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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.