'I'm sorry about my absence this afternoon, the hospital called me and I had to get over there very quickly,' he said joining his hands as in prayer and concentrating his eyes on the papers on his desk. 'The tests?we have some?how can I say, unfortunate news!'
'Parkly?' Ryan said, immediately concerned by the sick man's condition.
'No, Parkly is fine,' Swami reassured him, adding as an after thought, 'his condition is stable.'
'Good,' he replied, waiting for Swami to explain.
'The tests have shown the presence of Kommabacillus.'
'Kommabacillus!'
'I'm afraid so.'
Kommabacillus, a comma-shaped bacterium, was isolated by a German physician Robert Koch in 1883. Now commonly known as Cholerae vibrio pacini after the Italian Filippo Pacini, who first observed comma-shaped particles, or vibriones, in the stools and intestines of the victims of a cholera outbreak in Naples; he had hypothesized that the particles could have been the cause of the victims' deaths. However, Pacini's observations, published in the Italian journal Gazetta Medica Italiana Toscana in 1854, went unnoticed by the world until Robert Koch rediscovered the bacteria years later.
The once fearsome, but now easily treated disease, was caused by the infection of the intestine, producing diarrhoea, vomiting and leg cramps. In most cases it could be treated by a single dose of 300mg of doxycycline, a powerful antibiotic, and rehydration.
The problem was that beyond the disease itself was its terrible reputation, capable of destroying the reputation of a town like Kovalam overnight, with the certain risk of tourists fleeing Kerala and the collapse of its tourist industry, one of the state's key economic sectors of activity.
Ryan remembered reading the case study of the famous Swiss resort of Zermatt, where in 1963 officials denied the rumour of an epidemic of typhoid fever with the result that four people died, including a tourist, and hundreds were infected. The conspiracy of silence caused ten thousand tourists to flee the resort, transforming Zermatt into a ghost town overnight, sealed off from the outside world, a financial disaster that took the Swiss tourist industry years to live down.
'How did this happen,' Ryan asked, knowing full well, from what he had observed, Kovalam beach was a breeding ground for all kinds of dangerous pathogens.
The disease was spread by unsanitary conditions and transmitted through the consumption of water contaminated by the bacteria. Cholera however was rarely spread directly from person to person.
Cholerae vibrio lived naturally in the plankton of fresh, brackish and salt water, attached primarily to copepods, small crustaceans, which formed part of the normal zooplankton. Both toxic and non-toxic strains existed. The non-toxic strains could become toxic with coastal cholera outbreaks often following a sudden increase in zooplankton. Cholera was therefore a zoonotic disease, that is to say transmitted to humans from other creatures, and in the specific case of cholera, to those present in contaminated well water.
'The authorities will look after this Sir,' announced the deputy superintendent.
'May I ask which authorities?'
'The state authorities Sir.'
'In Delhi?'
'No Sir,' replied the deputy superintendent to Kavanagh, thinking the tourist clearly knew nothing of India. 'We have a national, state, district, block and village structure in India, so in this case the governing authority is that of our state, Kerala, and to be precise our district authorities in Thiruvananthapuram,' he added didactically.
'I see,' said Ryan realizing he was out of his depth.
*****
Chapter 50
The first known outbreak of cholera occurred in August 1817 in Jessore, now in Bangladesh, just seventy miles from Calcutta. It spread from the subcontinent to the Middle East and Russia, and by 1831 every European capital was threatened. Its symptoms were extreme diarrhoea and vomiting, the victims dieing of extreme dehydration, sometimes within just a matter of hours. By the end of the nineteenth century it had killed many hundreds of thousands of people across Asia, Russia, Europe and the Americas. It was named cholera; a Greek word signifying spewing out.
At the beginning of the 21st century, the world was experiencing its seventh great pandemic of cholera with over sixty countries reporting outbreaks each year.
Typically Cholerae vibrio bacteria were excreted by infected persons and it could be spread directly to others, who after touching the sick person failed to very carefully wash their hands before eating. The bacteria could also contaminate food or water supplies and in certain cases cause an exponential epidemic.
Once inside the intestine, the bacteria multiplied and produced a toxin causing the intestines to secrete considerable quantities of liquid leading to severe diarrhoea and vomiting. An infected person could lose more than fifty litres of fluid during the course of the disease.
An untreated victim normally died of dehydration after a ten or fifteen percent loss of body weight and in extreme cases in only a couple of hours.
There was no effective vaccine against cholera. The only means of prevention and contamination was by stopping the cycle of contagion, but if Cholerae vibrio reached the water table and wells it could spread uncontrollably.
Infected persons required urgent oral re-hydration with a solution composed of a mixture of glucose and electrolytes. However, because of severe vomiting many cholera patients could not drink the solution and intravenous drips were necessary for rehydration.
Cholera was much more common than the average tourist imagined and very recently a cholera outbreak in Vietnam, another country in vogue with tourists, had affected several hundreds of people in a number of the country's provinces with four deaths.
A cholera epidemic in urban areas demanded a strict epidemiological surveillance system and the immediate availability of medical supplies and equipment, a challenge for the Indian authorities who normally dealt with epidemics in less high profile locations.
Ryan recalled reading the recommendations published by the Foreign Office and on various web sites concerning India. One site estimated the risk of cholera infection for European or North American travellers to endemic areas as one or two cases per million trips, which translated into six cases of cholera annually given the four million foreign tourists travelling to India.
'I imagine you're taking all the isolation precautions in the clinic?'
'Of course.'
Then the deputy superintendent, speaking in an official tone, said: 'Doctor Kavanagh, I must advise you that the Director General of Police in Thiruvananthapuram has been instructed by our Health Minster to report all developments in this case and has ordered to us take all the necessary precaution as regards preserving public health in Kovalam. I have been informed that a specialised medical team has been put on alert and in the meantime Mr Parkly will be moved to an isolation centre in Thiruvananthapuram.'
Ryan was about to speak when the Deputy Superintendent held up his hand.
'Sir I must also inform you that though Mr Parkly is a British subject, this is an Indian affair and more specifically concerns the State of Kerala.'
Ryan was stopped in his tracks: 'But Mr Parkly's family?'
'They are being informed, one of my officers, a lady, has left for the hotel.'
'I am Mr Parkly's physician and would like to ensure he is suitably cared for.'
'Our doctors are perfectly capable of assuring Mr Parkly's treatment and will advise you of his progress. Dr Swami assures me he will be on his feet in a few days.'
'I see, I will have to inform the British Embassy, perhaps you are aware Mr Parkly is an important financier in the City of London.'
'We shall do that Mr Kavanagh, and perhaps you should recall the British have no jurisdiction in India,' he said adding sharply, 'since 1949!'
Ryan held back not wanting to antagonise the local authorities.
'You may return to your hotel, you will be accompanied by one of my men. Before you go I have to warn you that the interests of K
erala are involved and I must have your word that you will not divulge the details of Mr Parkly's illness to anybody whatsoever.'
'Am I to believe I'm being gagged?'
'Call it what you like. If you refuse I'm afraid I will have to take disagreeable measures.'
'What measures?' asked Ryan recovering his courage.
'You will be detained in your hotel.'
'I don't believe this.'
'Sir, you must do as we ask or I may be forced to put you under house arrest, you are not in the UK.'
'You have my word,' he said resignedly, not sure if it Vijaya, or whatever his name was, was making an empty threat or not. In any case he did not want to find out what an Indian jail might look like.
*****
Chapter 51
Back at the hotel Ryan looked for Emma, she was not in her room and neither Sarah nor his mother had seen her. He then enquired at the reception and was informed she had checked out.
'Checked out?'
'Yes sir.'
'That's not possible, they are booked until Friday.'
'I'm sorry sir, they have left.'
Angrily he spun around trying to figure out what was happening. He saw two porters pushing a baggage trolley on which he recognised a beach bag he had seen with Emma. There were also packages and items of clothing that should have normally been packed in the suitcases.
Watched by the desk manager, he confronted the porters.
'Excuse me, whose baggage is that?'
'Room 201 Sir.'
'Mr Parkly's?'
'I don't know Sir.'
'Where is it going?'
'I don't know Sir.'
The desk manager arrived.
'Is there a problem Dr Kavanagh?'
'Yes, I would like to know where Mrs Parkly is.'
'She has left Sir.'
'For the airport?' he asked knowing full well it was not the case.
'That I don't know.'
Sarah arrived just as Ryan, not wanting to cause a scene, decided to try another tactic.
'Sarah, let's get out of here.'
Heading for the pool bar Ryan quickly explained that Emma had left the hotel for unexplained reasons and asked Sarah to discreetly return to the entrance and enquire to the doorman where the baggage was being taken.
As Sarah casually strolled back towards the entrance she saw the porters loading the baggage into a taxi. She stopped as though enjoying the evening air, then flashing a seductive smile asked the doorman where the taxi was going.
'Trivandrum Madame,' he obliged, admiring the attractive young woman.
'The airport?'
'No, the General Hospital.'
'Thank you,' she said turning and leaving before she drew any further attention.
*****
Chapter 52
Night was falling when Emma Parkly arrived in Thiruvananthapuram, she was in a daze, in the heat and confusion of the last few hours she had not yet grasped what was happening to her. Swami had brought her to a small, very exclusive private clinic situated in a residential district of Trivandrum.
The clinic stood on the grounds of a large house built by a wealthy British tea and spice plantation owner in the twenties, it was surrounded by a vast walled garden and was almost invisible from the outside, as were many such houses in the district. The clinic belonged to Swami's extended family who had acquired the property after India's independence.
Emma, accompanied by Swami and a woman doctor, alerted by phone some minutes before of their arrival, was immediately led to Parkly's room, part of a private medicalized suite she was informed. The room was spacious and modern, bathed in a soft bluish light, just sufficient for the nursing staff to monitor the patient's condition. The air conditioning hummed softly, electronic medical apparatus beeped from time to time and two screens showed different data plots. Parkly was sleeping or unconscious, he was being hydrated by transparent tubes from an intravenous drip to compensate for the massive loss of body fluids.
'There you are Mrs Parkly, you see we are giving your husband the best possible care.'
There was little doubt Parkly was being well cared for.
'The medical faculty is just a couple of blocks from here and all the necessary tests are being carried out to monitor your husband's progress.'
Emma nodded. She felt very alone in the strange environment.
'What exactly does my husband have doctor?'
'According to the analysis received from the pathology department at the state medical centre, your husband is suffering from an acute digestive disorder.'
'I see.'
'Has he ever suffered from ulcers?'
'Not to my knowledge.'
'I see. We'll see how he is tomorrow morning. In the meantime the family room is next door, we thought it better you be close to him. I will show it to you,' he said turning to lead the way.
The family room was equally spacious and modern, almost like a comfortable hotel room with a flat screen television, a minibar, a sofa, a table and chairs, an en suite bathroom and toilet, naturally it was all decorated in an aseptic white offset by framed abstract paintings.
'Your bags will arrive shortly,' Swami said with a sympathetic smile trying to put her at ease. 'For diner there is a menu, just pick up the phone and it will be delivered to you. You'll find everything you need to drink in the minibar.'
'Thank you.'
'If you need me call Dr Govindurajulu, our medical staff is present night and day. I'll be leaving you now Mrs Parkly. Dr Govindurajulu will give you a mild sedative to help you sleep if needed.'
With that Swami left, instructing his driver to take him to the home of city's chief medical officer.
Thiruvananthapuram was the capital of the State of Kerala, the seat of its legislative assembly, and Kovalam was one of the many wards of the Thiruvananthapuram Municipal Corporation.
The mayor had convened an emergency meeting at the chief medical officer's home so to avoid attracting unwanted attention, especially that of the press. Those present included district the police commissioner - who also headed the Tourist Police, the public health executive engineer, the head of the state tourism department and a senior army officer.
The object was to review the situation and if necessary health inspectors, medical officers, hospitals and public health centres, in all of the district's wards would be put on an emergency footing.
*****
Chapter 53
Kerala, a relatively small state, situated in the extreme south west corner of India, covered an area equivalent to little more than one percent of the total area of the country, and had a population half that of the British Isles with a population density four times greater.
The Western Ghats, a mountain range with its highest peak at 2,695 metres, separated Kerala from the rest of the subcontinent, forming a natural geographical barrier. Its annual rainfall was almost three times the national average making it one of the greenest and most plentiful states of India.
The problem however, was that Kerala with its high population density had less rainwater water per capita than that of parched Rajasthan. Kerala's rain was quickly lost since its abundantly watered mountains fell by almost two thousand metres to the coastal plane before emptying into the sea in just sixty kilometres from the peaks. The water stored in its groundwater aquifers was not sufficiently replenished due to uncontrolled deforestation the direct cause of massive surface runoff and intense erosion.
Wells were the principal source of water for its population with probably the highest open well density in the world, up to two hundred wells per square kilometre, equivalent to one well per acre.
Kerala had little or no municipal effluent treatment and as a consequence of groundwater depletion there was a constant growth in the concentration of bacterial pollution. This was visible in the Parvati Puthan River, which flowed from Thiruvananthapuram to Kovalam, burdened with raw sewage that transformed the river into open drain.
T
he root of the problem lay in Thiruvananthapuram's sewage system that dated back to 1938, when the population was a mere one hundred thousand, which had since grown to eight hundred thousand producing 150 million litres of sewage a day.
The collection system, controlled by the Kerala Water Authority, pumped its effluent to a seriously inadequate sewage farm at Valiyathura, which because of its low capacity overflowed and seeped raw sewage into the Parvathy Puthanar River that carried it down to Kovalam and the sea.
Kovalam was in fact a suburb of Thiruvananthapuram and because of its importance as a tourist destination a plan had been drawn up to connect it to the sewerage network described in an official report entitled Executive Summary of Kovalam.
It was a dramatically urgent need, and to make matters worse, in addition to the direct discharge of domestic sewage to the rivers there was also that of slaughter houses, markets and hotels. Specialist reports showed that all rivers were contaminated with high levels of faecal coliform bacteria, a sure indicator of contamination, caused by sewage on their lower reaches.
It was ironic, Thiruvananthapuram had been one of the first cities in India to have a piped water distribution system, and eighty years later it was still without a real sewage treatment plant, the direct cause of the high degree of pollution on a large strip of coastline to the south of the city, more precisely Kovalam's beachs.
More than three quarters of the state capital's population had running water, but just a quarter of its households were connected to a municipal sewage collection system. The others relied on septic tanks or soak pits, a serious source of well and groundwater contamination.
The rivers of southern Kerala were dying from sewage discharge from its capital and the surface water systems had been transformed into open drains. At the same time high ranking Union Government officials insulted Australia, before the cameras of the world's television, treating it as a small and insignificant nation, perhaps it was small in numbers, not in size, in any case India would need an incalculable time to provide the equivalent of Australian sanitary conditions for its citizens, rich or poor.
The tragedy of developing countries, like India, was the cost of installing effluent treatment plants for municipal waste water was far beyond their means. It was an absolute impossibility for governments to catch up with their targets for building vitally needed sewage treatment plants. The volume of sewage generated grew at an ever increasing rate and in rapidly urbanising cities like Thiruvananthapuram the situation had become perilous; as for Kovalam and its tourists, who were at the receiving end, that New Year announced a year of all the dangers.
Death of a Financier Page 15
