EBOLA PASCALE: I’m Pascale Harter, and in today’s Crossing Continents I’d like you to join me on an extraordinary Congo Journey to the heart of one of the world’s deadliest diseases, Ebola. We’ll go to the remote village of Kelle, in the Republic of Congo, Brazzaville, that’s the lesser known Congo, not the bigger, war-torn Democratic Republic of Congo with Kinshasa as its capital. Earlier this year, as the BBC woman in Congo, I went on an assignment with a BBC film crew. It was a journey that brought me closer than I could ever have imagined to those infected with Ebola and from which I was lucky to return. And the journey ended with the Congolese authorities throwing me out of the country. So, what is Ebola? Well, it's so deadly it can kill up to 90 per cent of those who catch it and it’s highly contagious. You can catch it from any body fluid, even sweat. The first signs are common enough: you feel tired, have a slight temperature and diarrhoea. But then internal organs start to haemorrhage. You bleed from places like your nose and mouth. Within seven days you’re usually dead. But I didn't fully understand all this as we set off to the outbreak zone. “So I’ve decided to keep an audio diary of this trip to Kelle. The noise in the background, that chugging is the generator. We have stopped at a hotel and today was the first day, we set off from Brazzaville this morning. My main worry is that we are going to talk to people and come into contact with people who have Ebola and we don’t know they do. Medecins Sans Frontieres seem to think that you are contagious before you get very harsh symptoms and people in Congo are so used to malaria that they will wander round at death’s door, so I’m a bit concerned about that.” “The further north we get the nearer to Kelle, the more people seem to be in denial about Ebola. They say, it’s a question of sorcery, people in Kelle making human sacrifices in order to become more powerful.” En route we passed a barefoot hunter selling two dead monkeys. They were dripping blood onto his feet as he stood at the roadside in the rain. Monkeys can carry Ebola, and scientists think that human outbreaks start when people touch or eat these infected animals. Sheltering from the pelting rain under an umbrella, I stopped to speak to the hunter, but I didn't want to get too close. “Did you catch these monkeys, yourself? HUNTER: “Oui,” TRANSLATOR: “Yeah he said he caught them himself.” PASCALE: “Do you know that at the moment there is an Ebola outbreak near this area and it’s the monkeys that can spread Ebola?” HUNTER: “Oui, oui, je sais.” TRANSLATOR: “He said he knows.” PASCALE: “Aren’t you sacred of getting Ebola, maybe from hunting these monkeys?” HUNTER: “No, no, no.” TRANSLATOR: “He said nay, nay, nay smilingly.” PASCALE: “Why not?” HUNTER: “Je ne crois pas.” TRANSLATOR: “He says that he doesn’t believe.” PASCALE: “How do you think that you do get Ebola then?” HUNTER: “ Cela, c’est bien complique, huh? TRANSLATOR: “He says, it is complicated he says.” PASCALE: “Do you know, do you have any idea how you get it?” HUNTER: “Non” TRANSLATOR: “He says no.” PASCALE: “The village of Kelle is a good three days drive from the capital Brazzaville that’s three days of bone shaking driving along rutted muddy tracks which after a good dose of rain make progress very, very slow. You have to go in a convoy with one truck pulling the other out of the mud every twenty minutes. “ “At first sight Kelle is such a beautiful peaceful village that’s quite a big village about four thousand inhabitants but once you spend five minutes here the feeling of sadness is tangible. It’s very green, lots of palm trees, blue skies, birds singing, nature is everywhere. Unfortunately there is too much nature here for the inhabitants of Kelle, there is no electricity and there is no running water. Even the hospital doesn’t have a generator.” Guy Ewono, a native of Kelle who now lives in the capital, came with us on our trip. For Guy it was a sad homecoming but he did his best to show us around his once lively home-town. The authorities had closed schools and churches and banned public gatherings. But as day turns to night, one aspect of Kelle's social rituals remained intact, the night market. Guy took me to see the women of Kelle gather with their candles to sell their wares: GUY: “This is where people bring food and other things the evening and start selling them.” PASCALE: “It looks to me like a pretty quiet night market has it changed much since the last time you were in Kelle?” GUY: “OK, this is really apparent, normally the place is not as calm as that because of the atmosphere which is prevailing now which is due to the outbreak of Ebola.” PASCALE: “How do you feel coming back now and seeing Kelle so changed?” GUY: “For a native of Kelle it is really sorrowful because I used to come here and find people kind and joyful, they were dancing, singing, playing all the time but now the situation has negatively changed, and it’s rather an atmosphere of sadness everywhere. I don’t really feel at my ease like that.” PASCALE: The doctors in Kelle were a team of Ebola specialists flown in from all over the world by the WHO, the World Health Organisation. What they found when they got to Kelle was a disaster. A crumbling hospital that had long ago stopped offering any health services. It lacked even the basics. Many of the hospital’s staff had run away and the doctors relied on help from local Red Cross volunteers, whom they paid out of their own pockets. Dr Erwin Van den Enden, or Dr Erwin as he prefers to be called was one of the WHO specialists battling against impossible odds to contain this outbreak. “Dr Van den Enden, you have come from the Institute of Tropical Medicine in Antwerp as one of the emergency WHO doctors, here to Kelle to try and contain the outbreak. Can you just describre to me what kind of facilities you have got here to work with?“ DR VAN DEN ENDEN: “When we arrived things were pretty basic over here, and there is a hospital without running water without electricity, with virtually no drug supplies and several of the nursing staff died so we are down to three active staff members and virtually no supplies.” PASCALE: Since there’s no cure for Ebola, modern medicine relies on barrier nursing methods to control outbreaks. In Kelle this means patients languishing alone within the bare concrete confines of the isolation unit. With two of the three hospital nurses dead the WHO doctors could only make two visits a day because it takes them about an hour just to prepare for each visit to the unit, putting on their protective clothing and their masks. DR VAN DEN ENDEN: “Well at this moment I’m wearing cotton underclothing to absorb most of the moisture over that I wear a thick surgical gown, I wear two pairs of gloves which are taped with sellotape. I wear heavy duty rubber boots, I wear an uncomfortable mask goggles and head cap. Over that I wear a plastic protection suit.” PASCALE: “Does it get very sweaty in there?” DR VAN DEN ENDEN: “Extremely sweaty, we lose if we are in there and it’s a little bit warmer than now we lose about one kilogramme in one hour, sweat.” PASCALE: “And what happens if you were to come into contact with vomit or diarrhoea or sweat of the patient?” DR VAN DEN ENDEN: “We take chlorine shower to disinfect, Ebola virus can be destroyed by chlorine” PASCALE: But there is one person who walks around the ward, helping to feed and even clean up the other patients without so much as a pair of surgical gloves. I interviewed her from a safe distance, she’s still contagious. “Adele Mvoua is the surviving Ebola patient here at the isolation unit, I’m going to speak to her, I can’t get too close, she is standing on the other side of a fence so I have to try and speak to her whilst keeping my distance” TRANSLATOR: “She said that she spent two weeks without any treatment and she was sleeping here under veranda alone.” Everybody including those working in hospital had run away and she stayed here alone eating only lemons. When WHO doctors came her and started taking care of her she was vomiting blood and due to the medicine they gave to her little by little she was feeling well.” PASCALE: “Adele, you are a fetisheur, a sorcerer in the village and a lot of people in Kelle refuse to believe in Ebola virus they say it is sorcery, and yet you as a sorcerer have been one of the first to come here to the hospital.” TRANSLATOR: “The way she thinks sorcery exists so does Ebola but as far as the present situation is concerned it is certain that many people are dying from sorcery but many others are really dying from Ebola.” PASCALE: But Adele is the rare exception, her immune system must be particularly efficient in fighting the virus. And Adele isn’t safe just yet. Inside the isolation ward, she could still be re-infected and die. The longer I stayed in Kelle the more I came to understand that Ebola has a far greater effect on a community than most diseases. It doesn’t just kill. It breaks down the relationships of the living. Congolese village life is based on close social ties. In Kelle, these had totally disintegrated. Years of friendship had turned to mistrust in a new climate of fear and superstition. A group of local school teachers, who tried to educate their students about the virus, paid a heavy price for injecting some rationality into the atmosphere of panic. Parents of the school children reasoned that if the teachers knew so much about Ebola, it was because they had summoned the virus through witchcraft. A mob hunted down the teachers, calling them sorcerers, and murdered four of them. But one managed to escape. “Here in Serge Aberou Refain’s garden at first glance everything looks normal. His teenage daughter is braiding her mother’s hair out in the garden, the two small children are playing in the dust, the birds are singing and everybody is sitting outside, but Serge has just come back from hiding in the forest for three days. He escaped Kelle after some of his students and around 300 people from the village threatened to kill him accusing him of being responsible for the Ebola epidemic in Kelle which had so far killed more than eighty people.” SERGE: “Ils ont trouve un bouc émissaire, un enseignant Louis Mbanda…” TRANSLATOR: “They found a scapegoat, a teacher called Louis Mbanda, they told him that they were going to kill all the teachers and that is how it all began.” SERGE: “ Parce qu’il y avait, six, six victimes d’Ebola, six cadavres là bas.” TRANSLATOR: “There were six Ebola victims who needed burying that day and they tried to force this teacher and three others to dig the graves but they refused to go and one man said, I’m innocent, you can’t ask me to bury these bodies otherwise I’ll be infected as well, and so they killed him there and then. PASCALE: “How does it make you feel being accused by your neighbours and the other villagers of being responsible for these deaths?” SERGE: “Franchement je me sens mal à l’aise et c’est parce que il y a de…” TRANSLATOR: “ I feel really uneasy, there are road blocks everywhere otherwise I would have gone before now, imagine what it feels like when the entire community accuses you of being a sorcerer, of having caused the deaths of 79 people. As soon as the road blocks are lifted I’ll be off. You know it was the very children that I taught who wanted to kill me, how can I teach them now?” PASCALE: “Mr Louis Autard is being buried this morning. He died yesterday afternoon in the isolation ward. Unlike the other Ebola patients three members of his family have come with a plywood coffin which they have decorated with pink and white material and they have decided to have the burial near their home. It’s a very strange sight to see the family walking along behind the coffin being borne by six volunteers from the Red Cross who are all wearing full protective clothing.” Dr Erwin and his team oversaw the funeral. PASCALE: “Is this quite typical of an Ebola funeral where there are still relatives who are willing to come? DR VAN DEN ENDEN: “Half of them are buried without anybody present, half of them will be like this.” PASCALE: “So no Ebola victims get a normal celebratory funeral, which is typical of Congo?” DR VAN DEN ENDEN: “They used to do this. When the deceased person’s body is on the ground they will wash it with their bare hands, they might kiss it and in this way transmit the disease to themselves so I think the message has come through that this traditional burial is one of the most dangerous practices that you can have.” PASCALE: Dr Erwin told me that he estimated the WHO team had only managed to treat ten percent of the Ebola victims, the doctors were unable to get to those dying in the remote villages because of bad roads and unable to quell the fear and superstition within Kelle, and Kelle’s underlying problems are still unsolved. The world, and the Congolese government forgets, until next time. And Dr Erwin believes there will be a next time: DR VAN DEN ENDEN: “This current outbreak will continue to smoulder probably for two or more months and it is not a question of if there will be a next outbreak, but when it will be and many people suspect that if we get more or less on top of this one the next outbreak will be in early winter this year or next year.” PASCALE: And when there is a next time the people in Kelle will still believe in sorcery rather that a virus. They will still eat monkeys, they will still refuse treatment and they will keep infecting each other. Alain Ippeleboin, a medical anthropologist travelling with the WHO says to combat this, Kelle needs more than just a few doctors. ALAIN: “J’ai un ami Sénégalais qui dit que les sorciers les esprits…..” TRANSLATOR: “I’ve got a Senegalese friend who says that development so tarmac roads and electricity are the enemies of superstition and sorcery so if we really want to do something about Ebola this region needs major development, it needs roads, vaccination programmes and improvement in living standards, and I think this goes for all parts of sub-Saharan Africa. The people of Kelle are like sentinels protecting the entire world from this epidemic so effectively as long as it is just a few poor Africans who are dying, it doesn’t matter but when Ebola starts to spread we’ll regret not having put more resources into places like this” PASCALE: “It’s Monday morning our last morning in Kelle we are leaving at around midday or that is the plan but before we go we have to have a de-briefing from the doctors telling us and the drivers, everyone in the team what we’ll have to do when we get back to our homes if we start to, to get a headache or feel a fever or sore throat we have to take it seriously and take ourselves into isolation from other people, in case it is the onset of Ebola.” Travelling at the grand speed of twenty miles an hour it took us ‘til nightfall to reach the next big village of Etoumbi. We arrived hungry, tired and looking forward to some normality. “We’ve left Kelle now and we have arrived in Etoumbi we’ve had dinner - some very stringy athletic chicken in a very nice sauce - and we are in Mama Kati’s hotel. And the difference of being here and being able to get into bed without thinking, has anybody died here, is anybody sweated here, has anybody dripped blood here, has anyone vomited here, is an incredible relief, really an incredible relief. I think I’ll sleep very well tonight.” Or so I thought. But although we'd left Kelle behind, Ebola wasn't finished with us just yet. “Woke up in the night with terrible stomach pains and with a temperature and diarrhoea which are often the first signs of Ebola. Better stay away from everybody.” The prospect of us falling ill brought tension within the team to boiling point. Eager to be done with our Ebola trip, the more powerful of our two vehicles raced on ahead. Struggling to keep up with them we drove off a small homemade bridge. “The tyre has burst which sent us all flying in different directions. I hit my head and then started to vomit everywhere, I made it out of the car just retching. I have got a temperature, my stomach is just going round and round.” It was three o’clock in the morning before we all made it safely to a hotel in the village of Makwa. By now I was seriously ill and had stopped recording my audio diary. I spent the night drifting in and out of an anxious sleep. When first light came I was relieved to see there was no sign of blood. But I could barely stand and I couldn’t rule out the possibility that I had Ebola. I had to get to a hospital. The nearest one happened to be in the president’s home town of Oyo. But once in Oyo local people soon heard about me and it wasn’t long before the village chiefs came to my hospital bed and told me I had to leave. By the time we reached the next village the news of a white woman with Ebola had got there before us. “We were 2 hours out of Brazzaville and we have gone through all the checkpoints without any problem, I was asleep and we stopped at a checkpoint, it was quite a big checkpoint staffed by COMUS troops and they are the most notorious the most, they are the worst behaved” COMUS are the countryside paramilitary. They are scarcely under government control and have a well-earned reputation for rape and murder. We spent nine hours shut in the car at gun point. They whiled away the time with loud discussions as to how they could kill us without getting Ebola themselves. Happily for us it proved too tricky a dilemma. The next morning WHO staff, contacted by satellite phone came and negotiated our release. But they weren't too keen on getting close to us either and instructed us to get back in the car and shut the doors. We were told to follow the WHO and arrived at the military hospital in the capital, Brazzaville, where I started recording my Ebola diary again: “Ebola diary continued. I don’t know what day it is now, I’m in an isolation ward at the military hospital in Brazzaville. Arrived yesterday after an absolute nightmare journey and I was treated as a suspected Ebola case.” As the first suspected Ebola case in the capital, and a westerner, I had become a dilemma for the Congolese government. Should they put me on the next plane to Britain and export Ebola to the west, or keep me in Brazzaville and risk an outbreak in the city? My isolation unit was a tiled white cell off the courtyard of the military hospital. I was told that the armed soldiers were for my own protection as well as Brazzaville's. My only way out was a negative Ebola test. But the Congolese doctors were too scared to take the blood sample. While I waited for someone to take my blood, I watched the soldiers perform their morning military parades through the barred window. “It’s day three in the isolation ward at the military hospital in Brazzaville. They’re having their morning sort of parade at the moment, they are all standing to attention out in the courtyard and playing their military music rather badly.” Eventually an international aid agency, doctors without borders or Medecins Sans Frontières arranged to come and take a blood sample. “It’s my seventh day here in the isolation unit at the military hospital. I didn’t expect to be staying this long but there seems to have been a problem with the blood sample that was taken on Saturday. The World Heath Organisation was supposed to send that sample to Franceville in Gabon to be tested for Ebola and once I had got a negative result then I could leave the isolation unit but it turns out that the blood sample hasn’t even left Brazzaville now so I don’t know when I’m going to be let out.” In isolation I was given an array of medication to take. After several days I felt better, good enough to know that whatever I had, it wasn’t Ebola. What frightened me most now was the way I was ostracised and feared. I thought constantly of what it must be like for real Ebola victims to spend their last days being treated like this. “I was very scared last night of being attacked and the back window of the isolation unit, people were banging on the bars and saying Ebola, Ebola. That stopped, but I’m a bit worried about my safety when I leave here. I might have to leave the country depending on how hostile people are feeling but they are very scared.” Keen to get rid of their most notorious patient the Congolese authorities eventually decided to expel me without an Ebola test. An air ambulance arrived to take me to Johannesburg and the flying doctor was the first person to be nice to me in such a long time, that I wanted to marry him. And standing at 2am on the tarmac of Brazzaville's Maya Maya airport, I was glad that the nightmare was finally over. But I felt a great sadness at being forced out of my adopted home. The Congolese minister for information, with whom I had grown quite friendly, came to see me off. He said: "The president sends a message. He said he is not angry that you took Ebola to his home-town, Pascale, but he thinks you ought to go now." In Johannesburg I tested negative for Ebola what I did have was one of the worst strains of malaria and dysentery to boot. What dominates my recollections of Congo now is the memory of the people in Kelle. Unlike me, they still live under the shadow of Ebola, the dead un-mourned and the living terrified of who will die next. CROSSING CONTINENTS EBOLA