The Nightmare Scenario (23 page)

Aeolus sighed. “I wouldn’t bet the house on that, but, okay, what is it now, Catherine?”

“As you might know, we have recently launched a bold program to eradicate obstetric fistula in Ethiopia.”

“Actually I had no idea,” responded Aeolus. He paid very little attention to the work of ‘the Others’.

“You know what it is, I presume,” she said sternly nailing him with her eyes.

“Yes, it’s a condition of incontinence that is caused at childbirth under primitive conditions.” Aeolus was already glancing at the most recent reports signed Ed and Kevin lying on Mandy’s desk.

“And it is extremely stigmatizing for the women who suffer from it. Now, it can be fixed by a simple surgical procedure,” Catherine tapped Aeolus’s arm with a rolled-up magazine to regain his attention.

“Yes, I know, but I’m still not sure why you’re here?”

“Fixing the condition is easy enough, but the underlying root cause…”

“Female circumcision,” Aeolus cut her off, slightly embarrassed at his lack of attention. He did like the woman, after all. She had spunk.

“Not female circumcision,” she corrected him, “genital mutilation!”

Aeolus nodded in agreement.

“Now, I have the funds to mount a program to provide surgery for all the affected women in the country, but if we don’t also educate the people of the consequences of their treatment of pre-teen women, it will never go away.”

“Let me guess, Catherine. Some politician won’t allow it?”

“Exactly! The prime minister claims that genital mutilation is a cultural tradition and that it has no connection with the condition!” She slapped the magazine on Mandy’s desk for emphasis.

Aeolus was already sold. He trusted her blindly within her area, as he did all off ‘the Others’.

When Aeolus took leadership of the WHO, he had embarked on a fundamental transformation of the organization. The Director-Generalship had previously been largely a ceremonial and administrative role, overseeing a vast variety of departments but without any actual operational responsibility. The functions involved in pandemic response had been spread over different fiefdoms reporting to different Assistant
Directors-General. Aeolus had stripped all these pieces from the different departments and folded them into one organization reporting directly to him.

All the other departments were moved out of the head office. Aeolus gave little attention to their activities. It was not that he didn’t care about the 600,000 birth-related deaths each year in the developing world, or that 2.4 billion people lived without basic sanitation. It was just that he was no good at solving it – and he knew it.

Initially it had caused uproar among the non-epidemiological staff, who thought they’d been relegated to second-class citizenry. That was until they realized the extent of the autonomy they’d been granted within their respective areas – no one looking over their shoulders, no need to explain their priorities to a non-expert. And most importantly, every time they asked Aeolus for support, he threw the full weight of his office behind them, no questions asked.

This was one of those times.

“Catherine, the prime minister of Ethiopia you said? This isn’t the same guy who said that HIV...?”

“The very same! His suspicion of modern science runs so deep it’s practically medieval!”

Now it was Aeolus who picked up and slammed the magazine on Mandy’s desk, with enough force to make Mandy jolt.

“I think we’ve had enough of this man by now, wouldn’t you say, Catherine?”

Catherine smiled discreetly, seasoned enough to know that the fury of God was about to be unleashed upon her long-time nemesis in Ethiopia.

“I think it’s about time we brought that country’s government into the twenty-first century, or at the very least the twentieth,” continued Aeolus.

“Catherine, I want you to write an op-ed on the topic, for publication in a major international newspaper, half a broadsheet page. Describe the science and write a passionate appeal to stop that abhorrent practice, which is female genital cutting. I will sign it myself.”

Catherine was now nodding attentively.

“Kevin, see if you can get hold of this Roger Burton fellow through Rebecca. Ask him whether he can help us place a heart-wrenching personal interest story on female genital mutilation in whatever publication is appropriate. Not sure he would be willing, but, if anyone, he is definitely the man to do it.

“Walt, have Stan leak that I’m considering pulling all our resources currently going into Ethiopia, and I mean
everything
, down to the last dose of penicillin. Mandy, schedule a meeting with this colporteur of witch-doctor medicine. Face-to-face. Next month. Topic: ‘Discussion of WHO Priorities in Sub-Saharan Africa and Consequences for Resource Allocation to Ethiopia.’”

Mandy was already typing the invitation.

Aeolus handed the magazine back to the Catherine. “I think that should do the trick, don’t you agree? If it doesn’t, let me know, and we’ll bring
out the big guns… They do get ‘CBS 60 minutes in Ethiopia, don’t they?

“You should keep in mind, though, Catherine, that this is all contingent on the world still standing a couple of days from now,”

Catherine said nothing, just nodded, turned on her heel, and left the room. Aeolus knew she was too proud to thank him, but he also knew that she was smiling with contentment while walking away.

Ed and Kevin were both clapping their hands gently in applause of admiration.

“Cut it out, guys,” said Aeolus, waving his hand dismissively. “We have real work to do.”

Once he’d sunk into his chair and quickly leafed through the overnight reports, Aeolus turned to Ed with a wry smile. “So the Hong Kong case was a false alarm after all?”

“Yes,” answered Ed, embarrassed.

“I seem to recall that someone told you so. Pick it up, Ed. Mistakes like that are junior league. You’re a big boy now.”

“Apologies once more for what might be a stupid question,” said Richard, “but why does it take so long to test someone?”

Aeolus was beginning to find this man supremely annoying.

“You have to get a nasopharyngeal swab, send it to a lab, and test it for the presence of influenza virus antigens with specific influenza virus antibodies, a process which takes about six hours.”

“There’s no faster way to do it?”

“There might be, but we haven’t touched upon that question yet. It’s pointless to even start before you have reagents and a basic test. We have rapid tests for HIV that, although not a hundred percent accurate, gives an answer within sixty seconds. But we should, actually, start looking at this now. I have a call to make, I would appreciate some privacy for this one.”

Everyone left the room and Aeolus picked up the receiver. He paused for a moment to gather strength. Once again, he had no choice. Yelena was one of the most experienced people in the world when it came to quick point-of-care tests for viruses. She’d been instrumental in producing such tests for HIV, and he needed her skills now –hers, and those of someone else.

Mandy put Aeolus through and after the usual series of beeps, Yelena answered.

“Yelena, it’s me.”

“Dr. Hughes. You cannot imagine my surprise. You are calling with some request, I presume, as it could hardly be that you are looking for my counsel,” said Yelena in a very unpleasant tone. Aeolus said nothing. He knew no way to respond other than to wait her out.

“I understand Loo has completed the immunofluo-rescence test,” continued Yelena in a different voice, precise, clinical, focused. This was the voice Aeolus wanted to hear.

“Yes, and this brings us to the next point of order.”

“You want a rapid test?”

“Yes. We’ll need something we can use at airports for the countries that opt for screenings instead of quarantine.”

“And you want me for that? It’s quite a while since I did those cushion tests for HIV. I have been focusing entirely on attenuated influenza vaccines the last years. HIV research is more of a hobby these days. I can’t guarantee I am up-to-date on all the latest cushion test research.”

“Be that as it may,” Aeolus said, “I trust you, which is not something I can say for a lot of people. Also, most of the recent developments have been in corporate labs, and not made public anyway. I’ll get someone to dig out what can’t be found in the academic papers for you.”

“Okay. I admit, I have given it some thought, but this is going to take time. Loo’s reagent combination is quite shaky. Works for immunofluorescence, but I doubt we can build a cushion test from it.”

“I’m obliged to remind you that time is one thing we don’t have a lot of.”

“And what about the attenuated vaccine? You want me to put that on hold?”

“That’s more long term and also quite mechanical in the beginning, right? Pass it on to some of your students for now.

“You will need to go down to the hot zone to have material to work with. I’m not sure what the lab equipment situation is down there, but if you let Walt know what you need, I’m sure we can organize it.”

“True. We’ll need a lot of
in vivo
. Can’t do much with the grown viruses.”

“Yes. And Yelena, I want you to bring on someone else as well.”

“Who do you have in mind?”

“Boris Yevchenko.”

“I don’t know anyone by that name.”

“You might or you might not, but he works at
Biopreparat
and he is
very
good at what he does.”

“Our biological weapons program was dismantled with the end of the Soviet Union and I’ve never met anyone by that name. I am pretty sure I would have, if he existed.”

Aeolus wondered whether she was lying. On the one hand, Yelena was as straight as they come, and sounded sincere, but could it be possible she didn’t know him? Not even the Russian military could maintain that level of secrecy. He decided to push on and put the cards on the table.

“In 1987, he published a paper on the evolution of HIV based on phylogenetics. Although the results would be considered trivial today with current computing power, it was a big achievement at the time. The paper was in Russian, not broadly distributed and didn’t receive the attention commensurate with its importance. It’s since been expunged from all medical databases, as has any reference to the person who wrote it.”

“If that’s the case, how come you’re so sure he exists?”

“Because I have a hard copy of the paper.”

“Well, paper or not, I don’t know him.”

Now Aeolus knew she was lying. She might not have known about the paper, but the mere existence of such a thing, by a Russian no less, was sure to have triggered her interest and curiosity. Was she punishing him? Could she possibly be so petty? Or was she choosing to prioritize saving face for a Soviet government that no longer existed, rather than saving lives?

He did nothing to show his disappointment. He knew from experience that arguing with Yelena was pointless. She was stubborn to the point of the absurd, even more so than him. He decided to try for a compromise.

“Yelena, I’m not asking you to give away state secrets, just make sure he’s involved.”

“Aeolus, I can assure you that, hypothetically speaking, if there was such a person, I would make sure he was involved.”

“Thank you, Yelena.”

“I’ll keep you updated on the progress, but this is going to take time and I doubt we will have anything within the timeframe you require.”

“Well, if anyone can do it, it’s you. The world is counting on you. I am counting on you.”

AUGUST 8
^TH
, 8 AM, INFECTIOUS DISEASE WARD, HOSPITAL KUALA LUMPUR, MALAYSIA

J
afri bin Mohamad’s favorite part of the day was the morning round. Followed by a trail of grad students, he would leisurely stroll through the patient ward, stopping at the cases he found most interesting, sometimes quite arbitrary choices. Each patient gave an opportunity for pontification and finding fault in the actions taken by the interns and residents who worked the night shift. Most importantly, it offered the opportunity to impress the occasional female students, who were now, for reasons surpassing his understanding, allowed entry into medical school. As the highest medical authority in the infectious disease department, he commanded a certain respect from them and enjoyed certain privileges. When he played his cards right, he could occasionally find opportunities for private tutoring, with in natura compensation in return.

As the students gathered around him he took the time to courteously shake all their hands while sipping his morning cappuccino. He started, as always, with an anecdote from his long and distinguished career.

This was his moment of adaption. He needed a few minutes to adjust to the environment, the harsh fluorescent light, the stench of antiseptics and the occasional wailing of patients in pain, so different from the atmosphere of his comfortable office.

Already in the first room he found what he was looking for – a patient with a persistent violent cough, delirious from fever. He started going through the motions even though he already had his diagnosis clear in his mind.

He studied the chart intently, remarking how characteristic the fever curve was for this particular condition. He took the blood pressure and pulse. He did an audial inspection of the cardiac rhythm. Listening to the patient’s lungs turned out to be slightly difficult as every attempt to take deep breaths led to an explosive cough, which sent phlegm flying.

After a moment of feigned contemplation, Jafri declared confidently to the student group that this was a classic case of bacterial pneumonia and ordered the nurses to administer intravenous broad-spectrum antibiotics.

“Excuse me, doctor, but could you explain how you arrived at the diagnosis a bit more in depth?” asked the supremely annoying Chinese registrar, Suyin Li. He disliked her, not only because she had proven impervious to his advances or the fact that she was Malaysian
Chinese, but mostly because she was such an obnoxious know-it-all.

“I arrive at the diagnosis based on years of experience from seeing similar cases,” he responded. “In due time, you too will acquire this skill. Differential diagnostics is not something that can be taught mechanically. It is nothing a computer could ever do. It is more of an art.”