By Stephanie Nolen
On Sept. 30, 2023, an anxious father brought his 5-year-old son to the hospital in Kamituga, a muddy, bustling town carved out of the thick forest in eastern Congo. The boy had a high fever and oozing sores on his torso and face.
Nurses diagnosed chickenpox. They admitted him to the pediatric ward and tried to manage his fever.
Days passed, and the child’s health did not improve. His fever climbed higher and the lesions spread.
Perplexed, the pediatric staff called Dr. Steeve Bilembo, who was managing urgent care. He and a trusted nurse colleague, Fidèle Kakemenge, examined the boy and named, and then quickly eliminated, possibilities: not chickenpox, not measles, not rubella, not a bad case of dermatitis.
The spreading sores meant it wasn’t malaria or typhoid or cholera.
“And then at one point, we said, ‘Could it be mpox?’” Bilembo recounted. “Although we have never seen it — only in books.”
They looked it up, and quickly confirmed that the child had all the symptoms of mpox. Yet, it made no sense. Although mpox was first discovered in Congo in 1970, and has been endemic in the country ever since, the disease circulated in remote villages in the center of the country — 2,000 kilometers (more than 1,200 miles) away. It was unknown in the east.
How could a boy who had never left Kamituga have mpox?
It as the start of a medical mystery that would reveal swift and startling changes in a virus once considered a familiar foe, lead to the declaration of a global public health emergency and draw scientists from around the world on a dayslong journey along a muddy, rutted track that is the only way to reach Kamituga.
Fifteen months later, the new strain of the virus has spread to six other countries through East and southern Africa, according to the Africa Centres for Disease Control and Prevention, and individual cases have turned up in Europe, Asia and North America, as well. The virus seems to have adapted to spread more easily and quickly between people. More than 62,000 cases of mpox have been reported in Africa this year, three-quarters of them in Congo.
An estimated 1,200 people have died of mpox, which kills about 2.5% of those it infects in Congo.
The World Health Organization declared the outbreak a global emergency in August, and authorized the use of a first-ever vaccine and a rapid test for mpox in an effort to try to contain the spread.
But that day in early October 2023, it was just Bilembo and Kakemenge. They scraped fluid from the child’s lesions and sent it off for testing in Goma, the only city in the east with a lab that could do it: two days to travel 175 miles on the back of a motorbike courier, and then a daylong boat trip up Lake Kivu. Long before the results finally came back two weeks later, confirming that Kamituga Reference Hospital had its first case of mpox, they were already convinced.
They had taped big sheets of paper to the wall in an empty supply room, and stayed up all night mapping out all the ways the child might have been infected. Mpox transmission in Congo was believed to start most often with an infected animal, which passed the virus to a hunter, or to a child through a bite. But the child’s family said they did not hunt, and he had not been bitten.
Then, Bilembo said, the father mentioned that he had seen an ailment similar to his son’s, not too long before. The father is a traditional healer, who uses natural remedies and magic spells, and he told the hospital staff he had been called to cure a local businessman of an affliction after he was cursed by jealous competitors.
The father told Kakemenge that the curse had caused the man to break out in oozing lesions that so disfigured him that he looked “like a monster.” He said he had tried to heal the man by rubbing his limbs with an ointment he made.
When they heard this, Bilembo and Kakemenge took a marker and drew a dotted line on their paper from the infected child to the businessman with the curse. The man, named Julien, was the 35-year-old owner of a popular nightclub in Kamituga called Mambegeti, the word for the buckets in which they sold bottles of beer. Julien also ran an adjoining business, a maison de tolerance, as it is known here — a collection of bedrooms rented by servers at the bar who also sell sex.
About a dozen women worked there, most of whom Julien was said to have recruited from other regions of Congo, Rwanda and Burundi, even a few from Tanzania and Uganda. They came to this hardscrabble town of about 300,000 people because it’s surrounded by gold mines. When the miners are paid, they come into Kamituga ready to spend 75 cents for some time behind the thin cotton curtains that separate the women’s rooms.
The next day, contact tracers from the hospital went to the nightclub to inform its employees that a suspected mpox case had been traced to the house. They learned that Julien had been ill for a couple of weeks and, the day before, had left for Bukavu, the regional capital.
The club manager said several of the young women who worked there also had fevers and lesions. So, as it happened, did he. The men who run the maisons de tolerance typically collect a “tax,” having sex with all the women who worked in their bars, Kakemenge explained.
As for trying to trace how mpox had arrived in Kamituga? Julien, their index case, had vanished, and the trail had gone cold.
They didn’t know that in Bukavu, Julien had gone to stay with his uncle — a man who happened to be a doctor, and a regional public health official. He made an on-the-spot diagnosis for his nephew.
“He said, ‘You have mpox,’” Julien recalled. He asked to be identified only by his first name, to protect his privacy.
The doctor called a team from the hospital to collect samples from Julien’s sores, and sent them to Kinshasa for testing. Julien agreed to be isolated in the hospital when his diagnosis was confirmed, but he refused treatment.
“The truth is that it was sorcery: Someone put this curse on me,” he said. “And it was the traditional healers who cured me.”
Julien recovered about five weeks after he first fell ill.
In Kamituga, the child slowly recovered as well.
By the time confirmation came from the far-off lab that it was mpox, these first mysterious cases had become an epidemic.
In Kinshasa, researchers at the National Institute of Biomedical Research sequenced the genome of the virus infecting Kamituga patients, and realized it differed significantly from the one that had caused mpox outbreaks in Congo for years.
They labeled it a new subclade, a sort of genetic cousin of the familiar virus, and scrambled to try to understand how it differed: Were the genital lesions a sign of sexual transmission? How was the virus now moving so quickly between people?
By the middle of this year, the new subclade had turned up in neighboring countries — Rwanda, Burundi and Uganda — traveling with migrant workers from the mining town. The international spread of the virus brought the sudden glare of attention to Kamituga.
Now, the hospital has an efficient mpox treatment center, run by Alliance for International Medical Action, or ALIMA, where patients are isolated and cared for through their illness. The virus is moving through the general population, and hitting children hard.
There is a small laboratory where mpox tests undergo genetic analysis on site: Cases are confirmed within an hour or two.
Until a few weeks ago, not a single person in Congo had ever been vaccinated against mpox; now about 50,000 people have.
Today, everyone in Kamituga is familiar with the disease and on the lookout for signs. Here, it’s known as mambegeti, after Julien’s nightclub. He has since shut it down, and opened a new club, called Mercato.
“They say people here were the first in the country to be vaccinated, maybe first in the world,” said Marie Bayaya, who braids hair on the front step of a wooden shack hair salon not far from the entrance of the hospital. “It’s because of mambegeti that our town is known, now.”
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