[MADAGASCAR, AFRICA]
[BEN SHAPIRO, VICE]
In September of 2013, the Minister of Health issued an epidemic alert
The villages where it originated are extremely isolated.
In fact, the only way to get to these Northern villages
is by helicopter, so that's what we're doing.
We're traveling 1,000 kilometers North of the capital to
get some firsthand accounts of what it was like
to have experienced the plague.
[VICE REPORTS]
[THE RETURN OF THE BLACK DEATH]
The black death, otherwise known as the black plague,
is by far the most terrifying of the great epidemic diseases.
If you've been to a Renaissance fair,
you probably have some vague knowledge about it.
Rats, fleas, dead bodies in the streets, and the pure burgalian triumph of death.
It's pretty much the worst thing that's ever happened to our species, as evidenced
by the 100 million or so people who died from it back in the 14th century.
What most people don't realize is that this mythic disease is
still going on today, and that more than 2,000 people get it every year,
including a few in the Southwestern United States.
The majority of black plague happens in the Middle East and Sub-Saharan Africa,
with the most by far occurring on the tiny island nation of Madagascar,
a former French colony that gained independence in 1960.
Most people don't know a whole lot about Madagascar,
except maybe it's filled with a bunch of lemurs.
But in the fall of 2013,
just months before the current Ebola crisis began in West Africa,
Madagascar suffered it's own epidemic, a major outbreak of Black Plague.
I decided to had to the countries capital Altanerivo, to find out why.
The first thing I wanted to learn is what the black plague actually is.
So I started at the Madagascar branch of the Institut Pasteur,
a non-profit organization dedicated to fighting the disease.
We're going meet up with their expert team of rat catchers,
who have pretty much the worst job they can possibly imagine.
Just like in the middle ages, the primary vector for
black plague are the fleas on rattus rattus, the black rat.
These fleas can jump off the rats and bite humans.
To fight the black plague, somebody's got to travel to these at-risk areas to
catch rats and autopsy them, which is where Maligazi Plague Unit comes in.
So we tagged along with them on the search and capture mission.
[MAMY RATSINBA, LAB TECHNICIAN] It's primarily rats that carry this disease.
So, we analyze them at the laboratory.
to try and predict an outbreak in the plague zone.
So, we go on lots of capture missions.
So right now we're setting these traps to catch rats overnight.
They've got what seem to be little onions in here and some dried fish.
I've caught a lot of rats in various apartments in New York over the years, but
I've never used tilapia.
While we waited for the rats to take the bait, I went to go visit Dr.
Christophe Rogier the Director of the Institute.
What is the plague exactly?
It is a disease that is due to a bacteria.
[DR. CHRISTOPHE ROGIER, DIRECTOR, INSTITUT PASTEUR OF MADAGASCAR] The damage and the pathogenicity of this
[DR. CHRISTOPHE ROGIER, DIRECTOR, INSTITUT PASTEUR OF MADAGASCAR] of this bacteria is still very impressive.
It is one of the most pathogenic microbe in the world.
The first thing I learned about Black Plague
is that the symptoms are fucking horrifying.
The most common form of the disease is known as Bubonic Plague which is
spread by fleas on rats.
After an incubation period of 3-7 days,
you experience sudden violent flu symptoms.
You develop smooth painful liaisons on your groin, armpits, and neck.
Which are known as buboes, the black plague's classic calling card.
Then internal bleeding turns your fingers and
toes black, and you start vomiting blood.
As the disease progresses, you lapse into constant seizures, confusion and
coma, and then you die in total mind-numbing agony.
If the bacterium enters your lungs it can develop into pneumonic plague,
which spreads like the flu, and is way worse than the bubonic version.
In fact, it can move faster than the Ebola virus, and
you can expect death in about 36 hours if some coughs plague into your mouth.
[COUGH].
I have no plague.
I hope so.
Oh, they got one!
He's sleepy.
Oh, my God!
Look at this guy!
Species one, rattus, rattus.
Rattus, rattus.
Yeah.
This guys pretty much directly responsible for
helping revive a mid evil disease in this country.
And he's pissing right now also.
[LAUGH].
The next step was to dissect the rat to see if it had the black plague.
So we headed back to an open air autopsy table to dig in.
Oh God.
[MICHEL RANJALAHY, LAB TECHNICIAN] He just broke this rat's neck very, very quickly.
So now he's brushing the rat to see if there are any fleas on it, which may or
may not carry plague.
There is a flea.
A flea.
Yes. There's the flea?
Yes.
Where. In there?
Yes.
Is it possible that that flea, has plague.
Yes.
Because he drinks the blood from the rat.
The blood might be contain plague bacterium.
So you work with rats everyday.
How do you feel about them generally?
Do you have any emotions towards it at all?
No.
There was a time when
I loved them.
And I want not to kill them.
But at home I don't like them.
because, you see, they cause many destruction.
This is a lot more gnarly than the frogs I dissected in high school.
We found what we'd been looking for, a potential plague flea.
But, after testing the rat and
the flea, it turned out that luckily, this particular rodent was clean.
As night fell, we headed back to our hotel room to pop some pills.
So, this little guy right here is doxycycline,
it's a pretty common antibiotic that I was prescribed before I got here.
It prevents a bunch of things, one of which being malaria but most important for
this trip, is plague.
So my daily routine will be to take this guy, and go like this.
After telling us how stupid we were for traveling to a plague infected area,
all of our doctors in New York advised us to scrub the shit out of ourselves several
times a day, and hand wash all of our clothes with anti bacterial soap.
Today all I had to deal with was getting pissed on by a rat.
But tomorrow, I'd be heading into a hot zone.
When the black plague epidemic began, it started in the remote village of
Beranimbo, a community of 700 subsistence farmers in Madagascar's rural highlands.
Beranimbo is too small to end up on any map.
It's 1000 kilometers North of the capital, and
no roads take you across this impassable terrain.
You can see a lot of evidence
of the illegal logging that's been going on in this country
Loggers move into the n parks and began cutting down rosewood trees,
which are used to make extremely expensive furniture
generally sold to the Chinese.
What his does is it forces rats out of the forest
and into more suitable conditions.
The outbreak of the epidemic started in Beranimbo,
a small rural village located about 1,000 kilometers north of Antananarivo.
and quickly spread to other villages through out Beranimbo, as
plague-infected villagers left the village seeking help from other villages nearby.
Through out September the plague raged unchecked in the highlands for
weeks before the villagers realized they couldn't handle it on their own.
The closest doctors were a days walk away,
and many people died of black plague on the way there.
After a few weeks the red cross realized what was going on and
issued an epidemic alert.
But during the entire outbreak,
the villagers had no idea what it was that was killing them so quickly.
There was several reasons for this delay.
The first reason is a misunderstanding of what was is happening.
There was also belief in traditional medicine.
The population preferred to look at traditional doctors,
In fact they are not doctors.
All the traditional healers died from plague.
So at that time the population,
the committee said,
OK, something is wrong.
They decided to go to the health centers.
We just stopped to refuel in Ambatondrazaka,
a small town in the middle of Madagascar.
Two guys drove in a truck overnight to meet the helicopter so
that we could refuel, because they didn't have enough fuel to take us all the way
up to Barinimbo, and you can really feel the isolation between these towns.
It would be incredibly difficult to get to the nearest hospital,
if you're living in one of these small villages.
One of the first responders to the outbreak was Dr. Gatsen, a local doctor
who was the only person we could find who actually knew where Barinimbo was.
[DR. GATSON, EPIDEMIC FIRST RESPONDER] What was going on at the village when the plague hit?
It started with one man who had bubonic plague
and no one was aware that it was the plague.
He lived far from the village.
After he died,
his body was transported to Beranimbo
to be buried.
And that's how the disease spread to everyone.
who was present at the funeral.
Is there a flag?
Yes, this is it. This is the village.
We honestly didn't know what to expect,
this was the first time reporters had ever been to Beranimbo.
We even brought along full body hazmat suits, but Dr.
Gatzon told us we'd be fine without them, so we took him at his word.
The village could have been a desolate ghost town, or worse a plague zone.
But as soon as we landed, we realized it was nothing like what we'd expected.
It's great to see you here
What news do you bring?
We're here covering such an awful thing, but
this is a really, really touching moment, actually.
Kill the zebu!
The sacrifice of the zebu marks our friendship.
I can't express enough our gratitude and happiness.
Thank you so much for having us here.
Enjoy it with all our gratitude.
We were the first outsiders to visit Beranimbo since the outbreak, and
the villagers were more than ready to share their stories.
While they prepared the freshly slaughtered zebu, we went to
[VELORAZA & RASOA MAROZAFY, PLAGUE SURVIVORS] meet with some of the villagers who'd managed to survived the black plague.
Can you tell me a little bit about when you started to get sick?
There was one person who died,
then we were contaminated.
It was chaos here.
Nobody wanted to stay here.
If we hadn't found a doctor quickly,
it would have exterminated the village.
Without the help from the community
we would have died.
Do you feel closer together, now that you've been through this together?
Of course! We love each other even more.
Now there's no way we'd seperate.
We already have grandchildren.
Yes, we've been blessed by our seven children.
We got here about an hour and a half ago, and
the first thing that we saw was they slaughtered the zebu for us, and
now they've prepared a meal, and we're gonna go eat that zebu with the village.
Yeah never had zebu before.
Let's see here, zebu with rice and some green plants, all right.
This is really good, it's pretty good, it's pretty good.
It's a little gamey.
We're going now with Dr. Gatson to meet a family where the grandfather in
the family had bubonic plague.
[RAJAORAVO, PLAGUE SURVIVOR]
What did it feel like to get the plague?
I have never been that sick.
I started to have abdominal pain and it went down to my legs.
I had a headache and was coughing up blood.
How has this outbreak affected the village?
We cleaned up everything.
We levelled everything to the ground after the plague.
Now, if it ever comes back again,
we know to go and see the doctor.
We wanted to stay longer, but our pilot saw storm clouds rolling in
over the mountains, and told us that a severe storm was about to hit.
If we didn't want to get stuck overnight in the highlands,
we needed to leave immediately.
The villagers were so welcoming it was easy to forget that a few
months earlier Beranimbo had been gripped by a full on plague epidemic.
It's one thing to have a plague outbreak in an isolated community like Beranimbo,
but if plague were to reach the capital city of Antananarivo,
the results would be catastrophic.
ANTANANARIVO, MADAGASCAR, JANUARY 2009]
Antananarivo is in shambles.
In 2009, the city was the epicenter of a violent,
some might say French-backed coup that threw the country into absolute chaos.
After the coup, Madagascar was promptly suspended from the African Union, and
immediately lost the majority of its international aid.
The economy spiraled into free fall, and the health standard plummeted.
Today, over 90% of the population lives on less than $2 a day.
The living conditions in the poorest areas of Antananarivo are much
worse than they are in the villages, making the capital city a powder keg.
Before the coup, foreign aid made up 70% of Madagascar's national budget.
Now without that money,
the country's in no position to defend itself against the plague outbreak.
This fact became clearer when I spoke with Dr.
Jean Louis Robinson, the former Health Minister who was ousted during the coup.
[DR. JEAN LOUIS ROBINSON, EX-HEALTH MINISTER]
[DR. JEAN LOUIS ROBINSON, EX-HEALTH MINISTER] Hello.
[DR. JEAN LOUIS ROBINSON, EX-HEALTH MINISTER] How are you?
[DR. JEAN LOUIS ROBINSON, EX-HEALTH MINISTER] Hello, nice to meet you.
Nice to meet you.
What kind of effect did the coup have on public health in this country?
More than 400 healthcare centers were closed.
There used to be established structure and control programs.
In the inner-city slums, there's no sanitation program.
Public restrooms are insufficient.
Garbage is not picked up regularly
so there is lots of trash piling up.
And, because of the crisis, there wasn't enough money.
It's a little anarchistic.
On our way out, we saw some evidence of this anarchy right outside Dr.
Robinson's compound.
He's extremely wealthy.
He's one of the 8% of this country that lives on more than $2 a day, and yet
still, just outside the gates, there's just all of this garbage.
We wanted to see how vulnerable the poorest areas of Antananarivo were to
an outbreak of black plague, so we traveled to Andavamamba,
a deep slum whose name translates to the crocodile hole.
If there is a case of [pneumonic] plague in the slum,
there will be dozens, hundreds, or
thousands of cases.
For me it's the main risk.
Plague is a bacterial disease.
But it's also a social disease.
There's a number of factors here that contribute to it being pretty vulnerable
for the plague.
There's an open sewer system, garbage pileup,
a lack of access to clean water, dilapidated mud houses, rats, and
just a general level of filth surrounding the entire landscape.
It's basically medieval, especially when you start to consider that we're so
close to farms, and people are living so close to one another.
So, today we're gonna meet up with a guy name Billo who lives here and
he's gonna give us a guided tour, and show us why this area is so at risk for
an outbreak of plague.
[BILLOW ANDRIAMBELOSON, ANDAVAMAMBA RESIDENT] So, this pretty much just looks like an open sewer here, is that right?
This is a piped dirty water system.
People through trash in it
so it becomes clogged.
Dirty water comes out of here,
this channels it.
The problem is it's full of garbage.
It attracts rats because it's filthy
Would you say things have gotten worse since the 2009 coup?
Yes.
We're located in an inner-city slum so nobody pays any attention.
The roads are not repaired.
The projects to fix pathways and irrigation are gone.
The canals are clogged and never fixed.
I know that [the politicians] aren't going to change things very much.
Are you scared of a plague outbreak happening here?
Of course.
I fear for my family.
The thing is, if there were to be an outbreak in the capital,
Malagasy doctors probably wouldn't be much help.
When poor people go to clinics, they're often rejected.
And many doctors are too scared to treat the black plague.
Some misdiagnose it completely.
This creates a culture where the poorest people in the country have zero ability to
protect themselves.
A fact made infinitely more depressing when you consider the black plague is
treatable with cheap antibiotics.
Two preliminary cases arrived in
big hospitals of Antananarivo
and at each time it was very difficult
for the medical staff to manage it.
We have seen that physicians or nurses
prefer to dismiss [plague patients] than to treat people,
There was some panic, in fact,
in the medical staff to do things appropriately.
In December 2013, Madagascar had a democratic election.
And now foreign aid has begun to trickle back into the country.
But it's an open question whether or
not that aid will get to those who need it most in time.
There is an urgent need for funding
the control of this neglected disease.
And it is a neglected disease
in neglected areas,
where no politicians are going,
where no physicians want to go, because it's too remote.
A neglected disease in a neglected area
is very dangeroud for the population.
But, because people are moving, in fact,
it is dangerous for everybody.
[LIBERIA, JULY 2014] The reality is that this is exactly how the Ebola virus spread
[LIBERIA, JULY 2014] throughout West Africa.
Belief in old practices, rampant misinformation, and
apathetic, corrupt politicians have combined to
make the current outbreak much more widespread than it should be.
For Madagascar though,
it's unknown how many people will die of plague before things start to change.
There's no easy answer, but it's clear that the cutting of
international aid has encouraged the spread of the disease.
On the one hand, first world creditor nations should set standards, and
deny aid to regimes that undermine democracy.
But on the other, there's a human cost to cutting that aid.
And in Madagascar's case, it's the revival of a medieval disease.
We're not in the Middle Ages anymore.
Every death from this disease is entirely preventable.
Which makes the horror, much more cutting.
[LAUGH]