“What’s wrong with my men?”
The Chief Exec answered. “They have cerebral malaria.”
“Malaria? But I checked, and they were bang up-to-date with their medication. Are you sure?”
“Ricardo?” He passed the question to the Clinical Director.
“Quite sure. The blood films and DNA tests confirm it. Plasmodium falciparum infection to be precise. The more severe form and the most common in that area.”
“But you can treat malaria, can’t you?”
“Normally, yes. But I’m afraid this is a multiresistant organism. Your colleagues are not responding to Quinoxocarb or Dopranamid, and those are the treatments of choice. We’ve tried other drugs but without success.”
I looked from one to the other in disbelief. “Isn’t there anything you can do for them?”
“Basically we’re down to controlling the fever and keeping their electrolytes stable. That’s not much different to what we would have done fifty, even a hundred, years ago. I’m sorry. It’s frustrating for us, too.”
I blinked, then shook my head. “Wonderful. So my people have come down with a brand new strain—”
“Not new, no. We’ve been taking in patients with this particular infection for the last couple of years. The death rate can be as high as seventy-five per cent. And that’s among the people who get to this hospital. In the more remote areas it’s probably worse.”
“But that’s appalling. Who else knows about this?”
“We work closely with the United States Public Health Service. They have sent a unit to investigate.”
“And?”
“Perhaps you should ask them.”
“They’re here?”
“Of course. We have an academic department that specialises in this field. It was logical for them to be based in the same building. I can take you down there if you like.”
I stood. “Let’s do that.”
The Clinical Director got up and gestured that I should follow him. At the door he paused for a brief exchange with the Chief Executive but the Spanish was far too rapid for me to follow.
8
The Clinical Director strode quickly along a series of seemingly endless corridors. I was hard behind him. I’d never seen men go downhill as fast as this and I was determined to find out what had happened to them.
At first we had to weave in and out between briskly moving nurses and doctors, knots of wandering visitors, and trolleys pushed by men in baggy uniforms. Then the hospital traffic and numerous ward signs petered out and I guessed we’d passed into the academic wing. I drew level and he spoke a little more as we walked. He told me the person in charge of the PHS unit was Lieutenant Abby Moore. From the mention of the rank I gathered that this was a Commissioned Corps Officer. We passed signs for various departments – “Epidemiologia”, “Infectologia", “Microbiologia clínico” – and I figured we must be getting close, but to my surprise we took a lift to the basement and went along another corridor there. Eventually we paused outside a door bearing a handwritten notice: “USPHSCC Emergency Response Team”. He knocked and opened the door and we went in. Then his pager sounded. He spoke briefly into it in Spanish, then said:
“I’m sorry, I’m needed urgently. I will have to leave you here.”
He hurried off. The door closed, leaving me standing in an empty room.
It was quite big, longer than it was wide. The floor was covered with the same lightly cushioned grey composite I’d seen everywhere else in the hospital. The walls were painted white, but were mostly concealed behind large-scale maps; I moved over for a closer look and saw that they covered the north-western part of Colombia. There were some box files on the bookshelves and a desk with a touch screen a bit like the one in my own office.
I was beginning to wonder if I should come back later when a door opened at the back of the room.
The woman was wearing the naval summer uniform: a white, below-the-knee skirt and a white blouse. She was full-figured, almost matronly, although her complexion was fresh enough to put her in her late twenties. Her dark hair was tied back neatly and she was wearing little or no makeup but looked none the worse for that. The shoulder boards of that well-filled blouse sported two stripes and the special insignia of the PHSCC. As she came towards me I saw her gaze flick to the eagles on the collar of my tunic and knew she’d registered my rank, too.
“Lieutenant Moore? – Jim Slater.” I jerked my head towards the door. “The Clinical Director brought me here. He would have introduced me but he was called away.”
She stood very straight, appraising me. Her eyes were an amazing blue; they reminded me of looking into the depths of a glacier and they were just about as warm.
“And what can I do for you, Colonel?”
“I’ll tell you. I sent a crack unit to this country on an important mission. The whole lot have ended up in this hospital. All but three are in bad shape. Two have died and from the look of them we could lose a few more. The Director tells me they have a multiresistant form of malaria. I gather that’s the reason you’re here.”
“That’s right.”
“Well, I was hoping you could tell me a bit more about it.”
She smothered a sigh – to let me know, I suppose, that I was interrupting her work.
“Come over here, Colonel.”
I moved to stand with her behind the desk.
“Most of this data was collected by the academic department upstairs.”
Neatly manicured fingers moved over the screen and a chart came up. She pointed.
“This is the incidence of malaria in Colombia. There’s a certain amount of under-reporting so the figures may be on the low side.”
“Oh? Why’s that?”
“Self-medication, mainly. Health care provision in this country is patchy; it tends to be concentrated in major centres of population. People in more remote areas often have to fend for themselves. Some resort to traditional remedies. Those who can afford it self-administer. They know what works.”
“And I suppose if they get better, no one bothers to report it.”
“Exactly. Now as you see, the overall incidence hasn’t changed much over the years. There are still many low-lying areas where malaria’s endemic.”
Again her fingers moved over the screen and a second line joined the first one on the chart. Unlike the first, which was almost flat, this one turned sharply upwards.
“This is the death rate. These figures are reliable because deaths have to be reported, by law. Look at the rise in recent years. That’s the result of this new strain of Plasmodium.”
I looked at the numbers. “That death rate looks very high, even for malaria.”
She glanced at me, one eyebrow slightly raised.
“You’re quite right, it is. The organism divides very rapidly in the liver. When it floods the bloodstream it frequently overwhelms the host. It’s a particularly deadly mutant.”
“And that’s why you’re here?”
“Yes. The local physicians were alarmed by the rise in virulence so they sent blood samples to us at the PHS. The organism was characterised at the Centers for Disease Control and Prevention and assessed as a major threat. The Commissioned Corps sent in an Emergency Response Team.”
“With you in charge.”
“Yes.”
“And when was that, Lieutenant?”
“Getting on for a year ago. Why?”
“Why?” My voice acquired a distinct edge. “Because if people have been aware of this problem for at least a year I’m wondering why my men are lying in hospital, close to death. With there being this much bad news around I find it kind of surprising that none of it filtered through to Special Forces before we put our people’s lives at risk. That’s why.”
She wasn’t tall but she seemed to grow before my eyes. Her lips tightened, a crimson flush rose to her cheeks, and those amazing blue eyes flashed dangerously. She was evidently struggling to maintain self-control.
; When the answer came her voice was quiet, measured, and loaded with meaning.
“Look, Colonel. You just happened to have stumbled across this problem. I’ve spent every waking hour of the last year with it. I’m sorry about your men. I hope they pull through. But if they don’t you can add their deaths to the thousands who’ve died already. And bear in mind that if this were a more densely populated country the numbers would be much worse, maybe ten or a hundred times worse.”
I gritted my teeth. “My men are more to me than statistics, Lieutenant.”
“I understand that, but I don’t see what more I can do. I send in monthly reports. They’re the bane of my life and they take me away from the work I consider important, but I do it because it’s part of my duties.”
I thought for a moment. “What happens to those reports?”
She pursed her lips. “Most of what I submit is for internal use. Anything interpreted as a new health threat is copied to relevant departments. The State Department is one of them. They issue travel advisories.”
“And where do the armed forces enter the loop?”
“I should think they’d be notified by the US Army Center for Health Promotion and Preventive Medicine.”
I took a deep breath. “It seems to me that somewhere along the line some idle functionary glanced at your reports, said ‘Nothing new here, that area’s known to be malarial’, and filed them. And because of that my men are dying.”
She shrugged. “Possibly. To be fair, it’s not always easy for someone up in Washington to see what’s happening from monthly reports. You have to assemble the data over a longer period to get a complete picture. Maybe that wasn’t done. The information’s obviously been lost somewhere in the system.”
“All right. When I go back, I’m going to find out who’s responsible. And maybe we can persuade these people that when they ask for reports they’re under some obligation to do something with them.”
Her cheeks were still flushed but she seemed to register the conciliatory tone.
I continued, “Now, Lieutenant, it occurs to me that if you wanted to study the organism the CDC could do that at Atlanta. There must be a good reason for you to be on site, and right now I’m missing it.”
She skewered me with a long, appraising look, then said abruptly, “Come with me.”
I followed her to that door at the back of the room. We passed through into a much larger room, equipped with desks and computers. There were a lot of papers and books lying around and more maps on the walls, these ones sprouting clusters of coloured pushpins. Rising behind a desk in one corner was a bank of electronic equipment, which I recognised as a satellite communications setup. The dish would be on the roof. That wouldn’t be hard to rig – the services in this building ran on the outside – but I was still wondering why this unit wasn’t six floors up, integrated with the relevant academic department. And why was there no one else around?
She seemed to read my mind. “The team is out on assignment,” she said without pausing.
She’d answered one unspoken question. We crossed to the other side of the room, where there was a large steel door. Looking at it I realised that this was the answer to the other question.
This unit is in the basement because it’s more secure.
She punched a combination into a key pad and placed her hand against a reader. There was an audible clunk of machinery and the door opened.
My nerves jangled as I followed her inside.
What in God’s name are they keeping down here?
9
I don’t know what I was expecting, but it certainly wasn’t this.
It looked as if we’d entered the back room of a pharmacy. The walls were lined with shelves and every shelf was stacked with small white cartons printed in red and black or blue and black. The fronts of the shelves had been neatly numbered and labelled. In a way it was a bit of a letdown. The degree of security seemed better suited to gold bullion than something like this.
She selected a carton from a pile on one shelf. Then she went over to a small cupboard at the back and emerged with another.
“Tell me the difference between these two packs, Colonel.”
She held one out. I could feel her eyes on me as I took it. If this was some sort of test I intended to pass it.
I turned the carton over in my hands. One side was red, with “Dopranamid 50 mg tableta” standing out in large white letters and the long chemical name in smaller letters underneath. The opposite side was plain white, printed in Spanish in small black type, with a hologram of the company logo in the corner. On one end the drug name and “50 mg” was repeated in white on a red background. On the other end a number was embossed into the white card. A small adhesive spot had been added to this end and on it was a neatly handwritten number. I pointed, eyebrows raised.
“That’s our identification code,” she said.
I nodded and gave the carton back to her in exchange for the other. Again I examined every detail. The adhesive spot had a different number. Apart from that it looked absolutely identical.
“I give up. I can’t see any difference.”
“Quite right. And yet there was a difference.” She held up the first carton and pointed to the cupboard at the back. “This one comes from our reference collection. As it says on the label, it contains 50 mg tablets of Dopranamid, enough for a full course. This one,” she held up the other carton, “was collected in a village this side of the Cordillera Occidental mountain range. The tablets contain about 2 mg of Dopranamid. The rest is chalk.”
I met her eyes. “Counterfeit?”
“Yes, counterfeit. This is what we’re doing. We go out to villages where there’s been an unusually high rate of malaria fatalities. Language isn’t a problem – all my team are fluent Spanish speakers. They collect the villagers together and tell them they’ve been sold bad goods and that’s why their people have been dying. If they have any tablets left we will exchange each pack for a full pack of the real thing. It’s a good deal. They get an effective drug and we get evidence.”
I waved a hand to indicate the shelves. “So all these are counterfeit drugs you’ve collected?”
“Yes, nearly a year’s work – it’s a big geographical area to cover. All right, now let’s come back to drug resistance. There are two main ways in which an organism can become resistant. One is if the patient doesn’t take the recommended dose or stops taking it before they should. Remember, these are poor people. If they can manage on half the tablets they can leave some behind for the next victim. There’s a certain social pressure to save the expense.”
“What can you do about that?”
“Educate them. Any legitimate supplier, like a doctor or a pharmacist, will emphasise the importance of taking the full course. The more difficult problem is the second one: counterfeit drugs like these.” She pointed at the shelves. “They’re taking what they think is the right dose and seeing it through but they’re getting a small fraction of the effective drug. These organisms mutate all the time and the dose isn’t enough to kill all of them. Some are bound to survive and they’re the ones that go on to multiply.”
“Natural selection.”
She nodded. “Yes, natural selection. And so the resistance spreads.”
“Well where are they getting these fake drugs?”
“Small towns where some enterprising person has an old computer and a satellite link. He orders all sorts of goods for the local people over the Internet and takes a small commission – that’s how he makes a living. He gets the stuff delivered to a suitable location and handles the distribution himself. He can visit a lot of outlying villages in a big all-wheel drive. Suppose he has an order for antimalarials? He does what any good businessman would do: he looks for a cheap supplier. He charges the people the normal price or splits the difference. That way he can make a greater profit.”
“Can’t you stop him?”
“Well, what he’s doing isn’t actually illegal. He’s re
ndering a service, and he can say he’s acting in good faith. So far as he’s concerned the drugs are genuine and there’s no good reason to believe otherwise. After all, you couldn’t tell the difference, could you?”
She returned one carton to the cupboard and replaced the other on the shelf, first checking the numbers on the adhesive spots.
“Can’t you find out where they’re ordering from?”
She huffed a short, derisive laugh. “Look, the suppliers aren’t exactly helpful. They don’t like us. Put yourself in the position of a villager who’s lost his wife or son or entire family. We tell him the drugs he’s bought are fakes. Now he’s not only grieving: he’s hopping mad and he knows just who to blame. Put a few of them together and you’ve got a lynch mob. The supplier may have to flee for his life.”
“If he left his computer behind you could access it.”
“Very good, Colonel. Those who can afford it use some sort of portable and when they do a runner they take it with them. Usually. In one case we were lucky. We found out where the supplier was operating from and got the cooperation of the local police. The boys went in last week. The guy must have seen us coming because he managed to get away, but he was in such a hurry he left his desktop machine behind.”
“And…?”
“We brought it back here. We’ve had a quick look, but it’s encrypted.”
“Encrypted?”
“Yes.”
I looked at her through narrowed eyes. “You know, this doesn’t sound like someone who’s acting in good faith to me. It sounds more like someone who knows bloody well what he’s doing.”
She shrugged. “You could be right.”
“What have you done with it?”
Counterfeit (The Jim Slater series Book 2) Page 6