The ultrasophisticated material demanded experienced and specialized personnel, and it was far from clear that it would ever really work as planned.

Staring at this apparatus, I recalled a potent image from my early childhood: the iron lung. In 1958, when I was nine, Belgium hosted the World Fair. My father, who worked at the National Agency for the Promotion of Belgian Agriculture and Horticulture, oversaw one of the displays, and my parents took us there every Sunday afternoon from April to October. It was far and away the most exciting thing that ever happened in my childhood. My younger brothers and sisters were too young to roam about, but I was allowed to roam freely across that one square mile of futuristic exhibits.

There were colorful glassed-in cable cars, like something out of a Jetsons cartoon. A gleaming monument, the Atomium, dramatized the chemistry of molecules; it loomed high above the cantilevered pavilions, all angles and glass and curved steel. A huge fairground was open every day until 4
A.M.
Rockets, on one ride, carried you across a city of the future, where houses showed off fantastical gadgets; then you flew past the Milky Way and around Mars before returning to Earth. Robots distributed bars of chocolate. There was a machine that manufactured and bottled Coke; a mine shaft complete with trolleys; a model of an oil refinery. There were people with strange skin colors and extraordinary looking eyes. There were pavilions for plastics, for explosives, for chemistry, for photography, for glass, and for every imaginable country and international organization.

But there were just two objects that drew me back, again and again. The Russian pavilion contained a Sputnik, a small silver sphere that was suspended just beneath a massive, frowning statue of Lenin. It was barely a year after the first Russian space flight, and here was a real representative from that new world of discovery, outer space.

And in the United States’ pavilion, just next door, there was an iron lung—a terrible, sealed glass container that breathed for you. In a way, I think that ugly, cylindrical cage had a profound impact on my life. Everyone was terrified of polio in those days; the oral vaccine wasn’t licensed until 1962. If you caught the virus, you could become paralyzed and may not be able to breathe without the support of an iron lung, perhaps your only hope for long-term survival. The nightmarish vision of being caged for life was I think something that motivated me to care for the sick. I pondered it intensely. Surely there must be some better alternative? Turning away from the negative-pressure isolation bed, I felt uneasy.

NOW THAT IT
was clear that our virus was not a subspecies of Marburg, but was in fact a new (and possibly far more virulent) hemorrhagic fever, more international personnel began flying in to join the team. My friend Guido Van Der Groen arrived with enough equipment to install a field virology lab at Clinique Ngaliema. For several days he had been working there in a plastic isolator—a small laboratory bench under a plastic tent, accessed via two plastic built-in sleeves, the low internal air pressure maintained with a small electrical pump. With a grin, he handed me a good-bye note penned by our boss, Stefan Pattyn, who had returned to Belgium to pursue his hospital and teaching work. His note urged me yet
again
to catch as many bats as humanly possible, and warned me to beware of traps that would be laid for me by our American and French team members.