Lifeblood

by Alex Perry

  One of Mugo’s assistants, a man called Sharif, interjects. “The partners’ meeting will be at twelve noon,” he says. “So I heard from UNICEF.”

  “Where did they get this?” asks Mugo. “UNICEF is not supposed to organize my time. It was always supposed to happen at twelve, but since this has happened now . . . Is Akvali here? Is Juma?”

  “She is somewhere around,” replies Sharif.

  “I would like to have a meeting with my staff,” says Mugo to no one in particular, “but since . . . ”

  “They are in the building,” interjects Sharif.

  “ . . . Why don’t we have our meeting?” says Mugo to Chambers. “I see the program has been reorganized. I do not know how. We are not ready for the new program. I suppose the partners keep their meeting, and we keep our meeting, which is almost now, and then we can have our other meeting, and then the press conference.”

  Says Chambers, “We’ll just talk fast.”

  Mugo: “Where is Juma? What’s got Juma?”

  A woman, evidently Elizabeth Juma, Kenya’s malaria control program manager, joins the meeting.

  After a pause, Mugo tries to begin the meeting formally. “First of all,” she says, “thank you for your letter . . . ” Then she interrupts herself. “Do you want some tea? We are not always this disorganized. We are normally more organized. I think we can have a beautiful meeting now. Because if we go to the other meeting, by the time we get there, it will be time to come back again.”

  Mugo takes a deep breath and begins again. “Let me once again welcome you to this office and thank you for your keen interest in the Global Fund. I thank you also for your letter which I received in Addis. The Lancet magazine has confirmed our success, which is extremely encouraging. Also, we talked about the gaps. Last month the news about the Global Fund came—the health meeting here, which I opened, that’s when the news came—and I had the opportunity to appeal to the chair, and they were very accommodating and sympathetic to our situation. Then your letter came, and that strengthened our case much more, and they told us they would give us five million nets through UNICEF—not UNICEF, UNITAID—and this UNITAID is meeting this week. We were with its director in Brazil, George

  . . . George . . . George something. Then this UNICEF is there who are the people getting the nets for us. UNICEF is looking for money for distribution. The World Bank is looking to see if there is money which can be reprogrammed. We had been thinking that there was another million that was going to come, but according to the press here, the Global Fund did not know this one million.” With that, Mugo concludes. “That’s the effort we have been trying to make,” she says.

  Juma mentions that as well as the five million nets from UNITAID (not UNICEF, she corrects her boss), a rejigging of previous grants from the Global Fund should yield money for another 2.4 million nets. In theory, the combination of these two additions should reduce the net gap from 11 million to 3.6 million. “We will probably get one million from the President’s Malaria Initiative and the UK’s DfID,” says Juma. “So now we are missing about 2.6 million,” says Mugo.

  Basu speaks up. “I am quite optimistic about the World Bank,” he says. “There is some room in their allocations to move things around. And the World Bank is very good at coming in and closing gaps.”

  Mugo turns to Chambers. “We definitely need this 2.6 million gap closed. Maybe that should be part of your campaign?”

  Chambers ventures: “There is the hope or expectation that perhaps the government of Kenya would make some effort to help close the gap.”

  Initially Mugo seems to agree. “Yes, endemic countries should help in closing the gap. Yes, we are very committed to malaria.” But then she changes tack. “We have had no real rain for the last three years. It has been drought and famine, there is a food crisis, and [as a result] we have cut money from all the ministries. So I would hesitate to think that malaria is something we can get resources for. I would hesitate to say that we can raise any money for malaria from the Kenyan government.”

  Chambers replies: “I think the government contribution is more symbolic than actual real money. My sense is that, as a businessman and an envoy, even if it was something in the five hundred thousand nets area . . . ” But Mugo still refuses.

  The meeting drags on. Chambers advises that Kenya’s strategy should be twofold. Plan A: appeal the Fund’s rejection of Kenya’s grant application to pay for 11 million nets. Plan B: try to raise the money from other sources in case that fails. To that end, he mentions a “tacit commitment” from Safaricom to fund 1.5 million nets. Mugo muses that the Fund’s five consecutive rejections of Kenya’s applications are bizarre and complains the Fund has not explained its decision. Then tea arrives. “Ah!” says Mugo. “Though I do not know that we can all have tea in here. There is no room . . . ”

  Mugo also wants Chambers to rehearse with her their lines for the press conference later in the day. “We have a very hostile press,” she says. “They must always add things that must sell newspapers. We do not want to create panic. The press knows we did not get the Fund, but they also know we are appealing, so I think we take a softer line. I introduce you. You say, ‘We are concerned, and it shows that the UN takes seriously malaria in Kenya because we are here. We did not get the Global Fund, but together we are making efforts to close that gap, and we are confident we will close the gap.’ You can also say something about your office and the global campaign and that you are happy to be in Kenya because we are doing a lot of work on malaria. Maybe take that line. That you are hopeful. Don’t make people panic.” I look over at the aide called Sharif. He’s not panicking. He’s asleep.

  The meeting ends, and Chambers, Basu, and Castano take an elevator upstairs to a top-floor boardroom where the partners—the NGOs and foreign donors—are waiting. Chambers gives a brief outline of where the global malaria campaign stands and asks to hear what obstacles remain to achieving universal coverage in Kenya. “We really need Kenya to succeed,” he says. “That’s why we’re on the phone and email every day.” He also says that Kenya, as East Africa’s economic powerhouse, should be a place where nets should eventually be sold rather than being given away. “Aid is never something we want to be permanent, something people depend on. It can get you out of a crisis and over the hill, but then the private sector has to make it sustainable.”

  Michael Mills, an economist from the World Bank, says the Global Fund’s rejection, yet again, of Kenya’s application is a deepening crisis. “We’re all worried,” he says. “We don’t know what’s going to happen.” However, it was “a bit of a wake-up call, which is a good thing. We are going through a painful time right now, it’s not an easy time, but sometimes you come out of those stronger. I hope you are right that we can find funding from other sources. It’s going to be a big stretch.”

  The meeting wraps, and it is time for the press conference. The journalists are shown in. Once they have set up their cameras, Mugo kicks things off by introducing all those attending and then declares: “Today is a special day for us at the Ministry of Public Health and Sanitation.” In line with the Global Malaria Action Plan, she says, “the government plans to distribute eleven million nets next year.”

  I glance at Chambers and Basu. There is no change in their expressions.

  “The government of Kenya is committed to improving the health of its people,” continues Mugo, “and Ray Chambers has been very supportive of the Kenyan government’s malaria control program and our vision for a malaria-free future. Ray, we thank you for your tremendous effort and your great concern.”

  Chambers speaks next. “It’s a pleasure to be back in Kenya at such a critical and important time,” he says. “Time is getting short, but I am fairly confident we are going to achieve our targets, and Kenya plays a key role in that. The plan is to distribute eleven million nets next year, and we will see no more of these deaths. This is a disease that has killed fifty million children over time, but also one where we can see lig
ht at the end of the tunnel. If we can put $40 billion back into Africa, what other diseases can be tackled, and what other economic opportunities can evolve?”

  A reporter asks Mugo why Kenya’s application to the Global Fund was rejected.

  “Technical reasons,” she says, “which are being addressed. We are appealing, and we believe we have a good chance of succeeding this time.”

  Another journalist asks whether Kenya will attain universal coverage.

  “We are confident that we will fill the gap,” says Mugo. “If not from the Fund, then from other sources.”

  Chambers chips in. “The application from Kenya was an excellent application. I would have approved it, but it’s not up to me. Even if the appeal does not succeed, we will raise the money to reach universal coverage by December 31, 2010. It’s a little bump in the road that’s occurred because of funding. But we are confident.”

  It’s all too much for me. I walk outside into the corridor. Basu is also getting some air. “How can Mugo say she’s committed to malaria?” I ask. “Half an hour ago, I saw her refuse to put even a single dollar into this.”

  Basu looks at me nonplussed. “What did you think press conferences were about?”

  “I thought they were based on truth,” I say. “I thought most of what was said had some relation to reality, that it was all some spun version of it. I didn’t think people flat-out lied. No journalist would go to press conferences if we thought they were all just fabrication.”

  Basu grimaces. In truth, he finds the spectacle as unpleasant as I do. “Every time I go to a press conference, I feel I need to take a shower,” he confesses.

  “Then again,” says Basu, “Chambers got a result.” “What?” I ask. “The most important line to come out of this is that she said: ‘We will get to the 2010 deadline with or without the Global Fund,’” says Basu. “They’ve never said that before.”

  It’s the Newark model of accountability before the press, I realize. It’s like Uganda too: in a few words, Chambers has found his leverage.

  Basu says he has other good news. Because Kenya is facing a genuine emergency, Michael Mills, the World Bank economist, says Bank rules allow him to take some of the tens of millions of dollars it is meant to spend on a program called TOWA (Total War on HIV/AIDS) and reprogram it—that is, spend it on malaria instead. “They have enough to fill the gap of 2.6 million nets,” he says. “Mills thinks that’s the way to move this the quickest. The money put into TOWA is just not moving as fast as expected.”

  There is one hitch. Bank procedure demands the switch be requested by Kenya’s finance minister, Uhuru Kenyatta, son of Kenya’s founding president Jomo Kenyatta. We are assured of a meeting with Kenyatta at 3 PM.

  Chambers, Basu, Castano, and Mugo arrive at the Finance Ministry at exactly 3 PM. We are shown into Kenyatta’s office. It is empty. Once again, the minutes tick by. Soon half an hour has gone. Then fifty minutes. Even Mugo is becoming embarrassed. “This is not a good day for Kenya,” she says mournfully. Finally somebody manages to raise Kenyatta on his mobile phone.

  Mugo takes the phone first and speaks. “They are saying that you, as minister of finance, will apply to the World Bank, and they will allow you to use this money for the malaria program,” she says. “They will apply for another allocation for AIDS. Mr. Chambers is here, and I will put him on to say hello to you. I have already made your apologies and regretted for you—because we are sitting in your office.”

  Mugo hands the phone to Chambers. He closes his eyes and talks.

  “If you can reallocate some of the slow-moving funds from HIV/AIDS over to malaria, then the World Bank will replenish the HIV/AIDS money,” he says. “It would really help to close that gap, so that you can live up to the commitment of universal coverage at the end of next year.”

  “Yes . . . ”

  “Right . . . ”

  “That would be wonderful. It’s clear you understand the whole situation, including the importance of covering this gap so that you do not regress and have children who have been covered no longer being covered.”

  “Right . . . ”

  “Yes . . . ”

  “I agree with you. We are proud of the progress Kenya has made. This reallocation would seem to be the most painless way to do this.”

  “That’s great . . . ”

  “I agree with you, Minister. It seems like the most elegant solution at a very important time.”

  “Yes . . . ”

  “Thank you for this time on the phone. Sorry I could not meet you. My sense is that we will meet soon. Thank you, Honorable Minister, and I look forward to meeting you.”

  Chambers hands the phone back to Mugo. “He said we should move it to malaria because otherwise the World Bank will just move it to another country.”

  Chambers makes for the door, then turns back to Mugo. “A lot of people have talked about how Kenya is going to get close, and maybe we are going to get there in the first quarter or the second quarter of 2011,” he says. “That’s unacceptable. Let’s turn up the burners. Let’s turn up the heat. Let’s get this done. I am so pleased with the progress we made here today. Let’s keep it moving forward.”

  I ride the lift down to the basement with Basu. In minutes, Chambers and Basu will be heading back to the airport. I remark on the astonishing turnaround: from humanitarian crisis to apparent solution in a single day. “That’s what Ray does,” replies Basu. “No one can wheeler-deal like Ray.” His phone buzzes. Basu fishes it out of his pocket and opens it. “It’s a text from Alan in the DRC,” he says. “Ray was right not to come. Kabila’s not even in the country. Nobody knows where he is.” Basu sighs. “Like I said: one crisis after another.”

  CHAPTER 11

  The Heart of Illness

  I knew the DRC. As a twenty-year-old backpacker, I’d spent two months in 1990 trying to reach a remote jungle river in the northeast of what was then Zaire, down which I planned to canoe in a dugout with a couple of friends. We spent a month crossing a few hundred miles of jungle on the backs of trucks, made it to the river, and bought our pirogue—but after a week or so, we abandoned the expedition. The heat was crushing, the swarms of little black flies were murderous, there were crocodiles in the water, the jungle was impenetrable and offered little to see, and the pirogue was no good—only half-finished, we realized, too heavy to paddle at more than a crawl, and leaking.

  The DRC had become a lot more difficult since. On several return trips since arriving in Africa in 2006, I’d seen ethnic militias and the Congolese army rampage across the east of the country, raping, looting, and executing anyone who got in their way. I’d explored the crumbling, sweltering capital of Kinshasa, impossibly crowded by day and a dangerous, dingy place at night. Outside Kinshasa, there were still very few roads. Mobutu Sese Seko, the dictator who ruled Zaire for more than thirty years, chartering the Concorde and drinking champagne while millions of his people endured disease and poverty, was gone. But he had been overthrown by a guerrilla leader, Laurent Kabila, who had proved just as autocratic and corrupt and whose assassination in 2001 had ushered into power his shy and inexperienced young son, Joseph. From 1998 to 2005, the country had been at war with itself in a conflict that sucked in armies from nine of its neighbors. The fighting killed tens of thousands, and the resulting hunger and disease killed millions more.

  Even veteran Africa correspondents considered the DRC “hard-core.” Lots of men with guns, few of them friendly, many fighting for control of the DRC’s mineral wealth—copper, gold, diamonds, oil, cassiterite—which was often extracted by slave labor. Journalists died in the DRC. So did dreams and, it sometimes seemed, humanity. The country was littered with abandoned palm and rubber plantations and crumbling missionary outposts. Grand plans to light up Africa with hydropower from the Congo River had stayed on the drawing boards for decades. Rape was the weapon of choice for the eastern militias, the Congolese army, and sometimes even UN peacekeepers. The riches in the ground attracted t
he worst type of business. There was a threat of bloodshed from the moment you arrived. In the east, you came across the militias the day you crossed the border. Flying into Kinshasa airport in the west in 2008, I picked up my bag to find it soaked with blood leaking from sacks of bushmeat spinning out on the carousel.

  The DRC was Chambers’s most daunting challenge. Thousands of miles of jungle, tens of millions of people, with nothing connecting them but footpaths and rivers. This was the route—by barge, dugout, bicycle, and finally porters—down which thirty-two million bed nets would have to travel. In 2008, I’d experienced one of the more remote areas of the DRC’s interior while on assignment to observe the creation of a new wildlife sanctuary for the bonobo, a cousin of the chimpanzee. I’d traveled to central DRC with a group of primatologists by a tiny private charter plane. After several hours flying over unbroken jungle, we touched down on a grass strip from where the only car around—a wrecked, doorless jeep—had taken us for three days down a bicycle track to the bonobos. After a few days, the plane’s pilot, who had promised to pick us up, radioed to say that the country had run out of aviation fuel and he was unable to fly. We eventually made it out by tying three dugouts together, strapping an outboard to the back of one, and coasting for six days downriver until we reached a town with an airport. The whole trip cost several thousand dollars.

  All that to visit one place. Chambers’s campaign had to get everywhere in the DRC—because malaria was everywhere. The DRC government estimated its people suffered between sixty and one hundred million cases of the disease a year, which resulted in a hundred eighty thousand deaths. Out of all child deaths, 39 percent were from malaria. Dr. Benjamin Atua Matindii, head of the DRC’s malaria program, told me in June 2009 that just 10 percent of children with malaria and 7 percent of pregnant women received treatment, while bed-net coverage was 6 percent for children under five and 7 percent for pregnant women.