No Time to Lose: A Life in Pursuit of Deadly Viruses (8 page)

We established our main logistics base at the Ebonda plantation, which we had visited during our first trip, because they had direct radio contact with the Unilever office in Kinshasa. So Karl Johnson and the others could drive over to the Unilever HQ and talk with us directly: a small matter, but a huge improvement over the sisters’ patchy hookup in Lisala.

Then we drove up to the Yambuku mission, now lashed on a daily basis by torrential storms. We brought a lot of stuff for the sisters, including mail, which we had picked up at the
Procure
, the logistics base of most of the Flemish missionary orders in Kinshasa. (I had also purchased a most unexpected little artifact: a Flemish-Lingala dictionary and grammar book. I studied this for an hour every day and picked up quite rapidly enough words to hold a very basic conversation.)

A few days later, a Puma helicopter—another of President Mobutu’s personal aircraft—arrived to serve us. Accompanying it were two pilots and a mechanic. The mechanic was a
Kibangiste
, a member of a Christian church founded by a Zairean prophet, Simon Kibanga, who died in a Belgian colonial prison in 1951. Because of this, he didn’t drink or smoke or sleep around, whereas the two pilots did very little else. Accustomed to accompanying President Mobutu about the country, in high luxury and low supervision, they were deeply resentful of their assignment to our service: there was no champagne, no fun, and little opportunity for profit. They spent some of the next six weeks using the big Puma helicopter to fly from one bar to another, impressing women, and I, in my tightly wound Flemish way, resented this greatly, for I was paying them a per diem for their expenses, as well as buying all the fuel.

We needed the Puma because we planned surveillance visits to areas that couldn’t be reached by four-wheel drive, particularly in the rainy season. Many villages were now completely inaccessible by land, and the rivers were so swollen they could no longer be forded. We planned to head north up the Ubangi River, a trip which, though it represented only 60 miles on the map, would have taken a day or more of almost impossibly hard labor by road.

We also made a second tour around every village in the Yambuku area. Yahombo, Yapama, Yambonzo, Yaongo, Yandondi, Yaekanga, Yalitaku, Yamisako, Yalikombi, Yaundu, Yanguma, to the west. Yalikondi, Yamoleka, Yamonzwa, Yaliselenge, Yasoku, Yamotili, to the east. Little strings of villages, like tiny beads lost along the muddy paths that meandered through the thick forest.

When we arrived in a village we settled ourselves under an awning or largish tree and were rapidly surrounded by people—children with bright eyes and prominent bellies, young girls with high round breasts, women in their forties with breasts hanging to their knees, and old men and women smoking marijuana. (We endeavored to arrive early in the morning, before work in the fields began.)

Later on I visited a few distilleries hidden in the forest to safeguard from theft. Many villages had a basic distillery: Bananas were left to ferment in a hollowed-out tree trunk and then flavored, by local specialty, with leaves or bark. This mixture was cooked, slowly, in an enamel pot covered with leaves. The vapor was caught and cooled in a hollow bamboo stick, with a carefully shaped piece of bicycle tire creating a bend and guiding the now-condensed liquid down again. Congolese moonshine. My favorite had a small Perrier bottle to capture the distillate (only God knew how that bottle arrived there).

I always sipped from the
arak
, out of politeness, though it was presented in a single, collectively used cup. I also occasionally sampled the communal cannabis pipe. However, I didn’t partake of the plates of caterpillars or flying termites fried in palm oil, or the villagers’
boucané
monkey meat. Game (whether squirrels or monkeys) was the most common source of protein, and the villagers smoked it and hung it until it was blackened and half-rotten; the smell was so vile that it caught in throat and made you choke.

Family by family, Pierre and I slowly questioned everyone who seemed to have any relationship with the hemorrhagic fever, scribbling the details into a notebook. In only one village did we find a cluster of women and children who had died from Ebola without a clear narrative beginning with a hospital or funeral. This cluster remained something of a mystery until, on a second visit there, I met with one woman who had survived her illness and noted the scarifications across her forehead. I asked if they were recent and what they meant, and she said, “We had headache, so the
nganga
kisi
[traditional healer] came to do this.”

What had happened was that one young woman had gone to the antenatal clinic in Yambuku. When she returned with Ebola symptoms, including the typical searing headache, the
nganga
treated her with scarification, slicing her skin lightly with a knife. And just to be on the safe side, he performed the scarification on a series of other women in the village as a preventive measure—using the same knife.

Later, I met this particular herbal healer. He was a polite man, who received us in a room not very different from any other village hut. There were no fetishes or masks in evidence, though a series of liquids were macerating in gourds along the beaten-earth floor. We asked how he treated people who had Ebola, and how he protected himself, and he politely showed us: household bleach. He bought it at Noguera’s shop in Bumba, and though he presented it to the villagers as traditional medicine, this bleach was apparently the main element in the potions and poultices he used to disinfect wounds and heal people.

There was a certain lack of poetry in this, but at the same time a welcome dose of common sense. Whether or not this
nganga kisi
also used traditional magic that he chose not to discuss with us, his use of bleach had probably saved a number of lives—though sadly he had not thought to use it to keep his knife clean.

THE LAST EBOLA
victim in the Yambuku region died on November 5, two months after the beginning of the epidemic. Pierre left Yambuku on November 9 to return to Paris. The heroic phase of the epidemic was over: it was clear that the outbreak was coming to an end. But epidemics can rebound and rear up unpredictably. My job was to keep an alert watch for new cases; we didn’t want to take risks.

The international team still planned to arrive with a generator and lab equipment for plasmapheresis, and we planned a solid epidemiological investigation to find out exactly how Ebola was transmitted. We knew blood was involved, but what about mother-to-child and sexual transmission? We also needed to learn about the natural animal reservoir of the virus: was it bat, bee, rodent, or smoked, dried monkey. Finally, Karl was also planning a serum survey, because although we had identified people who had been very sick, or who had died, it was entirely possible that Ebola had infected half the population and only some had fallen ill.

Pierre’s departure left me alone with Father Léon and the sisters of the Holy Order of Our Lady. We spoke mostly about work and about Flanders. Despite all the trauma, they seemed to have gone back to hard work and their daily routine—no posttraumatic stress here (that came later). It was hard to have a more personal conversation as our worlds were too far apart, even if we all told about our family backgrounds. Only with Sister Genoveva, a humorous woman of about forty-five, could I have something of a discussion. At one point she made a comment—something like “God will protect us”—and, weary of courtesy, I said, “Do you really believe this?” She admitted to doubts, and that was something I cherished, for it made her seem more human, and in a way more tragic—doubts as later also expressed in the letters of Mother Teresa.

If Sister Genoveva was my favorite nun, my favorite village was Yamotili Moké—
Little Yamotili
, in Lingala, meaning its inhabitants had split off from the village of Yamotili. There was nothing really special about it, but the people seemed more open, and their agenda of needs (for food, supplies, cash) was perhaps a little less intense than in other villages. Also, it was close to Yambuku. I started going there nearly every evening, bringing some beer, or tins of sardines, or a little cloth to offer as a gift. If people had a medical problem they came to me, and I gave them an aspirin or an antimalarial—never a shot, but whatever I had. (I suspected that most of their fevers and so on were malaria and certainly everyone had parasites. We did a little lab work at a later stage; filarial and amoebas and all sorts of things showed up in their blood and feces.)

But for some reason I felt comfortable; I didn’t feel I had to play the Big White Doctor who investigates disease and saves the world. Mostly I sat with the elderly men: they smoked their pipe and talked among themselves, not even in Lingala but in Buja, the language of their tribe, and I felt I was accepted by them. There was an older man whose name I forget (perhaps he was only forty-five but he had hardly any teeth) and like most men in Zaire he knew far more about Belgian soccer than I did, thanks to the magic of transistor radios. The goalkeeper of the Belgian national team at that time was Christian Piot, who shared my name, so that made for some comment and a funny sort of bond. But most of the time our companionship was a silent one.

No women ever participated: they were sweeping, cooking, pounding or grating manioc (cassava) roots, their staple food. Sitting with the Yamotili men was basically an alternative to sitting with my own tribe at the Yambuku mission.

I was answering those questions that had occurred to me when I first arrived in Yambuku. These people were living closer to the Middle Ages than to the year 2000. How did they manage to survive? Weren’t they scared? To me they seemed so vulnerable, both to the invasive forces of nature—animal, viral, climate—and to soldiers. They told stories of insane cruelty culled from the multiple rebellions that had already crisscrossed the region. It was still only 16 years since Lumumba’s speech at Independence and already there had been many wars, much killing and looting and rape. Even in times of peace, Mobutu’s soldiers stole their meager possessions and raped girls and women. Even now, thinking about how vulnerable the villagers were gives me pain; their stories, and many subsequent experiences in Zaire, made me appreciate our well-functioning states where the rule of law is intended to protect its citizens, not scavenge off them.

In addition, though, by just hanging out with people, drinking arak and chatting about soccer I put together the very beginning picture of a whole culture. I’m a strong believer in what I later learned is called
qualitative
research. You do need the standardized epidemiological questionnaires, of course, for quantitative analysis, but you may also sometimes need to develop a kind of feel that’s a lot less systematic, but may reach out to places that are deeper and more unexpected.

So, for example, that was how I put together a picture of what happened during funerals. As in so many cultures, funerals were a major event for the
Buja
, stretching across several days and could easily cost a full year’s income. What made those funerals so lethal, apart from this prolonged and intense contact, was the preparation of the cadaver. The body was thoroughly cleaned, and the process often involved several family members, working bare-handed. Since the bodies were usually covered in blood, feces, and vomit, exposure to Ebola virus was enormous—particularly since the usual custom was to clean all the orifices: mouth, eyes, nose, vagina, anus.

People don’t tell you this sort of thing. You get at it obliquely. You’re talking about washing the body, and you say, “So, of course you’re cleaning the anus?” Some people say, “Sure,” and another says “No,” and for a long while you don’t know what to believe. One woman said that the body was licked. But nobody else agreed with that, and we were talking about the body of her very young, almost newborn child, so perhaps that had been a special case, not the norm. Then the body was wrapped in a cloth and buried in the ground right outside the door of the person’s hut: (I often saw a row of mounds just outside a house—the burial ground of family members.)

The nuns were one source of information, but while people reported that their behavior was Christian, they had a separate, extra religion that they hid.

I became immersed in this place. I developed genuine respect for these people. I was growing up and answering my own questions, I guess. I wasn’t thinking of Belgium, but of course I worried about my pregnant wife, particularly at night, in my austere cell with its crucifix on the brick wall. But what could I do?

Perhaps I was also finding that there was more to me than I had thought. I wasn’t a boy with a great deal of self-confidence; that wasn’t part of a Flemish education in those days (fortunately my own children are quite different). You learned humility and silence, to work hard and never think you’re better than anybody else. This has its advantages: it protects you from snobbery and the corruptions of power. But it also means you aim small.

Now I was “director of operations” for the International Commission. A C-130 full of food and equipment arrived and I had to organize distribution. I was hiring people, paying them, negotiating with the
Commissaire de Zone
(who badly wanted the Puma for his own use), making sure the money didn’t disappear, organizing the collection of specimens, and building a system so that 25 people could arrive from Kinshasa and operate in a clinic and a lab.

A SECOND HELICOPTER
arrived, this time an Alouette donated by French President Giscard d’Estaing to Mobutu in return for God knows what favor. It lent an almost comic flavor to my life. I did not request it or need it, but Bill Close sent it to me, and by this time I was starting to find all this normal. Need a helicopter? Here are two! People in the humanitarian field are often like this: it’s a mentality that’s somehow not very grown-up, part cowboy and part Boy Scout.