The past two weekends I've gotten out of my little town to go do some of the “touristy” stuff in the region. So I could tell you about the beautiful walk I had along deserted tropical beaches last weekend or about the karst formations stretching as far as the eye can see in the Reserve de l’Ankarana this weekend, or about the lemurs I FINALLY saw jumping around in the trees, but I wont. I could also tell you about my project here, but that’s for a separate opportunity (mainly so non-medical people don’t have to slog through it). Instead, I’m going to tell you why my weekend felt like I was in a Michael Crichton novel.
So yesterday, as I am walking through the forest with the obligatory guide, Rosia, at the Ankarana Reserve, she offhandedly tells me that one of her fellow guides died last week. I say something I think appropriately sympathetic, after which she says “yeah, he was 29 and was completely healthy and then all of a sudden on Monday he felt sick, and by Thursday he was bleeding out of every orifice and died.” Oh, I say. Anyone else affected? He was the only one… doctor said it was “gastrointestinal hemorrhage.” Ok. I’m pretty sure Ebola and Marburg viruses have never been reported in Madagascar, so I’m thinking through the differential in my head, telling myself a perforated ulcer or something of that sort is much more likely, and I mostly manage to put it out of my head. We spend about 5 hours together walking through the forest, and we agree to meet again this morning at 7:30.
I show up at the appointed time and Rosia, who was totally fine yesterday, isn’t there, so someone goes to find her. He comes back and says “Rosia is very ill, she had to be taken to the hospital in [the nearest sizeable town] by ambulance. I’ll find you another guide.” People here don't go to the hospital unless something is very, very wrong, so now I’m starting to panic a little, trying to remember what I learned about the incubation periods of Marburg and Ebola, how close you need to get for transmission, etc, all the while knowing full well that the chances of this being anything other than a coincidence are infinitesimally low. And because I’m rational like that, I go on the planned walk to the Grotte des chauves-souris, or cave of bats, with my new guide, Dolphin (pronounced doll-FAN). We stop at some point on the way to look for lemurs (there were none) and of course I had been ruminating so I pull out my phone to see what my medical encyclopedia can tell me about Ebola virus. And what do I find? The animal reservoir is unknown, but it’s thought very likely that it is… bats.
Ok, but I know I’m being unreasonable so onwards I go. It’s a steep 163 stairs down to the entrance of the cave, and even as we get to about 100 feet away I can hear thousands of bats in there screaming loudly and the odor is almost suffocating. It’s one of those smells you can FEEL in the air, if you know what I mean. And at this point of course I go back in my head to all the fungal infections that people get by going into bat caves and inhaling the air and I start to wonder if those are truly found only in the southwestern United States, or if that is just the example they teach us in medical school because that’s where we live and practice.
And then there is rabies, for which bats are one of the most common carriers, which I think about constantly as the bats swoop around my head in the darkness, outlined by the light from my headlamp. Or, more mundanely, the risk of slipping on one of the wet rocks in the dark and breaking a bone, with no way out but to crawl up all of those 163 irregular stone steps on hands and knees. I tell myself to take deep breaths and try to relax, but the idea of deep breaths just makes me think of inhaling all those infectious particles that I know are hanging about in that thick, heavy air.
In the end, through sheer pride or stubbornness or whatever, I follow Dolphin into the depths of that cave in absolute darkness and don’t leave until he has said his prayers to the gods of the cave and told me we have seen everything, and a small part of me is proud not to be one of those screaming foreign women he had told me about who were afraid the bats would get caught in their hair.
Now I’m back in Anivorano, I’ve confirmed that no cases of Ebola or Marburg have ever been reported in Madagascar, and moreover they are usually spread only by contact with secretions. So I’m probably out of the woods. But if not, I’ll let you know in 2 – 21 days.