by Alex Perry
Table of Contents
Lifeblood
Title Page
Dedication
Preface
CHAPTER 1 - Great Lake of Disease
CHAPTER 2 - Original Sickness
CHAPTER 3 - The Selfish Philanthropist
CHAPTER 4 - Aiding Who?
CHAPTER 5 - The Business of Caring
CHAPTER 6 - Levers of Power
CHAPTER 7 - Global Network
CHAPTER 8 - Gil and Belinda
CHAPTER 9 - A Big Player
CHAPTER 10 - Committed
CHAPTER 11 - The Heart of Illness
CHAPTER 12 - Buzz
CHAPTER 13 - Trade Not Aid
CHAPTER 14 - Countless
CHAPTER 15 - Fine and Fair
Acknowledgements
Notes
Index
Copyright Page
Lifeblood
In 2006, Wall Street wizard and philanthropist Ray Chambers flicked through some holiday snapshots taken by his friend, development economist Jeffrey Sachs, and remarked on the placid beauty of a group of sleeping Malawian children.
“They’re not sleeping,” Sachs told Chambers.
“They’re in malarious comas.” A few days later, they were all dead.
So begins Chambers’s race to eradicate a disease that has haunted humankind since Hippocrates, still infects half a billion people a year, and kills a million of them. The campaign draws in presidents, celebrities, scientists, and billions of dollars and becomes a stunning success, saving millions of lives and propelling Africa toward prosperity. By drawing heavily on business, Chambers also reinvents foreign aid, showing how helping can be both efficient and in all our interests.
As he follows two years of the campaign, awardwinning journalist Alex Perry takes the reader across the globe, from a terrifying visit to the most malarious town on earth to the White House, from the forests of the Democratic Republic of Congo to soccer’s World Cup. In Lifeblood, Perry weaves together science and history with on-the-ground reporting and a searing exposé of aid as he documents Chambers’s frenetic campaign. The result is an incisive and often surprising portrait of modern Africa, a story of revolution in aid and development, and a thrilling and all-too-rare tale of humanitarian triumph, with profound implications for how to build a better world.
For Tess
They sprayed and sprayed till their eyes got sore
Then they refilled their machines and sprayed some more.
They worked most of the whole night through.
Killing mosquitoes for me and for you.
Their labors resulted in great success.
Of every one hundred mosquitoes, there were ninety-nine less.
But they were mocked and they were scorned,
Their heads with criticism were adorned.
What could be the problem then?
That such reward befell these men?
This answer is simple as numbers can be.
And the calculations reveal for all to see.
That if ninety-nine percent of one billion are slain.
Ten million of the devils still remain.
—Matt Yates
President, American Mosquito Control Association
Malaria-free countries and malaria-endemic countries in phase of control*, pre-elimination, elimination and prevention of reintroduction, end 2008
Preface
Does aid work? As a journalist working in the developing world—for three years in the Far East, five years in India, and now four more in Africa—I spend a lot of time trying to answer that question, and many hours sifting press releases from aid groups claiming heroic progress. I first heard about the malaria campaign in the usual way: an April 2009 email from a London PR executive, Rebecca Ladbury, asking whether I would be interested in writing about the launch of a new charity, Malaria No More UK. Ladbury explained the group had been jointly founded by “Wall Street pioneer Ray Chambers, now UN Special Envoy for Malaria” and Peter Chernin, then president of News Corporation. Chambers and Chernin had “decided to apply their private sector expertise and considerable networks to tackle the world’s biggest solvable health crisis.” After founding Malaria No More in the United States in 2006, they were broadening their scope, launching a British branch at a conference, held at Wilton Park in southern England, on malaria and efforts to fight it. The event was bringing together experts on the disease from all over the world.
The phrase “solvable health crisis” stood out. That meant, presumably, that Chambers and Chernin aimed to end malaria. Sure enough, the email went on to say that the two were part of a campaign that wanted “to end malaria deaths in our lifetime.” I called Ladbury.
“Let me make sure I’ve got this right,” I said. “Your clients are trying to kill malaria?”
“Right,” said Ladbury.
“That would save millions of lives,” I said. “It would be about the single biggest boost to health and development the world has ever seen. It would be astounding.”
“Right,” repeated Ladbury, a little impatiently. “Do you want me to set up some interviews?”
I did. The ambition was breathtaking. Malaria was one of the world’s biggest diseases. It affected half the planet and killed a million people a year. But over the next three days, as Ladbury dragged ever more delegates to the telephone at Wilton Park to speak to me, I realized it wasn’t just the campaign’s aspiration that set it apart. There were religious leaders at Wilton Park. African health ministers. A smattering of celebrities. Business in particular appeared to be playing a central role: many of the people I was speaking to were senior managers at the world’s biggest corporations and talked about running their campaign as though it were a business.
When eventually I spoke to Chambers, he described fighting malaria in terms of efficiency, investment, and returns. His focus was to be “as aggressive as possible to bring deaths as close to zero as possible.” This was as much about “economic cost” as “humanitarian cost,” he added. “Malaria costs Africa $30–$40 billion each year,” he said. “Fixing it is in everyone’s interest.” The key to that, he added, was a universal, global distribution of bed nets treated with insecticide. “When the mosquito lands on the net, she dies. In areas where we have completed net distributions, deaths go down to zero. We can prevent this disease. This is the greatest opportunity any of us will have in our lifetimes. It’s outstanding. And it’s doable.”
Aid types normally didn’t use words like “aggressive” or “opportunity” or even, much, “doable.” Malaria was traditionally viewed as a humanitarian concern. Chambers saw it equally as an economic one. My curiosity was piqued. And in the months that followed, I set out to track the campaign. I wanted to plot not only its progress but also its innovations. At first, I was simply pursuing a journalist’s hunch that this was a big story. Later, I was able to say why: it opened the door to a new way of aid.
Aid and development are increasingly mired in scandals over inefficiency and corruption, fueling a debate about whether such external assistance does any good at all. The malaria campaign was different in its fresh thinking, particularly the way in which it drew heavily from business. Its results were unusual too: Chambers said malaria was down by two-thirds in Zambia, by 60 percent in Rwanda, by half in Ethiopia, and by close to 100 percent on the Tanzanian island of Zanzibar. And as the months and years passed, during which I watched Chambers go to work in funding forums and aid conferences, and African hospitals and villages, I realized his campaign offered something extraordinary to the aid world: reinvention, even salvation.
There are thousands of people trying to defeat malaria, and it would take a very long book to mention them all. I am also aware that others involved in the work may feel, quite reasonab
ly, that by focusing on Chambers and the group around him, I am denying them their due credit in the pages that follow. So let me be clear: this is not an attempt to document the entirety of the global campaign to kill malaria. Rather, this book tells the story of a small group of people who found themselves at the center of that campaign, whose new ideas and energy were crucial to its remarkable success, and who, I believe, have much to teach us about effective aid. By singling out Chambers and his team, however, I have no wish to downplay the role of others, and any offense is unintentional.
But my initial instinct turned out to be right. Chambers’s story is exceptional, with lessons not just for the aid world, but for all of us. Like an infinite army of tiny vampires, mosquitoes were killing close to a million people a year across Africa. And in days lost to fever, and money wasted on medicine that otherwise might have bought a mobile phone or seeds or an education, mosquitoes were taking a giant financial bite out of Africa too, making it dependent on Western charity. Fixing malaria would save lives, but it would save money as well, in Africa and the West. In the beginning, I was planning a story about blood-borne disease and Africans. By the end, I had something much more: a tale about Africa’s lifeblood.
CHAPTER 1
Great Lake of Disease
To reach the most malarious place on earth, head north from Kampala, cross the Victoria Nile at Karuma Falls, and just before you come to the refugee camps that mark the southern edge of Uganda’s twenty-year civil war, bear right into the vast swamps on the western edge of Lake Kwania. Unlike Africa’s other Great Lakes, known for their fresh water beaches and cool evenings, Kwania is a poor place to live. It is wide, stretching sixty miles from its eastern end to the rocky sluice at its western tip, through which it pours into the White Nile. But it is shallow, generally no more than waist-deep, and choked with lilies, papyrus, and water hyacinth, and it has no shoreline: the point where land and water meet is lost in miles of ponds and creeks that resemble ten thousand silver fish bones from the air. Swamps are bad for farming and even worse for fishing. Kwania’s miserly depth means even miles out in the open water, the shallow floor can kick up breakers big enough to flip a dugout. And Kwania is full of crocodiles.
Worse danger lurks on land. Kwania’s warm, stagnant creeks combine all the conditions guaranteed to sustain an everlasting epidemic of malaria. On the lake’s northern edge, the town of Apac turns out to be a particularly good place to culture the malaria parasite: no nearby big cities with public health programs, plus a dense population of warm-blooded creatures on the few pieces of dry land, which form an all but inexhaustible blood bank in which to breed and multiply. Apac also has ideal conditions for propagating malaria’s carrier, the mosquito: a consistent equatorial climate of heat and rain, no high mountains to attract snow, and just enough of a breeze off Kwania on which to float a billion bugs. The area is a favorite of one of the deadliest subspecies of mosquito, Anopheles funestus. Over millions of years, the funestus has evolved into a bloodsucker that feeds almost exclusively on humans. Its appetite is voracious. Researchers in Apac have found each funestus fly will bite human flesh around a hundred ninety times a night.1
My interest in Apac has been growing since early 2009, when I first began following the new campaign to wipe malaria off the planet. Malaria is our oldest and most widespread disease, almost as old as life itself and far older than humankind. For all our sophistication, more than three billion people still lived with it, every year five hundred million were catching it, and nearly a million were dying from it. It seemed unlikely that a disease so mature and widespread could have retained a center. And yet here in Africa’s Rift Valley, where humans first walked out onto the savannah, it had. A trip to Apac seemed like a journey to confront an ancient curse: not Original Sin, certainly, but perhaps Original Sickness. Moreover, if I wanted to know why killing malaria was important and how hard it might be, it seemed a good idea to see how bad it could get. The toxicity was unimaginable. I had tried to imagine living in a place where the average person is bitten tens of thousands of times a year by mosquitoes, of which 1,586—4 bites a day—resulted in infection by malaria,2 but I couldn’t. So in August 2009, I visited Apac.
Research into malaria had already taken me from Cambodia to the Democratic Republic of Congo (DRC), from Zanzibar to Zambia to Zimbabwe. Along the way I had developed a rule of thumb to gauge my chances of being infected. Malaria is a particularly bad risk, it turned out, in places beginning with a K. In Africa, there was Kigali, Kibuye, Kivu, Kinshasa, Kisangani, Kisumu, Kilifi, Kampala, and Karonga on the western shore of Lake Malawi, where in a month’s time South African scientists would discover a new type of funestus. In Asia, there was Khe Sanh, where US marines found the disease as deadly as the Vietcong in a seventy-seven-day siege during the Tet offensive in 1968; the Burmese hills of the Kayah, Kachin, and Karen, where cerebral malaria is particularly bad; and the Khmer heartland on the Thai-Cambodia border, whose forests have twice turned medicine upside down by producing drug-resistant strains of the parasite. So it was with some foreboding that on studying a map I realized the road to Apac took me from Kampala to Kigumba, onto Karuma via Kitwanga, before turning right on the dirt road to Kwania.
Since I arrive in Apac in the late afternoon, my priority should be finding a netted room. But as I enter the town, I am distracted by a naked man lumbering toward me. He makes no attempt to cover himself and gives no indication he knows he is exposed. He is tall, thin, and filthy. His skin is gray with dust and his ragged hair sprinkled with twigs and dry grass. You might expect a naked man to attract a crowd, but there is no one else around. I approach the man slowly in my car and edge around him. He is talking to someone only he can see. He doesn’t appear to register me.
I am still watching him in my rearview mirror when a second naked figure lurches out from a side street. Aside from a torn yellowed cloth slung over his shoulder, the second man looks identical to the first. The same emaciated frame, the same raw and cracked skin at the knees and elbows. Spittle stretches between his dry lips as he mouths his own unintelligible mantra. Ahead, I can make out a third naked figure, sitting in the dust by the side of the road, holding his head in his hands. I keep driving. The third man groans as I pass. I can’t shake the thought that I’ve arrived in a town of zombies.
I decide to stay in the car until I have a better grip on what’s going on. In five minutes, I have covered every street in Apac. The town consists of the main road on which I entered, three parallel roads of several hundred yards, and a handful of cross alleys. Aside from the three naked men, I haven’t seen a soul. Eventually I find myself outside a building whose sign announces it is the district headquarters of the health ministry. I pull into the empty car lot, walk in through the entrance, and find my way down a dark corridor to a door marked “District Health Officer.” I knock. A voice asks me to enter.
Behind two sets of fly screens and under a ceiling fan, Dr. Matthew Emer is at his desk. I introduce myself and explain my interest in malaria. Dr. Emer offers me a seat and a glass of water, and asks how he can help.
Who are the naked men wandering around outside? What are they?
“Brain damage,” Dr. Emer replies. “Severe malaria can do that to a baby. You never recover.”3
Dr. Emer thinks I should see some statistics. The district of Apac has a population of 515,500. Between July 2008 and June 2009, 124,538 people sought treatment for malaria. I note the figure of 124,538 includes 58,632 children below the age of five. Malaria targets the very young, whose immunity has not had a chance to build, and the pregnant, whose immunity drops away so that the fetus is not flooded with adult-strength antibodies.
Dr. Emer pulls out a bar chart showing that his staff deals with around 3,000 cases of malaria a week, rising to 5,000 in the worst weeks. The 2008–2009 numbers, I note, are actually an improvement on the previous year. Then 148,082 people were diagnosed with malaria, of whom 67,281 were children under five. That means that in 2007–200
8, 7 out of every 10 small children in Apac contracted malaria.
Over the next three days, I learn how Dr. Emer’s staff is underfunded, underpaid, undersupplied with out-of-date drugs, and undertrained on how to use them. For now, Dr. Emer feels it enough to mention the chronic understaffing. He has just three of the seven doctors he needs for his hospital, and he is missing a third of the nurses and assistants he requires for his thirty-seven clinics.
What does so much disease do to a place? Dr. Emer explains that contracting malaria is often just the beginning of someone’s troubles. Malaria might kill you. But if it doesn’t, it is generally the start of a long cycle of illness and poverty. “Because kids get malaria, there is a lot of absence from school,” he says. “So our kids don’t do well. So they don’t get good jobs, and they don’t earn money. Then they have children, who also get sick, and the parents have to spend their little money on them instead of spending it on schools or other things—and they also have to stay home to look after them, so they lose more money. Malaria keeps us poor.” And if malaria breeds poverty, poverty boosts malaria. “Say every house has five children, and each child has five to ten episodes of malaria a year,” says Dr. Emer. “And Coartem [the malaria cure] costs $8 to $10. That’s up to $500 a year for someone who earns $1 a day or less.”
Dr. Emer watches me jot down the figures in my notepad.
“That doesn’t add up,” I say, finally.
“It doesn’t add up,” repeats Dr. Emer.
“What happens to the children whose parents can’t afford Coartem?” I ask.
“They die,” replies Dr. Emer.
“Do people accept this?” I ask. “That malaria will inevitably kill some of their children?”
For a moment, I think Dr. Emer is going to hit me. Then he says, tightly: “People do not accept it. Something kills your child, this is not something that can be accepted. They are always asking for bed nets. They are always asking us, ‘When are you going to spray?’ When Kampala sends us Coartem, we finish it in one day.”
