A Risky Burial in the Heart of an Ebola Outbreak

When the motorcycle rickshaw transporting the remains of Innocent Mandro Likpa hit a bump on a dirt road in a Congolese gold-mining town, two men sitting atop the coffin bounced into the air as the lid rattled off, revealing the contents within.
It was not the first bump on the journey to bury Mr. Likpa, who had died of Ebola the day before. And it may help explain why the disease is still spreading barely controlled in the Democratic Republic of Congo.
Because the virus remains highly infectious after death, the bodies of those who have succumbed to Ebola must be handled with extreme caution. The protocols call for burials to be conducted by trained workers wearing personal protective equipment, and the health workers who handled Mr. Likpa’s remains on Saturday initially appeared to follow them.
But few safety precautions were in evidence when I photographed his funeral and burial near the town of Mongbwalu, the epicenter of the outbreak.
The day began with Red Cross workers showing Mr. Likpa’s body to his family at the hospital. Any exposure to an Ebola-infected corpse carries risks, but with Congolese hostility toward health workers widespread, letting loved ones get a glimpse of the remains helps build trust.
Only then did they seal up the body bag and coffin, spraying them with disinfectant.
“When we look at past outbreaks, a community death has always been a new chain of infection,” said Dr. Marie Roseline Belizaire, a top World Health Organization official in Africa. “When it is not a safe and dignified burial, it is creating a new transmission chain that is difficult to manage.”
As the motorcycle rickshaw carrying Mr. Likpa’s body continued along the dusty road, the men quickly grabbed the lid and placed it back on the coffin. When they pulled up to a cluster of homes clinging to a hillside in his village, Nzebi, wailing mourners swarmed the coffin, touching and caressing it.
Among them was one of Mr. Likpa’s sisters.
The body was moved to a courtyard, where it was placed on two small tables under a canopy. As members of his church sang hymns, a barrier fashioned from mosquito nets was erected around the coffin.
Mr. Likpa, who was a gold miner, was 56 when he died. As the funeral service progressed, his mother, Alienne Kahindo, holding a walking stick, looked on.
Several steps away, women prepared a communal meal for a wake, cutting vegetables, hacking dried fish with a machete and stirring bubbling cauldrons of rice, beans and cassava leaves.
Once the courtyard service was over, the church group led the rickshaw downhill on foot along narrow tracks and through the village, where the procession encountered another rickshaw carrying the coffin of Sifa Dime, 25, who had also died from Ebola.
The swelling procession became a convoy for the dead. Then it was on to the cemetery.
There, amid banana trees and corn stalks, mourners sobbed as men stamped down the earth in Ms. Dime’s grave.
Then it was Mr. Likpa’s turn.
The scene was too much for one of his daughters, who had to be carried away after she collapsed.
As the men jumped into the graves to compress the dirt, their feet pulsed to a rhythm — thump-thump, thump-thump — like a heartbeat. Then it stopped. Graves full, people dispersed to their homes and villages.
The communal meal prepared earlier was served at Mr. Likpa’s wake, and his life celebrated. But the food was laid out on the same tables where his coffin — potentially a source of infection — had rested not long before.
Those who attended the funeral must now be considered very high-risk Ebola contacts and should be monitored for 21 days, said Dr. Belizaire, the W.H.O. official.
The Congolese health ministry said on Sunday that there were 1,274 confirmed cases in the country and 360 deaths.
Mr. Likpa’s body was just one of at least four I saw that were handed over to families during the past 10 days. None of the burials were carried out by Red Cross teams, a crucial step in fighting the virus.
The president of Congolese Red Cross, Dr. Serge Lemy Tabay, did not offer an explanation for the apparent lapses, but he disputed accounts from some local workers that they lacked needed gear. “We are in fact equipped sufficiently,” he said.
On Sunday morning, a group of miners carried a woman suspected of having Ebola into the hospital on a makeshift stretcher fashioned from sticks and a tarp.
A health worker later explained to them the risks of the virus. They listened quietly.
And the health workers themselves took care to protect themselves as they carried yet another body to the hospital’s morgue.
The W.H.O.’s Ebola safety protocols call for anyone handling an infected body to use protective gear, including gloves, disposable gowns, surgical masks, face shields and boots.
These ones were newly disinfected and hung up to dry.
For the patients who cannot be saved, the path at the hospital ends at the morgue.
Matthew Mpoke Bigg contributed reporting.