South Africa (Johannesburg) – Reality

“So Frank, what are you returning home with from Africa?” Tineke asked. Her and husband, Tom, moved from the Netherlands years ago and in addition to retirement activities, they also tenant a guesthouse for accommodation.

I sliced a piece of egg white, pierced it with my fork, but paused before lifting it off the plate. “A lot of things, outside a few material possessions.” I sank into the kitchen chair. “Last night, I kind of reviewed the last seven weeks traveling through Africa. I find it difficult to imagine that I’m returning home; I’m not even sure I want to go home, but I miss a lot of people.” Answering the question, “Certainly, I’ve learned a lot and been to places I’ve only dreamed about visiting. There’s a also the appreciation value as well.”
“You know, Africa is like AIDS,” Tineke linked together. Not sure if I liked that comparison, though. “It lives with you for the rest of your life. Africa will always be a part of you.”
That is very true.

Alan, lead researcher for the Arbovirus division, and I arrived to NICD to find the power off in the Special Pathogen Unit (SPU) offices. Running blackouts are not uncommon in Johannesburg, but today’s outage was due to someone stealing the power cable outside the institute.

“Someone stole the power cable?” I asked amused by the concept.

“It’s not the first time this has happened,” Alan explained. “People steal the cables to resell the copper. It’s quite a problem. They’ll take a truck and rip the cable from the ground.” Backup generators provide power to computer systems and prevent key areas like the BSL4 lab from going down.

Under bright fluorescents and leading into the closed-door BSL4 lab, Bob and I were welcomed into the office for the Head of Special Pathogens, a position once held by Dr. Swanepoel, but passed forward after reaching retirement age. I sat against a corner behind a small round table and poured milk into the coffee graciously brought by Janusz’s secretary. I leaned forward over the mug and introduced myself and project—a monologue I delivered by that point with plenty practice.After much agreement and topic reinforcement, Janusz added, “Aside for maybe next year, you might be back here in a few weeks.”
Bob’s attention was piqued. “Something happening?”

“A guy died three weeks ago mysteriously, and now a paramedic servicing him has also died. Blood samples from the medic are on their way.”
Lucile, a woman highly respected for her work with hemorrhagic patients entered the office. The three talked over details; I leaned onto the seatback and listened. This is how the process of research, mobilization, and control begin: First a case mystery, agency notification, and then old-fashioned detective work.
“The key to identifying any disease is through determining an exact case history,” Bob strongly instructed me, his South African accented voice rising with commanding purpose deeply punching each word. “Before anything is done, the epidemiologists must get an exact history on the patient. How many days from contact? What are the symptoms and when? Who and where has this patient been?” Different pathogens incubate (the time between contact and symptoms) in a host at different lengths of time with varying onset symptoms. Many false alarms can be avoided if doctors can get a correct history from the patient.

Returning to the SPU/Arbovirus offices, Bob added, “And that’s how things happen, but more often than not it’s chasing at nothing or some coincidence, but we have to treat it seriously.” A lot of money and resources are spent investigating potential special pathogen cases, which is why a good report is necessary. “Of three thousand leads, maybe ten go somewhere.”
With grid power back online, Alan walked me across the brick building campus to one of the smaller structures on the lot; the block path leading in cut by an unmarked meter-wide trench to piping deep below. Through the tinted glass entrance and maze-like corridors, we stepped into a room dominated by a space-filling cage, housing dozens of bats huddled together in a tight roost. On the floor are a couple round trays of water and nicely diced assorted fruits.

“So, they’ve been tested for rabies, Marburg, etc., right?” I semi-jokingly asked Alan, both of us ducking into the nest.
“A lot of them are second generation born here. So, yes, they’re clean. And they have to be for control purposes.”
Once the BSL4 lab is operational again, the bats will be used for Marburg and Ebola studies including transmission means from bat to animal and human. Is the virus transmitted via direct contact, birthing, guano, or some other means?

Inside, the bats became agitated by our presence and several leapt from their perch and flapped to any corner of the cage. A small drop of urine splattered on my arm.
“Hmmm, that’s nice.”
“They’ll do that when nervous, especially jumping into flight.”I stood still and watched one on the floor scale the linked rod cage wall to his mates above, its long reaching caped arms and stubby feet reminding me of a skilled rock climber with his stro

ng body agility.
“Can I hold one?”
“Sure.” Alan gathered a box and covered one in flight. With a thick rag, he covered the bat and flipped it upside down into the cradle of his palm. “This one is a female and she’s pregnant. Probably why she’s very hostile”Obviously unhappy, she reared her canine like teeth and jaw, struggling for freedom. Alan gripped the bat’s feet and allowed her to hang naturally. After a moment, she flew off into the mass gathering.
“It’s interesting, even though they’re away from any predators and when no one’s around, they still jockey for space on top of each other, scratching and cutting each other.”
I looked at one motionless female, her baby clinging to her underside, staring at me with huge black eyes. “This one hasn’t moved at all.”
Alan looked around her to notice a male mounted behind. “That’s because they’re copulating.” It’s an Animal Channel soap opera in the making.

Early into the evening now, I sat at Dr. Swanepoel’s desk reading into the first chapter of his memoirs, the tiny headset speakers for an iPod Nano blasting character music in my ears. Like the couple other virus hunter books available, his story epitomized the excitement surrounding the events leading up to an outbreak. In this case, an Ebola case in Johannesburg amidst an outbreak of Crimean-Congo Fever, another viral hemorrhagic fever. But I couldn’t help draw an ironic parallel with what was going on behind me.
On the phone with CDC-Atlanta’s top special pathogen brass, Bob elaborated on the details pertaining to the case discussed that morning, however intensified. Now there were potentially five suspected related cases included two fatalities. Illustrating his point to me earlier, Bob ripped into the epidemiologists for not getting exacting facts. Within the few hours transpired, PCR tests had not confirmed the existence of Ebola, Marburg or any other known tropical disease, but more testing was in the works. Symptoms suggested a contagion like Lassa or a Hantavirus, but the incubation times were much too short, even for a filovirus like Ebola and Marburg, on the order of a couple days—as described by the epidemiologist already in the field.
Lucile entered the office and discussed flying to the location a couple countries north of South Africa the next day. Bob expressed hesitancy knowing though he would return to the office later that night after shuttling me to the airport to follow-up on lab results.
“Should I cancel my flight?” I asked. In fact, I had already spoken to Tyler Batson from the Kenya documentary inquiring about making a flight change through his travel agent just in case.
“Frank, like I said, the reality is, this is most likely nothing. This is our bread and butter. We deal with things like this on a regular basis.”
“And the PCR tests confirmed negative for Ebola and Marburg,” I reconfirmed. “And if it were a new strain?”
“If it were a new strain, we wouldn’t be able to detect it.”
A PCR test, short for polymerase chain reaction, detects viral nucleic acids and tests them against a database of known genetic sequences.
“So, like what happened in Bundibugyo,” I identified.
“Yes, exactly. And the only way you can tell it’s a new strain is by isolating the virus through an electron microscope and looking at its shape.” In the case of a filovirus, a cigar shaped moderately large structure sometimes curled at one end like a Shepard’s crook.
“Look, you can do whatever you want, Frank, but I’m telling you we see this stuff all the time.”
Less than eight hours before departure, and according to Tyler, I need to make a decision real soon… like now. I have a tendency to draw patterns as if there’s some mystical significance behind what goes on in my life. That “A Chance for Peace” would bring me to Africa when the opportunity to capitalize on this project—a project I’ve waited over ten years to produce—would conveniently occur at the same time. That almost everything to this moment has seemingly fallen into place with gentle effort. And now, reading in a memoir the exact events transpiring right now as they did almost two decades ago on my last day in Africa. (I know that’s a stretch.)
Earlier the day before, Bob and I discussed previous journalists tagging along in the field. During the Kikwit outbreak of ’95, one went on to follow a lead that claimed having seen patients prior to the suspected index case. Apart for Bob redefining ‘index case’ as pertaining to the first case bringing attention to an epidemic and not ‘patient zero’, he defended, “People can believe what they want to believe, but this is our job and we’re not going to let something fall through the cracks for whatever reason. What makes a journalist think he can do our job better?” After all, they are the pros, and for that reason…
The reality was, I chose against my instincts and would board the KLM flight 23:30 that night; the action of not staying a haunting thought. I would have to wait until I got home, twenty-four hours later, perhaps even a couple days before knowing if my decision to leave was amiss.

South Africa (Johannesburg) – BSL4

A gray haired man treads his way through tall blades of grass and brush into a forest of tall bare-trunk trees with bushy leafed tops. A local man scales a single stock of bamboo, its branches trimmed into ladder rungs to a height exceeding thirty feet. From his high vantage point, he connects one end of a net to an adjacent tree forming a near invisible barrier in the forest canopy. Here bats are caught and taken into a mobile lab for bleeding and dissection, stored in liquid nitrogen for later analysis. The process is repeated for other animals and insects alike. The year is 1996 outside the then Zairian village of Kikwit a month following one of the most historically devastating Ebola outbreaks.
In a lab-office at the Special Pathogens Unit of the National Institute of Communicable Diseases, three of us stood around my laptop watching Final Cut Pro ingest footage from a mini-DV tape recorder. One of many investigative studies filmed over the last ten plus years in search of a reservoir for the Ebola virus.
“I was old then doing that,” Dr. Swanepoel commented watching himself wrangle a bat.
“If you were old then doing that, what did you do when you were young?” I asked smartly.
Bob grinned under his large tinted wire frame glasses, “I was doing as many girls as I could.” We laughed.
At 72 years, Dr. Robert Swanepoel is as sharp, witty and energetic as someone in his middle ages, or perhaps younger. That was the idea those who’ve before spent time with him impressed upon me. He did not disappoint.
I sat behind Bob in his office sipping a Singapore knockoff of Nescafé, which for an instant coffee was surprisingly good. I was on my second cup. Bob scrolled through pictures from previous outbreaks and field investigations and painted a deeper story to the virus with each instance.
“So why has it taken so long to isolate the virus?” I asked.
“Timing.” On a used sheet of paper, Bob drew two circles, one within the other representing the basic structure of a cell. He labeled the inside circle ‘nucleus’ and its surrounding space ‘cytoplasm’, noting each one as headquarters and factory respectively. “If this were Henry Ford’s assembly line, the headquarters sends out a blueprint to the factory in the form of messenger-RNA, or we call it mRNA. The factory assembles many spare parts, but inefficiently produces more than it needs.”
He dotted the cell’s interior and continued, “Windscreens, tires, steering wheels—nucleic acids to build proteins for a virus.” A third circle was drawn on the cell’s outside and labeled virus. Again more dots. “So of all those parts, you get a few viruses with all these spares. We were always seeing the parts, but never the whole virus because we weren’t catching it at the right time of production.” Bob went on into more detail, involving the factors involved with determining the ‘right’ time and the tests used.
I asked Bob about Kitum cave.
“The Dutch schoolboy’s family lived on the Kenya side; he went in on the Kenyan side.”

The next day following lunch, Bob led me to a tall brown speared fence. Inside the fence is a three story isolated brick building, two large stainless steal vents piped into the walls.
“This is our maximum security lab,” Bob explained. “There are only two like this in the world. Here and at the CDC.”
There are more labs like it sprouting up throughout the world, but this lab was the second to be built a year after the Centers for Disease Control constructed the first high containment lab in 1978. “I am going to take you inside, but I cannot take you onto the floor. We are under surveillance now being close to operational again.”
The lab is under the process of being remodeled, and after four years in the process should open again by the end of the year. We crossed through a narrow opening through the gate and entered from the back of the lab. Beside a bright red biohazard flower emblem in small letters, a sign read: BSL4; for Bio-Safety Level 4, also known as a ‘P4’ or ‘Hot Lab’. Within these walls, the most infectious diseases known to man including at the top of the list Ebola and Marburg are grown and studied. Bob swiped his card key, the red LED light turned green, and he opened the door. The heightened risk of bio-terrorism has made such facilities a security fortress, and as of right now, I do not have clearance to photograph or film anything.
In contrast to many of the other hallways I’ve walked through at NICD, the paths skirting the outside of the lab proper breathe a sterile slick laboratory atmosphere of expansive white walls, pipes and polished steel. We passed a series of narrow windows looking in at glove box workstations, tables and storage closets and cabinets. Hanging from the ceiling, a number of yellow hoses.
“Those hoses are what you connect to your suit for air-intake for your suit,” he walked past a couple steal boxes marked, ‘Autoclave’. “Here you can put something in and close the door for someone to access from the other side with out it being incinerated, but anything put in from the lab is automatically autoclaved.”
Down another corridor, and through a series of open airlocks, we could look onto the lab floor and through to a locker storing yellow spacesuits. The lab directly in front of us is labeled, ‘Animal Room 2’. On one wall are a dozen cages for small animals including rats up to perhaps guinea pigs. Between this room and another lab leading to the suit room is a double heavy door airlock. The space between those two doors acts as an intermediate shower room decontaminating an individual crossing one area into another.
The decontamination and undressing procedure is a cumbersome and timely process. Coffee is not recommended, as bathroom breaks require exiting the lab. Wearing a diaper is a touchy subject and is useful for long stints inside the suit. From what I gather, people do not freely admit to wearing a diaper even if they do so.
The hair on my arms stood and I couldn’t help stop smiling excitedly. “You know Bob, to me this is an equivalent to visiting the space shuttle.” And going inside would be equivalent to going into space—or close to in my book.
“The engineering and control for this lab is on par with the space shuttle, monitoring everything to prevent contamination. There is a lot of money built into here,” Bob added.
In contrast, my visit to the developing Ugandan Virus Research Institute (UVRI) a week earlier in Entebbe illustrates the use of a barebones operation. Primarily built for HIV research and immunology, the limited BSL3 laboratory is authorized to handle viruses like Ebola with very specific restriction. The CDC, through the introduction of the BSL3 lab, is fostering a long-term relationship with the Ugandan government to establish a foothold in east Africa for VHF (Viral Hemorrhagic Fever) testing.

South Africa (Phinda) – Vacation

When I return to the States, I will face what I’ve come to recognize as reverse culture shock, and oddly, that reverse culture shock is greater than the culture shock from arriving on the continent. I do not quite understand the difference except something about returning to a common routine is… well, shocking when everyday is literally a radical experience.
So when I got off the South African Airways flight from Entebbe, Uganda and walked into the main terminal at Johannesburg International Airport, my mind wasn’t prepared for an appetizer to western culture.
Suddenly I’m not in minority, but that seems alien to me. Technology is everywhere and I feel like sitting down to absorb everything. I was told the drive to Phinda Game Reserve is a rough road, but subtract driving manual from the literal right side of the vehicle on the proverbial wrong side of the road, a speeding ticket halfway out to the South African ‘bush’, and trucks making half the designated speed on a one-lane highway, the handful of potholes and windy roads are a Sunday pleasant drive compared to where I came from. Even the eight-hour haul from Jo-burg airport to the game lodge felt like a regular commute to work, minus the persistent freaking out about stalling into 1st gear (seldom happened, in fact, but I think the gear box will need some work).
Roughly 10 kilometers of grated dirt road through darkness, past warthogs and zebra brought me to Phinda Mountain Lodge. I was warmly greeted by the pleasant and confident smile of host-manager, Karen, then directed to my cottage for a brief freshen-up before riding into the reserve for a bush dinner.
Room 21: the bathroom is four times bigger than the thatched roof hut I slept under in Transmara with an indoor and outdoor private shower and stand-alone bathtub. I guess it’s like taking a hand-bath with running hot water. Brilliant!
A soft knock at the door.“Hullo, sir. Are you ready for me to take you to dinner?”
At night, all guests must be escorted on the property in the event a lion or some other ‘Big 5’ animal wanders into the lodge premises. Later, when I would actually ‘camp out’ on the reserve, I wouldn’t have that protection.
“What would you like to see tomorrow, Frank?” Ian, my arranged group’s park guide asked at the dinner table. Two couples, one from the UK and the other from South Africa sat across from each other. I was seated at the head of the table across from Ian.
“I’ve seen pretty much all of the ‘Big 5’ animals, except I would like to see a cheetah.” The ‘Big 5’ include: lion, elephant, leopard, rhino and buffalo; not based on tourist appeal—I had thought giraffe was on that list—but based on the most dangerous animals to hunt back in the day. I can understand the first four, but asking how buffalo made the list, the answer I received summed up explained that a wounded buffalo is extremely vicious. Meaning, if hunting a buffalo, best you kill it on the first shot.
“We haven’t seen cheetah in a while, but that’ll be something to work towards tomorrow morning,” Ian offered.
Although I slept comfortably in Room 21’s pillow queen bed, I couldn’t shake off the awkwardness of sleeping in luxury.

At lunch that afternoon, I met with Ilze, former general manager of the Sossusvlei Mountain Lodge (refer to the first four Namibia blog entries). Ilze and Bryan had moved to Phinda after a short stint at SML, and now conduct training for new rangers into the CC Africa organization (they are undergoing a name change as their lodge expands into India and South America).
“Bryan has a tough life here,” Ilze joked. “He travels to Tanzania, Botswana, Namibia to train rangers and look at wildlife.”
I laughed, “I get the same thing. It’s like a vacation, only I’m operating a camera and working pretty much every day. Admittedly, I can’t imagine myself doing anything different though, but today is the first day in, I don’t know, weeks I haven’t done anything regarding ‘work’.” I lied. Later, on the afternoon game drive, I would bring out the camera even though I said I wouldn’t.
“I’m in a bit of a shock, Ilze.” I took a taste of my drink cocktail. “Not only am I in a bit of a shock, but I guess I’m really sensitive to snob bullshit right now—pardon my language.”
“Oh, tell me. I must hear this.”
“For one, this morning on the game drive we’re following this cheetah and her three cubs and from the looks of things she’s on the hunt for food. I want to see a kill, and this would be just awesome if we could catch something like that, you know. So we loose track of the cheetahs ‘cause the stupid cubs go off chasing some zebra and disappear behind the trees. Ian suggests we look for a little longer than go back to the lodge for breakfast if that’s all right with everyone. Well, everyone’s all for getting some food, and I’m like, ‘What? Screw breakfast. I want to see a kill!” Of course, I just thought that and didn’t say anything given I’m not really a guest. But seriously, it’s not like you can witness a kill anytime.”
Ilze agreed.
“Then all I hear is moaning and bitching at breakfast about the water being shut off. So go wash your hands in the pool or use the bottled water so nicely left for you. C’mon, this is Africa. T.I.A. Be resourceful. I understand they paid hundreds of dollars to stay here, but you’re in the middle of the f-ing bush and shit happens.” I took another taste of my cocktail. “Guess I just see things a little differently now is all.”

Not that I didn’t enjoy being pampered the first two nights, but the real fun was ‘camping’ out with the guide trainees a few kilometers outside the lodge overlooking the reserve’s flood plain. 

‘Camping’ is in quotes because there is running hot water and modern amenities on generator power switched on for a couple hours at night. So not quite roughing it, but living with restrictions. I felt more at home and certainly the company of the trainees made for a fun experience through their practical joking.
My job was to present an applicable introduction to naked eye astronomy for the purposes of entertaining guests during night drives. The night was overcast, so the trainees had to endure a two hour lecture in the conference hall. Drawing from my experience at Sossusvlei Mountain Lodge, as well as a night drive the day before I condensed Astronomy 101 into a dramatic narrative of human insignificance through bright object examples. As with all astronomy lectures, the green laser pointer became the instant star of the presentation.

You know how cats are captivated by a laser dot? How do you think a lion would react to it?” I half-jokingly inquired.

“Hmmm. I don’t know. It would be interesting to try.” Bryan offered.
“I asked Ian that same question on the evening drive yesterday when we were parked beside a lioness and her four cubs, but he suggested trying it when no guests were around.”
A good idea, but unfortunately the experiment will have to wait for my next visit. After my last experience with lions (Namibia – The First), I’ve since evolved like modern man has from throwing rocks to shooting laser beams.

Uganda – Bundibugyo: Part Two

Accepting a stranger with a camera into your home must have been awkward to say the least for the Myhre family. Who is this guy? What does he want? And awkward doesn’t begin to describe what emotions surface reliving a difficult past.
Arriving with the Chedester family, I was welcomed to a weekly team meeting dinner party. Today’s menu: brick-oven roasted pizza, plain cheese to supreme and everything in between. Not that I dislike east African cuisine, in fact I very much enjoy the native dishes, especially the charcoal barbequed bush meet speared and sold on the street. From the bus window, I would spend the thousand Ugandan Shillings (~.65 cents USD) for two long toothpick-like skewers knowing very well my digestive track would hate me for it that night and day after. But a change in menu is very appetizing, especially a taste from home. Odd I would find it here far removed from anything near western civilization, and better tasting than most pies back at home. After a brief astronomy lesson navigating around tree canopies, followed by an episode of Band of Brothers on DVD, Scott and I sat across from each other in the family living room and talked about Ebola. I looked at my arms; the skin looked like a few dozen mosquitoes had bitten me. The pink blotches in fact were bukukuni bites, a gnat-like fly with a taste for human skin. Bob had warned me earlier about wearing a long sleeve shirt at night, and that in conjunction with not taking his advice about getting on an empty bus because it won’t be leaving anytime soon (that morning, resulting in a three hour departure wait), were now two things I should have listened to.
“Don’t say too much, you’ll end up repeating it,” Jennifer suggested from the kitchen, switching off the lights. Jack, Julia and Caleb, three of the Myhre’s four kids had already retired on the school night. The next day would be a whirlwind event at the school celebrating Parents Day, which in addition to their respective doctor roles at two different local institutions, both Scott and Jennifer are heavily involved with the school’s development.
“I, Dr. Sessanga, and Dr. Jonah were in the room together looking over Jeremiah Muhindo’s chest x-ray trying to figure out what was causing the illness, this was before knowing it was Ebola,” Scott recounted the days just before the announcement. “He was having shortness of breath, his eyes were real red, and I remember putting my hand on his hand to check his pulse. His hands were just cold as ice; the man was in shock. We all came in contact with the patient. In a way, it’s not fair two of the three of us would get Ebola, and one of us would die.” “Were you afraid?” 

“After Jonah got sick and Sessanga gets sick, then Ebola is confirmed … I was afraid. It was right at that point we decided we had both been exposed because of our visit to Kikyo and having been in contact with a number of patients that had died, we had twenty-one days to determine if we were developing symptoms or not and decided we needed to send our kids away from us. If we got sick, we didn’t want to expose them.”

“What were you going through those twenty-one days?” I feel like the answers to my questions are obvious, but I needed to ask. Scott and later Jennifer were pros; going beyond what I thought was an obvious response.
“You’re super-sensitive. After Jonah was buried, I was sitting at church and had a headache. I don’t usually get headaches. I leaned over to Jennifer and said, ‘I just don’t feel well,’ and she said, ‘Well go home and go to bed.” There was a knowing exchange of looks that this… and I laid down and I thought, ‘Well, this could be it.’ And I told her, if I really felt like I was sick, I was going to go across the street to a vacant missionary house and lock myself in there, because I wasn’t going to have her take care of me and expose herself and leave our kids as orphans. Nothing ever came of that, but I talked to an MSF worker [Doctors Without Borders] and she said that, ‘Typically if you do come down with Ebola this late after contact, you’ll get sick, but probably not die of it.’”

The following morning, Scott drove me the thirty minutes to Bundibugyo hospital. We stopped 

at the gravesites of the four healthcare workers, including Dr. Jonah Kule, whom died caring for Ebola patients during the outbreak.
“Not many people came to Jonah’s burial in fear of getting Ebola. Afraid they might get Ebola from the air, or from the bodies. It doesn’t help to see the MSF burial team, dressed in their Tyvex spacesuits disinfecting the bodies sealed in bags then dropping the coffins into their graves,” Scott quietly explained before he and I walked across the medical campus. Men and women of all ages loitered through the open covered pathways. Some women waited outside the x-ray building for an ultrasound. Some just sat on the sidewalk ends looking at the many people passing by. Through the antenatal ward where the Ebola infected healthcare workers we treated, an education workshop was underway. Nurses sifted through disorganized books and records; I honestly couldn’t guess what was going on. Over a shallow hill of drying grass took us to a chain link fence enclosing the isolation ward.

We walked around the two-car garage-sized building to an unlocked door. I walked inside.
Sunlight seeped through a gap where the wall would meet the floor, and from the middle seam between blue painted wooden window panels. Eight bed frames, four on each side are planted on the grey polished cement floor, their white latex coatings peeling from its metal bars. I visualized the beds made and occupied. A suited individual examines one patient through his plastic helmet mask and thick blue gloves, checking the still individual’s pulse and examining his eyes.

“I was partially conscious, but not alert to all my senses,” one Ebola survivor told me. “I would not be able to drink. I would not be able to turn my body. I would sleep like that until someone could assist me. The thinking was not so easy. You could think of either surviving or death. And you just hand everything to God to decide on your fate.”
I then pictured myself inside one of those Tyvex suits and contending with the heat and humidity compounded underneath the protective garment. Leaving the isolation ward, I further imagined drenching myself with a concentrated bleach solution in one of the many white tents established by the MSF team, sealing the suit in a biohazard bag before redressing into my clothes and allowing the thickness of the air become a sad refreshing relief.

“You. What are you filming? What are you doing here?” a burly man in a suit approached me mounting the back of a motorcycle, the camera gripped tightly by my left hand over my lap.
Denato spoke to him, but the man ignored whatever was said stepping over banana bundles charging forward. People in the market stopped in mid-commerce to witness the exchange. In particular, I recall one older woman holding a food item frozen in transaction.
Being the only mzungu around draws enough attention, regardless of the few white families residing on the outskirts of town. But a mzungu with a camera rivaling anything the country begs special attention whether by lens happy children or protective elders.
“I ask you, why are you here?” The man stood dangerously close. I looked to Denato; no more help there.
“I’m filming a documentary,” I calmly stated, knowing I’m not going anywhere unless I direct Denato to drive.
“What again?”
“A documentary on the Ebola outbreak here last year.”
“On Ebola?”
“Yes.”
He smiled. And almost immediately, his whole body relaxed and he said shaking my hand, “Oh, that is good. Thank you. Welcome. Be free, you are welcome here.”

Not quite the reaction I expected, but a welcome one. Denato, Scott’s assistant, revved the engine and I prepped the camera to film over the driver’s head while riding the uneven dirt road. Even after replaying the footage days later, I’m still shocked at myself for putting faith into a motor bike and its driver at the stake of breaking my camera—or injuring myself. I did regretfully pack the camera for the thirty-minute return drive back to the Myhre’s on a motor-boda. Over steep inclines and sharp drops, dodging people and potholes, the choice was probably a good idea, although the mountain and valley views were breathtaking.

In her blog, Jennifer drew a parallel between the Ebola and HIV viruses, “HIV attacks the disease-fighting cells of the body, so that a person succumbs to other illnesses. Few AIDS patients are technically killed by the HIV virus alone, almost all die from things like TB or fungi or common bacterial infections that can no longer be resisted. On a macro level, Ebola acts in a similar way. Ebola attacked the disease-fighting personnel and programs of this society. Only 37 people died of Ebola during the epidemic, but many more, untold numbers, have died because of the lack of medical services. I think we will never really know the true impact.”

*Pictures from the 2007 outbreak courtesy Scott and Jennifer Myhre.