Pharmageddon Chapter 15

Northern Lesotho, Saturday 10 September

The giant mountains stood around them – peaks coated with the last of the winter snow, valleys filled with rushing icy waters, feeding the rivers which sustained vast tracts of land to the east and west. The slopes where they stood were rich and green with grass and low bush, and sprinkled with cattle, sheep and goats. If the mourners gathered to bury Jacob Moloi noticed their surroundings, or the icy wind which cut through the blankets they wore over humble street clothing, they gave no indication. They were used to it.

As a Swede, Miu Andersson was also used to cold weather and was dressed appropriately, but she was aware that she stood out from the small crowd not only for her expensive trench coat but also because she was the only foreigner present. She had been invited by the local headman to attend the funeral of his great-nephew. She came, hoping to get a better idea of the reality of a nation dying from AIDS, so she could lobby even more aggressively for the restoration of universal ARV treatment.

Through a teenage interpreter the headman, Phineas Moloi, told Andersson about the young man they were burying. When Jacob was 22 his father, a mid-ranking official in the education ministry, died of ‘the illness’. Jacob inherited a fifth of his father’s livestock – an equal share with his four brothers – and the right to graze them on these slopes which, like most of the country, were owned by the king and administered by the local chiefs.

Soon after his father died, Jacob himself became a father for the third time. His wife, Matumeleng, produced a child while Jacob already had children with two other women. His inheritance was good news for these children and their mothers, since it meant he could provide for them.

But shortly after his father’s death Jacob had fallen ill and, like two of his brothers and three of his sisters, was diagnosed with advanced HIV infection, AIDS. He was prescribed antiretrovirals and, within a few weeks, was as strong and vital as ever.

Then the news came – there were no more ARVs. After a few weeks Jacob and two of his siblings took the bus to the clinic at Butha Buthe to plead for their lives, but the nurse confirmed there were no drugs at any price. But a well dressed man outside the clinic told them he could get them a year’s supply of ARVs for about $400 – the price of three cows – each. They had to pay half of this upfront, and the balance when they came back to collect the drugs in two days. When Jacob and his brother and sister returned there was no sign of the man, just a knot of angry people who had also paid over a large part of their meager savings.

The old headman said they never found this man, but they heard he had done the same thing to many people in surrounding villages, and that there were other con-men doing the same across this tiny country. Some people were so desperate that they paid more than one of these men, but nobody managed to get any ARVs – except of course the politicians, police and army. People with guns and power.

Before she was promoted to a desk-job in UNICEF, Andersson had worked for many years in remote locations like this and was used to witnessing the stoicism of poor people, perennially cast in the role of victim. The headman caught her eye and smiled sadly before continuing his story. His young translator sounded as though she were standing in front of a classroom, reciting a poem, rather than describing the horrors of powerlessness.

Jacob hadn’t given up. He went to a local sangoma – a traditional healer – and paid her two goats for a small packet of herbs, which made him vomit and gave him diarrhea but did nothing to improve his condition.

The old man hesitated, and glanced at his young translator, then seemed to reach a decision. After he spoke she continued her recital. ‘Just before he died, Jacob told my grandfather that he went to Maseru, where he made friends with a small girl of about eight or nine years. But it turned out that this little girl had many friends already.’

Miu found the headman’s eyes were locked onto hers, pleading for understanding. With her own eyes she granted it. He broke eye contact and spoke again, and his grand-daughter relayed his words.

‘Jacob’s skin became very bad, and his face and body became very thin. He was suffering from diarrhea and had difficulty swallowing food. He began to cough all the time. We brought him some medicine from Butha Buthe, but it wasn’t the right medicine, and it didn’t help. It is the same for many of our young people now.’

Miu followed the headman’s gaze, and found herself looking at a very thin woman with a baby tied to her back.

‘That is Jacob’s wife, Matumeleng. Most of our young parents have the illness. Soon we will be only old people and orphans.’

Word of a funeral spread rapidly in these mountains because Sotho culture, like that of most African tribes, dictates that everyone who comes to the funeral must be fed. In the case of people like Jacob, who was perceived to be wealthy because he owned livestock, attending a funeral meant eating and drinking as much as you could, and taking home as much meat as you can carry. However, as the headman explained, there was little motivation to carry home meat these days, because every day saw another funeral, and another feast.

‘Our herds are being slaughtered for funerals, and sold to pay for herbs or for medicines which never come. You may think there are many animals on these mountains,’ he gestured at the grassy slopes across the valley, ‘but we can already see they are few. The animals will all be gone before I die.’

It took a moment for his meaning to penetrate. Miu turned to the girl. ‘But... surely you don’t have to slaughter so many animals? Can’t you have smaller funerals?’ The girl turned to her grandfather but he already understood, and spoke again.

‘Grandfather says it is our tradition. If we change our traditions it means we have lost hope in the future – that we don’t believe that things will return to normal. Saving our animals will not save us.’

Phineas Moloi gestured towards a cluster of stone and thatch homes, and his grand-daughter said, ‘They are calling us to the feast. Please, come with us.’

New York, February, year three

‘But Dr Fujimora, how is this possible?’ 

‘Ma’am... it’s our best guess.’

‘Help me to understand your guesswork then!’ UN secretary general Maryam Kapur wasn’t sure if her horror was the result of the numbers she was looking at, or the fact that she was so intellectually and emotionally unprepared for them.

The senior demographer from the UN Population Division was a genius in his field, but seemed awed to be in her presence. ‘Well ma’am, South Africa started with nearly 50 million people, of whom about six million lived in the Cape province...’

Kapur stared at the table of figures in front of her. ‘So that’s this figure here – a base population of 44 million in the rest of the country?’

‘Yes ma’am. The Balkanization process led to a mass exodus of expatriates and people with the means to emigrate. The biggest group by far were Africans, especially from neighboring countries. Nobody is sure of the numbers who left because the borders were simply opened to let them go, but we believe it was more than ten million. In addition, the Cape recorded an ingress of 2.3 million people, through the treatment camps, and about a million are reported to have emigrated or returned to non-African countries – especially Britain, India and Australia.’

‘So fewer than 30 million remained? What about mortality?’

‘Those figures are also guesses, ma’am. We think around 150,000 people were killed attacking or defending their homes and businesses, but it could be double that number. In the tribal war phase, we believe it is between half a million and a million. Our general mortality expectation includes a million violent deaths... so far.’

‘And non-violent?’

‘Counting AIDS-related deaths, other disease, starvation – particularly among children – we think at least two million have died from natural causes to date, but some of the team are convinced it is at least double that number.

Kapur stared at the figures she’d been writing down. ‘Between three and five million deaths in all?’

‘That would be about right, ma’am.’

‘So... 25 to 27 million people left?’

‘Yes... it could be fewer. Nearly four million are currently located in the treatment camps, so the population in the rest of the country is not much more than 20 million.’

Kapur stared at the table of figures. ‘Have you any thoughts... projections... of future trends?’ The demographer held her eye for a moment, saying nothing.

‘I need to know, Dr Fujimora.’

He took a breath. ‘We... are pessimistic, ma’am. The exodus of so many uninfected people has increased HIV concentration in the country. And we know that social unrest creates an ideal situation for infection – there has been widespread cleansing... raping of women and children... so we expect adult prevalence will be well into the sixties by now.’

The man looked as though he was expecting a rebuke at any moment, but Kapur was too distracted to notice. ‘If prevalence is around two thirds, what does that mean for mortality?’

‘As you know ma’am the rate of progression of the disease is related to quality of life – nutrition, stress, exposure to pathogens, quality of medical care. As things are, we believe the median time from infection to death will be between three and four years. Instead of ten.’

Kapur wrote a number in the margin of the table. ‘What about further violent deaths?’

‘We are hoping that fatalities are falling quite steeply – the tribal militia are not being re-supplied, so they have to run out of ammunition. But any reduction in violent deaths will be more than offset by AIDS related mortality. But right now our greatest concern is nutritional status...’

‘Go on.’

‘We believe that stored food reserves – grain, canned goods and so on – were depleted within the first year. Agricultural cultivation and processing were interrupted, of course, and the land has been picked clean. Satellite imagery suggests there is almost no new cultivation – maybe five percent of what was done before – and it will be very low yield if it is brought to harvest. The national herd has been wiped out, along with the wildlife. There are not a lot of nutrients left.’

‘What is your projection, doctor?’

‘Ma’am, unless the people are supplied with food and medical services on a truly massive scale, we think the total number of deaths so far will be doubled this winter. We may see the emergence of... a new kind of violent death.’

Kapur did not feel the need to extract the word ‘cannibalism’ from the demographer.

‘And in the longer-term? Assuming we are able to address the issues of starvation and AIDS?’

‘Excluding inward migration, we expect negative population growth for several years. Some of the causes are structural, such as smaller populations of children and men, while others are bio-medical, like the reduction in fertility among HIV positive and malnourished women.’

‘So you’re saying the only way the population will grow over the next two decades is through immigration?’

‘It’s unlikely to grow, ma’am. But immigration will help to slow the rate at which the population shrinks. Making a lot of assumptions, we expect a return to positive growth only in ten or fifteen years. By then the population will be around 12 to 15 million. We think.’

‘My god! It’s just... horrible. Dr Fujimora, I know this isn’t your area, but do you or your team have any thoughts on how we could go about addressing the situation there?’

‘Well ma’am, we talk about it all the time. Strictly as lay people, of course. None of us believe that air-drops of food and medicine will work – the warlords will simply use those supplies to rebuild their militia. We believe relief can only be delivered through some kind of direct intervention. A military ground exercise...’

‘To defeat the militia?’

‘Oh, no ma’am. I doubt they will offer any significant resistance at this point. We were thinking of securing hospitals in the major centers to deliver medical care and food-aid...’

‘You know the Indians tried that and... it was a disaster?’

‘Yes ma’am. But that was when the tribal militia were at their strongest.’

‘And of course we couldn’t give the people food rations to take home – they’d simply be targets for the militia. We’d have to feed them in situ. Every day.’

‘Only if you are not giving food to the militants as well, ma’am.’

‘True, the food will have no black market value if it’s freely available. But that implies we would have to cover the entire country...’

The man looked helpless. ‘I’m sorry ma’am. The logistics are... we didn’t talk about that.’

‘No Dr Fujimora, I’m sorry. I didn’t mean to imply there was any flaw in your reasoning. I’m simply trying to visualize a solution. I welcome any ideas you have.’

The demographer was encouraged. ‘In our coffee breaks, we imagine that everyone is fed and given medical attention, almost immediately. We don’t think you... we... can talk about restoring order or economic activity until people are eating and receiving medical treatment.’

Kapur was no longer writing, but was staring thoughtfully at the Japanese academic. ‘Yes, thank you doctor. What you say makes sense. Now it’s just a question of resources.’

+++

Maryam Kapur had spent her entire career in politics and diplomacy, graduating with a doctorate in political science from Cambridge, then teaching at the University of Karachi for a decade before being drawn into the maelstrom of Pakistani politics.

Her long-standing friendship with Benazir Bhutto meant her own political fortunes tended to wax and wane with those of the heiress to the Bhutto political dynasty, and Kapur served in Benazir’s cabinet during her second term as prime minister from 1993 to 1996. When Bhutto was again dismissed by president Musharraf, Kapur accepted an ambassadorial post to Malaysia, the first of several such postings.

The assassination of her friend in 2007, and the election of Benazir’s widower, Asif Ali Zardari, as president the following year, gave further impetus to Kapur’s career and she was serving as Pakistan’s ambassador to the UN when the incumbent secretary general resigned suddenly due to ill health. Maryam found herself the front-runner to replace him – largely, she suspected, because she had somehow avoided making enemies of any of her ambassadorial colleagues, especially those representing the permanent members of the security council.

Kapur had met Yvonne Delgado on several occasions over the years, mainly at international political conferences where the Harvard professor and the Pakistani diplomat were both popular speakers, yet they had never done more than exchange pleasantries, even after Kapur became secretary general and Delgado was appointed secretary of state.

As she looked at Delgado now, Kapur felt a pang of regret that they hadn’t ever found time to get to know each other better. They were about the same age, with similar backgrounds, and both had fought their way to the top without inheriting or marrying into power, while at the same time raising children. Kapur lost her husband to cancer while Delgado was still married – apparently happily – to the senior partner of a prominent DC law firm. The Pakistani resolved to get closer to the American if the opportunity arose.

‘I thought it’d be a good idea to do this in private, my dear.’ Kapur waited for the steward to pour the tea and leave the room before moving past banalities. ‘I’m getting dozens of conflicting opinions on South Africa – both on what’s really happening, and about what we should do about it.’

‘It’s the same in Washington, Maryam. We’re getting lots of information, but somehow it doesn’t clarify anything.’

The secretary general smiled wistfully and shook her head slowly. ‘My agency heads tell me we did everything we could, and more. After all, our strategy succeeded everywhere else. And the treatment camp initiative worked perfectly, yet the situation in South Africa simply went from bad to worse.’

‘Maryam, I can’t believe that anyone will accuse you, or the UN, of not doing everything humanly possible to avoid this. You’ve been an example to all of us.’

The secretary general took a deep breath and pulled back her shoulders. ‘Right now my particular concern is food security. I’m advised that a combination of starvation and disease is likely to kill several million people during their winter, unless we intervene.’

‘Do you have a strategy in mind?’

Kapur handed a folder to her guest and described the contents in broad strokes. Delgado heard her out before returning to one aspect, as Kapur knew she would.

‘I see the logic behind the plan, Maryam. But I’m concerned about the size of the operation, and more especially the idea of such a massive deployment by India. I can’t help wondering where they get all these people from...’

‘Dutta says they have Pakistan and China to thank for that. India has the third largest standing army in the world – effectively the same size as your own – but with the growing détente with my government and the Chinese they have little to do. Unfortunately it’s not politically expedient to demobilize such large numbers of men.’

‘But what about the doctors and nurses, the engineers, the educationists, economists... this is a truly massive undertaking.’

‘Well I understand India now has more graduates than they can accommodate. In medicine alone, they have more than 200 medical colleges, producing tens of thousands of graduates each year. What they’re proposing is to offer them a year of practical experience abroad. Recruiting for their treatment camps revealed a huge latent demand, so I’m told.’

‘Even so, I worry about having all our eggs in the Indian basket....’

‘My reaction was the same, my dear. Unfortunately it would be impossible for us to put together a multi-national team of that size and complexity in a few months. In fact I really doubt we could do it at all. Yet we must, if we are to avoid millions of deaths.’

‘At the same time, Maryam, I feel certain the Chinese will veto any resolution along these lines, on the basis that the South Africans themselves would never approve of it. If they had a functioning government, that is. But I’m sure you’ve thought of a way around that?’

Kapur shrugged. ‘The Indians weren’t planning to take it to the security council. These discussions are purely hypothetical.’

Delgado pretended to be surprised. The secretary general said nothing, but waited for her to speak. Instead the secretary of state took a sip of her tea and paged through the dossier. She knew most of the major players would back the Indian plan – or at least do nothing to oppose it – as long as the American administration agreed first. After all, this really was a remarkably generous offer from the Indians. The key question was whether the benefits of strengthening US relations with India would outweigh adding strain to their relations with China. Then again, if the rest of the world stood together, what could the Chinese do about it?

‘Of course you understand I can’t make a commitment without taking this to the president?’

Kapur nodded.

‘But I can foresee two conditions that he’s likely to insist on. The first is deniability – we must be able to say we had no idea of the real scale of this project.’ As she spoke, Delgado handed back the folder to the UNSG.

‘And the second condition?’

‘When the time comes, we will publicly oppose any suggestion of permanence.’ Her emphasis on the word ‘publicly’ drew a tiny smile from Kapur.

‘I’m sure the Indians will be very happy with your political and material support for a compact, short-term relief operation.’

Delgado looked at the secretary general with even greater respect. Perhaps she should invite her up to their cabin in the Rockies for a weekend.

‘Will you send me a revised proposal? Just the bare bones?’

Without a word Kapur handed over a second folder, and smiled at the American. Delgado could have sworn she heard the Pakistani say that she’d love to meet Vernon and Halley.

Cape of Good Hope, April, year three

For safety reasons commercial flights to Cape Town no longer passed over South Africa, so BA059 from Heathrow was routed over the Atlantic, making landfall somewhere along the Cape’s arid west coast just as the sun was rising.

I pushed up the blind from time to time to squint at the empty beaches scrolling past, but the rising sun was too strong to leave the blind open so I concentrated instead on my pink grapefruit salad, eggs Benedict, croissant with cheese and preserves, coffee – and the lifejacket demonstrator.

She was a Brit, late thirties, fine-boned with lively grey-blue eyes, a generous mouth, flawless pale skin and auburn hair caught up in a mass of braids which accentuated her neck. I kept ordering things I didn’t want – sparkling mineral water, another espresso, biscotti – so I could swim in those eyes and fantasize about that mouth.

It had been nearly a year since I lost Emily and I was finding it easier to focus on the future. Or at least to stop fixating on the past. But it still felt like I was treading water. Running in place. So when the invitation came to return to South Africa for a tour of the treatment camps, it felt like an opportunity to close the loop, somehow.

I pushed up the blind again and squinted into the dazzling sun. In the distance, rising above the wispy sea- fog which softened the coastline below us, I could see the silhouette of mountains.

‘That’s the Cederberg.’

Her name-tag said Kimberly Fossett. She was looking into my eyes, not through my window. ‘Yeah, I thought it might be. The edge of civilization.’

It was meant to be funny but she frowned. ‘Yes. It’s a tragedy. But it doesn’t seem to have affected the area too much. Having that refugee camp on their border, I mean. They still get a lot of tourists. It’s only a couple of hours drive from Cape Town, and there are some lovely lodges and hiking trails. There’s even a hot- springs resort, if you like that kind of thing.’

‘Do you?’

She rolled her eyes. ‘Oh, I’m a sucker for massage, saunas, jacuzzis, gourmet salads.’

‘Toweling robes, oysters, Pol Roger from room service ...’

She was laughing now. ‘Venison pie and claret in front of a log fire...’

‘It’s that cold?’

‘It can be. It was the last time I visited, which was in September. I got to see the spring flowers...’

Oh well, in for a penny. ‘You go there with your mates during a layover?’

‘Yes, we try to do something whenever we’ve got more than one night in Cape Town. Or at least I try – the other girls aren’t always interested. Most of them prefer chasing boys in the clubs.’

‘How long is your layover this time?’

There! The unmistakable flash of interest. ‘Four nights.’ 

‘Well, there you go. Venison pie it is.’

Now she smiled, reading the signals.

‘What about you, Dr North? What brings you to Cape Town?’ 

‘Please, call me Gipsy.’

+++

‘Where are your bodyguards, Mr Minister?’

BT looked like what he was these days, the only surprise being that it had taken him less than three years to change from a rangy radical into a political suit. His black hair had the first streaks of gray and his angular lines had definitely softened, but at least his shirt was open at the throat and his eyes hadn’t lost their humor. He chuckled, and for the first time I recognized some of the resonance of his evangelical brother.

‘Oh, we don’t go in for that kind of thing so much. There’s nothing to be gained by killing any of us – we all believe in the same thing. At least, that’s what we tell ourselves.’ He sidled closer. ‘But we take precautions...’

‘That’s what I love about you, BT. A free spirit with a cautious streak.’

Now he gave one of the wild laughs I remembered so well. ‘Hey man, I like that! Can I use it?’

‘It’s all yours, mate.’

We arrived at a black BMW 750 with darkened windows and he opened the back door for me. I saw there was a driver already behind the wheel, and another man sitting next to him.

‘Ah, I see what you mean about precautions.’

BT said something in Afrikaans to the men in the front of the car, and they laughed. ‘I just told them we all have new names – I’m Free Spirit, and they are Cautious and Streak.’

As the car eased its way through the morning traffic, over the flank of Table Mountain and into the downtown area he answered my questions about the transformation of the Cape Province into the independent state of the Cape of Good Hope.

‘I don’t know anyone here who regrets the secession, but we all feel very conflicted about the fact that we’ve done very well while the rest of the country has turned into a game reserve.’

‘A game reserve?’

He smiled sadly. ‘Ja, an area populated by wild animals. Civilization in a few camps surrounded by razor-wire.’

‘Do you see any moves to... tame the wild animals?’

‘Ag, people have been talking about nothing else for months. From what we hear, the tribes have stopped fighting. Now they are just focusing on survival.’

‘What about here in the Cape? Don’t you have the same tribes?’

‘Ja, of course. Mainly Xhosas, but lots of Zulus too. But we sat down with their leaders, and told them we’re all in the same life-boat. If you guys start fighting the boat will turn over, and we’ll all drown. All of our ancestors came from somewhere else – we’re all immigrants in the Cape – so we might as well forget all that ethnic shit and consider ourselves Kaapenaars. Capetonians. But I must say it’s hard to stop thinking of ourselves as South Africans also.’

‘What a pity they didn’t do that in the rest of the country. But you say they can’t wait to lay down their arms...?’

‘That’s what we hear. Some say they’ve run out of ammunition, others say they’ve run out of people to shoot. I think so many of them have been wiped out by AIDS that the others have lost interest in fighting.’

‘Any ideas on how to sort things out?’

‘Ag, I really don’t know. We hear terrible stories. Nobody knows how to fix it.’

‘What about the people who left South Africa? Can’t they come back and help to stabilize the country? Like the exiles who returned after Mandela was released?’

He shook his head. ‘We came back to a country that was politically messed up, but everything was working.’ I’d seen this argument on the forums, but it never quite made sense.

‘But BT, all the power stations are still there, the water-purification plants, the schools and universities, the hospitals and factories, the roads and the cellular towers...’

‘Ja, I know what you mean. So why is it such a big deal to get them all working again?’

‘Yes, exactly.’

‘It’s like... if you want to turn on the electricity, you don’t just need a few guys to flip switches. You need coal from the mines, which means the mines must be working, then you need the guys who know how to operate the generating plants, and people in every city to sort out the substations and the meters. And you need consumers who can pay for their electricity, which means you need an economy. But you can’t have an economy unless you can get the electricity going. It’s like a Catch-22 situation.’

‘Okay, but what about foreign aid?’

‘Well, ja, of course, but remember we’re talking about rebuilding the biggest economy in Africa, from nothing, when we have huge gaps in skills...’ He caught himself and laughed. ‘Listen to me, talking about “we” like it’s our problem.’

‘Isn’t it?’

He blew out his cheeks. ‘Man, you have a real talent for asking hard questions, Gipsy. Our official position, as the Cape government, is that it isn’t. Our responsibility is only to the people who live inside our borders. And we’re doing a bloody good job, even if I say so myself. But we all grew up as South Africans first, and Kaapenaars second, so our hearts and minds are on opposite teams.’

+++