Cases of Marburg haemorrhagic fever began appearing in Uige province in Angola last Fall, but initial response from local government agencies was slow. Way too slow. By yesterday, as many as 250 deaths had been reported. This is twice the number who died in the previous outbreak, in the Democratic Republic of Congo between 1998 and 2000. Uige is only 180 miles from Luanda, the capital of Angola, which has a population of four million, many living in conditions of severe crowding and dire poverty -- a nightmare waiting to happen, should the virus show up in that coastal city. Marburg has a 90 per cent mortality rate. The scenario is not unlike that depicted in Outbreak, the 1995 movie made from Robin Cook's medical thriller. Or, closer to home -- because it's nonfiction -- the African Ebola epidemic described in The Hot Zone by Richard Preston. Here's a bit of background from less than a year ago...

from: Ebola and Marburg Viruses: a View of Infection Using Electron Microscopy, book review by Pierre Rollin
source: Emerging Infectious Diseases, 1 August 2004
via: HighBeam™ Research
Copyright © 2004 U.S. National Center for Infectious Diseases

More than 25 years have passed since the discovery of a filovirus, Marburg virus, which caused an epidemic of hemorrhagic fever among laboratory workers in Marburg, Germany, in 1967. The persons affected had contact with the blood or tissues of monkeys or with other infected persons. Marburg virus has reappeared only three times since its discovery, with the largest and most recent outbreak occurring in 1999 in Durba, Democratic Republic of the Congo. Ebola virus, another filovirus, was first described in 1976 during two hemorrhagic fever epidemics in Zaire and Sudan. Since then, Ebola virus has caused large hospital outbreaks of hemorrhagic fever in Kikwit, Zaire, in 1995, and Gulu, Uganda, in 2000. Ebola virus has also been implicated in small chains of transmission among persons with direct contact with intermediary hosts, mostly nonhuman primates in the central African countries of Gabon and Republic of the Congo.

The reservoirs for both viruses are still unknown...

What is meant by reservoir in this case is the natural non-human carrier-host of the disease: a bat or an insect, for instance. As Richard Preston describes in The Hot Zone, researchers combed the cave in Zaire where the Ebola virus was suspected to have originated, but despite an intensive search, and analyzing every possible life form they encountered, none was found to harbor the pathogen. Strange. Is it for a lack of funds -- read political will -- that the source of this deadly virus has never been identified? Or is it perhaps because there isn't one in the normal sense. The World Health Organization's Communicable Disease Surveillance and Response pages that list Marburg and Ebola press releases also link to Preparedness for Deliberate Epidemics. Stranger still. Unless you think about it for a second.

The Sunday New York Times reports: "For the people of Uíge, rampant death is now joined by the near equivalent of a space invasion: health workers encased in masks, goggles, zip-up jump suits, rubberized aprons and rubber boots as they collect corpses in the stifling heat. The garb is all white, a symbol of witchcraft here."

Not so strange at all. "Any sufficiently advanced technology is indistinguishable from magic," said science fiction author Arthur C. Clarke. To the people of Angola who are dying today, it matters little whether the "reservoir" for Marburg is witchcraft, a tick, or some super-secret biowar lab. If the last possibility seems farfetched, consider that the West Nile virus is now doing very well in Colorado thanks to a hurricane that partially destroyed just such a U.S. government laboratory a mere two miles off the coast of Long Island. For all the mind-blowing details, see Lab 257: The Disturbing Story of the Government's Secret Plum Island Germ Laboratory.

This facility, once the responsibility of the U.S. Department of Agriculture, is now under the management of the Department of Homeland Security. I feel safer already.

In 1994, Pulitzer Prize-winning journalist Laurie Garrett warned the world of the threat from new and deadly diseases including Ebola and Marburg haemorrhagic fevers in The Coming Plague: Newly Emerging Diseases in a World Out of Balance. In the same vein, so to speak, she followed this in 2000 with an even stronger warning -- Betrayal of Trust: The Collapse of Global Public Health.

In 2003, Tracy Kidder, best known for his book, The Soul of a New Machine, wrote a very different sort of book: Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. Here's a review clip...

from: The heart of charity; A doctor's efforts to save the world, one patient at a time
source: The Christian Science Monitor, 4 September 2003
via: HighBeam™ Research

Haiti ranks as the poorest country in the Western Hemisphere. A quarter of Haitians die by age 40... Yet in a place where even cement must be transported by donkey, Farmer defies limitations to build a healthcare center. Thirty-five miles north of Port-au-Prince, along a boulder-strewn road, a walled citadel rises from a barren landscape. Inside, tropical greenery surrounds two clinics, a hospital, an Anglican church, a school, a laboratory, and a kitchen that serves 2,000 meals a day.

By Farmer's decree, no patient can be turned away. But medical aid alone is not enough. He also emphasizes the need to eliminate problems that contribute to illness: dirty water, inadequate nutrition, poor sanitation, illiteracy.

Shuttling between Haiti and the Boston hospital where he works part of the year, Farmer dreams of ending the disparities that define the two worlds of poverty and privilege. As Kidder explains, "He'd leave peasant huts full of malnourished babies and, arriving in Miami Airport, overhear well-dressed people talk about their weight-loss diets."

Farmer subsequently published Pathologies of Power: Health, Human Rights, and the New War on the Poor, of which The New England Journal of Medicine wrote:

There are many kinds of gifted physicians: clinicians, researchers, and those who build institutions. Paul Farmer is the rarest of all: a prophet. Pathologies of Power is a jeremiad on how the "structural violence" of denied opportunities, economic deprivation, violent despots (and the powers supporting them), and international financial organizations harm the health of billions of people who are so distant that they are glibly and uncomprehendingly referred to as living in a "third world."

On Saturday, the website of Médecins Sans Frontières, which is in charge of operations at Uige's Provincial Hospital reported that several cases of Marburg have already been reported in Luanda -- a nightmare waiting to happen indeed. And it may have waited long enouigh already. Another page reprints an Economist article from January, 2001, which begins...

Imagine two countries. The first, with one of the fastest-growing economies in Africa, will receive $3.5 billion of investment from the international oil industry each year for the next ten years. By 2005 it will have become Africa's largest oil producer. The second is rated by the UN's Human Development Index a dismal 160th out of 174 countries.With a third of its children dying before their fifth birthday, and with two-fifths suffering from malnutrition, it is considered by Unicef to be "the worst place in the world to be a child". Both descriptions fit Angola, home to shocking juxtapositions.