Cook, Robin - Outbreak

Outbreak ByRobinCook Copyright(c)1987byRobinCook Formymother,Audrey,whoultimatelyisresponsiblefor allthis.PrologueZaire,AfricaSeptember7,1976ATWENTY-ONE-YEAR-OLDYalebiologystudentbythenameofJohnNordykewokeupatdawnattheedgeofavillagenorthofBumba,Zaire.Rollingoverinhissweat-drenchedsleepingbag,hestaredoutthroughthemeshflapofhisnylonmountaintent,hearingthesoundsofthetropicalrainforestmixedwiththenoisesoftheawakeningvillage.Aslightbreezebroughtthewarm,pungentodorofcowdung permeatedwiththeacridaromaofcookingfires.Highabovehimhecaughtglimpsesofmonkeysskitteringthroughthelushvegetationthatshieldedtheskyfromhisview.Hehadsleptfitfully,andashepulledhimselfupright,hewasunsteadyandweak.Hefeltdistinctlyworsethanhehadthenightbefore,whenhe'dbeenhitbychillsandfeveranhourorsoafterdinner.Heguessedhehadmalariaeventhoughhe'dbeencarefultotakehischloroquinephosphateasprophylaxis

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againstit.Theproblemwasthatithadbeenimpossibletoavoidthecloudsofmosquitoe5thatemanatedeacheveningfromthehiddenpoolsintheswampyjungle.Withahesitantgait,hemadehiswayintothevillageandinquiredaboutthenearestclinic.Anitinerant priesttoldhimthattherewasBelgianmissionhospitalinYambuku,asmalltownlocatedafewkilometerstotheeast.Sickandfrightened,JohnquicklybrokecampstuffedhistentandsleepingbagintohisbackpackandsetoutforYambuku.Johnhadtakenasix-monthleavefromcollegetophotographAfricananimals,suchasthehighlandgorilla,whichwerethreatenedbyextinction.Ithadbeenhisboyhooddreamtoemulatethefamousnineteenth-centuryexplorerswhohadoriginallyopenedtheDarkContinent.Yambukuwasscarcelylargerthanthevillagehe'djustleft,andthemissionhospitaldidnotinspireconfidence.Itwasnomorethanameagercollectionofcinder-blockbuildings,allindireneedofrepair.Theroofswereeitherrustingcorrugatedmetalorthatchedlikethenativehuts,andthereseemednosignsofelectricity.Aftercheckinginwithanun,swathedintraditionalattire,whospokeonlyFrench,Johnwassenttowaitamongathrongofnativesinallstatesofdebilityanddisease.Lookingattheotherpatients,hewonderedifhewasn'tlikelytocatchsomethingworsethanwhathealreadyhad.FinallyhewasseenbyaharriedBelgiandoctorwhocouldspeakalittleEnglish,thoughnotmuch.Theexaminationwasrapid,andasJohnhadalreadysurmised,thediagnosiswasa"touch"ofmalaria.Thedoctororderedaninjectionof chloroquineandadvisedJohntoreturnifhedidn'tfeelbetterwithinthenextdayorso.Theexaminationover,Johnwassentintothetreatmentroomtowaitinlineforhisinjection.Itwasatthatpointthathenoticedthelackofaseptictechnique.Thenursedidnothavedisposableneedlesbutmerelyrotatedoneofthreesyringes.Johnwascertainthattheirshortstayinthesterilizingsolutionwasnotnearlylongenoughtorenderthemgerm-free.Besides,thenursefishedthemoutofthefluidwithher fingers.Whenitbecamehisturn,hewastemptedtosaysomething,buthisFrenchwasnotfluentenough,andheknewheneededthemedicine.Duringthenextfewdays,Johnwasgladthathe'dbeensilentsincehesoonwasfeelingbetter.HestayedintheYambukuarea,occupyinghimselfbyphotographingtheBudzatribesmen.Theywereavidhuntersandeagertodemonstratetheirprowesstotheblondforeigner.BythethirddayJohnwaspreparingtorecommencehisjourneyuptheZaireRiver,followingHenryStanley'sfootsteps,whenhishealthtookarapidturnfortheworse.Thefirstthinghenoticedwasaviolentheadache,followedinrapidsuccession bychills,fever,nauseaanddiarrhea.Hopingitwouldpass,hetooktohistentandshiveredthroughthenight,dreamingofhomewithcleansheetsandabathroomdownthehail.Bymorninghefeltweakanddehydrated,havingvomitedseveraltimesinthedarkness.Withgreatdifficulty,hegothisthingstogetherandmadehiswayslowlytothemissionhospital.Whenhearrivedinthecompound,hevomitedbrightredbloodandcollapsedontheclinicfloor.Anhourlaterhewokeinaroomoccupiedbytwootherpatients,bothsufferingfromdrug-resistantmalaria.Thedoctor,thesamemanwho'dexaminedJohnonhispreviousvisit,wasalarmedbytheseverityof John'sconditionandnotedsomecuriousadditionalsymptoms:astrangerashoverhischestandsmallsurfacehemorrhagesinhiseyes.Althoughthedoctor'sdiagnosiswasstillmalaria,hewastroubled.Itwasnotatypicalcase.Asanaddedprecaution,hedecidedtoincludeacourseofchloramphenicolin

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casetheboyhadtyphoidfever.September16,1976Dr.Lugasa,DistrictHealthCommissionerfortheBumbaregion,glancedouttheopenwindowofhisofficeattheexpanseoftheZaireRiverasitshimmeredinthemorningsunlight.HewisheditwasstillcalledtheCongowithallthemysteryandexcitementthatnameinvoked.Then,forcinghismindbacktowork,helookedagainattheletterhe'djustreceivedfromtheYambukuMissionHospitalconcerningthedeathsofanAmericanmale,oneJohnNordyke,andofavisitingfarmerfromaplantationneartheEbolaRiver.Themissiondoctorclaimedthattheirdeathshadbeencausedbyanunknowninfectionthatspreadrapidly;twopatientshousedwiththeAmerican,fourmembersoftheplanter'shouseholdwho'dbeencaringforthefarmer,andtenoftheclinic'soutpatientshadcomedownwithseverecasesofthesameillness.Dr.Lugasaknewthathehadtwochoices.First,hecoulddonothing,whichwasundoubtedlythewisestchoice.Godknewwhatkindoframpantendemicdiseasestherewereoutthereinthebush.HissecondoptionwastofilloutthebewilderingarrayofofficialformsreportingtheincidenttoKinshasawheresomeonelikehimself,buthigheronthebureaucraticladder,wouldprobablydecideitwasprudenttodonothing.OfcourseDr.Lugasaknewthatifheelectedtofillouttheforms,hewouldthenbeobligatedto journeyuptoYambuku,anideathatwasparticularlyodioustohimatthatparticularlydamp,hottimeof year.Withatwingeofguilt,Dr.Lugasalettheonionskinletterslipintothewastebasket.September23,1976AweeklaterDr.LugasawasnervouslyshiftinghisweightfromonefoottotheotherashewatchedtheagedDC-3aircraftlandattheBumbaairport.FirstoutwasDr.Bouchard,Dr.Lugasa'ssuperiorfromKinshasa.Thedaybefore,Dr.LugasahadtelephonedDr.Bouchardtoinformhimthathe'djustreceivedwordthataseriousoutbreakofanunknowndiseasewasinprogressintheareaaroundtheYambukuMissionHospital.Itwasaffectingnotonlythelocalinhabitants,butthehospitalstaffaswell.Hehadnotmentionedtheletterhe'dreceivedsomesevendaysbefore.ThetwodoctorsgreetedeachotheronthetarmacandthenclimbedintoDr.Lugasa'sToyotaCorolla.Dr.BouchardaskediftherewasanymorenewsfromYambuku.Dr.Lugasaclearedhisthroat,stillupsetaboutwhathe'dlearnedthatmorningfromthewireless.Apparentlyelevenofthemedicalstaffof seventeenwerealreadydead,alongwithonehundredandfourteenvillagers.Thehospitalwasclosedsincetherewasnoonewellenoughtorunit.Dr.BoucharddecidedthattheentireBumbaregionhadtobequarantined.HequicklymadethenecessarycallstoKinshasaandthentoldthereluctantDr.LugasatoarrangetransportationforthenextmorningsotheycouldvisitYambukuandassessthesituationfirsthand.

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