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

by Piot, Peter

  Greta was worried. Ebola was making some minor news in Belgium, and all travelers from Zaire had to submit to medical exams. She was alarmed to learn that I was about to go back to Yambuku and that I would be staying in Zaire for considerably more than 10 days. I felt strangely disembodied. I was sorry that she was anxious, and I was relieved that her pregnancy was advancing without problems, but my life in Belgium now seemed very far away.

  Again we took the president’s C-130 airplane to Bumba, and again the pilots kept the engines running as we unloaded. As soon as we disembarked, they took off. As we watched the plane take off from the red dirt airstrip I wondered when, how, and even whether we would see it again. We had set no date for them to return, and there was no other way to get out of quarantined Bumba. I had an empty feeling as we headed over to Father Carlos’s mission.

  With the help of Dr. N’goy Mushola, I hired and trained a few men to create a surveillance network around the town. These men sought out cases of Ebola and brought symptomatic patients to the hospital in Bumba or the clinic at the Unilever plantation in Ebonda. We drew blood to test later for Ebola antibodies. (Patricia Web’s lab at the CDC in Atlanta was frantically developing the antibody test that Guido later deployed in Kinshasa and Yambuku.)

  We also needed medical staff. N’goy told us that none of the local nurses or medics had received their pay for months. These were government employees, so the money for their salaries had to come from Kinshasa. The doctors and nurses in Bumba were at the bottom of a huge pyramid, and as the money percolated down, at every level—regional, local—a portion of their wages was sliced off by corruption, and the slices had become so vast and shameless that there was often nothing left.

  N’goy suggested that we simply agree to pay their normal, full salaries for a while. For us it was hardly any money at all, but for them it was a gift: to be actually paid, in predictable fashion, a fair, agreed-on wage for your work.

  All the people we hired for the mobile surveillance networks were men. In those days it didn’t occur to me that there was a specific need to hire women. I knew, but at the time didn’t perceive, the fact that whenever we went to villages we saw only men, partly because women traditionally worked the fields and did all the heavy work. If we asked to talk to women—or to a specific woman—a man would say, “Why? I can tell you what you need to know.”

  We established our main logistics base at the Ebonda plantation, which we had visited during our first trip, because they had direct radio contact with the Unilever office in Kinshasa. So Karl Johnson and the others could drive over to the Unilever HQ and talk with us directly: a small matter, but a huge improvement over the sisters’ patchy hookup in Lisala.

  Then we drove up to the Yambuku mission, now lashed on a daily basis by torrential storms. We brought a lot of stuff for the sisters, including mail, which we had picked up at the Procure, the logistics base of most of the Flemish missionary orders in Kinshasa. (I had also purchased a most unexpected little artifact: a Flemish-Lingala dictionary and grammar book. I studied this for an hour every day and picked up quite rapidly enough words to hold a very basic conversation.)

  A few days later, a Puma helicopter—another of President Mobutu’s personal aircraft—arrived to serve us. Accompanying it were two pilots and a mechanic. The mechanic was a Kibangiste, a member of a Christian church founded by a Zairean prophet, Simon Kibanga, who died in a Belgian colonial prison in 1951. Because of this, he didn’t drink or smoke or sleep around, whereas the two pilots did very little else. Accustomed to accompanying President Mobutu about the country, in high luxury and low supervision, they were deeply resentful of their assignment to our service: there was no champagne, no fun, and little opportunity for profit. They spent some of the next six weeks using the big Puma helicopter to fly from one bar to another, impressing women, and I, in my tightly wound Flemish way, resented this greatly, for I was paying them a per diem for their expenses, as well as buying all the fuel.

  We needed the Puma because we planned surveillance visits to areas that couldn’t be reached by four-wheel drive, particularly in the rainy season. Many villages were now completely inaccessible by land, and the rivers were so swollen they could no longer be forded. We planned to head north up the Ubangi River, a trip which, though it represented only 60 miles on the map, would have taken a day or more of almost impossibly hard labor by road.

  We also made a second tour around every village in the Yambuku area. Yahombo, Yapama, Yambonzo, Yaongo, Yandondi, Yaekanga, Yalitaku, Yamisako, Yalikombi, Yaundu, Yanguma, to the west. Yalikondi, Yamoleka, Yamonzwa, Yaliselenge, Yasoku, Yamotili, to the east. Little strings of villages, like tiny beads lost along the muddy paths that meandered through the thick forest.

  When we arrived in a village we settled ourselves under an awning or largish tree and were rapidly surrounded by people—children with bright eyes and prominent bellies, young girls with high round breasts, women in their forties with breasts hanging to their knees, and old men and women smoking marijuana. (We endeavored to arrive early in the morning, before work in the fields began.)

  Later on I visited a few distilleries hidden in the forest to safeguard from theft. Many villages had a basic distillery: Bananas were left to ferment in a hollowed-out tree trunk and then flavored, by local specialty, with leaves or bark. This mixture was cooked, slowly, in an enamel pot covered with leaves. The vapor was caught and cooled in a hollow bamboo stick, with a carefully shaped piece of bicycle tire creating a bend and guiding the now-condensed liquid down again. Congolese moonshine. My favorite had a small Perrier bottle to capture the distillate (only God knew how that bottle arrived there).

  I always sipped from the arak, out of politeness, though it was presented in a single, collectively used cup. I also occasionally sampled the communal cannabis pipe. However, I didn’t partake of the plates of caterpillars or flying termites fried in palm oil, or the villagers’ boucané monkey meat. Game (whether squirrels or monkeys) was the most common source of protein, and the villagers smoked it and hung it until it was blackened and half-rotten; the smell was so vile that it caught in throat and made you choke.

  Family by family, Pierre and I slowly questioned everyone who seemed to have any relationship with the hemorrhagic fever, scribbling the details into a notebook. In only one village did we find a cluster of women and children who had died from Ebola without a clear narrative beginning with a hospital or funeral. This cluster remained something of a mystery until, on a second visit there, I met with one woman who had survived her illness and noted the scarifications across her forehead. I asked if they were recent and what they meant, and she said, “We had headache, so the nganga kisi [traditional healer] came to do this.”

  What had happened was that one young woman had gone to the antenatal clinic in Yambuku. When she returned with Ebola symptoms, including the typical searing headache, the nganga treated her with scarification, slicing her skin lightly with a knife. And just to be on the safe side, he performed the scarification on a series of other women in the village as a preventive measure—using the same knife.

  Later, I met this particular herbal healer. He was a polite man, who received us in a room not very different from any other village hut. There were no fetishes or masks in evidence, though a series of liquids were macerating in gourds along the beaten-earth floor. We asked how he treated people who had Ebola, and how he protected himself, and he politely showed us: household bleach. He bought it at Noguera’s shop in Bumba, and though he presented it to the villagers as traditional medicine, this bleach was apparently the main element in the potions and poultices he used to disinfect wounds and heal people.

  There was a certain lack of poetry in this, but at the same time a welcome dose of common sense. Whether or not this nganga kisi also used traditional magic that he chose not to discuss with us, his use of bleach had probably saved a number of lives—though sadly he had not thought to use it to keep his knife clean.

  THE LAST EBOLA vic
tim in the Yambuku region died on November 5, two months after the beginning of the epidemic. Pierre left Yambuku on November 9 to return to Paris. The heroic phase of the epidemic was over: it was clear that the outbreak was coming to an end. But epidemics can rebound and rear up unpredictably. My job was to keep an alert watch for new cases; we didn’t want to take risks.

  The international team still planned to arrive with a generator and lab equipment for plasmapheresis, and we planned a solid epidemiological investigation to find out exactly how Ebola was transmitted. We knew blood was involved, but what about mother-to-child and sexual transmission? We also needed to learn about the natural animal reservoir of the virus: was it bat, bee, rodent, or smoked, dried monkey. Finally, Karl was also planning a serum survey, because although we had identified people who had been very sick, or who had died, it was entirely possible that Ebola had infected half the population and only some had fallen ill.

  Pierre’s departure left me alone with Father Léon and the sisters of the Holy Order of Our Lady. We spoke mostly about work and about Flanders. Despite all the trauma, they seemed to have gone back to hard work and their daily routine—no posttraumatic stress here (that came later). It was hard to have a more personal conversation as our worlds were too far apart, even if we all told about our family backgrounds. Only with Sister Genoveva, a humorous woman of about forty-five, could I have something of a discussion. At one point she made a comment—something like “God will protect us”—and, weary of courtesy, I said, “Do you really believe this?” She admitted to doubts, and that was something I cherished, for it made her seem more human, and in a way more tragic—doubts as later also expressed in the letters of Mother Teresa.

  If Sister Genoveva was my favorite nun, my favorite village was Yamotili Moké—Little Yamotili, in Lingala, meaning its inhabitants had split off from the village of Yamotili. There was nothing really special about it, but the people seemed more open, and their agenda of needs (for food, supplies, cash) was perhaps a little less intense than in other villages. Also, it was close to Yambuku. I started going there nearly every evening, bringing some beer, or tins of sardines, or a little cloth to offer as a gift. If people had a medical problem they came to me, and I gave them an aspirin or an antimalarial—never a shot, but whatever I had. (I suspected that most of their fevers and so on were malaria and certainly everyone had parasites. We did a little lab work at a later stage; filarial and amoebas and all sorts of things showed up in their blood and feces.)

  But for some reason I felt comfortable; I didn’t feel I had to play the Big White Doctor who investigates disease and saves the world. Mostly I sat with the elderly men: they smoked their pipe and talked among themselves, not even in Lingala but in Buja, the language of their tribe, and I felt I was accepted by them. There was an older man whose name I forget (perhaps he was only forty-five but he had hardly any teeth) and like most men in Zaire he knew far more about Belgian soccer than I did, thanks to the magic of transistor radios. The goalkeeper of the Belgian national team at that time was Christian Piot, who shared my name, so that made for some comment and a funny sort of bond. But most of the time our companionship was a silent one.

  No women ever participated: they were sweeping, cooking, pounding or grating manioc (cassava) roots, their staple food. Sitting with the Yamotili men was basically an alternative to sitting with my own tribe at the Yambuku mission.

  I was answering those questions that had occurred to me when I first arrived in Yambuku. These people were living closer to the Middle Ages than to the year 2000. How did they manage to survive? Weren’t they scared? To me they seemed so vulnerable, both to the invasive forces of nature—animal, viral, climate—and to soldiers. They told stories of insane cruelty culled from the multiple rebellions that had already crisscrossed the region. It was still only 16 years since Lumumba’s speech at Independence and already there had been many wars, much killing and looting and rape. Even in times of peace, Mobutu’s soldiers stole their meager possessions and raped girls and women. Even now, thinking about how vulnerable the villagers were gives me pain; their stories, and many subsequent experiences in Zaire, made me appreciate our well-functioning states where the rule of law is intended to protect its citizens, not scavenge off them.

  In addition, though, by just hanging out with people, drinking arak and chatting about soccer I put together the very beginning picture of a whole culture. I’m a strong believer in what I later learned is called qualitative research. You do need the standardized epidemiological questionnaires, of course, for quantitative analysis, but you may also sometimes need to develop a kind of feel that’s a lot less systematic, but may reach out to places that are deeper and more unexpected.

  So, for example, that was how I put together a picture of what happened during funerals. As in so many cultures, funerals were a major event for the Buja, stretching across several days and could easily cost a full year’s income. What made those funerals so lethal, apart from this prolonged and intense contact, was the preparation of the cadaver. The body was thoroughly cleaned, and the process often involved several family members, working bare-handed. Since the bodies were usually covered in blood, feces, and vomit, exposure to Ebola virus was enormous—particularly since the usual custom was to clean all the orifices: mouth, eyes, nose, vagina, anus.

  People don’t tell you this sort of thing. You get at it obliquely. You’re talking about washing the body, and you say, “So, of course you’re cleaning the anus?” Some people say, “Sure,” and another says “No,” and for a long while you don’t know what to believe. One woman said that the body was licked. But nobody else agreed with that, and we were talking about the body of her very young, almost newborn child, so perhaps that had been a special case, not the norm. Then the body was wrapped in a cloth and buried in the ground right outside the door of the person’s hut: (I often saw a row of mounds just outside a house—the burial ground of family members.)

  The nuns were one source of information, but while people reported that their behavior was Christian, they had a separate, extra religion that they hid.

  I became immersed in this place. I developed genuine respect for these people. I was growing up and answering my own questions, I guess. I wasn’t thinking of Belgium, but of course I worried about my pregnant wife, particularly at night, in my austere cell with its crucifix on the brick wall. But what could I do?

  Perhaps I was also finding that there was more to me than I had thought. I wasn’t a boy with a great deal of self-confidence; that wasn’t part of a Flemish education in those days (fortunately my own children are quite different). You learned humility and silence, to work hard and never think you’re better than anybody else. This has its advantages: it protects you from snobbery and the corruptions of power. But it also means you aim small.

  Now I was “director of operations” for the International Commission. A C-130 full of food and equipment arrived and I had to organize distribution. I was hiring people, paying them, negotiating with the Commissaire de Zone (who badly wanted the Puma for his own use), making sure the money didn’t disappear, organizing the collection of specimens, and building a system so that 25 people could arrive from Kinshasa and operate in a clinic and a lab.

  A SECOND HELICOPTER arrived, this time an Alouette donated by French President Giscard d’Estaing to Mobutu in return for God knows what favor. It lent an almost comic flavor to my life. I did not request it or need it, but Bill Close sent it to me, and by this time I was starting to find all this normal. Need a helicopter? Here are two! People in the humanitarian field are often like this: it’s a mentality that’s somehow not very grown-up, part cowboy and part Boy Scout.

  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 t
he 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?”