After a while, a cluster of lights appeared, and the Friendship descended and landed at Kisangani, a city on the Congo River that was once known as Stanley Falls.
The air terminal at the Kisangani Airport was a decay-in-progress made of rain-spalled concrete, guarded by soldiers loyal to the maximum president of Zaire, Mobutu Sese Seko. The doctors helped the church people get settled in chairs in the waiting room of the terminal, and then bought sodas for them. Sister Myriam felt well enough to drink a Fanta or a Coca-Cola. The little group passed much of the night—their second night since leaving the Yambuku mission—sitting in the waiting room at the Kisangani Airport. J. J. Muyembé kept the box of samples next to him on the floor, where they were as warm as Zaire. He knew the blood samples and the piece of liver were decomposing, but he remained hopeful that something would be preserved.
In the early hours of the morning, a Boeing jet flown by Air Zaire landed at the Kisangani Airport. The doctors and their patients got on board, and the jet carried them westward over lightless tracts of rain forest dissected by pythonic rivers. Sometime after dawn, the rain forest gave way to tracts of savanna and gallery forest and cultivated land, and Kinshasa appeared, a brown sprawl giving off haze. The plane landed at N’djili International Airport.
They got off the plane. By then, the sun had risen and another day had begun in the capital. Muyembé escorted the nuns and the priest out of the terminal to the taxi area. The air was thick with diesel fumes and smoke from cooking fires, and there was an ever-present chatter of motorbikes. He got them a taxi and told the driver to take the nuns and the priest to Ngaliema Hospital. He bid them goodbye, assuring them that he’d contact them as soon as he had any information about the disease. The piece of liver had been in the heat for two days. He was very anxious to get it into a microscope and look at it.
A taxi dropped Muyembé at the university. It had a comfortable-looking campus spread with modern buildings. He hurried into his lab with the samples. Muyembé had a lab staff, and working with them, he divided the piece of liver into several pieces. He and the staff then prepared some very thin slices of the liver and mounted them on glass slides. Muyembé wanted to get multiple opinions on these liver samples. Could this be yellow fever? If not, what was it? He had two different colleagues look at the slides and make findings. He put a slide holding a very thin slice of the liver into a powerful microscope. He needed to look, too.
Under high magnification, liver tissue infected with yellow fever virus would show distinct changes. But when Muyembé looked at the tissue he saw nothing definite. There was nothing to see. The tissue had rotted into a mush. This was perfectly unsatisfactory. He couldn’t rule out yellow fever or rule it in.
He still had the blood samples, though. With these he would be looking for typhoid. If the disease at Yambuku was typhoid, then the blood would be teeming with typhoid bacteria. The bacteria would have multiplied in the warm, rotting blood. He and his lab staff set out some petri dishes and put drops of the blood on them, and then stored the dishes in a warm place. It would take a day or two for any colonies of typhoid bacteria to grow on the petri dishes. If he saw any typhoid colonies on the dishes, then he would know that typhoid fever was raging at Yambuku.
NGALIEMA HOSPITAL, KINSHASA
Midday, September 27
Ngaliema Hospital sits on a hill overlooking the Congo River at the lower expanse of the great Malebo Pool, a broad, sluggish detention of the river before it pours into the Great Falls of the Congo. The Ngaliema hospital is a neat arrangement of low pavilions, painted white and set around rectangular courtyards covered with grass. Sister Myriam was put in a private room in one of the pavilions, where she got sicker. She began vomiting and had episodes of diarrhea. Sister Edmonda cared for her, but she didn’t wear rubber gloves or a protective gown or mask.
Father Sleghers, the feverish father superior, got lucky. It turned out that, indeed, he did have malaria. There was nothing else in his blood except malarial parasites, and malaria medicine eventually made him better. But Sister Myriam did not have malaria, and she declined rapidly at the hospital.
J. J. Muyembé had been tracking Sister Myriam’s illness, and at the same time he had been watching the petri dishes into which he’d placed a few drops of the blood he’d collected from various people who’d been exhibiting the symptoms. Nothing yet had grown on the dishes. At this point he began to think that he might not have a good handle on the disease. It might not be transmitted through bites of mosquitoes or through oral consumption of contaminated food and liquids. It might be contagious, in fact. He phoned Sister Myriam’s attending physician at Ngaliema Hospital. “We don’t know the exact kind of disease this is,” he said to him. “We must take care, and we must be prudent.” He advised that the hospital staff take basic infectious-disease precautions with Sister Myriam. They should consider her to be potentially contagious.
“Ce n’est pas un problème,” the doctor replied—it’s not a problem. “I think it’s a simple typhoid fever.”
Muyembé was extremely busy with his duties at the university. In addition to running the microbiology lab, he was the dean of the medical school. While he was waiting for results from the petri dishes, he met with professors and students in his office and around the campus. At this time Zaire was a newly independent country, and there was a sense of optimism and energy in the air. The campus was a lively place, and Muyembé got caught up in meetings and work.
The day after he returned from his trip to Yambuku, however, he got a grim piece of news. Father Germain, the thin, older, goateed curate of the mission, who had given last rites to Sister Beata, had fallen ill. This was very disturbing. Whatever it was, it was spreading.
The next day, Sister Myriam started bleeding. Muyembé considered the advice he’d just given to the doctor at the hospital, to consider that it might be contagious. Meanwhile no colonies of typhoid bacteria had grown on the petri dishes. Therefore the disease wasn’t typhoid.
At this point he was at a loss. He also began wondering just slightly about Sister Myriam and himself. That rash he’d seen on her torso and breasts. With the red bumps and the petechiae, the blood spots. He had noticed how rapidly it spread up her neck and down her arms. He began to wonder if he had been exposed to something.
Sister Myriam’s bleeding got worse, and it became frankly hemorrhagic, and the rash on her body darkened and became bruise-like, and her eyes turned bright red. She bled from her gums and her intestines. They began giving her blood transfusions to replace the blood she was losing from the orifices of her body. They were pouring blood into her and the blood was coming out through her intestines. Sister Myriam’s care companion, Sister Edmonda, couldn’t manage the workload of caring for Sister Myriam, so a hospital nurse named Mayinga N’Seka was assigned to care for Sister Myriam as well. Nurse Mayinga was twenty-three, and she had come to Kinshasa from her village near the city to work as a nurse. Nurse Mayinga and Sister Edmonda were dealing with a lot of blood that was coming out of Sister Myriam.
Muyembé thought about what was happening in that hospital room. He also thought about Father Germain, whom he’d met at the dinner table, and who might be dying in Yambuku. He remembered the long, hot ride in a crowded Land Rover, when he’d been pressed up against Sister Myriam. He could feel the moisture of sweat from her skin touching him, her arm bumping against his arm. Her skin had been pale; the rash, the mottling, had been easy to see in her skin. It would not be so easy to see the rash on an African person.
Then word came that Sister Myriam had died. J. J. Muyembé didn’t know what had caused her disease, but it seemed to be a virus. A virus without a name. He thought about his family. He had a wife and children. An infection by a virus has an incubation time, which is the time between the moment the person is infected and when the person begins to develop symptoms. During the incubation period there are no symptoms. Meanwhile you feel nothing. Muyem
bé wondered if he was in the incubation period of a virus. He felt all right.
Another nun at Yambuku, named Sister Romana, had also fallen ill. Sister Romana quickly died in the women’s ward at the Yambuku hospital, and several hours later Father Germain died in the otherwise empty men’s ward. Then Sister Edmonda—Sister Myriam’s traveling companion, who’d cared for her at Ngaliema Hospital—got symptoms. Sister Edmonda’s case was not as severe as Sister Myriam’s, but she developed black diarrhea. Nurse Mayinga, having cared for Sister Myriam, now gave care to Sister Edmonda. In the early hours of the morning on October 14, Sister Edmonda died in her room at Ngaliema Hospital.
KINSHASA
October 15
About thirty hours after Sister Edmonda died, Nurse Mayinga woke up in the morning and realized that she had a fever. This frightened her deeply. Rather than reporting to work at Ngaliema Hospital that morning, she took the day off, and went all over Kinshasa seeking medical help—she didn’t want to tell the doctors at Ngaliema Hospital that she might have caught the nuns’ disease. Running a fever, she spent hours waiting at the emergency room of the city’s biggest hospital, called Mama Yemo, hoping that a doctor would see her. During this time she was in contact with many other people—Mamo Yemo Hospital had a huge, busy waiting room. She couldn’t get a doctor to see her, so she went to another hospital. Finally Nurse Mayinga returned to Ngaliema Hospital and told the doctors she was sick. The doctors isolated her in a room. News reports had begun to appear about the Yambuku disease, and when news came out on the radio and in newspapers that Nurse Mayinga had gone all over the city while she had the Yambuku disease, the city went into a panic. Nurse Mayinga may have spread the Yambuku disease into Kinshasa. The disease had reached the capital.
As dean of the medical school, J. J. Muyembé took responsibility for tracing Nurse Mayinga’s contacts during the time when she had gone around the city seeking medical help while she was running a fever. Muyembé and the investigators discovered that Nurse Mayinga had had face-to-face contact with at least two hundred people in Kinshasa—in the space of just a few hours. All of them had to be found by surveillance workers and watched, since the infectious agent could appear in any of them. Muyembé could not forget that he himself had been in close contact with Sister Myriam. Mayinga had caught the virus from either Sister Myriam or Sister Edmonda, or from both of them.
Muyembé began seeing in his mind’s eye flashes of certain incidents while he’d been investigating the disease at Yambuku. He could see, and feel, the cadaveral blood running over his fingers and dripping from his wrist. His exposures to the virus had been massive. It could be growing in him now.
He again thought about his wife and children. He thought about the close contacts he’d had with many people at the university. Faculty members, students, lab technicians, citizens. He began taking his temperature twice a day, in the morning and evening. He couldn’t bear living at home with his family, he might give them the virus, and so he moved out of his house and began sleeping in a room at the university. As the days went by, he kept visualizing all the terrible symptoms of the disease, including that strange rash, with the red pimples and leaks of blood under the skin. It had been obvious on Sister Myriam’s white skin. But had he actually seen that same rash on the dead nurses, too? It would have been less visible on their darker skin, but he thought he had seen a rash on their bodies. He wondered if his temperature had risen slightly. He inspected his skin, wondering if he would start to see little leaks of blood appearing under the surface of his flesh, and spreading.
BUSH DOCTOR
KINSHASA
September 28, 1976
While Sister Myriam lay dying at Ngaliema Hospital, a Reverend Sister of the Catholic Church got in touch with a doctor in Kinshasa named Jean-François Ruppol and asked him for help investigating the disease. Dr. Ruppol, who was then thirty-eight, was the director of the Belgian government’s medical aid mission in Zaire, called the Fonds Médical Tropical, or Fometro. Ruppol was a small man, with a sharp chin, blue-green eyes, a leathery face with a tropical tan, and wavy light brown hair, and he was reputed to be a man with a sharp temper. Ruppol lived in a whitewashed stucco house on Avenue Mfumu Lutunu in the downtown with this wife, Josiane Wissocq, and two young daughters. As head of the Belgian medical mission, he was in charge of about two hundred doctors working across Zaire.
Ruppol traveled frequently across Zaire as he managed the doctors under his supervision, visiting small, rural hospitals, treating patients, giving advice, and helping the hospital staff do their work. Whenever he arrived at a rural hospital, the first thing Ruppol did was to organize the hospital’s dispensary. Then he would start seeing patients. Meanwhile, word would spread through the local villages that an important doctor had arrived, and patients would start coming into the hospital for treatment. They came from up to fifty miles away. They either walked to the hospital or were carried on special Congolese travel chairs by family members. Ruppol treated the patients with whatever medicines and supplies he had on hand, doing everything from dispensing worm medicine to occasionally delivering babies. Jean-François Ruppol was what is known as a bush doctor.
As a part of his work as a bush doctor, Ruppol was an epidemiologist. He tracked outbreaks of sleeping sickness, kept statistics, and tried to stop the outbreaks. Sleeping sickness is a lethal, difficult-to-cure disease that is spread through bites of the tsetse fly. Sleeping sickness could devastate a village. When it got into a village, so many people would die that the survivors would sometimes abandon the village and move elsewhere.
Ruppol agreed to help with the Yambuku mystery, and he got written orders from the government of Zaire to try to identify the agent and arrest its spread. He was joined on the mission by a French army doctor named Gilbert Raffier, and by an energetic Congolese physician from Kinshasa’s Mama Yemo Hospital, Dr. Buassa Krubwa. (Like many Congolese doctors, he went by his first name, as Dr. Buassa.)
Ruppol wanted to collect some blood samples at Yambuku. He’d been in touch with J. J. Muyembé and knew Muyembé hadn’t been able to keep his samples cold, and they’d rotted. Ruppol went to a beer brewery in the city and rented several large cylinders of compressed carbon dioxide gas. The gas could be used for making dry ice, which he hoped would keep his samples of blood really cold.
Doctors Ruppol, Raffier, and Buassa arrived at the military airfield in Kinshasa just after dawn on October 4. A C-130 Hercules military transport aircraft of the Zairian Air Force was sitting on the tarmac waiting for them. But when they tried to load their gas tanks of CO2 onto the plane, the pilot told them to forget it. The plane had reached maximum takeoff weight, he claimed.
The plane was bound for a town in the north where President Mobutu was building a palace. Ruppol and his colleagues looked around the plane’s cargo hold and discovered it was packed with a number of items destined for the palace. There were crates of imported vegetables, crates of local vegetables, Belgian beer, cases of wine from Burgundy and the Médoc, cases of Champagne, Parma hams, tins of pâté de foie gras, two crates of Camembert cheese from Normandy, and a large number of concrete blocks. Everything was for the President’s palace. The pilot said that if the doctors’ gas cylinders were loaded onto the plane, it might not get off the ground. The Hercules could turn into a delicacy-enriched fireball at the end of the runway.
Ruppol began what he described in his journal as “difficult negotiations” with the pilot. Bribes were common in Zaire, but Ruppol never offered bribes, never. That way led to perdition for a medical man. Instead, Ruppol offered the pilot a cigarette and began a tedious discussion. The pilot kept refusing. Ruppol’s spleen rose. He had friends on the cabinet. He would call in several cabinet ministers and they, not he, would settle this affaire. When his mention of cabinet ministers didn’t impress the pilot, he began dropping the president’s name. President Mobutu will want to hear about this. Finally Ruppol said he was
going to call the president. The pilot obviously didn’t believe him.
So Ruppol went to a phone at the airfield and called President Mobutu. After a short wait, Ruppol was told that the president wasn’t available to speak with him. Ruppol walked back to the Hercules and told the pilot that the gas cylinders must be brought on board immediately.
The pilot finally said that he would take the tanks, but, for safety, something of equal weight would have to be left behind. For some reason the cement blocks were not eligible for jettison. The pilot looked around the cargo hold briefly, made a quick decision, and ordered that the two crates of French Camembert cheese be offloaded and left on the tarmac. The tanks of CO2 were brought on board. After a brace-for-impact kind of takeoff, the Hercules lumbered into the air.
Years later, the French Army doctor Gilbert Raffier recalled in his memoir, Africa from A to Z, that as the Hercules took off he experienced a sharp pang of regret as he thought about all that beautiful cheese from Normandy sitting on the tarmac and spoiling in the tropical sun. As a Frenchman, he had a painful grasp of the full dimensions of the tragedy that had just occurred. This was a sacrifice, but it had to be done in order to keep the blood samples cold. The plane flew for hours and landed near the president’s palace. The doctors slept in a hostel in town. The next morning a military helicopter delivered them and the cylinders of compressed CO2 gas to Bumba Ville.
When Ruppol and Raffier stepped off the helicopter, they found the town in a panic. The national government had thrown a quarantine around Bumba Zone, and soldiers had set up roadblocks and weren’t allowing anybody to leave. After meeting with the district commissioner, the doctors walked around the town putting up notices for a meeting to be held in the marketplace that day. The notices said that at noon there would be doctors at the marketplace who would explain the disease and make recommendations. Then Ruppol and Raffier went to the Bumba hospital to see if there were any patients afflicted with the mysterious disease whom they could examine, while Dr. Buassa met with the district commissioner to coordinate a government response to the outbreak.
Crisis in the Red Zone Page 19
