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Marburg Fever: Mobile MSF Team Helps Angolan Families Safely Bury Dead
April 26, 2005
When Doctors Without Borders/Médecins Sans Frontières (MSF) arrived in Uige town on March 27, the Marburg fever epidemic was already spreading uncontrollably across the area. In the face of this emergency, they had to take on a number of dangerous responsibilities including picking up highly contagious corpses in order to prevent the epidemic from spreading further. Those appointed to carry out this hazardous job were Christian Katzer, a logistician, Josefa (Pepa) Rodríguez, a psychologist, and two local staff members trained by MSF. The following describes a working day for this MSF mobile team.
The World Health Organization (WHO) has identified the body of someone they suspected has died of Marburg fever in the Candombe Velho quarter. They have asked MSF to go and retrieve the person, an urgent task because dead bodies are highly contagious if handled without the proper bio-safety gear. Pepa and Christian leave for the hospital to pick up the local team. Pepa tells us that the five Angolan staff members have been picking up bodies for five days. One of them, Manel, has lost four of his family members to Marburg. Last week he developed a fever and had to stay under observation the entire night. After testing negative the following morning, he went back to work as he was feeling better.
It takes 20 minutes for the team to put on the bio-safety outfits needed to handle the bodies. At the entrance to the isolation area, they get into the first layer of equipment: a green nurse's uniform, gloves, and rubber boots. They put on the second layer near the "high-risk" area: an astronaut-like suit covering them from head to toe, a mask, a second thicker pair of gloves and protective goggles. All of this they have to wear in the extreme, tropical heat.
The team crosses the town with the "astronauts" sitting in the back of the truck. As they drive by, people outside cover their mouths, thinking that the disease is air-borne. The fact is, however, that it is only transmitted through direct contact with infected people or their bodily fluids. Other people outside, although very few, point to the truck and laugh. "These are the two responses to fear," Pepa points out. The team reaches the Candombe Velho quarter, a patchwork of narrow paths and tiny huts scattered across the hill. Pepa thinks she recognizes the area: "We have already had a case around here."
They arrive at the deceased's house. A group of about 30 people are waiting outside. Neighbors peek out their windows and a group of on-lookers gather nearby. When the teams get out of their vehicles, they are met by a wave of weeping, wailing, and screaming. Presiding over it all are three women dancing. "This is their way of expressing grief," explains Pepa. "In this culture, the more visible and loud grief is, the better."
The group shows them to the body inside the house. Luckily, one of the few facts about the disease that has managed to reach the community is that bodies cannot be touched. The team of "astronauts" enters the hut. Meanwhile, Pepa, dressed in plain clothes, gets closer to a small woman who is crying more than everyone else. She is the deceased's wife. After giving her condolences, a very soft-spoken Pepa explains to the woman that the body is going to be taken away. "You will be able to see the grave in the cemetery where there will be a cross with his name," she tells her. She also describes the risks associated with this disease and warns her that any members of her family who may be suffering from the symptoms - fever, vomiting, hemorrhaging - should be taken to the hospital immediately. The woman seems to calm down and listens attentively. Pepa now walks towards the group of young people behind the woman to give them advice as well. All of them approach carefully and curiously. They want to know.
The team disinfects the house with chlorine and puts the body in a plastic bag together with the deceased's clothes and some personal belongings. According to the local custom, the deceased are always buried with some of their possessions. In this case, the custom works to the team's advantage, allowing them to confiscate possibly contaminated items. Once the bag is sealed it is disinfected again. The work is done fast. Christian supervises the team. He is leaving this afternoon and wants to make sure that the local teams can carry out this task on their own from now on. Once they take the body out on the stretcher, the crying escalates and the tension grows. An old woman sings and dances, lifting her arms towards the sky. All of the women begin to approach the body to offer their farewell, but Christian has to keep them away. He tries to be firm but polite. He is communicating all of this from his astronaut suit.
The teams get in their vehicles and drive to the hospital. Before going to the cemetery, they have to pick up the body of a patient who died in the isolation unit. When the team arrives at the cemetery, it starts to rain. They do not waste any time and head straight toward the burial site. After having traveled for over an hour through the chaotic streets, the quiet and stillness of the cemetery on the hill has a calming effect. The red earth of the recently dug graves stands out on the misty landscape of lavishly green hills. Against this backdrop, the team cautiously lower the bodies two meters down into the ground. The graves must be dug to this depth for safety reasons. It is all over in five minutes.