We set off again at sunrise and soon arrived at a mud hole in the hillside. There, an industry was born that involved pushing and pulling cars up and down hills. Diesel smoke was being spewed out and a lot of screaming was heard. I named the place Mordor after Tolkien's Hellscape.
As I scrambled up the hill, I thought about how everything that enters Kamitsuga travels this route: construction materials, clothing, rice, wheat, beer. This means that everything needed to respond to an outbreak, including all vaccines, virus samples, and latex gloves, will be delivered this way.
We arrived in Kamitsuga a little before noon. At the one-story brick hospital, I met Dr. Steve Birembo and Fidel Kakemenge, the doctor and nurse who identified the first mpox case at Kamitsuga Reference Hospital a year ago. It was a virus they had never seen before, and the international alert they raised brought epidemiologists and virologists to them. We put on protective equipment and entered the mpox isolation ward to talk to the patients. The youngest was 5 weeks old.
Then we went to something called Maison de Tolerance to talk to sex workers.. Women sat on overturned beer crates and talked about their suffering from the infection. Their children sat wide-eyed in the chaos of the facility. A boy with a fever from what appeared to be malaria was passed from knee to knee. Their vulnerability and the conditions that facilitated the transmission of mpox among women and their clients were clearly on display.
The way out of Kamituga was even more difficult than the way in. We got stuck in the mud in Mordor. At one point, one of my legs sank and the mud reached my waist and a passerby had to pull me up. Caleb, who is well over 6 feet tall, entered with both feet but was stuck until a herd of young children jumped out of the bushes and dug him out in exchange for a few hundred Congolese francs.