By Jillian Green and Jonathan Ancer
The haunting and nightmarish fixed stares of those dying from Marburg fever will for ever be imprinted on Professor Adriano Dusé's memory.
Dusé, chief specialist and academic head of microbiology and infectious diseases for the National Health Laboratory Services, spent three weeks in the Uige province of northern Angola, the epicentre of one of the most deadly outbreaks of the Marburg virus.
He had been called in by the World Health Organisation and Global Alert Response Network to join a multinational team tasked with stemming the epidemic.
| Now Dusé will never forget what he saw |
Now Dusé will never forget what he saw.
"A part of me will always be scarred," he said yesterday, three weeks after his return.
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In his time in Uige, Dusé witnessed the slow death of many patients, the lack of isolation facilities in the impoverished province, the glaring lack of proper infection controls, the mistrust of the people, and a lack of political will from the country's health department to deal with the crisis at hand.
"When we arrived at the Uige provincial hospital, we ourselves had to clean out four wards which had been used in the last outbreak of the Ebola virus. We had to scrub blood off the walls and floors and sterilise the beds," he said.
But it was all for naught, as the military later set fire to the beds as part of their infection control measures.
| 'In one week, 28 children died' |
"Because of that, some of the patients had to lie on the floor. Many died like that," Dusé said.
The professor described a dire medical situation where mothers in the paediatric ward would simply place their ill babies in available cots regardless of whether the cot had been sterilised.
"Babies were being placed in cots where others had died from Marburg. It is a tragedy," he said.
Infection control is a major problem, with syringes being re-used and no proper medical waste disposal procedures in place.
Uncovered needles and syringes still with blood in them, bloodied linen and placentas are simply discarded without care.
"At least five dogs and two pigs were found dead with haemorrhagic manifestations because of the poor waste disposal."
Dusé said the virus could survive up to 21 days in blood in a syringe. Blood left on a surface could still be contaminated if the pH balance was neutral.
Dusé's experiences tally with those of Swiss doctor Gian Meyer, who packed his bags and headed into a village in Uige province.
That was six weeks ago. He left Angola on Friday, shell-shocked at the death that ravaged the village.
"I have worked for 25 years and I've never seen as much death as I saw in those six weeks. I saw dead children. In one week, 28 children died. It's always the children that get to you," Meyer said.
He was speaking this week at a lodge in Timbavati Private Nature Reserve after a friend suggested that he head off to the bush to get his mind off the trauma he had witnessed.
The death toll from the fever has risen to 292 - out of the 336 known cases.
Meyer had sold his private practice, and because he can speak Portuguese and had worked for the International Committee of the Red Cross, the World Health Organisation approached him to be an intermediary between health workers and Angolan officials.
"I was scared about the personal threat. Whenever anyone died I would go into their hut. I was dressed in a spacesuit with three pairs of gloves and a mask. People would be walking in front, spraying everything with bleach.
"I would take a swab from the dead person's cheek and then walk out. The difficult part was undressing."
He stayed in a room without windows, and there was no running water so he used bottles of mineral water to wash, but it was the psychological stress that had the biggest impact. In addition to being a witness to death, Meyer became neurotic about avoiding any bodily contact.
"The enemy is everywhere. If someone wants to shake your hand, you back off."
A laboratory in Uige would perform tests to see if the person had died from Marburg - if so, Meyer would go back to gather the clothes and mattress to be destroyed.
He would then seek out the family, neighbours and friends of the dead person to urge them to go into quarantine in an attempt to contain the virus.
"There was a mother who gave birth, and a day later she died. The father gave the baby to a neighbour and ran away. The neighbour breast-fed the baby and then passed her on to other neighbours to breast-feed.
"The baby died seven days later - and the women who had been her wet nurses also died, but not before they passed on the virus to their families. It's really tragic."
Meyer said it was extremely difficult trying to convince sick people to go to hospital.
"They believe that if you go to hospital, you die. If you have Marburg, yes, but if they stay home they die too... and the virus spreads. The situation is explosive, it's absolutely terrifying."
- This article was originally published on page 6 of The Star on May 18, 2005
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