News of his son’s death crushed Brinkmann. He lost his will to fight the Hamburg old guard, to swagger as the hippie doctor, or to take bold steps to confront tropical diseases. Nearly twenty years later he would find it impossible to discuss Lassa fever without recalling the emotional traumas of the political battles, the long quarantine at Ebstorf, the group’s fears, criticisms from fellow scientists, and—most tragically—his son’s death.
In August 1974, Dr. Bernhard Mandrella quietly returned to Nigeria, continuing his missionary work at the Borromeo Hospital in Onitsha.
5
Yambuku
EBOLA
Men who never have had the experience of trying, in the midst of an epidemic, to remain calm and keep experimental conditions, do not realize in the security of their laboratories what one has to contend with.
—Dr. Martin Arrowsmith, from Arrowsmith, Sinclair Lewis
I
Mabalo Lokela was in a great mood. Sure, he had a fever, but it was undoubtedly just the malaria again. He was sure of that. The important thing was that he was back from a great vacation—one of the few he’d had in his forty-four years.
While he waited for one of the Sisters to give him malaria medicine, Mabalo shared with colleagues at the Yambuku mission stories of his recent travels. From August 10 to August 22 he and six other mission employees had driven around the far north of Zaire, visiting towns all over the Mobaye-Bongo Zone, sampling local delicacies and enjoying the sort of sightseeing that was rare for people in the Bumba Zone. It was possible to travel such distances—it must have been hundreds of miles!—only because Father Augustin was with them: his presence allowed the use of the mission’s Land-Rover.
“We got all the way up to Badolité, and we would have crossed over into the Central African Republic, but the bridge was down,†he told friends at the mission. When he got back to Yambuku four days ago, Mabalo (whom friends called Antoine) was so happy to be home that he spent a good bit of his schoolteacher income buying fresh antelope meat in the market—something to please his wife, Mbuzu Sophie. Sophie, who was eight months pregnant, dried the meat and made a stew for the family celebration of Antoine’s return.1
Antoine watched as one of the Belgian Sisters prepared a syringe, and gritted his teeth when the needle punctured his skin. “Chloroquine,†she told him as he rubbed his arm, “will cure your malaria.†He nodded, confident that all good cures come from needles.
Two days later, on August 28, 1976, a thirty-year-old man came to the Yambuku Mission Hospital complaining of terrible diarrhea. Though nobody at the mission recognized the man, he told the Sisters that he came from the nearby village of Yandongi. Well, his origins were no matter; the Sisters treated any needy soul who crossed their threshold, sometimes 400 a day, many of whom walked and hitched rides distances of fifty or sixty miles to reach the mission. Most of the sick got injections of one kind or another: antibiotics, chloroquine, vitamins—whatever supplies might be on hand in the modestly funded remote Catholic hospital. And usually that was enough for the people, who would, in any event, supplement whatever the Belgian nurses gave them with potions, incantations, and injections from local sorcerers.
But the case of the man from Yandongi was odd, and Sisters Béata, Edmonda, and Myriam weren’t quite sure what was the source of his illness. They put the man in one of the 120 beds in the hospital and, for two days, debated his diagnosis, finally writing in his medical chart a vague “dysentery and epistaxis.â€2
After two days the man left the hospital against the Sisters’ wishes, his diarrhea and epistaxis, or severe nosebleed, still unresolved. He was never seen again, though events days after his disappearance would prompt dozens of investigators from all over the world to scour villages throughout the Bumba Zone in search of the elusive patient.
The Bumba Zone lay in Zaire’s northern frontier, spanning savanna and dense rain forest lands between the Ubangi and Zaire (formerly Congo) rivers. Some 275,000 people lived in the Zone, most in villages of fewer than 500 people. They earned their living growing cash crops for export to the Zairian capital, Kinshasa, and by hunting. The equatorial jungles and grasslands were rife with game that included such marketable delicacies, pelts, and riches as green monkeys, baboons, black-and-white colobus tree monkeys, chimpanzees, spotted-necked otters, mongooses, civets, elephants, hippopotamuses, bushpigs, buffaloes, bongos, sitatunga antelopes, bushbucks, reedbucks, and oribi.3
Since 1935 the major hospital and dispensary for some 60,000 villagers living in the central Bumba Zone was that operated by Belgian Catholic missionaries in the village of Yambuku. A staff of seventeen “nursesâ€â€”so designated, though none of the Sisters had attended a certified nursing school—and medical assistants tended to the health needs of the community out of a rather modest set of cinder-block buildings. As one entered the front of the hospital, administrative offices were in a room on the right, followed by a pharmacy, and a surgical block comprised of an operating theater, scrub room, and facilities for “sterilizing†instruments: a thirty-liter autoclave and a Primus stove atop which water boiled.
Outside the surgical block one entered a long alleyway. To one side of the alley was a pavilion bisected by a hall, off of which were large hospital rooms: one common ward with eighteen beds, four eighteen-bed men’s wards, and three larger women’s wards. As was common throughout Central Africa, the beds were flat metal ones made tolerably comfortable with thin mattresses and ancient linens. Additional comforts and foods to supplement the basic rice or mealie-meal menu were provided by patients’ relatives.
Further along the outer alleyway was an outpatient clinic, through which flowed dozens of people every day seeking prenatal care, injections for a variety of ailments, vaccines for their children, and advice from the Sisters about all sorts of health problems.
There was no doctor in Yambuku. Patients were treated by the staff of four Belgian nuns who had received a modicum of training in nurse-midwifery, a priest, one Zairian female nurse, and seven Zairian men.4
This small team of hardworking health providers also monitored patients in another building housing a large ob-gyn ward and two more general medicine wards. The hospital was part of a larger mission complex that included a school where Antoine worked, a church, a variety of other service buildings, and the living and dining quarters of the missionaries. In addition to those working in the hospitals, the missionaries included several more Belgian nuns and priests who staffed the schools, the church, and other facilities.
Though his home was in the village of Yalikonde, about a mile from Yambuku, Antoine spent days on end at the mission, as did two of his older teenaged children. So it was natural that he returned to the Sisters on September 1 when, despite the chloroquine injection, his fever soared over 100°F. They checked his vital signs and told Antoine to rest for a few days. Antoine returned to Yalikonde, where Sophie tended to him.
At about the same time as Antoine was regaling friends with tales of his recent travels while awaiting his chloroquine shot, sixteen-year-old Yombe Ngongo lay in Yambuku Hospital undergoing transfusions to counter her severe anemia. Nearby, twenty-five-year-old Lizenge Embale was recuperating from what seemed to be malaria, tended to by her husband, Ekombe Mongwa.
And over on the men’s ward Angi Dobola was recovering from hernia surgery. The sixty-year-old villager from Yalaloa was watched closely by his wife, Sebo Dombe, who complained to the Sisters of exhaustion. Sebo was given vitamin injections, which helped her find the energy to cope with long, tense nights by her husband’s post-op bedside.
On September 5 Antoine returned to the mission critically ill. He was vomiting and had acute diarrhea, leaving him so dehydrated that he had “ghost eyes,†as the missionaries called them: deeply recessed, dark, glazed eyes surrounded by pale, parchmentlike skin stretched tightly
over pronounced facial bones. His chest hurt, he had a terrible headache, fevers continued, he was deeply agitated and confused.
And he was bleeding. His nose bled, his gums bled, and there was blood in his diarrhea and vomitus.
The Sisters had no idea what was wrong with Antoine, nor did they realize that he was not an isolated case. Yombe Ngongo had checked out of Yambuku Hospital on August 30, and was now fighting for her life at home, in the village of Yamisakolo. At the sixteen-year-old’s side was her anxious nine-year-old sister, Euza, feeling her own first symptoms of headaches and fever.
And Sebo Dombe’s exhaustion now exceeded the benefits of vitamin injections. Though her husband was recovering nicely from his hernia operation and the pair had returned home, Sebo was semi-delirious. She too was hemorrhaging blood. As was Lizenge Embale, who had returned to her home in Yaekenga in the beginning of September but was now struggling to stay alive. At her side, vomiting blood and bleeding from his eyes, was her husband, Ekombe Mongwa.
The Sisters knew only of Antoine’s case, and they did everything they could to save their friend. The hospital had no sophisticated laboratory facilities to aid in diagnosis, so they could only guess what might be causing such horrendous things to happen to a human body—perhaps yellow fever, or typhus. They pumped Antoine full of antibiotics, chloroquine, vitamins, and intravenous fluid to offset his dehydration.
Nothing worked. On September 8, Mabalo (“Antoineâ€) Lokela died. Unbeknownst to the Sisters, Yombe Ngongo died the day before in her village home. On September 9, her little sister, Euza, succumbed. That week Lizenge Embale and her husband, Ekombe, died in the hut in Yaekenga—again, the Sisters didn’t know.
Antoine’s funeral was well attended and, as was customary, his body was carefully prepared before burial by Sophie, his mother, Sophie’s sister Gizi, and other women friends. By tradition readying a body for burial required evacuating all food and excreta, a procedure that was generally performed by bare-handed women.
In a matter of days Antoine’s mother, Gizi, and Sophie were suffering the same ghastly disease; Sophie and Gizi survived, but Antoine’s mother died on September 20, as did his mother-in-law, Ngbua, who had assisted in the funeral preparations. And though Sophie survived those hellish September days, her baby was stillborn—another hemorrhagic victim.
In all, twenty-one of Antoine’s friends and family members got the disease; eighteen died.
Soon the hospital was full of people suffering with the new symptoms. Panic spread as village elders spoke of an illness, unlike anything ever seen before, that made people bleed to death. In Yambuku the Sisters were already close to the breaking point, not knowing the why, what, or how of the new disease.
The horror was magnified by the behavior of the many patients whose minds seemed to snap. Some tore off their clothing and ran out of the hospital, screaming incoherently. Others cried out to unseen visitors, or stared out of ghost eyes without recognizing wives, husbands, or children at their sides. Word, and the disease, spread quickly to villages throughout the Bumba Zone. In some, the huts of the infected were burned by hysterical neighbors.
On September 12, Sister Béata developed the sudden fever, muscle aches, nausea, diarrhea, and bleeding gums that she and her fellow nurses now recognized only too well. Sisters Myriam and Edmonda prayed for a miracle and radioed urgent pleas for assistance.
Bumba Zone medical director Dr. Ngoi Mushola scoured the city of Bumba for petrol, finally arranging transport across the roughly fifty miles to Yambuku on September 15. What greeted Ngoi upon arrival was a horror that shook the provincial physician to his very soul. The Sisters and priests beseeched him to tell them what disease was claiming the lives and spirits of their parishioners. In desperation they begged him to help cure Sister Béata.
But Ngoi was every bit as helpless as the hapless clerics. With great care he gathered as much clinical information as possible, and on September 17 rushed back to Bumba in order to cable his report to authorities in Kinshasa.
Republique du Zaire—Region of the Equator -S/Region of Mongala—Bumba Zone—Bumba Medical Service
Inquiry into alarming cases in the community of Yandongi, Bumba Zone, 15–17 September 1976.
I received an urgent call from Yambuku on September 15 from the medical assistant Masangaya Alola Nzanzu of Yambuku Hospital because of alarming cases in the community since September 5, 1976; I went to determine the reality of the situation.
Findings. The affliction is characterized by a high temperature around 39°C; frequent vomiting of black, digested blood, but of red blood in a few cases; diarrheal emissions initially sprinkled with blood, with only red blood near death; epistaxis [nosebleeds] now and then; retrosternal and abdominal pain and a state of stupor; prostration with heaviness in the joints; rapid evolution toward death after a period of about three days, from a state of general health.
Ngoi’s report described the first case, that of Mabalo Lokela, and then listed twenty-six cases of the strange illness, giving the names of the patients, noting that fourteen had died, ten were still sick, and four had fled the hospital in terror, their whereabouts now unknown.
Eerily, Ngoi corrected his report just before sending it to Kinshasa to note that two individuals on his “ailing†list had died by the time he reached Bumba. He listed the treatments tried, without success, at Yambuku Hospital: aspirin, chloroquine, nivaquine, blood coagulants, calcium, cardiac stimulants, caffeine, camphor. And he noted that the hospital had used up all its antibiotic supplies.
Nothing helpful had been discovered in the Yambuku Hospital group’s microscopic studies of blood, urine, and stool samples, Ngoi noted. And he tactfully added that protective measures by the hospital to isolate patients with the disease “are not strict.â€
Warning that “there is already panic†in all the villages, Ngoi requested assistance from Kinshasa authorities.
He left Yambuku having recommended that the Sisters take three measures immediately: “(1) Hospitalize the cases. (2) Use public cemeteries.5 (3) Boil potable water.â€
What Ngoi had written, though he did not know it at the time, was the first historic description of a new disease. In clear, succinct, and, as time would show, largely accurate terms, Ngoi had described what would prove to be the second most lethal disease of the twentieth century.6
At five o’clock in the afternoon of September 19, Sister Béata died. The same day reports came into the mission of illnesses and deaths from the bizarre bleeding disease in over forty villages. By now, there was real danger of a mass exodus of hysterical villagers fleeing to nearby zones—and taking the disease with them. Through the missionary radio relay system, the Sisters sent more urgent pleas for assistance.
Federal authorities dispatched two professors from the National University of Zaire to Yambuku: microbiologist Muyembe Tamfum Lintak and epidemiologist Omombo. They reached the mission on September 23, intending to conduct a six-day study of the problem, but cut their visit short and beat a hasty retreat from Yambuku after just twenty-four hours.
When they arrived at Yambuku Hospital, Muyembe and Omombo saw despair and horror everywhere they turned. Just hours before they arrived, twenty-six-year-old mission nurse Amane Ehumba had died of the disease, and anxieties among the Zairian hospital employees were at near-panic levels.
The professors first focused on a small child who was writhing in agony in a hospital crib. While they discussed what might be done, the child died before their eyes. The academics were shaken from their intellectualizing, and immediately set to work collecting blood and tissue samples from patients and cadavers, interviewing ailing patients and reviewing their medical charts.
As the professors commenced their research, Sister Myriam, who had nursed Sister Béata, was suddenly overcome by piercing headaches and fever. The fear among the mission staff was contagious.
Unfortunately, the academics hadn’t taken Ngoi’s field report seriously, and brought no protective gloves, masks, or gowns for their use during procedures that put them in contact with infected blood. Still, they worked around the clock, examining five blood samples for signs of malaria, parasites, or bacteria. They found nothing. When they performed autopsies, Muyembe and Omombo were aghast at the extensive damage inflicted by the disease, and removed liver samples to send to sophisticated laboratories for further analysis.
Sister Romana arrived during the day, having traveled all morning from the Lisala Mission, located in the zone to the southwest of Bumba. “I have come,†she told the other Belgians, “to replace Sister Béata.†The visiting nun set to work immediately, looking after the latest victims.
Among them was Sophie, still severely ill at that point, groaning in agony in her hospital bed. While the professors inspected the wards, their guide, nurse Sukato Manzomba, progressed from being mildly feverish to a life-threatening state. She began vomiting blood and passed into delirium. The stunned professors acceded to the missionaries’ pleas and agreed to take Sister Myriam, Father Augustin (who had traveled with Antoine in northern Zaire and was running a high fever), and Sister Edmonda (as an accompanying nurse) back to Kinshasa for treatment.
The group traveled the muddy, bumpy road from Yambuku to Bumba in a Land-Rover, passing several villages along the way, and were airlifted the following day to Kinshasa aboard a Zairian Air Force transport jet. Left to their own devices at Kinshasa’s N’djili Airport, inexplicably abandoned by the professors, the missionaries were forced to take a taxi to Ngaliema Hospital—Zaire’s premier teaching facility.
The Coming Plague Page 16