No Time to Lose: A Life in Pursuit of Deadly Viruses

by Piot, Peter

  The sick couple lay on raffia mats, piled on top of a low platform made of branches. Flies settled insistently on the black crusted blood around their mouths, noses, and ears. Both had dark blotches on their torsos and their eyes were darkly bloodshot. They had barely the strength to move. The husband began vomiting blood, painfully and spottily. Both had a look in their eyes that I later became familiar with in AIDS patients but had never seen before. It is an empty look, a ghostly deadness that some people describe as “glassy-eyed.”

  With easy, skillful gestures of care, Pierre Sureau slipped over to the bed. He nodded an attempt at reassurance and slipped a syringe into the woman’s arm. I merely watched; I had no idea how to be useful, for I knew we had no possible treatment to offer these people. We had supplies of tetracycline, a broad-spectrum antibiotic, and loperamide, a strong antidiarrheal, but neither of these was going to help.

  As Pierre drew the blood out of the wife’s arm, her husband gave one last strangled choke and then stopped breathing.

  I had seen dead people; in medical school I had cut dead people. And occasionally patients had died in various hospital wards where I had worked as an intern, as well as violent deaths during my work in the emergency room in Ghent in Belgium. So I had thought I was inured to dying. But most of those had been sedated deaths—unfortunate, sure, but sanitized, predicable. Watching someone die in front of me was new.

  Both Pierre and I froze: How would the other villagers react? Would they assume that in our nightmarish outfits we had killed this young man? I glanced at Pierre and saw that he, too, was shaken, and the same thought flashed through both of us: if the man had died while Pierre was taking his blood, we would quite possibly be killed. We explained what had happened and left as soon as possible, giving instructions that the bodies should be buried immediately, without any cleansing or ritual, and should only be touched with gloves (we left several pairs in the village).

  That morning we saw eight sick people, though none as obviously close to death as the first couple. All had the glassy look in their bloodshot eyes, severe abdominal pain, and bleeding from various orifices. We also saw a number of people who reported that they had suffered what seemed to be an attenuated version of the disease, with swollen face, severe headache, high fever, and chest and abdominal pains, but no hemorrhage. We asked them to allow us to take blood for antibody testing. This was difficult: they seemed convinced that witchcraft of some sort was involved, and it fell to Sister Marcella to persuade them.

  Although they seemed reluctant to discuss this in front of Sister Marcella, most of these people attributed their recovery to the intervention of the nganga kisi, the herbalist or sorcerer. Pierre and I both noted this, and later discussed the obvious difficulties of asking people for information while using as a translator a person who for religious and medical reasons was so obviously likely to disapprove of certain answers.

  We returned, stunned, to the mission in torrential rain, churning with difficulty through the sodden jungle paths. A midafternoon meal was waiting for us. I don’t remember exactly what it was, but the sisters ate largely African food: foufou porridge; local rice; goat or chicken or game from the forest. Once we even ate monkey—a dish of carbonnades, a quintessentially Flemish stew made with fresh monkey meat, probably from a vervet, Cercopithecus aethiops, as we were informed when the meal was over. Since we considered monkey a possible vector of the disease, this was perhaps not the most prudent of choices. But we found it hard to be rude to our hosts, and I reasoned with myself that the meat was so extremely overcooked that surely no virus would remain active.

  Later that first afternoon, Sister Marcella called the order’s mission in Lisala on the crackly old ham radio that was Yambuku’s only connection to the outside world. Her colleague in Lisala passed on a message to us from Karl in Kinshasa: Mayinga, the young nurse whom we had visited at the Clinique Ngaliema, was dead. In other words, the Marburg plasma that Margaretha Isaacson had brought with her from South Africa did not deliver protection from our epidemic.

  That evening there was a new sense among us of the gravity of the situation. A real camaraderie had sprung up among us. Joel Breman from the CDC was our leader—an experienced field epidemiologist, a veteran of smallpox, with a great sense of humor. Pierre Sureau, too, was a real inspiration to me. A chain-smoking fifty-year-old who had more experience in his left elbow than I had in my entire body, he nonetheless was never snide or scornful, indeed treated everyone with the same gentle courtesy. Dr. Masamba, the regional director of public health, who joined us in Bumba, was an excellent organizer, and he seemed impervious to fear. The Belgian Jean-François Ruppol took care of logistics. He spoke Lingala and Kikongo, having grown up in Zaire on his parents’ cattle ranch, and he was a good man in a pinch.

  Sitting around our lamplit dorm that evening, it struck me that the scene was a little like in those jokes where a Belgian, an American, a Frenchman, and a Zairean might all walk into a bar.

  FOR THE NEXT two days we toured villages every morning, taking blood where we could, jotting down every potentially telling detail and piece of data we could muster. We saw patients with blood crusting around their mouths or oozing from their swollen gums. They bled from their ears and nose and from their rectum and vagina; they were intensely lethargic, drained of force.

  In every village we organized a meeting with the chief and elders. After the ritual passing of a plastic cup of roughly distilled arak—banana alcohol, which Pierre had the courage (or perhaps the common sense) to refuse—we asked them to describe their experience of the new illness, the number of cases and deaths, the dates, whether they had knowledge of any people currently sick. We questioned every villager we came across about day-to-day practices—unusual contact with animals, new areas of forest cleared, food and drink, travel, contact with traders.

  We heard of entire families who had been wiped out by the swift-moving virus. In one case, a woman in Yambuku had died days after giving birth, swiftly followed by her newborn. Her thirteen-year-old daughter, who had traveled to Yambuku to take charge of the child, fell ill once she returned to her home village and died days later; followed by her uncle’s wife, who had cared for her; then her uncle; and then another female relative who had come to care for him. This extremely virulent interhuman transmission was frightening.

  We were all familiar with our terms of mission: we were here just for three or four days, to act as scouts in preparation for the arrival of a larger team that would try to set up systems to control the epidemic and break ground for further research. Our job was to document what was going on, sketch out some basic epidemiology, take samples from acutely sick patients, and, if possible, find recovering convalescents who might provide plasma to help cure future sufferers.

  And we were doing that job—harvesting samples, collecting data, and cataloging the basic logistical equipment that the larger team would need to bring. But we knew that from a human point of view this simply wasn’t enough. We needed to stop the virus from infecting and killing people.

  The mystery fever’s epidemic curve was starting to take shape. The classical epidemiological curve is pretty simple; it plots the number of new cases of an infection against time. In the simplest type of outbreak the number of people infected rises gradually, then picks up pace, reaching a peak at the midpoint of the graph. Once the virus has exhausted its stock of easy victims (the weak or easily accessible), the rate of new infections begins to wane until the epidemic fades to a whisper.

  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 conclusi
on 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.