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African Sun

John Atkinson

    02/08/05. The expiry date stamped on the faded white box of the Combivir was over three years ago. Dr. Higgins didn’t bat an eyelid as he handed it over to the emaciated, faceless blur in front of him. He gestured the figure out of the way, not registering sex, age or the desperation that raged in her eyes. “Next.” he called, past her to the crowd. Africa was like that; expiry dates mean nothing when the dated product is all that is available. And the individual is nothing compared to the constant mass of people; the feverish press of bony hands that clutch almost useless grey boxes to their chests. Africa strips your compassion, there is simply no room for it amongst the dust, the sun and the haze of bodies that every day clamour for the cast off medication, so generously ‘given’ by the companies who cannot legally keep it on their shelves.
    “Next, next.” He had barely even glanced at his clipboard of names, the guards patrolling the queue would turn back those who have no place here. He took a moment to glance down at the pile of boxes before him. The faded blue logo of PharmaGlobe hovering above prescription information that half of these patients couldn’t read or follow. He passed the box to the waiting hand and picked up another. The figure before him was a young woman, carrying a child. “HIV positive?” he asked her. She nodded. “The child?” She nodded again. “I can’t give these drugs to children, do you understand? I’m sorry, I can’t give them to you.” The woman stared at him for a moment before reaching for the box in his hands. “No,” he repeated, shaking his head for emphasis. “Not for the child.” He gestured at her baby, “I can’t give them to children.” The woman was looking at him, shaking her head and reaching for the box. “No. I’m sorry.” She didn’t understand, even when the guards dragged her away she screamed her incomprehension back at him. “I’m sorry,” he called after her. “Are you?” Dr. Malek’s lilting accent enquired. Higgins turned to his habitually silent partner at the desk in the middle of the dusty, dirty town that, in turn, was in the middle of the desert. “No. No I’m not. How can I be? We turn a hundred people away a day, people not on our list, people who are too far gone, people like her who would share and run out and end up worse. I can’t care for any of them and even the at the clinic it feels like we are wasting our time.” Malek looked over his wire framed, round glasses and blew a plume of cigarette smoke out before answering. “You’ve been here what? Five months? I’ve been here for three. Fucking. Years. It doesn’t get easier, it just gets... normal. What’s wrong with the clinic?” “Side effects,” Higgins replied. “Too many and too dangerous, especially in HIV patients.” “Don’t worry about it,” replied Malek. “PharmaGlobe has a good track record of, how to put it? Overcoming obstacles.” “Yeah, so I’ve heard. Is that true though or just rumour? How could they get away with it?”
    “My friend, this is Africa,” said Malek. “You can get away with anything here.”

**


    The dull green screens blocked Farouq Bulakwal’s view of the rest of the infirmary. For seven days now he had been surrounded by green screens, white coats, silver needles and the dark red of venous blood. He had learnt to identify the doctors assigned to him by the sound of their approach. Dr. Winston had a confident stride and thick soled shoes that clicked on the tiled floor. Dr. Higgins, on the other hand, seemed to scurry; his feet making scuffling and tinny sounds. But it was neither of these treads that approached him as he lay dying in the stifling, stinking hut that passed for an infirmary in Malawi. The steps that approached him were soft and slow; steady. They came to a halt at the edge of the screen and the smiling, slightly sad-looking, face of Nurse Saada appeared before the rest of her squeezed through the tiny gap in the screens.
    Saada looked down at Farouq’s ashen face; his brow covered in beads of sweat and his lips twisted into a grimace of pain and anger. He couldn’t seem to comprehend how tightly the tuberculosis had him in its grip. She mopped his face with a cool, wet towel and spoke to him as he lay motionless and perspiring in the bed. She spoke to him as she worked; reassurances and promises that could never be kept, not with the disease coursing through his veins.
    Slowly she withdrew the IV needle from the catheter on Farouq’s arm. The hanging bag of ST-1067836/Saline-0.25mM/litre was nearly empty. She replaced it with another bag, bearing the signatures of both Dr. Higgins and the trial leader Professor Burns. Nurse Saada didn’t know a lot about ST-1067836, patented under then name Cyclosporadulin, but she did know that it wasn’t doing Mr. Bulakwal any good at all. She slid the needle back into his arm, resolving to speak to Dr. Higgins about the effects of the drug and the possible consequences of its use. As soon as the needle was replaced Nurse Saada left, there was nothing more she could do for Farouq; only wait and hope the trial was a success.
    Throughout his brief encounter with Nurse Saada, Farouq Bulakwal had been fully cognitive and fully aware of his surroundings. He remained, however, totally unable to move.

**


    The white skin of Dr. Higgins’s arm contrasted sharply with the black neck it was curled around. The post coital smile of Nurse Saada didn’t last long on her face. She turned to face Dr. Higgins and spoke frankly. “The Cyclosporadulin you and Burns are giving to the patients in the clinic.” Higgins groaned and rolled away from her. “Not that again Sa, you know I shouldn’t have told you anything about it in the first place.” “You said it was a drug to treat TB yes?” Higgins sighed, rolled back and propped himself up on one elbow. “Yes,” he replied. “A new TB treatment drug from PharmaGlobe.” “Why is it that some of the patients are getting better and some are getting worse? I was treating Mr Bulakwal today and he seems to be completely catatonic. He was fine before you started dripping that crap into him.” “Fine?” Dr. Higgins was incredulous. “He was dying of TB for God’s sake!” “You know what I mean, he could move and speak and everything, and now he can’t.” “Well that is one of the side-effects that Professor Burns and I are investigating.” “Side-effects? For fuck’s sake Timothy, are you telling me that this drug hasn’t even undergone clinical trials?”
    Timothy Higgins gave her a long look. “What, in Christ’s name, do you think we are doing at the clinic!” “That’s illegal! You can’t administer drugs to patients without trials! Those patients haven’t even signed papers to acknowledge the trial. They know nothing, the nurses know nothing and you and Burns strut around handing out life and death! That drug is killing my patients Tim!” “Alright, alright already. I’ll talk to Burns about it, see if we can finish the trial early. God knows some of these patients are never going to get better.”

**


    Farouq Bulakwal lay in green-screened slumber in the hot humidity of the clinic. He stirred as he heard the footsteps approaching; the quick clicks of Burns and the timid shuffle of Higgins. He heard their raised voices grow louder as they neared his bed. The two men squeezed through the gap in the screens and stood over Farouq’s bed, looking down upon him like the harbingers of death that they were.
    “Look at him Dan, I mean look at him.” Farouq lay emaciated on a filthy sheet. A slow trickle of blood leaked from his mouth and his eyes flickered open and closed, unfocused and yellow with fever. “Yeah, look around you Tim. Everyone here looks like shit.” “But he was getting better. The Nurse here, Saada, said that before we started giving him Cyclosporadulin he was responding to the treatment he was on. Now look at him; catatonic, feverish, oral and nasal haemorrhage.”
    “HIV positive?” Burns knew the answer before he even asked. “Yes,” came the reply. “The same as all the rest.” Higgins wiped his brow and looked again at the hopeless man and shuddered out a sighing breath. “I’ll start looking for a non-HIV patient to replace him in the trial. And I’ll think of something to tell Saada.” “See that you do,” replied Burns. “There is a lot of money in developing this treatment. PharmaGlobe seem to think a TB pandemic is imminent and their head start on the competition could spell big money for all involved.” He looked pointedly at Higgins to insure his point had been taken before turning on his heel and leaving.

**


    The next day when Saada slipped through the gap in the screens she thought, momentarily, that a miracle had occurred. The man in Farouq’s bed was sitting up and eating the clinic’s morning meal of bread and bouilli. It was only when Saada realised that the man in Farouq’s bed was not Farouq that she began to shout for Higgins, for Burns, for anyone. The bed’s new occupant seemed perplexed by the reaction of his nurse, but happily resumed his breakfast once she had been removed from the clinic. The bag attached to his IV-drip feeding ST-1067836 into his veins. His TB was at an early phase, recently detected and easy to treat. He made the perfect replacement for the dead Farouq, and no-one would even know. This patient had been fully screened and blood-tested; there was no chance of this one dropping dead in the middle of the trial.

**


    By the time Dr. Higgins had caught up with Saada he thought she would have calmed down. In actual fact, she had whipped herself into a frenzy. “I couldn’t tell you,” were his first words to her. “They don’t know about us, and even if they did I can’t tell anyone about the trials we’re doing in the clinic. Do you have any idea how much money is at stake here? And this is Africa Saada, no one keeps track of things here. It’d be so easy for them to just make us disappear if they had even the slightest inkling that I’d told you anything about the drug or the trial.”
    She stared at him, aghast for a moment. “I don’t care about your fucking trial! What did you do to Farouq? Why is there another man in his bed and absolutely no record of Farouq Bulakwal ever having been in our clinic? Answer me! What did you do with him?” It was Higgins’ turn to look aghast at the woman stood across from him. “That’s the whole point!” he cried. “He was part of the trial! A vital part. This fucking treatment works fine on healthy people, TB remission in 3 months, far faster than rifampicin and no side-effects. No side-effects they told us! Not if you don’t count an actual <>Iacceleration of the disease in HIV positive patients as a side-effect. Their lungs turn solid almost overnight, they become virtually paralysed, their soft tissues start to haemorrhage and they quickly lose all cognitive ability.” Saada’s mouth was hanging open. “You know all this? You and Burns, that’s what you’ve been testing? So what Farouq died and you just wrote it down on your little clipboard and wheeled him down to the morgue?”
    Higgins had, at least, the grace to look ashamed. “I’m afraid not. PharmaGlobe need this drug. They’re on the brink you see; share prices going down, pressure from the board. They told us ‘no side-effects’.” “So what are you telling me?” Saada asked, incredulous. “The trials are a fucking fix?” “Yes. We had to remove Mr. Bulakwal from the trial and replace him with a non-HIV positive patient. One for whom we can note down ‘no side-effects’. PharmaGlobe need this Saada, and they are paying big for it. We can’t afford for this trial to go downhill and neither can PharmaGlobe, they’ll do anything to push this drug through. Anything.”

**


    Burns blew out a mouthful of cigarette smoke in frustration. The voice on the other end of the telephone was speaking gibberish. Higgins? Higgins was a good man, a little shy and nervous sure but essentially a good man and a good doctor. Maybe that was the problem. “Listen,” Burns interrupted the voice. “I simply don’t believe it. Higgins would never get caught up in something like this. He’s as passionate about this project as I am.” The tinny voice from PharmaGlobe spoke again, sweeping away any doubts Burns may have had. “Well of course it wasn’t me! I don’t understand it! Higgins never seemed the sort of guy to talk to the press about something like this. No. No, of course it wasn’t me. I’ll try to find him. What do you mean ‘not necessary’?” The line went dead with a faint click.
     “Shit,” said Burns, slamming the telephone back into it’s cradle.

**


    “The press? You spoke to the fucking papers about this?” Higgins was livid, since he had told Saada the bitter truths of the clinical trial she had insisted they make a run for it. He wasn’t convinced it was a good idea but she had threatened to go without him and he couldn’t allow her to go off on her own with the knowledge he’d given her. Plus he liked her and felt a protective desire to keep her safe. “I wanted to keep you safe,” he roared. “I was trying to look after you and you go and do something like this? Only Burns and I knew the details of that trial. All PharmaGlobe need to do is call Burns, find out I’m missing and they’ll know I told someone. How could you be so stupid?”
    “Stupid? Me Stupid? It is illegal Tim! What you and Burns and the drugs companies are doing in Africa is illegal. I’ve watched the West take and take from Africa for years, always thinking that there was nothing I could do to change it, nothing I could do to hit back at them. At you! Well now I have. I don’t care if they kill me for it, I don’t care as long as the world knows. As long as people know and people make it stop.”
    “And what about me Saada?” There were tears in Higgins’ words. “Don’t you care what they’ll do to me?”
    She looked him in the eyes, the pale blue eyes she had once thought so dreamy, but now flickered with cowardice. “You. You were responsible for the deaths of all those people in the clinic. Men, women, all of them. All you will get for this is what you deserve. Goodbye, Higgins.”
    Higgins sank to his knees, the tears already spilling down his cheeks. He was still there, weeping under the African sun, when the black Land-rovers arrived an hour later.

**


    “Yes,” said Burns to the tinny voice from PharmaGlobe. “Yes, as you say. Oh yes, Dr. Malek has settled in just fine, yes. Helping to finalise the results. So, got her as well then? And the reporter? Lucky break for you guys then eh? No, I know. No, certainly not. Yes, report’ll be on your desk in the morning. No, Sir. Goodbye.”



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