The Waiting Rooms

by Eve Smith

  His gaze shifts to the camera mounted in the corner. They’re not supposed to record the sound, but you never know. ‘They treat you well?’

  ‘Well enough.’

  He nods. ‘So, this must be your big year, then?’ Another smile flickers. ‘I suppose you’ve seen the protests.’

  I haven’t asked him here to make small talk, but I don’t have much choice. ‘Yes.’

  ‘Not that they’ll make any difference.’ He sighs. ‘There’s no way this government will entertain any watering down of the Act. Not while shelf lives are still struggling to get beyond a year. Apart from anything else, they could never afford the drugs.’

  He’s right, of course. Usage would go through the ceiling. “Reservoirs of resistance”: that’s what care homes like this were called. And, even with all the price caps and subsidies, antibiotics are still exorbitant. I remember the days when doctors used to hand them out like sweets, even for viral infections like coughs and colds. When, in some countries, you could buy them over the counter. One pill at a time.

  ‘I thought they’d raised the possibility of an extension, though?’ I say, indulging him. ‘Making cut-off seventy-five?’

  He snorts. ‘Delay tactics. No minister in his right mind would extend cut-off. You know how quickly things could slide.’ He flaps his hand. ‘All those weakened immune systems and repeat medications. Don’t forget, it was our age group that wreaked the most havoc. The over-seventies used to account for a quarter of all antibiotic prescriptions before resistance screening came in.’ He shakes his head. ‘Those old buggers can protest all they like. The truth is, the only reason things are just about functioning is because the seventy- and eighty-year-olds keep dying.’

  It suddenly occurs to me that this is the reason he thinks I’ve brought him here. To beg for an exception. Ask him to pull one of his many strings.

  His lids hover over his eyes. ‘Of course, they’ll have to do something eventually. But not until we’ve weaned ourselves off this absurd reliance on drugs.’ He wags his finger at me. ‘Gene editing: that’s the future.’ He nods. ‘We’ll eliminate disease by playing the microbes at their own game. The Chinese have already bred HIV-resistant mice, so it won’t be long before they’re meddling with humans. Smart, eh? But that’ll be too late for the likes of you and me.’

  A slow grin stretches across his face. ‘Does it worry you at all? This dying business? Or are you ready to meet your maker, Lily?’

  My heart hammers in my chest but I hold his gaze. ‘You know what, Graham? I’ve been ready for years.’

  He wheezes with laughter. ‘That’s more like the woman I remember. So, then.’ He spreads his palms out in front of him, as if he has all the time in the world. ‘What exactly was it that you wanted to discuss?’

  I steel myself. Even now, asking him for anything feels like treason. ‘I was sent something. A postcard.’

  One eyebrow arches. ‘How quaint.’

  ‘The photo on the front…’ I swallow. ‘It was a rhino. A white rhino.’

  His face betrays nothing more than mild curiosity. ‘Any message?’

  ‘No, it was blank.’ I clasp my fingers, letting the pain scream around my joints. ‘Only one person could have sent it.’ I stare at him. ‘Think about it. Only the team knew. This has to be him.’

  A small laugh escapes. ‘You don’t mean…? You’re not serious?’

  ‘Well, who else could it be?’

  ‘There’s just one problem. He died, remember?’ Graham slides his tongue over his teeth. ‘Nineteen years ago, to be precise.’

  I know how it sounds but I can’t lose him on this. I lean forward and whisper, even though the camera should be muted and there’s no one else here. ‘What if he didn’t? What if he did some kind of deal? With your lot or … or EAA?’

  ‘For goodness sake, he—’

  ‘I wasn’t there when it happened. Nor were you. The whole thing could have been some elaborate sham.’

  He throws his hands up in the air. ‘The man was cremated, for God’s sake! All that’s left of him are ashes.’ Graham turns his back to the camera. ‘Anyone could have sent this. There could still be relatives out there with an axe to grind. Not forgetting the press. They can’t resist dredging up an old scandal.’

  His words slice right through me.

  ‘After all this time? How would they even find me?’

  He gives me a disparaging look. ‘Anyone can find anyone, if they have the right technology.’

  I feel the room spinning away from me. ‘But … but you promised! You guaranteed I’d be safe.’

  ‘That was two decades ago. We were careful, very careful. But with the kit they’ve got nowadays, frankly anything is possible.’

  I clench my jaw, hot shards of panic coursing through me. ‘You have to swear, Graham. Swear to me he’s dead. Because if he isn’t, I’m not the only person he’d come for—’

  ‘You’ve been watching too many films, Lily.’ His lip curls. ‘What proof do you need? An affidavit from the prison doctor? The x-ray of his lungs? Look, at the end of the day, it’s just a postcard. You’ve had worse.’

  I scan his face but it offers no clues. I never could tell when he was lying.

  He gives an elaborate sigh. ‘Look, I’ll make some enquiries. Run a few checks.’ His voice has a weariness that shows just how futile he thinks it is. ‘But I’m telling you, whoever’s doing this, it isn’t Bekker. Not unless he’s figured out how to come back from the grave.’

  With some effort, he pushes himself up to standing. ‘Now, I’m afraid I really must be going.’ I notice a sheen of sweat on his forehead. Maybe he’s not doing so well after all. As he moves towards me I stiffen. ‘Goodbye, Lily.’ He holds out his hand. It looks like a relic I once saw in the vault of an Italian church: small, brown and shrivelled. ‘Don’t worry,’ he smiles. ‘I used the sanitiser.’

  I force myself to take it. ‘Goodbye, Graham.’

  ‘I’ll be in touch.’ He moves past me, trailing some fancy cologne that smells like fruit on the turn. ‘And do stop worrying. At your age, it really isn’t good for you.’

  I sink back against the wall. He thinks I’m overreacting, that what I said doesn’t make sense. A lot of things don’t make sense. It hasn’t stopped them happening, though.

  By the time I reach my room it’s all I can do to lift my wrist for the sensor. But as the door swings open I hear a rustling sound. Something’s trapped underneath, on the carpet.

  I peer over my frame. It’s an article, torn from a newspaper. The photo’s faded but you can still see them.

  ‘Kill Not Cure…’

  Some of the children appear to be sleeping. Others stare with fixed, glassy eyes, like the ones they used to put in dolls. They look as though they are searching for something. Something that never comes.

  The walls swoop in, crushing me between them like the boards of a flower press.

  I don’t have to read it, I know every word.

  It’s exactly the same cutting as the one in my box.

  CHAPTER 11

  Twenty-seven years pre-Crisis

  ‘Urgent Action Required’ Warns WHO as TB Deaths Continue To Rise

  The World Health Organisation gave a sharp message to governments this week about the dangers of tuberculosis, which has risen to become the fifth leading cause of death globally. WHO estimates that there were 7.5 million new cases of TB last year, which caused 2.5 million fatalities. 1.7 billion people globally are thought to be infected.

  ‘We are facing an extremely serious problem,’ commented a spokesperson. ‘The number of people infected is growing each year. We urgently need more investment in the development of new vaccines and new drugs so that we can roll out simpler, shorter treatment regimens. Doing nothing is no longer an option.’

  MARY

  The boy lies curled on the bed, shivering, although it must be nearly forty degrees. He looks maybe seven or eight. Probably older. He’s thrown off the sheets, exposi
ng his thighs: more bone than flesh. Sweat streams down his face, seeping into the surgical mask that covers his nose and mouth. The mask must have been white once, like mine; now it is patterned with ominous stains. He stares, transfixed, at the ceiling fan; the circling blades do little more than stir the air.

  All of a sudden, he convulses with a wet, rasping cough; his tiny body heaves and heaves. The boy tries to lever himself up, get his head over the side, but he hasn’t the strength. He claws at his mask as a red jet of sputum erupts onto the pillow. My hand flies to my mask. I snatch it away, praying Piet didn’t notice. The boy rolls over, draws his knees up to his chest and shuts his eyes.

  ‘He’s one of the lucky ones,’ mutters Piet. His expression is blank, but I sense the anger coiled inside. ‘At least he’s got a bed.’

  I look at the men, women and children, all sandwiched together in this fetid room. More patients are slumped against the peeling corridor walls, spilling onto the street outside. The stench of bodies is overwhelming. This clinic is just fifty miles from the park border: is this the best they can do?

  ‘Pulmonary tuberculosis,’ he says, eyes still glued to the boy. ‘There are no symptoms for the first two or three months, while the infection incubates. It starts with the cough. Most people dismiss it, wait for it to go away. But every day that passes, it gets worse. With each cough or sneeze, it spreads. Which, of course, is why it’s such an effective pathogen.’ He turns to me. ‘TB doesn’t announce its presence. Like the best killers, it moves quietly. Catching its victims unawares.’

  Tuberculosis? I think of history books with grainy black-and-white photos of children lying in hospital beds outside. Victorian ladies coughing into lace hankies. Surely this is a disease of the past?

  ‘After the cough comes the chest pain. Then the night sweats. Exhaustion sets in.’ His voice is monotone. ‘Body weight plummets as the fever intensifies. Then they start coughing up blood. That’s because cavities are developing in the tissue of their lungs.’

  A strange rattling noise makes us both look round. It’s a woman in one of the adjacent beds: her teeth are chattering.

  ‘Without treatment, the bacteria progress to other parts of the body. Eventually the patients start haemorrhaging and their organs fail.’ He doesn’t take his fierce blue gaze off the boy. ‘There’s a reason this disease used to be called consumption. It consumes you.’

  My eyes seek refuge outside. Corrugated iron huts line the road, holes cut in the sides to make windows and doors. Some have been painted bright colours, others are held together by planks of wood, Shoe Repairs or Barber scrawled across the front. Coils of barbed wire stretch across the top of concrete walls painted with garish slogans for things most people will never be able to afford.

  ‘I don’t understand.’ I swallow. ‘I thought TB had been wiped out.’

  He gives a dry laugh. ‘Maybe in countries like yours.’ Something inside me shrivels. ‘TB’s been in Africa since the Ancient Egyptians. We like to kid ourselves that it’s under control, but it always finds a way back. And this time, it’s back with a vengeance.’

  I wipe my forehead with my sleeve and adjust my mask. I’m finding it hard to breathe, but the last thing I’m going to do is faint.

  ‘HIV’s triggered an explosion of new cases. TB usually targets weaker immune systems: the old, the young and the sick. In most healthy adults, the TB bacilli can lie dormant for years. But with HIV all that changes.’ His chest swells with a sigh. ‘The virus targets and destroys the very cells responsible for immunity, laying patients wide open. It’s a lethal combination.’

  ‘But what about the vaccine?’ I ask. ‘Why aren’t they protected?’

  He makes a noise like a punctured tyre. ‘You mean the BCG?’ He shakes his head. ‘It’s not effective against pulmonary TB, not in adults. In any case, vaccination programmes out here are sketchy at best.’ His gaze moves to the window. ‘TB spreads through prolonged contact in a confined space. With HIV on the rampage, townships like these are a perfect breeding ground. The infection rate has climbed to one in a hundred. For children it’s double.’

  On the street outside a skeletal dog is licking a cardboard box. Slouched against one of the shacks is a man in a filthy brown shirt and tattered trousers. His sodden shirt clings to him, outlining each of his ribs. He reminds me of one of those Holocaust pictures.

  ‘But, if so many people are ill,’ I say, ‘surely there must be another vaccine in development?’

  ‘You’d think so, wouldn’t you? If all things were equal.’ His mask creases with a smile but it’s the kind that makes me shiver. ‘TB’s simply not a priority for the West. In fact a lot of countries have stopped using the BCG altogether. So, why bother investing in a new vaccine? No money to be made there.’

  A slow burn starts in my stomach and creeps all the way up to my cheeks. I want to rip off my branded shirt and designer sunglasses, kick off my trainers. I think of all the cash we waste back home on things we don’t need, while people out here are dying of a disease that should have been consigned to history.

  I clench my hands. ‘Surely there must be some kind of treatment?’

  A man on the other side of the room slumps forward and retches into a bowl.

  ‘Most people aren’t even diagnosed, let alone treated. It’s only when the headache and fever creep in, when they start bringing up blood, that they seek help. By then their diagnosis is immaterial. The nearest hospital’s too far away and they can’t afford the antibiotics themselves. Their families are the only ones left to care for them.’

  My eyes wander to another bed, near the window. A little girl lies on her back, clutching a toy rabbit. She stares at me with misted eyes, her chest rising and falling impossibly fast.

  ‘Even if they can get to a doctor, many don’t. They’ve been put off by stories about the number of tablets they’ll have to take and all the side-effects. Sometimes, the drugs don’t work. So they go without. Or they turn to other forms of medicine.’

  Does he mean traditional remedies? Is that where all this is leading? I think of my ignorant rebuttals at the dam, and my insides roil.

  A nurse brushes past with a trolley. Piet asks her something in Zulu. I notice the deep hollows under her eyes. I wonder how many of the staff end up getting sick too.

  ‘I thought so,’ Piet mutters. He nods at the woman in the bed next to the little girl. ‘That’s the girl’s mother. She was treated for TB about a year ago. They thought she’d made a full recovery, but now it’s back. She wasn’t going to come. But then her daughter got sick so they made the journey.’

  The nurse lifts the girl into a sitting position and hunkers down next to her. The girl looks tiny against her pillow, still clasping the threadbare rabbit. The nurse gently takes the rabbit’s paw and pretends to put something in it. She raises the paw to its mouth, smiling and nodding. The girl shakes her head. The nurse repeats the pantomime, but the tablets remain in their dish.

  ‘She says she’s not responding to treatment,’ Piet continues. ‘Nor is her mother. They’re seeing cases like this more and more. New strains are emerging that have developed resistance. It’s not surprising really. Even if patients agree to take the pills, many don’t finish them. They’re supposed to take them for six months. Imagine. There just aren’t the resources to follow up.’

  And there it is. I consider myself an educated woman, a graduate of one of the most renowned institutions in the world. But before this moment, I’d never even heard of drug-resistant TB.

  Piet swipes a sleeve across his forehead. The sweat has bled into his shirt; dark patches glue to his skin. ‘Some strains aren’t resistant to just one drug, either. To stand any chance of recovery, patients will have to take more pills for even longer.’ He shakes his head. ‘I just don’t see that happening. I’m telling you, it’s a ticking time-bomb.’

  The anger rushes up inside me. ‘Why don’t we know about any of this? Why the hell aren’t the government doing something?’ />
  He gives me a look that brings me up short, that reminds me we’re in the realm of apartheid and the rules simply don’t apply. The feeling I had earlier returns: shame about the colour of my skin, shame about the fact I will earn more money in a week than these people earn in a year, shame about my healthy lungs and the ease with which I breathe. Which is why I find myself saying: ‘How can I help?’

  He smiles. This time his eyes wrinkle with a proper smile. It banishes the fear of what he will ask next.

  ‘If we’re going to eradicate this disease, we’re going to have to find the solutions ourselves.’ He points out of the window. ‘Local healers are widely consulted. Not just in townships, either. Because some of these traditional remedies do work. The trouble is, we don’t always understand why.’ He turns to me. ‘Knowledge is handed down by word of mouth. It’s rarely documented.’

  I know what’s coming and my brain is screaming that I can’t do this, I can’t just switch horses mid-race, it would be career suicide. But I am cornered prey.

  ‘You remember Taxol?’ I nod. ‘Well, we’re setting up our own screening programme, here, in South Africa. A joint venture between two universities and a local pharma firm.’ His eyes bore into me. ‘We’ve already recruited some brilliant botanists, but I think we’d benefit from having more international players on our team.’ He pauses. ‘People with contacts as well as skills.’

  My gaze returns to the little girl. I think of my rooms waiting for me back in Oxford. The safe, respectable path I have chosen. My colleagues and my friends.

  I consider stalling, telling him I need more time.

  He takes a breath. ‘You know how much diversity we have out here, Mary. How much potential.’ He touches my arm. ‘Thousands of years of medicine can’t be wrong.’

  I dig my nails into my palms. His words shimmer with tantalising possibilities. The fan blades circle slowly round.