Last July, I read an article in a medical journal about a puzzling new strain of the mpox virus that had turned up in Kamituga, a scrappy mining town in the eastern Democratic Republic of Congo, more than 1,200 miles from where mpox was known to be endemic. It seemed to be spreading primarily through sexual contact, moving rapidly between people. That behavior hadn’t been seen in mpox before.
Soon the new strain had spread to a half-dozen countries in Africa, leading the World Health Organization to declare a global emergency.
Much of what I was hearing reminded me of the early days of the H.I.V. crisis. A virus jumps from an animal to a human host, circulates for years in small, isolated communities in Central Africa, and eventually, transport systems, migrant workers and sexual networks tip it into a much more widespread problem.
I have reported on H.I.V. for more than 25 years, and I saw how scientists slowly pieced together the H.I.V. origin story. But with this new mpox strain, genetic sequencing — and swift-acting health workers — helped unravel the mystery in mere months.
I wanted to travel to Kamituga. I imagined there was much I could learn, and report on, by being there to see the response to mpox firsthand.
In November, I landed in Kinshasa, where I spent a few days speaking with health officials before flying to Goma, in the country’s east. There I met up with a local journalist who contributes to The New York Times, Caleb Kabanda, and the photographer Moses Sawasawa. We took a boat down Lake Kivu, stopping at battered village docks to drop off passengers, and finally landed in the bustling city of Bukavu.
We set out for Kamituga the next day, having loaded the back of our Land Rover with rubber boots, toilet paper, drinking water, walkie-talkies and equipment for pulling a vehicle from the mud, in case we needed it.
When the road deteriorated into a squishy mud track, we switched over to motorbike taxis, our gear strapped perilously on the back, in piles. By midafternoon we were still about 28 miles from Kamituga. It began raining so hard that my knee-high boots filled with water, which spilled over the top like a fountain. We took shelter for the night in a guesthouse.
We set out again at sunrise, and soon arrived at a mud pit in a hillside. There an industry had emerged in pushing and pulling vehicles up and down the hill. There were belching diesel fumes, and a great deal of yelling. I nicknamed the place Mordor, after Tolkien’s hellscape.
Scrambling up the hill, I thought about how everything entering Kamituga — construction material, clothing, rice, wheat, beer — travels this route. Which means that everything needed to respond to an epidemic, every vaccine, virus sample and latex glove, comes this way, too.
Just before noon, we rolled into Kamituga. At the hospital, a collection of one-story brick buildings, I met Dr. Steeve Bilembo and Fidèle Kakemenge, the doctor and nurse who, a year earlier, had identified the first mpox case at the Kamituga Reference Hospital. It was a virus they had never seen before, and the international alert they raised brought epidemiologists and virologists trekking to their door. We donned protective equipment to enter the mpox isolation ward and talk to patients; the youngest was five weeks old.
Then we went to what’s called a maison de tolérance to speak with sex workers. The women sat on upturned beer crates and spoke of how painful their infections had been. Their children sat wide-eyed in the chaos of the establishment; a young boy, feverish with what was likely malaria, was passed from lap to lap. Their vulnerability, and the conditions that had fueled the transmission of mpox among the women and their clients, were on clear display.
The way out of Kamituga was even more challenging than the way in. We got stuck in the mud in Mordor; at one point, one of my legs sank, mud reaching up to my waist, and a passerby had to pull me out. Caleb, who is well over six feet tall, went in with both legs and was immobilized until a pack of small children burst from the bush to dig him out in exchange for a few hundred Congolese francs.
We eventually met up with a driver who had a Land Rover. But not long after, we came upon a vehicle, belonging to Congo’s National Institute of Biomedical Research, transporting a months’ worth of virus samples from Kamituga to Bukavu. It had broken down, and the clock was ticking on the temperature-controlled crates storing the samples, so we crammed the boxes, and researchers, into our car.
Along the road we had to negotiate our way past other vehicles entombed in the mud. Eventually we came upon a truck that could not be towed out. Night fell. We were 18 miles from Bukavu, but had no choice but to turn around. We drove six hours before finding a town with a church with a few beds. It took two men to free Caleb from his boots, which had become sealed to his legs with hardened mud.
We left again at first light, and made it to Bukavu just in time to put the virus samples on a boat for Goma.
The trip has left me with deep admiration for the scientists tracking the spread of this new strain of the mpox virus. It also made clear to me just how difficult it will be to control it; Congo’s health workers are underpaid (or unpaid) and overstretched, and its infrastructure is weak to nonexistent.
We know where this new virus came from. But we don’t have any idea where it’s going.
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