The Miraculous Fever-Tree

by Fiammetta Rocco

  To find the last remaining plantation of Charles Ledger’s Cinchona ledgeriana, you need to travel not to Java, but to the heart of Africa, to the city of Bukavu on the Rwanda-Congo border.

  Bukavu has never been a neat town, though for a while it tried to tame its natural tropical exuberance. By the edge of Lake Kivu, wealthy Belgian colons used to build white stuccoed holiday villas which they decorated with a particularly Mediterranean plumage of plumbago, scented jasmine and tall green cypruses, in an effort to pretend they were elsewhere.

  Five fingers of land spread down from the town into the lake. The green hillsides are wrapped in a misty tulle at dawn, and you can see why the view reminded some of the earliest European visitors of the south of France. There can surely be no other reason why this bloodstained, dusty metropolis used to be called the Monte Carlo of Africa. My grandparents reached Bukavu during their trans-African trek in 1929; my father too has been there. During his last visit, in 1990, he sat up late watching Germany beat Argentina in the final of the World Cup. The Central African night was warm, and in his excitement my father never noticed the mosquitoes streaming in through the open windows of his hotel room towards the bright television screen. Within days he had fallen sick with malaria. A quiet-spoken African doctor treated him with locally grown quinine sulphate tablets produced by a company called Pharmakina. It was to visit this company that my father and I travelled to Bukavu in the summer of 2002.

  Nearly a decade earlier, the Hutu tribesmen who live just across the river from Bukavu had embarked on a murderous rampage, killing hundreds of thousands of their fellow Rwandans, the Tutsis, in a genocidal mania that has never really been explained. Many of the Hutu interahamwe militias, who spearheaded the genocide, fled, still wearing their bloodstained clothes, into Bukavu and beyond into the forested hinterland of what was then Zaire. There they joined forces with soldiers loyal to the Zairean President Mobutu Sese Seko against the Tutsi-led government that took power in Rwanda. After Mobutu was overthrown in 1997 they fought for his successors, Laurent Kabila and his son Joseph. After some years, Rwanda and the Democratic Republic of Congo, as Zaire has been renamed, signed a peace agreement.

  On the ground we found that little had changed. Bands of rebels controlled much of the land around Bukavu. Their lorries, collecting sacks of niodium, germanium and colomo tantalite – the spoils of raids on mines that provide essential materials for manufacturing the capacitors that operate mobile phones – are often the only vehicles on the roads in eastern Congo. The rebels terrorise the local population to keep it quiescent, and make no effort to rebuild or replant anything. The acres of tea and coffee that once formed sculpted hills for miles beyond Bukavu are completely abandoned, with the result that the forest is drawing ever closer to the town. AIDS, tuberculosis and malaria are rife. Babies born HIV positive are particularly vulnerable to these diseases, and the malaria parasite most commonly found here is Plasmodium falciparum, the deadliest form of the illness. Two out of three children catch malaria, and many die. Most of the local people refuse to venture far from their villages; they grow what they need for their families around the huts they live in, and even that is often stolen by the rebels.

  At the top of the town, overlooking the lake, a long white wall encloses the Pharmakina factory. Above the gates you can see the swollen head of a Ficus thonningii, the giant African fig tree that is the centre of so many of the continent’s legends. Like a cat with nine lives, Pharmakina is something of a survivor. It is now the biggest employer in the region, the only company to maintain roads, run schools and finance clinics and hospitals. Pharmakina is also the owner of the world’s largest surviving cinchona forest.

  Congo’s cinchona plantations began in 1933 when the heir to the Belgian throne, Prince Leopold, paid the country a visit with his wife. The couple brought with them a tin of cinchona seeds, a gift that had been presented to the Prince’s father, King Albert, by the Dutch Queen Juliana. Offspring of the same seeds that Charles Ledger and Manuel Incra Mamani had collected and smuggled from Bolivia, the tin of Cinchona ledgeriana had been sent to Queen Juliana by Dutch planters from Java.

  The seeds were distributed to plantations around the region of Bukavu. Its sandy, loamy soil and moderate rainfall, and most of all its mountainous slopes that allow the water to run off easily and not soak the cinchona roots, bear a close resemblance to the hills on the shoulders of the trees’ native Andes. Within a few years, Cinchona ledgeriana was growing all over the region. When the cinchona plantations in Java fell to the Japanese during the Second World War, the only quinine that was available to the Allies came from the cinchona growers of the eastern Congo.

  After the war, the Belgian plantation-owners would send their precious bark to the factory behind the white wall in Bukavu. There it was processed into totaquine, a powdery mixture of alkaloids with a quinine content of about 80 per cent that was packed in barrels and transported, first by truck via Bujumbura in Burundi to the west coast of Lake Tanganyika, then by ship across the lake, from there by train to Dar es Salaam, by ship to Hamburg and finally to Mannheim, where it was further refined into quinine sulphate. By the mid-1950s the heavy machinery for milling, cleaning and filtering the bark that had been bought second-hand from a British company was beginning to wear badly. Pharmakina asked Boehringer-Mannheim, the German manufacturer to which they sent most of the totaquine, to despatch a small team – two chemists, a laboratory technician and a metalworker – to Congo to help restore its extraction plant.

  Boehringer-Mannheim had a long association with quinine. As far back as 1837, a young German chemist named Conrad Zimmer began manufacturing quinine sulphate from quinine bark in Hesse. After the French chemists Pelletier and Caventou successfully isolated the quinine alkaloid from cinchona bark in 1820, enterprising chemists like Zimmer began manufacturing in many European cities. In due course, Zimmer’s company was bought out by Engelmann & Boehringer, one of many small operations that that burgeoning family business took over in the course of the nineteenth century. In 1892 one of the Boehringer family’s partners, Friedrich Engelhorn, became the sole owner of the company, though he kept the company name. Boehringer was rapidly becoming Germany’s biggest manufacturer of quinine and quinine products, and under Engelhorn’s leadership it had a new company seal and trademark designed, featuring a branch from the cinchona tree.

  Shortly after its team refurbished the factory in Bukavu, Boehringer began making investments in Congo, eventually buying up the Pharmakina factory and, as more and more European plantation-owners left the country, the plantations themselves. Although chloroquine had taken over from quinine as the principal prophylactic against malaria, quinine was still being prescribed as a cure, and it was also widely used in the treatment of nocturnal cramp and the treatment of some heart diseases. By the mid-1970s, when the world price of quinine reached its peak, Pharmakina was processing more than three thousand tons of bark each year. Its Congolese plantations, not just of cinchona but also of coffee and tea, covered more than seven thousand hectares, and it employed close to ten thousand people. It liked to boast that its operation provided everything, from trees to treatment.

  In the mid-1990s, though, three separate developments almost killed off the company altogether. Pharmakina’s plantations were invaded by a fungus, a striped killer named Phytophthora cinnamoni, that insinuates itself into the space between the bark and the treewood, with the result that the tree weakens, dries out and eventually dies. First identified in Sumatra in 1922, the fungus has spread all over the world, but nowhere more than in Western Australia, where it affects nearly one in four tree species.

  Phytophthora spread like bushfire through Pharmakina’s Congolese plantations. The only economic solution was to pull up hectare after hectare of trees and leave the land fallow for three or four years while the fungus died out. But before the company had a chance to take any action, it was dealt another blow.

  For decades, one of the principal markets for qui
nine had been as a cardiomuscular relaxant to help heart patients adapt to pacemakers. In 1995 a new product was launched on the market which, with none of quinine’s side-effects, rendered the Jesuit powder irrelevant. Three-quarters of Pharmakina’s market collapsed. Two years later, Boehringer-Mannheim was swallowed up by the Swiss pharmaceutical giant Roche.

  The takeover meant a complete shift in strategy for the company. Instead of spreading itself around different areas of the industry, Roche decided to concentrate on becoming the world’s leading developer of diagnostic treatments. What to do with Pharmakina was not initially a priority, but on 1 August 1998, when the rebel war began in eastern Congo between President Mobutu’s soldiers and the Hutu interahamwe militias on one side, and the Tutsi-backed rebels who were fighting to overthrow Mobutu on the other, the Swiss mandarins decided to withdraw from the madness of trying to produce pharmaceuticals in Africa, and close down Pharmakina altogether.

  Selling off the stock of totaquine held in Europe was the easy part; Amsterdam Chemie, the Dutch company that had traditionally refined all the Cinchona ledgeriana produced in Java, was happy to boost its own supplies. But dealing with the Congolese company, and the 1400 people it still employed, presented a greater problem.

  For many weeks, Pharmakina’s five European directors in Congo turned the matter over in their minds. Undertaking a management buyout of a sophisticated manufacturing operation in the midst of an African civil war sounded like a crazy idea. And there were other problems. It was one thing working for a German multinational, even at a distance; it was quite another owning and running a sizeable business as foreigners in a country that could be notoriously paranoid and nationalistic. The managers who took over Pharmakina would be risking not just their pensions, but perhaps their lives. And what about their families? What did their wives and children feel about committing themselves to a lifetime’s investment in the heart of Africa?

  In the end, two of the five top managers felt confident enough to take the plunge. Horst Gebbers, a German agronomist in his late fifties, had been in Congo for more than twenty years. His wife liked living there; moreover he had two sons who were eager to join the business, one in Germany and the other in Bukavu. Younger by more than a decade was a Belgian accountant, Etienne Emry, who had also lived in Congo for a long period; he was married, for the second time, to a Congolese wife.

  In recognition of Boehringer’s historic involvement with the quinine industry, Curt Engelhorn, Friedrich’s grandson who was the head of Boehringer-Mannheim, committed family money to the management buyout. As important, if not more so in the years to come, was the moral support and the contacts within the pharmaceutical industry that the Engelhorns would offer the Pharmakina operation.

  When Gebbers and Emry finally took over the business in the first few months of 1999, the war in Congo was going through a particularly nasty phase. The hundreds of thousands of refugees who had fled Rwanda at the time of the genocide were joined by thousands more whose lives had been overturned and their homes destroyed by the rebel forces intent on gaining power after the fall of Mobutu. Many of Pharmakina’s plantations were cut off, and those that could be reached were not being properly tended. Production at the extraction plant in Bukavu slowed after the factory was attacked by rebels who caused millions of dollars’ worth of damage to plant and machinery. Production was down to a tenth of what it had been five years earlier.

  Pharmakina’s new owners began a complicated restructuring. Crucial to their efforts was a redundancy plan that would reduce their workforce from 1400 full-time workers to fewer than five hundred. Each worker was offered a cash sum, but a far more important part of the package was the offer of a hectare of land, along with seed, fertiliser and logistical help. The offer of land close to where they lived meant that the workers would be able to feed their families and have some produce left over to sell in the market, and would not be displaced.

  Once the corporate restructuring was complete, Pharmakina was able to concentrate on rebuilding its business. There was no fuel for sale locally, so to keep its trucks and factories running it had to import what it needed from Uganda, nearly a thousand miles away. Nor were there any banks, so Pharmakina’s new owners turned to an Indian trader they had known for many years. Today, they pay him euros into a bank account in Europe, while he supplies them with local currency in cash. Which currency depends on which rebel group is in charge at any particular moment. At one stage, in the late 1990s, there were eight different currencies that could be preferred at any one time.

  While the political situation remained unstable, Pharmakina concentrated on the plantations closest to the factory. It rebuilt roads and opened schools. Close by the main factory it built an AIDS clinic, the first of its kind in Bukavu. Without compulsory testing, Pharmakina has no idea what proportion of its workforce is HIV positive, but figures compiled by aid workers for the general population in the region show that it could be as high as one in four. By trying to treat, as well as educate, its workers, Pharmakina believes it is investing in the future.

  In new plantations now being established within the virgin forest, Pharmakina clears the forest base for planting but does not cut down many of the bigger native trees. The system of husbanding natural resources in the field is as simple today as it was three centuries ago when the Jesuits were urging the Indians in the Andes to plant five trees for every tree cut down. Rather than in the shape of a cross, the cinchona trees in Congo are planted today in straight lines, two close together, then a third line of some taller species, such as triphosia, a leguminous shrub with fronds of leaves that provide the cinchonas with shade while they are young and still adapting to the environment.

  The thick-stemmed cinchona trees that Ledger and Mamani saw in the Andean cordillera are rare today in Congo, although one that was planted by an Italian grower in Kaheyo in 1947 is still there to be gazed upon. For the most part, Pharmakina allows its trees to grow for seven or eight years before cutting them, that being the moment at which the quinine content is at its peak. The trunks are chopped down with pangas, heavy knives with wooden handles. They are then dragged out of the plantation to the roadside where they are stacked, waiting for a worker with a heavy mallet who will beat off the bark onto a dry cloth. Were Sir Clements Markham to find himself in Congo today, he would find nothing unfamiliar in the way the quinine bark is harvested.

  After being dried in the hot sunshine for ten to fourteen days, the bark is taken to the factory in Bukavu where it is weighed, and its humidity and quinine content measured, before being shovelled into the hammer mill to be ground and then soaked with an acid base and slowly heated up. The crude quinine bisulphate that is produced is like hot coffee from which the grounds need to be strained. Once cool, the grounds provide much-needed compost for Bukavu’s acid soil, while the liquid alkaloid is passed through a series of processes to clean, filter and crystallise it. In Boehringer-Mannheim’s time the result was totaquine, the halfway-house product that would be shipped for refining in Germany. Under the new regime, the refining is done in Bukavu.

  In a cupboard in Horst Gebbers’ office are samples of the final products: quinine drops for babies, syrup for children (the taste of which is a distinct improvement on the Nivaquine syrup we were made to take on my grandparents’ farm), and pills in elegant packs of blister foil. These come in two different chemical formulations and three different strengths. The only Pharmakina products that are manufactured abroad are the injectible ampoules, and that only as a precaution – injections made in eastern Congo, believed by many to be the AIDS centre of the world, were not thought to be easily marketable.

  The success of Pharmakina’s quinine operation lies, as it always has done, in the economics. The spread of malaria across this part of Central Africa is an example in miniature of the disease’s expansion throughout the developing world. The deadly falciparum malaria that once was to be found in pockets across the continent now strikes along a broad belt that stretches as fa
r south as Botswana and as far north as Chad. More than two hundred million people are at risk. The economic cost to these already impoverished nations is incalculable. And while resistance to chloroquine-based drugs has grown, the new drugs, such as Larium and Malarone, that have replaced chloroquine for Western travellers are so costly as to be unthinkable for Africans. A course of twelve Malarone tablets retails at more than $70. The Chinese artemisin-based drug Cotecxin retails for $6, but is often taken in conjunction with a course of antibiotic, which adds heavily to the cost. A small bottle of refined quinine salts, made in European and American factories, costs $12 in London, and more once it has been transported to Africa.

  Dirk Gebbers, the young son of the agronomist who opted for the management buyout, and the man who will probably take over the business, describes the options that a patient with malaria faces in Africa. With an average income of $10 a month, an African family with a child who is sick with malaria can either give the child quinine, or let him or her die. Expensive Western drugs are simply not an option. A course of quinine hydrochloride, Pharmakina’s most sophisticated product, sells in Bukavu for less than $2, and is, according to the local doctors, just as effective. Little wonder, then, that Pharmakina, which manufactures five hundred tonnes of quinine products a year, sells every pill it can produce.

  But Gebbers knows that the future is not built just on mathematics. Promising to show me a surprise, he leads the way towards a low white building by the side of the main factory. There, in the company of his chief plantsman Elisé Mudwanga, who has worked for Pharmakina for nearly three decades, he shows off what he calls la cuisine, the laboratory where he has developed micro-cloning of the plantations’ healthiest trees to produce a new generation of plants that are guaranteed to be free of the deadly Phytophthora fungus.