April 23, 7:23 a.m. CAT
Tshopo Province, Democratic Republic of the Congo
A sharp sting woke Charlotte Girard to the harsh reality of her situation. She had been dreaming of swimming naked in the bracingly cold pool at her family’s country estate on the French Riviera. She slapped at her neck and sat up abruptly inside the hot, humid tent. The air stifled and swamped. Another sting struck the back of her other hand. Startled, she shook her arm, tangling it in the gauzy mosquito netting around the cot.
She cursed in French and fought her limb free. She stared down at the culprit, expecting to see one of the biting black flies that plagued the refugee camp. Instead, a red-black ant—as long as her thumbnail— perched on her wrist. Its mandibles had latched deep into her flesh.
Aghast, she knocked it away and sent the insect flying into the netting, where it scrabbled up the gauze. With her heart pounding, she pushed through the drape around her cot. Lines of crawling ants traced the dormitory tent’s floor and zigzagged up the walls.
Where had they all come from?
She retrieved her sandals and donned them, knocking loose a few stray ants. She then tiptoed across the flowing map on the floor. Thankfully, she was already dressed in blue scrubs and a white vest.
She caught a peek at herself in a standing mirror, momentarily shocked by her appearance. She looked a decade older than her late twenties. She had tied her ebony hair into an efficient ponytail, but it hung askew from sleeping on it. Her eyes were still puffy and shadowed by exhaustion. Her complexion was peeling from days under the sun. Her dermatologist back in Montmartre would be aghast, but out here in the bush, she had no time for niceties like expensive sunscreens and moisturizers.
Last night, well past midnight, she had dropped, exhausted, onto her cot. She was the youngest of the four-member medical team from Médecins Sans Frontières, or Doctors Without Borders, at the camp. They were severely shorthanded with more refugees still pouring into the village camp as the jungles to the east continued to flood from the near-constant rain.
Eight days ago, she had been airlifted here via helicopter from the city of Kisangani, where she had been assisting UNICEF with their Healthy Villages program. Once here, she had quickly been overwhelmed. She had only finished her residency in pediatrics at USPC— Université Sorbonne-Paris-Cité—two years ago and had decided to give something back by applying for a one-year stint with MSF. At the time, her plan had seemed like a grand adventure, one she was determined to experience before settling into a routine at some clinic or hospital. Plus, she had spent part of her childhood in the neighboring Republic of Congo, at its capital of Brazzaville. Ever since then, she had always wanted to return to these jungles. Unfortunately, the passage of years had colored her perspective of the Congo region. It certainly had not prepared her for the hardships out in the rural bush.
Like the fact that everything here tried to eat, sting, poison, or swindle you.
She crossed to the dormitory tent flap and shouldered through to the morning’s cloudy sunlight. She squinted at the brightness and shadowed her eyes with a hand. The village’s thatched huts and tin-roofed shacks spread to her right. A good portion of the homes had already been swept away by the neighboring storm-swollen Tshopo River. To her left, a sprawl of tents and makeshift lean-tos spread far into the forest, occupied by refugees from other villages who had been forced to flee the rising waters.
And more people continued to flock here every day, overwhelming the area.
The smoke from a score of campfires did little to push back the smell of raw sewage. Cholera cases were already climbing, and the medical team was running low on fluids and doxycycline. Only yesterday, she had treated a dozen malaria cases, too.
It was hardly the bucolic natural world she had envisioned back in Paris.
As a further reminder, thunder rumbled ominously in the distance. Over the past two months, storm after storm had swept the area, flooding lands that were already swamps, even during the dry season. It had been the worst recorded rainfall in over a century—and more storms were forecast. Floodwaters threatened the breadth of the central Congo, and between corruption and bureaucratic red tape, relief aid was slow to keep up. She prayed for another drop-shipment of U.N. medical supplies before the situation became even more dire out here.
As she crossed toward the medical tent, she watched a young child squat and loose a wet stream of diarrhea. Ants climbed over the little girl’s bare feet and mounted her legs. She cried out from their bites, until a woman, likely her mother, scooped her up by the arm and brushed at her legs and feet.
Charlotte hurried over and helped pick off the last of the ants. She pointed to the clinic tent. Her Swahili was poor at best. “Dawa,” she said, guiding the woman and child. “Your daughter needs medicine.”
Dehydration—whether from cholera or a thousand other etiologies— could kill a child in less than a day.
“Kuza, kuza,” Charlotte urged the woman and led the way.
All around, locals scurried about. Many wielded brooms of palm leaves and fought the invading ant horde. She skirted behind a Luba native who swept a path toward the medical tent. Following in his wake, she safely reached the tarp above the clinic entrance. The smell of disinfectant and iodine wafted out, momentarily holding back the stench of the encampment.
Another of the doctors—Cort Jameson, a gray-haired pediatrician from New York—noted her arrival. “What d’ya got, Dr. Girard?” he asked in English, the de facto language among the clinicians.
“Another case of diarrhea,” she answered and started to follow the woman and child inside.
“I’ll handle it.” He passed her a steaming tin cup of coffee instead. “Fuel up first. Looks like you barely got your eyes open. We can hold down the fort for a few minutes.”
She smiled her gratitude and took the cup in both hands. She inhaled the aroma. The smell alone set her heart to beating faster. The coffee here was as thick as syrup, far from the delicate petit café at her favorite Parisian restaurant. The team had all grown dependent on the brew and only half-jokingly debated taking it in intravenously.
She stepped to the side to savor both this brief interlude and the dark, bitter elixir.
Her gaze fell upon the stocky figure of Benjamin Frey, a twenty-three-year-old biology post-grad from Cambridge, who was working on his doctoral thesis. The auburn-haired student wore khaki safari gear and a slouch hat. He also had on a pair of white trainers, which he inexplicably kept spotless. She suspected from his abrupt manners, along with a few tics, that he might be on the autistic spectrum, but if so, he was clearly high-functioning. The young man could also dive deep into an esoteric subject, oblivious of his audience’s interest—or lack thereof. She headed closer as he crouched near a thick trail of ants and held one up in a pair of tweezers. She was curious at this invasion, this newest plague to strike the camp.
Frey glanced over a shoulder as she joined him. “Dorylus wilverthi,” he explained, lifting the captured specimen higher. “The African driver ant. Also called siafu. One of the largest genus of army ants. Soldiers, like this one, can grow to be a half-inch long, with their queen up to two inches. They have mandibles so strong that the indigenous tribes here use their bites to suture lacerations closed.”
She felt the man ramping up into one of his lengthy discourses and cut him off. “But where did they all come from?”
“Ah, they’re refugees, like everyone else here.” He lowered the ant to the trail, then stood. He pointed his tweezers toward the rolling flow of the Tshopo River. “Looks to me like they were flooded out of their regular nesting grounds.”
It took her an extra moment to realize that the black islands floating in the current were not piles of debris, but massive rafts of dark-red ants all latched together.
“Why aren’t they all drowned?” she asked.
“From a little dunk in the river? No problem for them. They can survive an entire day underwater. Ants are hardy little soldiers. They’ve been around since the time of dinosaurs and have colonized every continent. Except Antarctica, of course.”
She felt sickened, especially as she watched one of those rafts break apart against the shore and disperse outward. The invaders all acted in unison, as if they had strategized this assault in advance.
“Smart buggers, too,” Frey added, as if noting the same. “Two hundred and fifty thousand brain cells each. Makes them the smartest insects on the planet. And that’s just one of ’em. Put forty thousand together, and they’re equal to our own intelligence. And mind you, some Dorylus supercolonies have clocked in at more than fifty million ants. Can you imagine? All led by a queen who can live to be thirty years old, longer than any other insect. So don’t underestimate them.”
Charlotte suddenly wished she had never approached the biologist. “Until this army moves on,” Frey warned as she began to leave, “ex-
pect a lot of bite injuries. Besides being smart, driver ants have nasty tempers, along with the armament to go with it. Those jaws are as tough as steel and sharp as razors. When on the march, they’ve been known to consume everything in their path, even killing and stripping the flesh off of tethered horses. Or dogs trapped in houses. Sometimes infants, too.”
She swallowed queasily. Like we need more problems here. “How long until they’re gone?”
Frey frowned, setting his fists on his hips. He watched the lines flowing from the river through the camp. “That’s the strange thing. Behavior like this is unusual. Typically, driver ants avoid areas of commotion like this camp, preferring to stick to the shadows of the jungle.” He shrugged. “But this flooding is certainly atypical. Maybe that’s what’s made them extra aggressive. Regardless, they should eventually calm down and move on.”
“I hope you’re right.”
He nodded, still watching the spreading mass with a worried pinch of his face. “Me, too.”
Charlotte flashed her penlight across the eyes of the three-month-old baby. The boy rested in his concerned mother’s arms. He held a thumb in his mouth but didn’t suck on it. He sat quietly, his back unusually stiff and straight. He pupils were dilated and only responded minimally to the light. Except for his breathing, he looked like a waxen doll. His skin had a feverish sheen, but his temperature was normal.
“What do you think?” Charlotte asked without turning.
Cort Jameson stood at her shoulder. She had called the American pediatrician over for a consultation. They had gathered behind a thin privacy curtain, set off from the main ward and its crowded cots.
“I saw a similar case yesterday,” Jameson said. “A teenage girl. Her father said she had stopped speaking and would barely move unless prodded. She presented with swollen lymph nodes and a rash across her belly. Like this lad. I thought it might be late-stage trypanosomiasis.”
“Sleeping sickness,” she muttered, considering his potential diagnosis. The disease was caused by a protozoan parasite transmitted by the bite of the tsetse fly. Early signs of sickness included swollen glands, rashes, headaches, and muscle soreness. Later on, if untreated, the organism attacked the central nervous system and led to slurred speech and a sluggish difficulty in walking.
“What happened to the girl?” Charlotte asked.
Jameson shrugged. “I gave her a bag of fluid since she was dehydrated, then pumped her up with doxy and pentamidine. I covered all the bases that I could. I tried to get her father to leave her, but he refused. I heard later that the man sought out his own village’s shaman.” She heard the disdain in her colleague’s voice. She reached a consoling hand to Jameson. “Her father was just covering all of his bases, too.”
“I suppose that’s true.”
Charlotte could not malign the tribesman for this choice. Many village shamans knew herbal treatments and cures for local ailments, regimens that medical science had not yet discovered or substantiated. She had studied several herself. Locals had been treating urinary infections with grapefruit long before the benefits of citrus were confirmed by Western medicine. Shamans also used Ocimum gratissimum—African basil—to treat diarrhea, which, if the camp ran out of supplies, their team might have to resort to.
“I don’t think this boy suffers from sleeping sickness,” Charlotte concluded. “Initially, from the minimal pupillary response or menace reflex, I thought it might be onchocerciasis, or river blindness. But I couldn’t detect any of the parasitic worms in his eyes that cause it.”
“Then what’re you thinking?” Jameson pressed her.
“His mother says he was fine two days ago. If she’s right, then the onset of symptoms was too fast for any parasitic disease. Protozoan or verminous. The rapidity makes me think of a viral infection.”
“There are certainly enough of those out here. Yellow fever, HIV, chikungunya, dengue, Rift Valley, West Nile. Not to mention—from the pebbling rashes on the boy and the girl yesterday—all manner of pox viruses. Monkeypox, smallpox.”
“I don’t know. The symptoms don’t match any of those. We could be dealing with something novel. Most new viruses arise from disturbances of a natural landscape. Digging new roads, deforestation, hunting exotic bush meats.” She glanced back to the pediatrician. “Also from heavy rains, especially in viruses transmitted by mosquitoes or other insects.”
As if summoned by this statement, a large driver ant climbed over the boy’s shoulder and latched onto the child’s neck. Blood dribbled as its mandibles gnashed the tender flesh. She remembered those painful bites from earlier this morning, but the boy didn’t move. He never lowered the thumb from his mouth to cry out. He didn’t even blink in pained startlement. He simply sat stiffly, his eyes dull.
Wincing in sympathy, she reached a gloved hand and removed the ant. She pinched it hard and tossed it away.
Jameson watched her, his brows bunched with concern. “Pray you’re wrong about it being a new virus. With the overcrowding here, the displacement, the shift in population . . .”
It could be a disaster in the making.