Yesterday, standing by the small, round mud-hut where Mr Paul died, we could hear a rustle in the ill-kept banana plantation nearby which also serves as a rubbish dump. 'Have you seen any rats?' Dr Maurice Lendunga asked a group of women washing clothes. Yes, they replied, they still saw them. The banana plantation is a reservoir of rats, explained Dr Lendunga. The director of the anti-plague programme in the region, Dr Lendunga had come to check the homes where new cases were reported last week, and supervise the spraying of the houses.
We stepped back into the maze of tiny mud and thatch houses. They are packed so close together that at almost any point you can touch two at the same time. Dressed in a long white soutane, rubber gloves and a mask, with cylinders of insecticide strapped to his back, a health worker stepped into one of the houses and paced slowly round, pumping the spray as if performing a religious ritual. A small crowd of silent people gathered to stare.
Sukisa district is like a tightly packed African village which has grown on to the edge of Bunia but it is not just the poorer areas of town which are affected. Eleven out of Bunia's 12 districts are now infected and in Ruwenzori Avenue, where the houses are bigger, spaced out and well-kept, we visited another family where two children, the sons of a tailor, have had plague. Dr Lendunga had diagnosed the symptoms in time and both were saved, but bubonic plague can kill within days or even hours. Quick diagnosis is essential.
Earlier yesterday Dr Lendunga inspected two new suspected cases at his clinic. One was a tiny child who screamed when the doctor touched the swelling in his groin. 'La peste,' said Dr Lendunga quietly. But the other case was a young man and after questioning him Dr Lendunga dismissed him as clear.
Bubonic plague is spread initially by rat fleas. The fleas infect the rats and when the rats die the flea seeks another warm-blooded animal. The infected flea is unable to ingest blood, so it bites, vomits back infected blood into the wound, and then seeks another host. Bubonic plague rapidly turns into blood poisoning and in its most virulent form attacks the lungs. According to medical experts here, if you are in the same room as someone with pulmonary plague you are almost certain to catch it and that form can kill within 48 hours.
Local burial traditions also spread the disease. When someone dies the body is laid out for two days for everyone to pay their respects. This involves sitting by the body and touching it. According to Dr Lendunga, not only can people be infected by the dead body but by fleas leaving the cold corpse and seeking new hosts among the mourners. He has known several cases of the disease spreading at funerals and is campaigning for immediate burial of people who may have died from plague.
The arrival of bubonic plague in Bunia could be catastrophic for the region. The disease came with the Belgian colonialists but after outbreaks in the 1920s, it was carefully controlled by the colonial authorities. After independence the health structures and research centres fell into disuse and people were afraid to report the disease, as the government way of controlling it was to burn down huts or whole villages.
Plague has broken out sporadically in the countryside in recent years but this is the first time it has emerged in an important trading centre. Bunia has about 130,000 people but draws in thousands from the surrounding area. It also sends food to the capital, Kinshasa, which has a population of about 4.5 million. The infected fleas and rats could easily spread to the capital or other major towns.
Such a potential disaster could be managed in most countries today, but Bunia is 680km (420 miles) from the capital. There are no road links and no telephones. Even if it were nearer, Dr Lendunga could not look to a ministry of health for help. Zaire no longer has an effective government and its economy is in ruins. Seventy per cent of the health centres are closed and the salaries of medical staff are a sick joke.
The economic plight helps the plague spread. Inflation and monetary chaos means that as soon as people have money they spend it on food and store it. The warehouses and storerooms are perfect breeding grounds for rats. And when people fall sick they cannot buy medicine.
Since he first came to Bunia in 1986 Dr Lendunga has watched the plague grow to epidemic proportions. And he knows how dire it is. He contracted it himself after operating on a dead woman to remove a foetus - African tradition demands that a dead woman and her child are buried separately. Too late he realised she had died of plague when he contracted it himself and only barely survived.
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