No Time to Lose: A Life in Pursuit of Deadly Viruses (9 page)

Actually both the Puma and the Alouette were an enormous hassle to manage. The pilots constantly demanded money and caused havoc all over the region, blowing the roofs off huts and sleeping with an apparently endless loop of girls, dirt poor and in need of some cash. The sexual appetite of some pilots was apparently unslakable and the village men were not happy. Even the children were fascinated by the helicopters, and started producing toy helicopters made of wire—one of them is still in my office.

One afternoon the pilots flew the Alouette up to Yambuku from Bumba to tell me that Karl wanted me to fly back to Bumba with them to meet with the US ambassador and the head of the Kinshasa office of USAID, who had flown in from Kinshasa and wanted to be briefed on the epidemic.

Then the pilots disappeared. They always did a lot of business, buying stuff in the villages and selling it in Bumba, where people were still short of supplies because of the quarantine.

Sitting on the verandah of the Yambuku mission, I threw a kind of tantrum. If these big shots wanted to know about the epidemic, I thought, they should damn well come to Yambuku where the epidemic was. When the pilots returned, they asked me for a beer. I could smell beer on their breath already.

The sky was becoming dark, as it did every afternoon as the storms formed. I don’t love flying; to be honest, in these helicopters that I was supposed to be ordering about, I was actually kind of scared. I also knew that the Puma pilots refused to fly in this kind of weather, so why fly in a much smaller Alouette, with pilots who had clearly been drinking?

So I said to myself, “The hell with it, I’m not going to go.”

As I told the pilots to return to Bumba without me, a middle-aged man who was sweeping the courtyard spoke up. “
Patron,
” he begged—“Boss” (I had long ago stopped asking people not to call me this)—“I have family in Bumba. I have never been in a
hélico
—can I go?”

“Sure,” I told him. “Have fun.” And they left. Soon afterward the sky broke into torrential equatorial rain and I felt glad for a moment that I had avoided being shaken up in the helicopter; then I went back to work.

The next morning I turned on the army radio that had come with the Alouette, for my daily contact with Kinshasa, and Karl was at full volume.

“You sonofabitch, where the hell are you? Where the hell is the Goddamn helicopter? You kept the ambassador waiting for hours! And the USAID guy! That’s where all our money comes from!”

I said, “The helicopter left last night and the next time your ambassador comes he can bloody well come to Yambuku”—we were both angry—but then we both realized that the helicopter and the people in it were missing, and we fell silent. I had a sinking feeling that it had crashed somewhere in the storm.

All around me there was so much death, with people dying because they had cared for a sick person or asked for a shot of vitamins or helped bury a relative. And although I pretended that it didn’t affect me, I think I must have been a little too close to breakdown by this time. In terms of contact with patients and the crazy parameters of operating in Zaire, I had been taking risks that were calculated, but still very real, and although I faked a great confidence about all this, deep down I knew how dangerous it was. Now I had survived two brushes with my own mortality—the frightening fever in Kinshasa and the Alouette crash. I was cut off from my normal support system and literally from the rest of the world, and knowledge of my vulnerability, which I had suppressed, flooded in. Thinking of the young sweeper who had probably perished in my place I was petrified, overwhelmed.

I cut off the radio transmission, went to my room, and laid down on the metal bed. I missed Greta. Our first child could have been born fatherless. I felt a wave of self-pity, then righted myself: sentimentality wasn’t going to help anyone. I reached for those traditional Flemish coping mechanisms, repression and work. Sweep everything tightly under a rug. Above all, get the job done. But, at the same time, I realized that my newfound lack of respect for authority and on-the-fly risk assessment had literally saved my life. A cherished lesson to trust my own instinct.

Two days later, the Puma helicopter arrived from Bumba with orders that I return to see the
Commissaire de Zone
. The pilots were extremely unpleasant. They were, of course, colleagues of the downed Alouette pilots. Now, flying to Bumba in their care, I was really scared. The Puma is a combat aircraft, and it can fly with the doors open so you can shoot out; only a patch of webbing holds you to your seat.

Citoyen Olonga was menacing. In essence, he accused me of knowing in advance about the crash, perhaps even causing it; that was why I had not taken the trip myself. In Zaire, in this population, nothing could happen by coincidence; if there was an accident, or an illness, then someone had caused it to happen, by hex or by potion. He announced that a hunter had found the crashed helicopter in the forest, and that since I was responsible, I must go there to collect the bodies, as well as pay compensation to the families of the dead young man and the pilots.

I went to see Father Carlos and said, “Now I really have a problem.” I needed three coffins by early next morning, and by now it was late in the afternoon. We bought some planks, some disinfectant, and a fumigator spray full of insecticide at Noguera, because after three days in the heat, these bodies weren’t going to be that nice. (I also brought an aspirator mask with me from Yambuku—not just a surgical, paper mask, but a gas-mask type of thing.)

As we drove this load back to the mission, we passed a group of prisoners working on the side of the road, and an idea hit me. I asked the prison commander to let me have six prisoners for 24 hours. I didn’t bribe him—I never paid a bribe in Zaire—but he agreed to my request. (Although when everything was over I did pay them a little money for their pains, and the prison commander probably figured that out and took it from them.) That night we banged the coffins together in the courtyard of the mission. It was almost a relief to be working at something manual—all of us together, shirtless, in the evening heat.

The next morning the Puma pilots flew me and the six prisoners to another Unilever plantation deep in the forest. A huge crowd of people had gathered there: I had no idea how so many people had come to be present in such a remote area, but I suppose the noise of the helicopter engine had called them to the scene. The pilots loped off for a beer—they didn’t bother to come with us to recover their colleagues’ corpses—and the hunter, the six prisoners, and I marched into the forest. The prisoners slung the coffins with lianas onto big sticks that they balanced on their shoulders. The hunter was in front, slashing the undergrowth with his machete. I stumbled behind, in my blue workers’ overalls, with socks rolled over my legs to protect myself from the snakes, spiders, giant centipedes, and other insects that teem in the Central African rainforest, which I cringed to even think about.

It was absolutely virgin forest, thicker than any kind of vegetation I had seen around Yambuku, and I was sweating with resentment and anger, in addition to the already suffocating equatorial temperature. I knew that we were being followed at a distance by possibly a hundred villagers. I couldn’t see or hear them but I could feel them; it’s dark in the Zairean rain forest, but I knew that they were there.

After well over an hour of marching through the virgin jungle, which was a very tiring experience, given that I had spent the night hammering coffins and had barely slept, I suddenly smelled something unmistakable. So I put on the mask, and when we saw the smashed helicopter the prisoners dropped their coffins and ran away. They didn’t go too far, I guess, but what the hell was I going to do now? The hunter merely gazed at me with curiosity. We shared no language.

I went up to the helicopter, which was lying on its side; it hadn’t burned or exploded. The pilot and copilot were still in their seats, totally swollen, and although I pushed a bit, I couldn’t extract them. It felt like a scene from some B movie, and I took pictures of the horror scene with a disposable Kodak camera I had bought in Kinshasa. Then, to give myself some more time to think, I began to fumigate the corpses, spraying great gusts of insecticide. I tried to remove the mask, because it was so hot I was almost suffocating, but then I almost fainted from the cadaver smell.

Nobody else was there, so if I didn’t manage to do this, it wasn’t going to get done. And if anything bad happened to me while I was out here, nobody was going to notice. In a situation like that, you can have self-pity, you can snivel and quaver, but it doesn’t make any difference: you’re alone.

One of the pilots’ legs was stuck out of the door at a sick-looking angle, and I noticed he had smooth new Italian boots on. A rather unpleasant idea came to me, and I yelled out, “The first one who helps me drag out this man gets these boots.” I said it in French, and to the best of my ability, in Lingala. So then a few of the young people who were watching from nearby stepped up, and the prisoners emerged from the undergrowth, since basically they had nowhere to go but home with us to Bumba; this was not the region where they belonged. And in the end, after some really hideous maneuvers that I would prefer not to remember, we got the corpses out and jammed them into the coffins, which we had lined with plastic tarps. The bodies were so swollen we had to jump down the coffin lids as if closing overstuffed suitcases. It was a really ugly scene.

Then we wound the coffins shut with lianas and back we went, marching for nearly two hours through the impenetrable rain forest, the prisoners staggering under the weight of their loads and the immensity of the stench. As we left the scene the hidden villagers moved in and began to deconstruct the helicopter for parts. (Years later huts were still decorated with bits of the Alouette!)

We loaded the coffins into the Puma, and I then joined the pilots for a lukewarm beer. No words were exchanged. I stared at the beer coasters, which exhibited the logo of Mobutu’s incredibly corrupt Mouvement Populaire de la Révolution with the utterly hypocritical slogan “Servir oui. Se Servir non.” (To serve: yes. To serve oneself: no). I swept the coasters into my pocket as a souvenir, paid for the beers, and then told the pilots I was done: they could drop me off in Yambuku. But they wouldn’t do it, they had orders to bring me back to Bumba for another dressing down.

Meanwhile, I had made a mistake: in my stress I had forgotten to dilute the disinfectant. In other words, I had poured pure Dettol (a powerful disinfectant on the basis of chloroxylenol) on the corpses. It was fortunate the helicopter doors were open, but even so our eyes were totally bloodshot by the time we landed. And I didn’t go to the
Commissaire de Zone
.
I went straight to the mission, to Carlos, and said, “I need to get drunk.” I had never felt anything like it in my life, and indeed I have never had that urge again.

I suppose I was waking up to the fact that I wasn’t living in a comic strip. I wasn’t Tintin, and in fact there was nobody
drawing
this comic strip, nobody but me. I had put myself in a situation where I was alone, far away, and wholly reliant on complete strangers, who could drop me out of the sky as easily as not and who had no real reason to help me in any way. In African terms, I was really still a child, because I had never truly understood before that life does
not
go on forever, and I too will die.

Carlos drew himself up and I actually saw him slip into his professional role of pastor. As I recall, he actually called me “My son” and said something about the bitterness of life and the hereafter.

I said, “Carlos, I don’t need this,” and went to one of the little shebeen bars in what passed for downtown Bumba. And after I’d had a few beers a white man walked in speaking Lingala. It was Simon Van Nieuwenhove, a sandy-haired young Flemish man with broad shoulders and eyes that constantly moved, scanning the room. He had just arrived in Bumba from the Sudanese border. Joe McCormick, the American whom I’d met in Kinshasa, had flown back to the Zairean capital with his blood samples, but Simon, who had accompanied him on his tour through southern Sudan to establish a link with the other Ebola epidemic, had continued by road, to meet up with me.

Simon was perhaps thirty-four years old, a physician, and he worked for the Belgian Development Cooperation agency in Isiro. He had been living in Zaire for several years and spoke a few local languages. He was a real bon vivant who knew far better than I did how to carry himself in a Zairean bar, where both men and women were quite naturally working on me for beer money and ready cash. He appeared at so precisely the perfect moment that it was almost hard to believe in the coincidence.

Everything bubbled up, the emotions and the alcohol. We talked about Ebola, of course, and he briefed me about the epidemic in Sudan, and we bought drinks for everyone in the bar—that was the mood I was in, I wanted great gestures and high drama—and in that instant of profound brotherhood we became friends for life.

CHAPTER 6

The Big Team

E
VERYTHING CHANGED WHEN
the big team came to Yambuku, at the end of November, because until then I had been the chief. Now trucks from the Ebonda plantation unloaded generator, a liquid-nitrogen tank to be kept at –170°, lab equipment, radio equipment, even video equipment. Two young physicians from the University of Kinshasa joined the team, Dr. Miatudila and Dr. Mbuyi as well as Mike White, a CDC epidemiologist from Atlanta, and two Frenchmen—a hematologist, to organize plasmapheresis from Ebola survivors to obtain hyperimmune plasma, and an entomologist, who planned to investigate possible Ebola reservoirs or vectors in the local insect population. (However, the hypothesis of an insect
vector
already seemed unlikely: Ebola’s main mode of transmission was pretty clear.) Finally, a young Englishwoman who worked at the British Embassy in Kinshasa came along to organize the administration. There were even two Zairean electricians, whose job was to install an additional power supply for the generator and rewire the Yambuku hospital.

All this increased considerably the burden on the mission in terms of everything from catering to toilets. With all of this to manage, and lots of large personalities on display, I kind of withdrew into my shell. These people wanted to start all over again investigating the epidemiology on the basis of highly structured questionnaires. Karl and Joel rightly argued that it was important to gather as much information about Ebola as soon as possible. This was a very scary virus, and it’s always better to do the work when an epidemic is fresh in memory: months later, people do not remember.

Thus we repeated the work that Pierre and I had already done. But this time we did it more thoroughly, as a more structured case-control study that retrospectively compared the sick and the healthy, to identify contributing factors. Basically we collected information on a case and compared it to that of two or three people who didn’t get the disease, to try to eke out all the differences.

In addition, we mapped every house in the villages around Yandongi and Yambuku, and organized a vast survey of several thousand randomly selected people whom we tested for Ebola antibodies. The point of this was to assess the extent of Ebola infection in the area and to establish whether some people had already contracted the infection but had either manifested no symptoms or survived them. (We did find the occasional person with an old infection, but the main conclusion of this work was that survival of Ebola—and asymptomatic Ebola infection—is very rare.) It wasn’t until 10 years later in 1986 that I fully appreciated the value of this precise and disciplined approach to a random population survey: because of the records we kept, and the CDC’s excellent specimen storage, we used these same blood samples to take a look at the prehistory of HIV.

Joel Bremen was my mentor. After the theoretical courses I had studied in Antwerp, I was finally learning epidemiology in practice. Joel taught me the Zen of a robust case-control study, hammering into my head that precise case definition and careful selection of controls creates or destroys the value of research. A walking encyclopedia with experience of health in Africa, Joel had the patience of a monk, a heart of gold, and a sharp and comic delivery of Jewish jokes in both English and French.

We were constantly following up false rumors and dead ends. One Sunday Joel, Mike White, Guido, and I took a trip upriver to a village that was only accessible by dugout canoe. Those are some pretty unstable boats—two-person dugouts, with one man rowing with a stick. We were seated a few inches from the water line, and God only knew what parasites and crocodiles were in the water. A separate dugout transported the drummer, who gave the beat.

Every so often the rowers stopped, and someone climbed a tree to fetch down a stash of fermented palm wine. (There are palm trees whose trunks you can cut, much like a rubber tree. The sap is collected in hollowed-out calabash gourd, where it ferments in the heat to create an insect/moonshine stew of varying degrees of alcohol.) It tasted foul, but the rowers were clearly getting high. On the riverbanks there were all kinds of monkeys and birds, and the village too was like something out of
National Geographic
. When we arrived, all the inhabitants were at the landing stage, drumming and dancing and chanting. Many of the men were in loincloths, and the women bare-breasted.

Again, it quickly emerged that nobody was particularly sick, and the rumor of Ebola had been just that, so we paid for a huge meal and everyone laughed a lot and then we poled as best as possible our zigzaggy way back to Yambuku. (Guido’s boat overturned, to everyone’s joy but his own.) That was the only relaxing day I remember.

Guido had set up a very sophisticated portable lab, complete with enclosed working cabinets, fluorescent microscope, laminar flow facilities, electronic blood-testing apparatus, and a refrigerated centrifuge. This meant that as well as testing for antibodies in people, we also had the resources to begin investigating any Ebola antibodies in domestic animals and rodents. Since I had experience dealing with pigs and goats, the sampling fell to me: seizing these skinny, half-wild pigs and slicing off a tiny piece of their tail to the total hilarity of every child.

We were becoming a close-knit community. Guido began fooling with the video equipment that had been delivered, entertaining the team and villagers with funny clips that he shot—“YBC News from the Yambuku Broadcasting Company.” None of the local people had ever seen television, so what to us was merely amusing was to them deeply powerful and fascinating.

All this sounds relatively lighthearted, but we all knew that the stakes were deadly serious. Before the big team had left Kinshasa, they were informed that Geoff Platt, a virology technician at the high-security Porton Down facility in Britain, had come down with symptoms of Ebola after pricking himself while attempting to inject some of our blood samples into a rodent. He was placed in an isolator in intensive care, his family and other contacts were quarantined, and a sample of serum from Sukato, the Yambuku nurse who had recovered from the infection, was rushed to Britain. When the team arrived in Yambuku, Platt was still very seriously ill. (He did ultimately spontaneously recover.)

Because Ebola virus had been detected in Platt’s semen, as well as his blood, it was resolved that we should collect some sperm from the local men, particularly those who had survived infection with Ebola. Actually I had begun trying to do this before the Kinshasa team arrived, but it was a little delicate to communicate. Obviously this was not something I could ask a nun to translate, and the word
masturbation
was not in my Flemish-Lingala dictionary. After a couple of conversations in which I waved my forearm a lot and felt extremely foolish, it really did seem to me that masturbation didn’t figure at all in the local culture. Nobody seemed to acknowledge what I meant.

So I asked Joel and Karl to bring a gross of condoms with them from Kinshasa. There was a long silence on the other side of the radio, and then a guffaw of laughter; what kind of superlover did I think I was, asking for a
gross
of condoms? But I had thought to use them to collect sperm. And indeed, this was easier to communicate. I explained, with a stick, how to roll a condom on a penis; the men went off to find their wives and girlfriends; and they emerged later with my trophies—used condoms, full and warm. It made me wonder whether I would have acquiesced if some African scientist had asked me, in Belgium, for such a thing. Clearly I was just as strange to the people of Yambuku as they were to me, and quite possibly more so.

As our camaraderie deepened, I began to develop great admiration for the power of American science, management, and entrepreneurship. I essentially shed the primitive anti-Americanism that I had developed, in common with so many Europeans at the time, and told myself that we Europeans should stop complaining about the United States, learn the best from them, and get our act together. I also decided I wanted to go to the United States for further firsthand experience of American science. I was determined to spend the rest of my life working on health in Africa; I felt that I would be marked for life by what I had seen of the degrading conditions of extreme poverty, and the intolerable suffering and disease to which it exposes people. But to do this as well as possible, I needed more training, more knowledge, and more skill.

In early December, Del Conn—a Peace Corps volunteer who had joined us from Kinshasa to provide precious logistic support—came down with fever and rash. Del was less lucky than I had been when I had my two days of bad diarrhea in Kinshasa: he was put in a plastic isolator and flown to Johannesburg with Margaretha Isaacson. Fortunately he did not have hemorrhagic fever—I don’t know what he actually had—but he must have felt extremely lonely and scared in his plastic tent, with Margaretha as his caregiver.

Sometime after Del’s departure, Stefaan Pattyn visited us, out of the blue. I now felt empowered enough to have a normal relationship with him.

On December 22, we finally flew out of the epidemic zone, to be replaced by David Heymann, a young American from the CDC who would be doing post-outbreak surveillance for two months. I had to hand it to him: it was nearly Christmas, but David was not only prepared to miss out on the usual holiday celebrations, he was also prepared to ensure the less than glorious work of postepidemic surveillance. This means ensuring that there is no recurrence of the epidemic and continuing the basic epidemiological surveys, while comforting the nuns and providing assistance to the hospital. He had lost his eyeglasses en route, and there was no optician for a thousand miles in any direction; I wholeheartedly wished him good luck. (As with so many members of the original Ebola team, our friendship developed further in subsequent years, as our paths crossed time and again—most recently when he became assistant director-general of WHO in Geneva and, again, in London, where we currently work together at the London School of Hygiene & Tropical Medicine.)

When the plane arrived to pick us up there was another big fight with the pilots of the Buffalo plane because General Bumba had demanded they bring a stock of rattan furniture back to Kinshasa, and a number of other people had bribed them to be allowed on board, so there was no place for our samples or lab equipment. (The quarantine had been lifted but no boats had yet arrived in town.) I argued and swore and joked around and cajoled.

Nonetheless, they ultimately conceded our right to board the plane, and allowed us to load our Land Rover, boxes, and nitrogen-gas canisters on board. Yet another storm was beginning. As we took off, the plane—overloaded and badly loaded at that—lurched and hit the trees. I could feel it straining against the wind to pull up and take flight. We had no seat belts, so we were flung about, and several of us were hit by heavy flying crates. There was quite a bit of blood and some shouting, and I thought, This time, this is it.

But weirdly I wasn’t thinking about myself anymore. I looked over at the crate that held the liquid-nitrogen canister with all those precious samples of sera for further analysis and thought, Shit, all this work for nothing.

But then we pulled up, and out, back to Kinshasa.

I WAS HOME
just in time for Christmas, after more than two months of absence, instead of the 10 days as originally planned—a quite transformed person. It took me a while to get used to the family and work routine again, to the absurd range of choices in supermarkets, and to the fact that, after all, Belgium is a well-functioning society. (Whenever I heard people say that we didn’t need government, I reminded them what it is to live and do business in a country without a functional government and without the rule of law.)

I was grateful to be alive, and had learned that anything can happen, good and bad, in life. But also that more is in me than I assumed. Ebola showed dramatically that, in contrast to prevailing medical opinion in the 1960s and ’70s, the world would experience a seemingly never-ending series of new infectious disease epidemics in humans and animals. This first-known outbreak of Ebola hemorrhagic fever was probably also the first example of highly integrated international collaboration to tackle an outbreak—a collaboration that was informal and ad hoc, driven by a very diverse group of scientists with a passion for solving problems in the field, and committed to working as a group (for example, we decided early on to publish our findings as an international commission, rather than as individuals, thereby avoiding the so-common conflicts among researchers about authorship). It was one of the last major disease outbreaks without global media attention, as neither CNN nor Internet-based social media existed in 1976. As so eloquently reported by Laurie Garrett, when Ebola hit Kikwit in 1995, 19 years after the false alert we investigated, there were nearly as many journalists as epidemiologists and doctors on site, which was a mixed blessing for those working in Kikwit, but certainly raised the world’s understanding that we are under constant threat of new pathogens. Since then, there have been about 20 outbreaks of Ebola infection, nearly all concentrated around hospitals in Africa, and with very high mortality. In general it is an infection that causes epidemics only if basic hospital hygiene is not respected, and is really a disease of poverty and neglect of health systems. The heroic and well-meaning sisters in Yambuku had dramatically shown that doing good is not enough, and can actually be dangerous if it is not bedded in technical competence and sound evidence. Health, economic, and social development are unmistakably intertwined.

Finally, 35 years later, it seems more and more likely that my boss at the time was right: fruit bats are probably the reservoir where Ebola virus hides in between epidemics in humans and apes. If only I had listened to good old Pattyn, who died in 2008.