IN SEARCH OF THE DYING

By NANCY GIBBS

In the darkened doorway of an abandoned building, the medical team finds an empty coffin, waiting like carrion. One by one, neighbors explain, the family that lived there died. First the daughter, 18, went to the Kikwit 2 maternity hospital in late March for a caesarean section. When she got home her incision began to bleed. Then her organs began to melt. The red-black sludge wiggled out of her eyes, her nose, her mouth. Soon her parents got sick. Her father, some villagers believe, died of horror: he told his wife that if she died, he would die too on the next Friday. And he did, followed by another daughter, then two sons, and a nurse who had helped tend them.

Two houses away, a new widow sits and watches the visitors making their way through town. Her husband, she quietly admits, also helped take care of the sick family. Then he died. She buried his body, but the mattress where he lay sick is still in the house. Dr. David Heyman of the World Health Organization listens to her story, and his heart sinks. He knows as much about the lethal Ebola virus as anyone alive; he was part of the team that investigated the first recorded outbreak, also in Zaire, two decades ago. Now he is leading the international brigade that has come to the city of Kikwit to battle the new emergency. "The virus is still loose, and it's spreading," he says. "If the mattress is warm and damp, and people go in and sleep on it, we're going to be in trouble." The villagers are terrified, and resigned. "It's useless for us to do anything," says a neighbor, Mbangu Fioti. "What can we do against this disease?"

For a while last week it looked as though the outbreak might soon be brought under control. The plague police-medical teams dispatched by who in Geneva, the Centers for Disease Control and Prevention (cdc) in Atlanta and other public health groups-had set up an effective isolation ward at the main hospital in Kikwit, where the first case had been identified. Belgium's Doctors Without Borders (Medecins Sans Frontieres, or MSF) rushed in loads of gloves, gowns, masks and other essential equipment to restore hygiene to filthy clinics. But when the strike forces, aided by local medical students, fanned out through the countryside around Kikwit, trying to follow the path of the fever, it became clear that the danger was far from past.

The teams' job was to figure out who might have been infected already and to warn people at risk. At first doctors thought the victims could all be traced back to a 36-year-old lab technician named Kimfumu, who died at Kikwit's main hospital last month. But once they discovered the case of the woman infected even earlier at the Kikwit 2 maternity hospital, they realized the crisis was worse than they had imagined. "It's a huge epidemic," Heyman says of the previously unrecorded cases, "and it's got nothing to do with the main hospital." By week's end who doctors had counted 97 Ebola deaths, and the toll seemed certain to rise much higher. The only good news was that the disease had not yet spread-as far as anyone could tell-to the 4 million people of Kinshasa, 250 miles to the west.

When the doctors descended on Kikwit 2, the only hint of hygiene was a torn garbage bag on the rusting operating table that clearly had not been changed for months. There were no lights, no running water; health workers collected rainwater from a cistern or went down to the river with buckets. Conditions were perfect for breeding a plague.

And there is more bad news. Since Kimfumu perished a month ago, no one has dared enter the thatched-roof hut where he lived. Mute children and frightened neighbors stare at the stick fence and whisper, as medical students arrive to search for the dead man's family and friends. Where is the cure, a man named Mola asks. A student explains that there is no cure; the only hope is prevention, staying away from the sick, not touching the body. Mola frowns. "I don't know what to say," he says. His father has just died from the virus. "I am the one who helped him. I have already touched the body. And now you tell me I must avoid contact?"

Mola confirms a grim fact about how the disease has spread. Though the Ebola virus is not easily transmitted -- it is passed by contact with blood and body fluids -- Zairian custom requires that preparation of a body for burial must include the handling of various organs. Health officials had hoped only family members were involved in the burial; from Mola and others they learn that friends help as well, which means even more people are in peril than the doctors had realized. "We are telling people of the enormous risks involved in doing this, and offering a safe and respectful form of burial with the aid of the Red Cross," says who spokesman Thomson Prentice. When the family insists on a traditional burial, he adds, "we are trying to tell families how to do so at the lowest possible risk. But it's really a tough fight."

As dedicated as the relief effort has been, Heyman realizes that it is not enough. He consults with local officials and orders that the teams of students tracking down possible victims be doubled. He wants bicycles, so the teams can travel more quickly, and more gowns, more rubber gloves, more masks to help protect families of the sick and workers in local clinics. He continually quizzes the students, to make sure they are asking the right questions and searching for the right clues.

He knows how hard their job is; their own friends and families are shunning them. "Even the taxis will not take us," says a pretty third-year student named Isabelle Lumbwe, 23. "Our friends say we should be quarantined." But the students are undaunted. "This is going to be our work," she says. "What kind of soldier are you if you flee the battle?"

The problem, the medical teams realize, is that since all the early cases were centered in hospitals, people are afraid to go to them. Officials try to spread the word that the main hospital, at least, is cleaner now, with better staff, supplies and hygiene. But whether out of fear or custom, the sick prefer to go home to die. Relief workers are finding eight, nine people living under the same roof with a potential Ebola patient. So teams of local workers fan out through the towns with bullhorns, describing symptoms, advising people of the risks and preparing pamphlets with pictures-designed for those who can't read-about how to care for the sick without catching the virus. The personnel are quickly engulfed by huge crowds of people desperate for information and reassurance.

Meanwhile, at the main hospital, a group of low, tin-roofed buildings painted sky blue in the center of town, Dr. Pierre Rollin, chief of the CDC's pathogenesis section, has restored some semblance of order since patients and workers fled the catastrophe. "When we arrived," he says, "it was very bad. People were vomiting; there was diarrhea and blood all over the floors and walls. The dead were lying among the living." Relatives who came to care for their loved ones walked in and out of isolation without protection.

Fully suited up in gowns, goggles and masks, Rollin's team went from bed to bed, picking up bodies off the floors. Workers then washed down the walls and floors and took the corpses to the morgue. The isolation ward was wrapped in a 6-ft. swath of gray plastic; at the entrance was a basin of disinfectant, so people would not carry the virus out on the soles of their shoes. A Belgian Jesuit missionary conducted last rites at a distance.

The staff now tries to teach caution: relatives are given masks and gowns and told to wash their hands before taking the gloves off. Only one family member is allowed to visit. "If I had a choice, I would prohibit it," admits Rollin, "but that's not possible here." The hospital has no kitchen, so the families provide the patients' meals. The staff is careful not to scare people off. "You can't hold patients against their will," says Heyman. "If we were to use force, then patients would be even less likely to come."

The situation is more desperate at the local clinics outside the city. Dr. Bele Okwo, an American-trained epidemiologist, is in charge of surveillance in the outlying villages. It is here that Zaire's poverty takes its most obvious toll. "We are so poor, we cannot take the necessary precautions," he says. "To maintain hygiene, you need funds, and we don't have them." Even who had no money in its budget for a quick-response team. When Heyman was summoned to Zaire, he begged the local pharmacies in Geneva for every gown and glove he could get his hands on.

For all the hard work of the Zairian doctors and students and the expertise offered by the international aid workers, the hardest job of all falls to the 26 local Red Cross workers. They drive through the villages in a bright orange Renault truck, picking up bodies and wrapping them in plastic as infected blood oozes everywhere. Unless the family dares claim a body, it is driven out of town to a mass grave. Until msf arrived with protective gear, the Red Cross worked with bare hands; already three victims have died of the virus, and one more fell ill last week. The gravediggers are pariahs. When they walk down the street, the children scatter. Their families have left them. Each day, in fact, frightened residents are abandoning anyone who gets sick, even from common illnesses. Parents are shunning their children. One day last week a sickly looking young man sat in the middle of a soccer field, rocking back and forth. No one dared come near him.

--Reported by Andrew Purvis/Kikwit, with other bureaus

With reporting by ANDREW PURVIS/KIKWIT, WITH OTHER BUREAUS