OBITUARY: WILLIAM T CLOSE

Date: Sat 7 Feb 2009
Source: The New York Times [edited]
<http://www.nytimes.com/2009/02/08/health/08close.html>


William T Close, 1924-2009
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Dr William T Close, an American surgeon who in 1976 played an important
role in controlling the 1st epidemic of the deadly Ebola hemorrhagic fever
in central Africa and preventing it from spreading, died on [15 Jan 2009]
at his home in Big Piney, Wyoming. He was 84. The cause was a heart attack,
said his daughter Glenn, the actress.

Dr Close was both personal physician to president Mobutu Sese Seko of
Zaire, now known as Congo, and chief doctor of the army at the time of the
epidemic, which caused widespread panic in the country, 3 doctors involved
in helping to control it recalled in interviews. His connections,
organizational ability, and medical expertise were essential in halting it,
they said.

Ebola was a newly discovered viral disease causing severe sore throat,
rash, abdominal pain, and bleeding from multiple sites, particularly the
gastrointestinal tract.

Medical resources were scarce at the time and under threat themselves. The
missionary hospital in rural Yambuku, in the heart of the epidemic, had
closed after 11 of 17 staff members died of the disease. Belgian missionary
nurses who had been infected at the hospital died after they were
transferred to Kinshasa, the capital. Roads were blocked. River traffic and
commercial air service stopped. Military personnel shunned the epidemic area.

President Mobutu was rumored to have fled with his family to France. There
was fear that infected people fleeing the epidemic could spread the virus
to neighboring African countries and elsewhere.

"No more dramatic or potentially explosive epidemic of a new acute viral
disease has occurred in the world in the past 30 years," the commission
that investigated and controlled the epidemic wrote in The Bulletin of the
World Health Organization (WHO) in 1978.

Dr Close's role in the crisis began on a flight from Geneva to Kinshasa as
he was returning from home leave in the United States. Overhearing comments
between 2 epidemiologists sent at Zaire's request from the Centers for
Disease Control (CDC) in Atlanta to help control the epidemic, Dr Close
asked to join in the conversation. The 3 spoke the entire night flight,
said one of them, Dr Joel G Breman.

On arrival in Kinshasa, Dr Close, a man with a take-charge personality,
immediately arranged a meeting with the Ministry of Health. He was able to
help commandeer pilots and airplanes to ferry equipment to where it was
needed. Dr Peter Piot, a co-discoverer of the Ebola virus, said Dr Close
played "an indispensable" role in controlling the epidemic by using his
direct access to Mr Mobutu to gain political and military logistic support.

Dr Close had one of the earliest mobile phones, "so heavy it had to be
carried by someone," said Dr Piot, who recently retired as director general
of the United Nations AIDS program.

"He impressed everybody" by commandeering a Zairian Army transport plane to
fly a team to the epidemic area and helping to identify capable people to
work on the team, Dr Piot said, adding, "I thought, 'This man is more than
Mobutu's physician.' "

"We, the investigating team, were scared," said Dr Breman, who now works at
the Fogarty Center at the National Institutes of Health in Bethesda,
Maryland. But, he said, "Bill was right in the middle, running the hospital
in Zaire, assigning aides and making sure the needles, syringes,
generators, and other equipment were getting to where needed."

The team broke the chain of Ebola virus transmission by providing
protective clothing for hospital workers, sterilizing equipment, and
strictly isolating patients in their villages. The final tally: 318 cases,
88 per cent fatal.

Dr Close's efforts also played an indirect role in early studies of HIV a
decade later. Tests showed that a high percentage of people in Kinshasa
were infected with the AIDS virus. But the rate of infection in rural areas
was unknown.

To determine whether the prevalence of the disease had changed over a
decade in rural Zaire, Dr Joseph B McCormick, a co-investigator of the
Ebola epidemic, led another team that tested people in the area in the
mid-1980s. In part by comparing rates found in blood stored from a survey
in the Ebola region in 1976 to rates from the newer samples, Dr McCormick
said, "we found that the prevalence of infection in the rural area was
stable and low at 0.8 per cent."

The AIDS study showed that HIV infection and AIDS could have existed and
remained stable in a rural area of Africa for many years. It was one of the
rare studies able to compare rates over time in the early period of AIDS
and would have been impossible without Dr Close, said Dr McCormick, now
dean of the University of Texas School of Public Health in Brownsville.

William Taliaferro Close was born on 7 Jun 1924, in Greenwich, Connecticut.
He was reared in France and educated in British and American schools before
entering Harvard in 1941. He left in 1943 to become an Army pilot in World
War II. After his discharge, he earned his medical degree from Columbia
University, trained as a surgeon at Roosevelt Hospital in Manhattan, and
soon joined a peace missionary group, Moral Re-Armament, for which he went
to Zaire in 1960. There, he had a private practice and directed the
1500-bed Mama Yemo hospital in Kinshasa and the Zairian national health
service.

"He made a real effort to get public health support into rural Zaire," Dr
McCormick said.

Besides his daughter Glenn of New York City, survivors include his wife,
Bettine; 2 other daughters, Tina Close of Wilson, Wyoming, and Jessie Close
of Bozeman, Montana; 2 sons, Alexander D Close of Belgrade, Montana, and
Tambu Misoki of Sacramento; his twin brother, Edward B Close Jr of
Littleton, Colorado; and 9 grandchildren.

Dr Close left Zaire in 1977 because he was disillusioned by Mr Mobutu's
corruption and was losing access to him, his daughter Glenn said. He then
became a rural doctor in Big Piney championing hands-on care. He wrote 4
books, including accounts of his life in Africa and Wyoming. He made his
last house call a month before he died, she said.

[byline: Lawrence K Altman]