Authors note: Part 1 is a fictional vignette designed to set the table and soften the topic of Ebola Virus Disease before we delve into Dr. Fowler's life story.

"Abandon all hope, ye who enter here." Dante's Inferno

"Fire is the devil's only friend." Don McLean, American Pie

The child lay in a fetal position atop a strand of palm fronds arranged carefully on the ground beneath a tall Okoume tree.  Above, two monkeys chattered incessantly on a low hanging bough, the black one, a male, kept its back turned and its tail secured around the branch, while a smaller, grey female groomed him with a delicate, practiced hand.  She ate the ticks one by one as she came across them and seemed quite content with the delicacy.  They were of the Mantled Guereza type, and their striking coats of fur contrasted with the lush, tropical greenery of the Zaire rainforest.  After the morning ritual, they would roam the canopy in search of edible fruits for breakfast. 

The child was still, his breathing calm.  He had been positioned in the shade, away from the rays of the fiery sun.  The air was humid, and the sun was starting to bake everything under its ubiquitous gaze.  The boy was naked, except for a ragged, oversized T-shit atop a skinny frame.  The boy’s father wandered over to check on his son, setting down his panga and squatting beside him.  He held a rough, soiled hand to Jengo’s forehead. 

“Still with high fever, my little June-bug,” he said softly, and let out a deep sigh.  He reached for a cup of water and removed the small leaf he capped it with in protection from soot and insects.  He cursed at the flies and swatted them away from the boy’s parched lips than readied him to drink.  “Drink, June-bug, drink.”  Jengo made a weak effort but most of the water trickled down from the corners of his mouth.  He wiped the boy’s mouth with his finger and laid him back down along the fronds.  Bomani sat beside his son, elbows on knees.  He rubbed his tired eyes and covered his face with his thick, calloused hands.  There were no tears, Bomani hadn’t cried since he was Jengo’s age, but they were lurking.  He was worried for his son. 

The village medicine man, the Nganga, elaborately dressed, had already visited the boy the day before.  The boy had been cursed, said the Nganga; rather, Bomani’s house had been cursed, by a witch, who planted a demon.  The illness was a manifestation of the demon.  The demon speaking.  It was not personal, he said, likely an attack against an ancestor, long dead.  The Nganga recommended removing the boy from the house, which might lessen the immediate danger. “Torch the house, and build afresh,” he instructed.  “If the house is gone, it can no longer house the evil spirit, who will then be swept free on the wind.”  To heal the boy, he must eat the liver of a new-born monkey, which will resolve the sickness.  Bomani wasted no time in executing the orders, and since then had been sleeping with Jengo out in the open, far away from the charred remains of the hut.  The other villagers saw and understood.

Bomani sighed and wondered what had gone wrong.  Did the boy not have enough of the liver?  He could hardly get any into the boys unwilling mouth.  Was the monkey also affected by the curse?  Not for the first time, he wished his wife, Nzuri, was still alive.  He resolved to abandon his efforts building the new hut and to set off on a hike from his village, Yambuku, to the larger village of Bakune, to call for medical attention.  The women of the village understood his intentions and agreed to look after the boy. 

The doctor arrived two days later and examined Jengo thoroughly, then peppered Bomani with questions.  Although they both spoke French, they communicated in Lingala, a Bantu language, now the preferred language since Mobutu Sese Seko had seized power in the 1965 coup, turning the Congo Free State into the republic of Zaire.  Bomani was not an educated man, few were in Congo, but he knew the word republic was a fallacy.  Mobutu was a dictator.  Bomani had been a supporter of the beloved Patrice Lumumba of the Congolese National Movement party, who had become popular after independence in 1960 after a century of horrors perpetrated by King Leopold II and the Belgians.  Lumumba became the hope of the people of Congo, but their future was skewered when he was assassinated by the CIA for his socialist leanings, leaving the door wide open for Mobutu’s coup in the years to follow.  Bomani, as were many of the Congolese, was devastated.

“Jengo had been fine.  Besides the occasional runny nose, he has never really been sick before, doctor,” said Bomani. 

“When did the illness begin?” asked the doctor. 

“About a week ago.  He awoke one morning and said, “Papa, my throat is sore.”  Then he complained of headache and muscle pain.  I thought he had just been swinging his panga too much, as we were clearing forest all day before, irritating his throat and causing his muscle soreness.  But then he began to burn up and shake with chills, even though the nights were very hot.  When this fever persisted, doctor, I called for the local Nganga.  I did as he instructed but as you can see, Jengo is no better.  Perhaps I should have called the Nganga even earlier.  What do you think, doctor?  Did I not follow his instructions well enough?  Should I have forced more of the liver into his mouth?”

The doctor did not respond to the question.  He took the boys blood pressure and felt the pulse, which was rapid.  “The blood pressure is very low.  You need to get him to the regional hospital.  I am confused as to what he has.  I do not think it is malaria, but it’s still possible.  Any other symptoms?” 

“Yes, on the day I left the village to seek help, he developed stomach cramps, vomiting and diarrhea.  His appetite went from little to none.  I can barely get him to even take a sip of water, doctor.”

“He’s very dehydrated.  I feel that if we don’t get fluid into his body….”  The doctor didn’t finish the sentence.  He didn’t need to.  Bomani understood.  His son was gravely ill. 

“The dots on his skin developed this morning, along with a bloody nose.  His eyes, you can see, have become yellow.”  While the two men continued to talk, Jengo began to vomit.  A few minutes later, he soiled himself with a black-colored stool. 

“He is bleeding internally,” said the doctor.  “Can you get him to Bumba?  If you can get him to Bumba, you can hop the barge on the Congo River and take it down to the regional hospital in Mbandaka, or Kisangani, depending on which way the barge is going, up or downstream.”

“That is a long way, doctor, and with no transportation, it will be difficult.  But I will try my best to get him to the hospital.”

“Okay.  Good luck to you and your son, Bomani.”

The doctor departed and Bomani sat looking up at the position of the sun.  Yes, it could work, he decided, and sprang into action.  His son was going to die unless he could get him to the hospital.  There were virtually no roads in Zaire, certainly no main roads, except the ones leading away from the mines, which were used to export Zaire’s mineral wealth in exchange for the lining of Mobutu’s infinitely deep pockets. Transport was only via scattered local roads, what little air service the country supported, and the river.  The Congo River, one of the longest rivers in the world and which crossed the equator twice, was the lifeblood of the country’s transportation. 

Bomani grabbed a nearby wheelbarrow, dumped its load of cinderblocks onto the ground, and replaced them with Jengo.  He studied the situation, tilted Jengo a bit, and fitted a blanket underneath him for shock absorption and padding.  He explained to the villagers what the doctor had suggested.  The compassionate but desolate look on their faces reinforced what Bomani already knew.  But he was going to try, anyway.  They lined the periphery of the wheelbarrow, next to the unconscious boy, with enough water, casava, and mango for the journey.  Some of the women kissed the boy on the lips and began to cry.   

The dirt road was pocked with ruts formed by tire activity during flooded road, followed by intense, sunbaked drying, leaving rock-hard casts that were cumbersome to maneuver around.  After about five hours, Bomani’s bare feet and hands began to cut and blister, but there was no choice but to carry on.  Eventually, a pickup came along with enough space to accept both Bomani and the wheelbarrow.  Bomani paid for the ride while several passengers lent a hand lifting the wheelbarrow and its contents into the middle of the truck bed.  The truck zoomed off, kicking up dust and pebbles, its driver seemingly ignorant of the plight of the passengers in the back, balanced precariously on the skinny edges of the cab.

The pickup listed violently from side to side, like a small boat in rough seas, with each knuckle-whitening descent into the deep, lopsided trenches which abounded, and which threatened to spill its passengers into the jungle on either side of what could only be described in Zaire as a road.  When the ride smoothened, though, the women would release their grips on the siding and begin fawning over the boy again and again.  One woman, in a brightly colored robe or liputa, with matching headwrap, dabbed at the boy’s forehead with a cool, damp cloth, for the boy, now delirious, was burning with fever.  When she began to taste the salty drops of sweat running down from her own forehead, she wrang the cloth out, freshened it with water, swiped at her own forehead, and replaced it on the boy.

“You have lots of women to care for you now, June-bug,” said Bomani. 

“What a wonderful nickname,” said a woman.

“You know, when my wife was alive, I never used that nickname.  I never liked it.  It was my wife’s name for him.  I didn’t think it was manly enough, so I never used it.  My son was going to be a warrior, not a June-bug.  Now, I use it all the time.  I think it helps me remember a time when we were all happy and together.”

When they reached the river, a small tributary of the Congo, everyone was herded onto a large wooden pirogue, or canoe, felled from a single, gigantic tree and which was waiting for them at the riverbank.  It was steered by two boys who stood at each end, using long poles as purchase to push against the shallow river bottom.

They arrived in the early evening at Bumba and the passengers found comfortable areas, clear of reeds but close to the riverbank, and munched on casava before sleeping until dawn.  They were awoken by the puttering and hissing of the government-run river barge, a giant, smoke spewing diesel vessel with six large river barges in tow behind.  Like most things in Zaire, its schedule was completely unreliable due to frequent breakdowns, with passengers sometimes waiting days for the giant snake-like river barge to materialize.  Without knowing it, Bomani had gotten lucky things worked out as they did.  The barge was here, and on board was a varied cast of characters numbering roughly 1500 and from every walk of life.  River travel along the massive Congo was a way of life, and virtually the only way to get from east to west or west to east.  It was the circulatory system of the country, and the only practical source of travel for long distances. 

The river barge was also a floating circus.  A melting pot of humanity in a small, confined space, where just about anything could be bought or sold from approaching pirogues that pulled alongside the still-moving vessel as it passed small outposts and villages on its endless journey up and down the river.  The barter included fruits and vegetables, to live monkey’s sold as pets, to monkey’s sold for food and fried alive on the barge, to chickens, and bush-meat, and ill-legal ivory, and, of course, one of the most bartered goods of all, prostitution.  The river was commerce, the lifeblood of the local economy.  The barge, a microcosm of life.  Bomani checked to make sure his trouser pockets were pinned shut.  Pickpocketing and general thievery was widespread.

The group from the pick-up stayed together, bonded by the boy’s illness and the father’s despair.  They found the only spot left that was in the shade, just behind the stinking community bathroom, and huddled together.  Other passengers were kind enough to share the space.  Bomani parked the wheelbarrow in the center of the group, and they formed an almost protective circle around the boy.  Bomani calculated that if the barge didn’t break down, which was not certain, they would reach Mbandaka by tomorrow afternoon.  Toward evening, Bomani allowed himself to rise for the first time, relieving himself in the boats filthy head.  Afterwards, he headed up to a make-shift roof, where a maintenance engineer was hosing down the deck with brown river water.  Bomani gave the man a few coins in return for a brief, refreshing spray of the hose.  The journey was painfully slow along the coiled, snake-like river, the shore a half mile away on each side.  The pirogues continued to come and go like an intricate escort service, buying and selling and passing news in both directions like the porous membrane of a living cell.   

Bomani was glad to be momentarily free from the impotent feeling of hovering over poor Jengo but soon felt guilty and returned to find the boy with a sweaty forehead and another high fever.  The boys’ clothes were damp from perspiration, and the women fanned his brow and continued to re-issue cool, wet compresses to his forehead and forearms, which they also circulated amongst themselves.  There was a distinct reddish hue now mixed in with the yellowed eyes.  With fever came worsening delirium, and with worsening confusion came incontinence of both bowel and bladder.  Those around him donated extra swaths of cloth and a fresh T shirt and Bomani went to work stripping and cleaning the boy and tossing the excrement-stained clothes overboard, the river absorbing the barge’s trash along the way.

The next day, as the barge limped into Mbandaka, the boy displayed a noticeably high respiratory rate and a greyish-blue hue to both lips and nailbeds.  At the hospital, the boy was stripped of his remaining clothes and his skin washed thoroughly by towels saturated with soap and water, and he was then examined by a weary looking nurse and a disheveled doctor. 

Bomani took in the scene.  Patients were squeezed into every nook and cranny of the building.  The staff worked at a feverish pace and often with bare hands, washing them thoroughly in a big basin on a table in the center of the room.  The basin was in a perpetual cycle of being emptied, scrubbed, and refreshed with more river water.  A second basin on the table held clear, fresh rainwater, a final step in the ablutionary process.  There were often no towels to dry one’s hands and staff resorted to the hand-flick method robotically.  A nun finished drawing blood from Jengo’s arm and began to label the test tubes.  An hour passed.  Then two.  Bomani sat on the floor, his back against the wall.

The doctor returned and stated he was unsure about the nature of the underlying disease and that he was sorry he had come all this distance but that he was certain the boy would not make it.  He asked Bomani if he wanted a priest to administer last rites.  After a few hours, Jengo was dead. 

Days later, Bomani returned with the empty wheelbarrow back to his village, but something was very wrong.  Half the village was ill with the sick quarantined in the center of the village, where makeshift thatched roofs had been hastily erected to shield the sick and dying from the relentless sun.  Bomani was handed a shovel and given a weary nod toward the outskirts of the village, where he could see others with scarves around their noses digging graves. 

As Bomani toiled at the gravesite, he began to feel weak, then dizzy.  After a sip of water, he sat on the ground and let his legs dangle into the grave.  He felt his forehead.  He was burning up.  He covered his face with a soiled hand, and wondered, with black humor, if he was digging his own grave.  He began to laugh, and then he began to cry.  It was all too much, he thought. 

As the days passed, he grew sicker.  The appetite went, then came the sore throat, pounding headache, the on and off high fevers that left his mouth parched and mind dazed, followed by the nausea, vomiting, and diarrhea, a copycat of the symptoms that felled Jengo. There was no one left to take care of him, everyone else was either sick or dead.  He lay in his filth day in and day out with no strength or will to even swat the clouds of flies.  One day he awoke with tiny dots studding the skin of his ankles and forearms and blood trickling from his nose.  He was thirsty, but there remained no one well enough to even fetch him water.  His stool turned black and tarry later that day.  He drifted in and out of consciousness.

It was then that the soldiers came.  They kept their distance and had few supplies with them.  In Bomani’s view, it appeared their job was more to keep the sick and dying within the confines of the village, rather than bring them out or ease their suffering.  The road was sealed, and no one was allowed into or out of the village despite their protests.  The few nurses who came with the soldiers soon began to feel ill.  It was the same for them.

Bomani could barely catch his breath now.  He could see his chest heaving up and down as if he had just been chasing Jengo through the fields but found he was only lying still on the ground.  He wiped a trickle of blood from his nose and stared up at the dawn sky.  The village was very still.  Then the realization struck him like a hammer blow.  The soldiers were gone, disappeared in the middle of the night!  The worthless buzzards! 

The wind whipped up, stirring dust and particles into a vortex.  His eyes stung, teared, then blurred.  He could barely make out the trees bending to the wind.  Birds scattered, monkeys began to shriek.  The air became hot.  He saw the specter of two giant metallic birds hovering overhead.  I must be delirious, he thought.  He looked on passively, no strength left for either reason or emotion, a spectator, a mind trapped in a dying body.  Both shiny birds appeared to have had swallowed a human, positioned behind the large glassy eyes.  Perhaps he would also be eaten alive.  A door opened, but instead of excrement, small cannisters were expelled that dropped to the ground.  When the cannisters hit the village floor, they began spewing a greenish-yellow gas which made Bomani cough violently.  The gas soon enveloped the entire village and appeared to suck the oxygen out of the air.  He started to choke.

He was unable to process what was going on.  He tried to turn over, to get closer to the ground, to shield himself from the toxic cloud burning his eyes and throat and lungs, but he was too weak.  His world turned black.  The roaring overhead and the great winds dissipated.  He sensed the metallic birds were no longer hovering over him with their strange beings just behind the eyes.  His throat began to close.  He clutched at his neck with desperate fingers.  He could feel life ebbing away, but so was the agony.  His last thought was of the Nganga.  Why would the birds want to suffocate him?  Why were the ancestors angry?  Only the Nganga would know.