Read an Excerpt
Monday, April 11, 2005
Standing in a tent outside the Américo Boavida Hospital in Luanda, Angola, I
peeled off my sweaty blouse and jeans and pulled on a green hospital scrub shirt and pants. It was noon, hot and humid—a typical day in southwestern
Africa—and it felt as if there were no air in the tent. A rooster crowed from a field of weeds just outside, and as I tied the drawstring on my pants I
thought, I've been writing about medicine for twenty-five years, and I've never been to a hospital with roosters before. The scrubs, not long off the clothesline, felt damp, and they reeked of bleach. But it was a reassuring smell. The tent had been pitched as a changing room for doctors and nurses just outside a building that housed the "hot zone," a special ward created for patients infected with the deadly, contagious Marburg virus. Bleach was the best way to kill the virus on clothing, equipment, and even people's hands.
It was my third day in Luanda, Angola's capital, a teeming city of four million where SUVs zigzagged around gaping potholes and women strode gracefully by with enormous baskets of bread or fruit balanced on their heads. About
180 miles (290 kilometers) north of us, the province of Uige (pronounced
Weej) was in the grip of the world's largest epidemic ever of Marburg fever.
There is no cure for Marburg. By the time I arrived in Angola, of 214 people who had caught it, 194 had died, usually after being sick for only a week. It was a shockingly high death rate, among the worst for any infectious disease. Of the first 100 or so victims, many were babies and small children.
The outbreak had taken Angola by surprise, and no one knew exactly how,
where, or when it had started.
Although Marburg had first been identified in blood samples from patients in
Uige in March of 2005, it had probably been killing people for months before that, maybe since October of 2004. Much of that time, doctors had probably been mistaking it for something else. There is so much disease in Africa—
malaria, diarrheal infections, and yellow fever are just a few examples—that it is easy for a new illness to sneak in and gain a foothold. That is precisely what Marburg did: it blended in and got such a head start on doctors and health officials that suddenly, before they even knew what was happening,
they had an epidemic on their hands. The disease was still spreading. Virus experts had flown in from all over the world to try to stop it. Tomorrow, I would fly to the center of the outbreak, Uige.
From New York, where I work at The New York Times, I had been following reports from the World Health Organization about the epidemic in Angola,
and urging (some might call it pestering) the paper to cover it. American newspapers were not writing much about the disease. Finally, when I sent around an e-mail noting that the outbreak had officially become the largest known Marburg epidemic ever, one of my editors said, "Do you want to go?"
"Sure," I said—and wondered immediately what I had volunteered for. But, I
must admit, the disease fascinated me. I was a biology major in college, and the student in me wanted to know more. The reporter in me wanted to tell the story of the crisis in Angola.
Some people thought going there was a crazy idea. Colleagues, relatives,
and friends asked if I wasn't afraid I would catch the disease myself.
Of course I was afraid. I would be walking into an epidemic of a contagious,
incurable, and usually fatal disease, in an isolated part of a poor, crumbling nation with a shaky health-care system. At least one doctor and several nurses in Uige had caught the disease from their patients and died. The incubation period—the time between when a person is infected and when he or she becomes sick—is short, between three and ten days. I knew that if I
became infected in Angola, I would probably die there, too.
But at the same time, I thought it should be possible to report on Marburg without catching it. Infected people aren't contagious until they start having symptoms, so I wouldn't have to worry around people who weren't sick. Even then, the virus does not spread through the air. To catch it, you have to touch body fluids like blood, vomit, and urine from sick patients. Many people in Angola became infected from taking care of others with the disease.
Corpses, teeming with the virus, are especially dangerous, and some
Angolans got sick and died from washing the body of a dead relative to prepare it for burial.
It seemed to me that if I didn't get close to sick people or dead bodies, and took care about where I went and what I touched, I should be able to avoid the virus. I would be interviewing experts in infectious disease, and I decided that I would follow their advice and do whatever they did to keep from being infected.
Still, there was a risk. The odds of not coming home were small, but real.
Even without Marburg, Angola wasn't the safest place. It had been torn apart by civil war from 1975 to 2002, and the countryside was still littered with land mines, so there were many areas where you simply couldn't walk or ride.
Outside Luanda, you weren't even supposed to drive up on the shoulder of the road to pass another car, because the shoulders had been planted with land mines. Medical care was poor, except in Luanda. Law and order were sketchy. The U.S. State Department Web site warned that bandits might stop cars along roads outside Luanda, especially at night, and that the police had been known to rob people. The State Department also said, "Police and military officials are sometimes undisciplined, and their authority should not be challenged." Even getting in and out of Angola could be tough, because there had been incidents in which officials at the airport pulled scams,
detaining travelers or threatening to vaccinate them with unsterilized needles unless bribes were paid.
I booked flights and a hotel in Luanda, applied for a visa, and saw a doctor who specialized in travel medicine. He prescribed pills to prevent malaria and antibiotics to carry in case I got sick from tainted food. He also gave me five shots: vaccinations against polio, meningitis, hepatitis A, typhoid, and yellow fever. But there was nothing that could protect me from Marburg fever—
except, perhaps, my own common sense.
I left New York on Thursday night, April 7. My arm was still sore from the shots. My suitcase was stuffed full of mosquito repellent, germ-killing hand cleaner, PowerBars, and packages of nuts in case I found myself in places with no food, or food I was afraid to eat. I was wearing a money belt hidden under my clothes, with about $4,000 in it. It made me nervous to carry so much money, but drivers and translators—the official language in Angola is
Portuguese—would be expensive and would have to be paid in cash.
On the first leg of the trip, a flight to London, I sat next to a man who had traveled quite a bit in Africa.
"Fortunately," he said, "I've always been able to avoid Angola."