4. Ebola Kiss
WHILE EBOLA was breaking out in Kikwit, I spoke with a doctor named William T. Close, who had lived in Congo (then Zaire) for sixteen years. When he was in Zaire, Bill Close rebuilt and ran the Mama Yemo General Hospital, a two-thousand-bed facility in the capital. When Ebola broke out for the first time, in 1976, Close went to Zaire and helped coordinate the medical effort to deal with the virus, and advised the Zairian government. Years later, during the Ebola Kikwit outbreak, he acted as a liaison between Congolese government officials and doctors from the CDC in Atlanta.
“In 1976, when Ebola broke out in Yambuku that first time, there was a nun, Sister Beata, who died of Ebola,” Close recalled. “There was a priest, Father Germain Lootens, who gave her the last rites as she died. She had a terrible fever, sweat was pouring down her face, and bloodstained tears were running down her face. Father Lootens took out his handkerchief and wiped the sweat from her forehead and the bloody tears from her face. Then, unthinkingly, he took the tearstained handkerchief and wiped the tears from his own face with it—he had been crying, too. A week later, he came down with Ebola, and a week after that he was dead.”
Now, Close had been hearing reports that some members of the medical staff of Kikwit General Hospital— Dr. Bwaka and his nurses—had continued to care for Ebola patients despite the grave risks to themselves. “Those hospital staff people have gone into that hospital to work knowing that they may die,” Close said. And the doctors and nurses in Kikwit were working without basic medical supplies. “The greatest need in Kikwit right now is for rubber aprons to protect the doctors and nurses, because the blood and vomit is soaking through their operating gowns,” he said. “This is a huge, lethal African hemorrhagic virus. We all sort of feel that Ebola comes out of its hiding place when something occasionally alters the very delicate balance of the ecosystems, in a tropical region where things grow as they would in a petri dish. But if there are lessons to be learned here, they are human lessons. This is about people doing their duty. It’s about doctors doing what has to be done, right now, without a whole lot of heroics. Have you ever been petrified with fear? Real fear? Possessed by naked fear, where you have no hope of control over your fate? If you’re a medical worker, when the die is cast, the fear goes away, and you do what you have to do—you get to work. That’s what’s happening with the medical people in that hospital right now. There are things happening in Kikwit…” He paused. “Magnificent human things…. How can I explain this? There was another incident in 1976, also in Yambuku. One of the doctors—he was a Belgian named Jean-Francois Ruppol— delivered a baby in the middle of it all.” Ebola has a profound effect on pregnant women: they hemorrhage profusely and abort the fetus, which itself is infected with Ebola. “There were people dying of Ebola all around in that room in the hospital, and there was a woman in childbirth. She was Dr. Ruppol’s patient, and her baby was his patient, too. The baby was stuck—too big for the birth canal.” The woman had a high fever, she was terribly ill, but her baby had to be delivered, even if it was infected with Ebola. “So he performed the Zarate procedure on her,” Close said.
“What’s that?” I asked.
“The Zarate procedure? It’s a simple and rather crude but very effective way of enlarging the outlet to remove the baby. With a knife, you split the pubic symphysis.”
“The what?”
“The front of the pelvis. The pelvic bones,” he said. It’s a hard, bony spot, and you can feel it, just above the pubic area, he said. “You split the bones there. You press a scalpel through cartilage. The bones go
“My God.”
“She was conscious. By the time he got the baby out, the baby had stopped breathing. The baby was in breathing arrest and drenched with the woman’s blood. He put the baby’s mouth to his mouth and gave the baby mouth-to-mouth resuscitation. The baby started to breathe. He pulled away, and his mouth and face were smeared with blood. There was a nurse standing by. When she saw his face she said, ‘Doctor,
“‘I do now,’ he said.”
5. Seeking the Ghost
WHEN THE WHO TEAM ARRIVED in Kikwit, they found Dr. Mpia Bwaka working alone in Pavilion Three with only two nurses—the third nurse had died of Ebola a few days earlier. Dr. Bwaka seemed to be all right. The WHO team had brought medical supplies, including jugs of bleach. They washed the ward with the bleach, rinsing the blood and feces off the floor. The team members put on double rubber gloves, waterproof gowns, masks, and goggles, and distributed the same equipment to Dr. Bwaka and his nursing staff. They wrapped the mattresses (which were blood-soaked) in plastic covers. Afterward, Ebola patients were placed directly on the plastic, without sheets. A Belgian team from Doctors Without Borders arrived a few days later, and put up white Tyvek sheets around Pavilion Three, as a sort of crude barrier to keep the virus inside the pavilion; the Belgian team also brought water for the hospital. Dr. Bwaka continued to work in the Ebola ward. It was so hot that the goggles fogged up, so the medical workers often didn’t wear them. One day, a nurse forgot himself momentarily and wiped his eyelid with his gloved fingertip, which was contaminated with Ebola blood. He died of Ebola.
But by the time the teams arrived in Kikwit, the outbreak was fading away. What really ended it was the fact that the virus had killed a third of the doctors in the city. Once the medical system collapsed, people didn’t go to the hospitals where the virus had spread. The outbreak burned itself out. Dr. Mpia Bwaka survived.
IN THE FOLLOWING MONTHS, a team of epidemiologists and zoologists led by Herwig Leirs, an ecologist at the Danish Pest Infestation Laboratory in Lyngby, Denmark, fanned out into the countryside around Kikwit and began trapping animals and birds and testing their blood. They were trying to find a species of animal that was either infected with Ebola or had antibodies to Ebola in its bloodstream, which would suggest that the animal was a natural carrier of the virus. They set out traplines and mist nets all through the forest of Mbwambala, and in other places in the countryside around the city. In the end, they collected slightly more than three thousand specimens. Most of them were mammals. About ten percent of the specimens were birds, and a few of them were reptiles and amphibians. Most of the mammals were rodents, and there were a number of bats. But they also collected wild African cats, as well as wild red pigs, pangolins, and elephant shrews. Not one of the specimens turned up positive for Ebola virus. Not one.
The Danish team didn’t look at any insects. Insect biodiversity in tropical Africa is enormous and unfathomed—many species of insects in Congo have never been identified or given names. A collecting team led by Paul Reiter of the CDC went around Kikwit and the countryside and collected thirty-five thousand arthopods— insects, ticks, sand flies, fleas, lice. They collected many bedbugs from around the city. For some reason, they didn’t catch any spiders or scorpions. They also didn’t report collecting any mites. (Mites are very small arthropods that are very difficult to see and collect.) Mites can live in hair follicles or on the skin of an animal or person, as well as in soil. The CDC arthropod team didn’t find any trace of Ebola in any of the thirty-five thousand specimens. No Ebola in a single bug.
It left the mystery unsolved. In what creature does Ebola make its everyday home? One interesting question about Ebola is this: Why aren’t humans infected more often with Ebola? Why are the outbreaks actually quite rare? If Ebola lives in some common animal or insect, then people should become infected more frequently. Possibly Ebola lives in primeval rain-forest canopies, in some creature that exists high above the ground in the remains of an ancient forest ecosystem. When a forest is disturbed—when trees are chopped down—people come in contact with the canopy and all that lives there. Perhaps the first man with Ebola in Kikwit, G.M., cut a tree down, then touched or ate a bat, bird, or insect that lived only in the tops of trees. Or perhaps he got Ebola from something that had lived underground, something he found in the small hole he dug that day in Mbwambala. He was dead, and many
