by Rose George
She did science in hell for a few weeks, then returned to England and to a job as principal of Somerville College for the next twenty-two years. It was academia, but it was no sinecure: she rose at dawn to dictate all the correspondence needed to run an Oxford college, before setting off every day to put a full day of work in at her lab nearby. If callers to the college wondered where the principal was, she responded, “Do they think I sit knitting?”135 She became an expert on radiation, researching the effects of nuclear fission on the metabolism of humans and rabbits, who were her test animals. A colleague called her “our radioactive principal,”136 which was more accurate than he expected, because if there was any risk that radiation had leaked, Janet Vaughan would disappear to have a bone biopsy taken from her tibia.137 She did this work for decades, and once answered the politician Shirley Williams’s question as to why on earth she was handling plutonium at her age with “What could be better than for someone in her seventies to do this work? I haven’t long to live anyway.”138 She fought to have women’s colleges accepted as full Oxford colleges, and she increased the intake of science and medical undergraduates at Somerville. Early on, she made sure to employ women as her research assistants and, going flagrantly against custom but forcefully in the direction of fairness, kept their jobs for them if they had children. She served on great and good councils, but also, when flu broke out, carried trays of food to sickly students. As principal she was radioactive, but also “accessible and exhilarating.”139 Kindness. She always had kindness. “She was a very human scientist,” a former student wrote in a eulogy.140 Vaughan lived long after retiring in 1967 and wrote books and academic papers until her eighties. She was a Dame, a member of so many associations (my favorite: the Bone and Tooth Society), and loaded with honorary degrees. She was establishment, but a socialist to the end.
Percy Oliver died in 1944, exhausted. He had never been robust, and he had watched his beloved service be overtaken by the Emergency Blood Transfusion Service, without him in it. He had not survived to see, as Janet did, the transformation of both into something exceptional and enduring. “To have seen the Blood Transfusion Service,” wrote Francis Hanley, a colleague of Oliver’s, in a memoir, “grow from a backroom, one-man enterprise here in London to a multimillion nationwide organization sustained by voluntary donors, is something not granted to many of us.”141
It was not granted to Percy Oliver, nor was much recognition. Perhaps medical eyebrows continued to be lifted at the truth: that the modern blood supply system was built on the shoulders of a layman and a very naughty little girl. It took thirty years for a handsome portrait and wooden memorial to be installed at the entrance to the Department of Hematology at King’s College Hospital, from where came that first-ever call, as the story goes. A ward at King’s is now named for Oliver and offers thirty beds for patients with general medical, respiratory, gastroenterology, and sexual health conditions.142 In 1979, the local council installed a blue memorial plaque on the Olivers’ house in Camberwell: PERCY OLIVER, FOUNDER OF THE FIRST VOLUNTARY BLOOD DONOR SERVICE, LIVED AND WORKED HERE.143 (So did Ethel Grace, whose efforts are relegated to the unsaid and unheralded spaces between the lines, where wives’ contributions generally reside.)
Dame Janet Maria Vaughan has no blue plaque outside her home, although her honors were many and prodigious. Her last years were marred by severe arthritis (she would tell her beloved grandchildren to get on with their lives, not waste time visiting their decrepit granny).144 She died aged ninety-two in January 1993. She had only recently stopped using her Mini, a common sight and sound all over Oxford, as she drove, in the words of a colleague, “idiosyncratically.”145 Another described her driving style as “like a kangaroo.”146 By then, the Blood Transfusion Service, later the National Blood Service, then NHS Blood and Transplant, had existed for forty-seven years. When she was asked in 1984 how she would like to be remembered, she answered with no hesitation. “As a scientist. That I have been able to solve, to throw light onto fascinating problems. But as a scientist who had a family. I don’t want to be thought of as a scientist who just sat thinking. It’s important you have a human life.”147
An accomplished, organized, indefatigable, always human woman. In 1941, Vaughan wrote to Katie Walker, the nurse who had worked at the Slough blood depot for fewer than two years. But what a two years. Janet had no need to write the letter, to one of a hundred staff: turnover must have been brisk. But she wanted Katie to know how much she would be missed. “I cannot in the nature of things see and know you Nurses as personally as I should like to but you must realize that I do love and care about you all very much.” She could have signed it formally, as Katie’s superior, as the woman in charge of a vast organization with vast responsibilities. She could have written, clinically, “With regards from Dr. Vaughan, Director.” She could have signed it with the formality due to a woman who was instrumental in setting up our modern system of blood donation and transfusion; who dared to stick a large needle into the breastbone of a small burned girl; who did science in hell; who never stopped encouraging science in all ways, and women to do more of it. She signed it, “Yours always with love, Janet.”148
Boniswa, a mural on the Isivivana Centre, Khayelitsha, by Breeze Yoko
FOUR
BLOOD BORNE
Our new home. This is what Khayelitsha means, and this name has never been anything except ironic and bitter because Khayelitsha is the ugly backside of beautiful Cape Town. Khayelitsha, formed when apartheid authorities lifted up its black and colored population and dumped them on the Cape Flats, miles away from the beautiful colonial houses of the city center, from the waterfront and ocean, from the looming, lovely Table Mountain. Khayelitsha is the second most famous township in South Africa after Soweto. It is called a township because that is the name for towns when their inhabitants are black or colored and poor. The population estimates for Khayelitsha vary, but it probably holds around half a million people.1 Some other figures are firmer and frightening: unemployment is 40 percent, and 50 percent among young people; a third of inhabitants live in “informal housing,” also known as shacks; common assault and attempted murder rates, when assessed in 2015, were found to have risen by more than 40 percent in five years;2 the sexual assault center records a hundred rapes a month and estimates that actually there are nine times more than that; and it is not unusual for girl children to be put on contraception at the age of ten by their mothers in case they are raped.3
Khayelitsha now is a place where Uber drivers will drop off a visitor but never return to collect them, in daylight or darkness. No one accepts fares from here. All the drivers who transport me there from the city are Zimbabwean, and all are shocked. They make a click sound when we approach Khayelitsha, not because they speak Xhosa, a language of clicks, but because this is a sound of disapproval in many African countries, farther back in the mouth than a tut but with the same purpose. Look at this, says one, with a click-tut: even in Zimbabwe people would not accept corrugated shacks. They would build, even with mud. Another gives me a running tour of township violence, all these places of danger lined along the N2, a highway that begins in Cape Town and ends on the other side of the country, skirting Lesotho and almost reaching Zimbabwe. The colored township is bad, this driver says. Too many drugs. Click-tut. But Langa is the worst. There you can die in cross fire, so easily. He nods to Langa but I see only painted houses and colorful washing, drying draped on the mesh fences, the pinks and yellows and blues and the sunlight making danger seem distant and impossible.
To return to Cape Town at the end of my day, I must rely on kindness and lifts from the staff of Médecins Sans Frontières (MSF), the international medical organization that is hosting me. MSF arrived in Khayelitsha without intending to stay, fourteen years ago, to set up a clinic to deal with HIV. It is still here because so is HIV. The virus is believed tamed in the richer northern countries of Europe and North America, but outside those places the epidemic thrives. Only now it is an epi
demic of women.
More than half the 37.5 million people living with HIV worldwide are female. Every week 7,500 young women are infected, and globally HIV/AIDS is the leading cause of death of women aged fifteen to forty-four.4 In sub-Saharan Africa, young women between fifteen and twenty-four are twice as likely to be infected with HIV as young men.5 In some parts of KwaZulu-Natal, an eastern province of South Africa, a fifteen-year-old girl has an 80 percent chance of being infected with HIV.6 Eighty percent! To be interested in HIV is to be pulled to the bottom of the African continent as if by a tractor beam, and to want to know why in 2017 being a black young woman is a death sentence.
As well as having permanent clinics around Khayelitsha (at the Site B Day Hospital, in Ubuntu), MSF has a satellite facility on a dusty road that is lined with small shacks and cut oil drums used to prepare braai, South African barbecue. The clinic is known locally as “the container” but it is actually a mobile trailer. It doesn’t look like much, but it provides HIV tests and counseling and maybe tea and coffee. Disco music plays from somewhere among the shacks, these structures of cobbled-together corrugated iron patched with anything possible. The container and the shacks are built on sand. In the summer the shacks are intolerably hot. In the rains they flood. It is now August and winter, and the shacks are cold, though the tiny stalls of the trailer are heated. The reception area is a plastic table outside with a few plastic chairs, monitored by a cheerful woman wrapped in a fleece blanket, a fashion I see often (blankets are cheap warmth), and black-and-white striped stockings, a fashion entirely her own. She looks like a cuddly witch of the west from The Wizard of Oz and she has equivalent power: she controls the kettle.
The clinic is open five days a week from seven a.m. until six p.m. The long hours are to enable working people to attend, the same working people who flock on the highway bridges and train station of Khayelitsha in the predawn hours, a murmuration of humans waiting for their ride to where the work is. Without the people of Khayelitsha, Cape Town would have no cleaners, waiters, or drivers. As people are tired and may not come, the clinic entices them with free Wi-Fi, a pull in a country where phone data is expensive. Another enticement is the general nature of the health services: it offers family planning and diabetes and TB (tuberculosis) screenings, so people aren’t as ashamed to come along as they might be for a dedicated HIV clinic. There are other clinics in Khayelitsha’s twenty-two subdivisions, which the apartheid government named with miserly imagination for the alphabet, so there are Sites A to J, but there is also Mandela Park or Harare. In the HIV clinics in Site B or Ubuntu, people are easy to spot, either by the color of their green appointment card or by their movements. If they turn left, they are going to general health. A right turn, and they are definitely heading for the HIV clinic. They are marked by their orienteering.
At the MSF there is no left or right, only three steps up into one of the snug stalls, so intimate that staff can talk through the walls, and where you can get a free fingerprick HIV test with results in fifteen minutes. South Africans have lived for so long with HIV they speak it fluently, talking easily of status and ARVs (antiretrovirals) and CD4 counts (levels of a particular white blood cell) and viral loads and condomizing. You have no need to tell them that AIDS is acquired immunodeficiency syndrome caused by the human immunodeficiency virus. They have had decades of announcements, appropriately messaged soap operas. Yet South Africa has seven million people infected with HIV, the most of any country.
One of the clinic visitors this morning is Themba, who has come for an HIV test. He tried to get tested the day before but he was too drunk and staff turned him away. That he has come back makes him unusual: men are notoriously difficult to get into health care clinics, anywhere. Other things about him are more routine: that he has been “fooling around” and had sex with a stranger because he was drunk. I look at him when he says this and think of the colossal rates of sexual assault in South Africa, and wonder. But he distracts me by saying he also has three long-term girlfriends. All his friends have several women. “It’s what we do. We brag about them.” He mentions that he has a box of condoms at home. When I ask him whether he will now condomize, his “yes” is the long one of the liar. But he remembers who he is talking to and he pulls himself up. “Yes,” he says, more emphatically. “I will. Because I don’t want to live in fear. I’m scared.”
The trouble with Themba is that South African women should be scared of him.
* * *
Here it comes. In this animated video, the virus, a spherical particle with green waving spikes on its surface, is descending to land on its target. This is usually a CD4-positive T-cell, a white blood cell also known as a helper T: “T” because it is made in the thymus gland and “helper” because it is very useful. If the immune system were Star Wars, helper Ts would be the Force: they guide other white blood cells to attack invaders and threats. (Some educational videos, attempting to explain the complicated, marvelous workings of our immune system, liken them to air traffic controllers.) These T-cells release chemicals that draw other white blood cells to the site of the threat and different chemicals that stimulate leukocytes to divide, the more to fight and to conquer. Helper Ts are fundamental and intrinsic, and without them the immune system is the Death Star without its core weapon or a sky of planes in collision. Helper Ts are an astute choice of prey.
In that animation of infection, the HIV particle—a virion—descends to the surface of its target T-cell with the slow grace of a moon lander. Its wavy spikes are sugars on the surface of its protein envelope, the casing that surrounds the virion’s core. The spikes become lander legs, waggling like hopeful insect antennae, until they join with other blue spiky forms on the T-cell’s surface. “Blue spiky” is my layperson’s term: they are more usually known as co-receptors CCR5 and CD4. HIV’s legs hook into the co-receptors as a child’s hand finds its mother’s to hold. The virion injects a spike into the T-cell, sucking up the cell’s surface until the invader and the prey have fused. It is unsettling. It is a hunt.
In reality, there are no green spikes or blue co-receptors: like other viruses, HIV is tiny, much smaller than bacteria and too small to have color. I find another video that shows real footage of infection. The color scheme is grays with only the T-cell colored to be distinguishable, and the actions are different: no streamlined moon landing but an incessant jostling and tussling, like a cat pushing its face at you again and again, a sinister nuzzle. I expected to be baffled or puzzled by watching viruses at work but not to rediscover the helplessness of a child watching a pantomime villain: T-cell, he’s behind you. Look out. And the hunt proceeds, until the T-cell is breached and the virus sidles in, inevitable.
The color of HIV and AIDS campaigns have always been red because the virus travels in blood and red is what we think blood is. But it is the white blood cells that HIV attacks. Leukocytes, named for the Greek for “white” when actually they are transparent, make up only 2 percent of our blood volume but they are, in the words of a biology textbook, “stupefyingly complex and astoundingly flexible.”7 They are the cogs of the immune system and they are very busy.
A splinter or a cancer. Should anything assault us, white blood cells immediately rush to the threat. Some eat viruses, bacteria, cancerous cells, and toxins; some recognize allergens; others trigger inflammation or produce antibodies, markers that can tag an alien presence so the body can recognize it in the future. White cells do these jobs frequently and successfully. It is rare to find a description of the immune system that does not resort to military terminology: leukocytes are our army, fighters, defenders, protectors. In the 1966 film Fantastic Voyage, about a trip in a miniaturized submarine through the human body, the antibodies approaching Raquel Welch are the terrifying villains. “Open it!” she screams at her companion standing at the sub hatch. “Before they get here!” Safely inside the sub, the combined might of four grown men can’t remove the antibodies glued to her body. They are indeed terrifying, but they are just
doing their job: to patrol and destroy. But they can’t yet destroy HIV.
* * *
A phone call came in to my desk at a magazine in northern Italy, where from the window I could see green fields and behind them the Dolomites. A clean, fresh view. Nothing wrong with the world. It was sometime in 1998 and the caller was an ex-partner, a young man. His voice was tight. He said, I have herpes and you should get tested and you should also get tested for HIV. My stomach dropped, a sign that my body had diverted blood to my legs and arms away from my gut, in case I needed to run. A sign of fear. I did need to run: I booked a flight to London to get an HIV test, although Italy provided testing. But I was a wounded animal who wanted the safety of home and not Catholic judgment. I invented a family emergency for my manager because how dare I tell the truth? HIV was unspeakable, like death. In 1998 it was the same thing. On the subway journey between the airport and my friend’s house, I remember looking at everyone around me. Someone must have it. Statistics say so. Is it you? Or you? Or me?
I was terrified because I was meant to be. And because so were the authorities. The UK government launched one of the most powerful and successful messaging campaigns in public health history. Anyone who watched TV in 1986 remembers the tombstone ad. Frightening music with spooky clangs. A color scheme of black and gray and sinister. An exploding volcano, then a disembodied pair of hands chiseling at rock, carving the word AIDS on a dark slab. John Hurt narrated, warning us in an eerie baritone of a danger that threatens us all. Anyone can get it, man or woman. “So far it has been confined to small groups, but it’s spreading.” A gravestone rises out of dark mist, then falls back with a crash, as we are told not to die of ignorance, before a bouquet of white lilies is flung on the ground, along with a government pamphlet. On YouTube, someone has uploaded the film with the caption, “This is the ad that scared the fuck out of everyone in the 80s.” The clip was criticized for excessive scaremongering. Actually the filmmakers had originally wanted to start with nuclear sirens, but Margaret Thatcher considered that too much for Cold War times. “If we’d kept it like that,” director Malcolm Gaskin told a newspaper, “I think everyone would have headed for the beaches.”8
