TWENTY-SIX HUNDRED AND SEVENTY-THREE miles away, in the Republic of Sundiata, Dr. Sandra Oku gazed numbly through her dusty windshield at the late afternoon light in the baobab trees, the fields of bell peppers and potatoes and cassava, and the devastation that had come to her village overnight.
Dr. Oku was the only health-care worker in the tiny village of Kaarta, in the Kuseyo Valley. Designated a “district medical officer,” she provided antiretroviral drugs to the farmers and villagers when they became available and tried to help anyone else who walked through her door—mothers and children, mostly, suffering from chronic diarrhea or skin infections or malnutrition. Many she couldn’t help and sent to the hospital in Tihka.
She was a long-limbed, graceful woman, with large, perceptive eyes and thick hair she braided and clasped back every morning. Until that day, she had been living her life in Kaarta with a dream—the sort of dream that most of the villagers could not afford. After the rainy season, she had planned to travel nearly a thousand miles to visit a man she had not seen in months—seven months next week, to be precise. A man she had met in medical school and with whom she expected eventually to share her life. But there was no room in her thoughts anymore for dreams; real life had suddenly closed in.
Dr. Oku’s most important work wasn’t distributing medicines; it was teaching preventive methods so the villagers wouldn’t need them. Some afternoons, she closed the clinic and drove her old pick-up into town to counsel the laborers and subsistence farm workers, and to distribute condoms to the nomadic women who worked the roadhouse along the lorry route. The women turned their backs when they saw her approaching, because they did not want to be educated, or even noticed. They wanted something else, something she couldn’t give them. Nearly 20 percent of the villagers were HIV-positive, Sandra Oku estimated, and many of them gathered at the truck stop whenever the faith healers showed up to hawk their healing potions. Over the past year, conditions had worsened in Kaarta. Water was scarce, and some residents had taken to fetching it from streams contaminated with untreated excrement. Since the revolution last year—when the Sundiata military chief had taken over the government of Maurice Kasuva—the central government’s health ministry had made it more difficult for the rural pharmacies and health clinics to get medicines.
Hers was a tiny clinic with just four beds. Twelve-volt automobile batteries powered the electrical equipment; the lights were run by kerosene. Scalpel blades, syringes, and needles were more often sterilized and reused than replaced. She had to make do with what she had and send the serious cases on to Tihka.
Dr. Oku awoke just before sunrise each morning, walked out back, kneeled in the dirt, and prayed for the people of her village. Some of them had come to depend on her, although they tried not to bother her after the clinic closed at sundown, because the clinic building was also where Sandra Oku lived. Some mornings, several of them would be sitting in the grass out front, waiting for her to unlatch the screen door.
This day, though, had been different. Something strange had arrived in Kaarta overnight. Something she had never seen before in her thirty-seven years. It began, for her, before dawn, when she had been awakened by an urgent knocking on the clinic’s back door.
“Please, please, will you come see?” A woman’s voice, speaking breathlessly, in Swahili. “Dr. Sandra! Can you come help? Please. I can’t wake him.”
Sandra Oku pulled on a sleeveless night dress and unlatched the door, pointing her flashlight at the ground. The eyes of Mrs. Makere, a farmer’s wife who lived across the dirt fields to the southeast, met hers with pleading urgency. Dew still glistened on the ground and in the baobab trees in the moonlight.
“What is it?”
“He won’t wake up. Nothing will wake him.”
“Your husband?”
“Yes. Please.”
“Okay. Let’s go see.”
Dr. Oku grabbed her bag and walked barefoot into the cool morning to her pick-up truck. It turned over after a reluctant whir-whir-whir sound. They rode together in silence, nearly a kilometer across the open plain to a cluster of mud homes where the Makeres and other farm workers lived—the route Nancy Makere must have just walked.
Like the others, theirs was a small, square-ish, mud-brick house, reinforced with sticks and cardboard and plastic bags. A pink light hung in the sky above the rusted tin roof as they arrived. The breeze smelled of wood smoke.
Joseph Makere, a large, gray-bearded man known to work ten or eleven hours a day harvesting soybeans this time of year, was asleep on a mattress in a corner room, as his wife had said. An open window faced the lorry route and the small produce stand Nancy Makere ran.
“There,” she said.
The two women watched him, inhaling and exhaling beneath a white sheet, as if struggling for air, his eyes closed. It was an eerie sound, one Sandra Oku had heard once years before—the sound of a man about to drown in his own lung fluids.
Dr. Oku pulled a surgical mask over her face. She knelt and touched his chest, and then felt his pulse, noticed a small, dried trickle of blood extending from each nostril. Hearing a cough, she turned; one of the Makeres’ four children was standing beside Nancy now, her face glistening with a thin film of sweat.
“Where are the others?”
Nancy Makere’s eyes pointed. “In there,” she said.
Dr. Oku followed her into the other bedroom. She set down her bag. The three boys were sleeping, unclothed, on a thin mattress, two on their backs, the other on his right side, breathing with the same deep raspy sound as their father.
She knelt beside them and gently shook the shoulders of one, and another. She opened the lids of the oldest boy and saw that his eyes were bright with fever.
“Have they been ill?” Dr. Oku asked, taking the boy’s pulse. “What sort of symptoms have they had?”
“None. Last night, when they went to sleep, they were fine. We’ve been trying to wake them for—” She looked at the battery clock on a shelf by her bed. “More than fifty minutes.”
“Okay. Help me carry them to the truck. I’ll need to bring them into the clinic. They’re contagious and are going to need to be quarantined.”
“Quarantined,” she repeated, a frightened look flickering in her eyes. Nancy Makere stood still, watching Dr. Oku. “And then what?”
“Then we’ll see. I don’t know yet. We’ll give them oxygen and antibiotics and see what we can do. Help me now, please.”
The two women bundled Joseph Makere in the sheet and dragged him to the back of the truck. One at a time, then, they carried the boys, laying them on the threadbare mattress that Dr. Oku kept in the truck-bed for transporting patients. As they rode silently across the field back to the clinic, the first crescent of sun appeared above the familiar distant mountains, silhouetting random trees on the plain.
At the clinic, Sandra Oku lay the four patients on cots and began to administer oxygen to them one at a time, monitoring their vital signs. It quickly became clear that there was nothing she could do to wake them. At 7:22, Joseph Makere stopped breathing. The youngest boy died twenty-three minutes later.
About an hour before the third boy stopped breathing, a station wagon arrived from the south village fields with seven passengers, four men and three women. Normally they would be in the maize and cassava fields by now. But Sally Kantanga, who owned the farm, could not wake them this morning.
“Not any of them. What’s the matter with them?” she asked. Dr. Oku saw that she was sweating profusely, even though the morning air was still cool.
“I don’t know,” she said. “I’m going to call Tihka Hospital on the radio.”
By ten o’clock, forty-three people had died at the clinic and in the still-moist grasses outside. Many others were lined up or lying in the dirt, waiting to see her. Sandra Oku had run out of blankets and sheets to cover the victims, and eleven of the bodies lay uncovered. Sixteen others, including Nancy Makere, her daughter, and Sally Kantanga, were sleeping deeply in what she had called the Recovery Room. No one was going to recover this morning.