The Secret (Dr Steven Dunbar 10) (4 page)

North turned out to be a tall, bearded, gangly man in his late thirties – a typical academic, Steven thought, from the open-necked checked shirt under the horizontally striped jersey to the corduroy trousers and casual boat shoes. His handshake was firm but Steven noticed that his knuckles were showing early signs of arthritis.

‘Good of you to see me,’ said Steven.

‘A pity it’s under such tragic circumstances,’ said North with a sigh. ‘Did you know Simone well?’

‘We’d been friends for some years,’ Steven replied. ‘You?’

‘I met her a few years ago at a polio conference in Geneva. She seemed a very dedicated woman.’

Steven nodded. ‘She was. Did you attend the meeting in
Prague?’

‘Yes.
I was there with one of my group but she and I didn’t have much time to talk. I think it was for that reason that she asked if she could come and see me in London. Apparently she was coming here anyway to see a couple of pharmaceutical companies about upping their support for the vaccination effort in Afghanistan.’

Steven smiled. ‘Sounds like Simone. Can I be rude and ask what exactly she was coming to see you about?’

‘She didn’t actually say but I suppose she didn’t have to. She’s been working for some time on the eradication of polio programme supported by the World Health Organisation and we’re an international reference lab for polio and vaccine development. It’s quite normal for scientists and workers in the field to meet and exchange information. Sometimes things that work well in the lab don’t translate to the real world, so reports from the field are valuable.’

‘But you’re a British lab.’

‘And she was French,’ said North, seeing it coming. ‘Don’t read too much into that. The outfit Simone worked for,
Médecins Sans Frontières
, prides itself on being independent and international. Apart from that, labs working on polio are not too thick on the ground these days.’

‘And you are one of the best?’

‘We like to think so,’ North said with a modest smile.

‘Tell me, in the brief time you saw her in
Prague, did Simone seem upset at all about anything?’

‘Upset?’ North thought for a moment. ‘More frustrated than upset, I think. She wanted to address the meeting but seemed to think the meeting organisers were avoiding her.’

‘Were they?’

‘I really couldn’t say,’ said North. ‘Meeting organisers are always under a lot of pressure from people wanting to speak, especially when things aren’t going too well and everyone has a theory. They have tough decisions to make.’

‘The Prague meeting was solely about eradicating polio?’

‘It was,’ agreed North. ‘O
r more correctly why that hasn’t happened.’

Steven raised his eyebrows and North continued. ‘Ever since the WHO eradicated smallpox from the planet, it’s been the ambition of the organisation to do the same with polio. A multinational body with the grand title of
the Global Polio Eradication Initiative was set up but achieving its goal has been proving more problematical than anyone imagined. The original target for eradication set in 1998 was the year 2000 but that wasn’t met. A new target was set for 2005 but that came and went too so they gave up on targets.’

‘So how are things going in 2011?’ asked Steven.

‘Not that well,’ admitted North with a grimace. ‘That’s really why the Prague meeting was called.’

‘So what
d’you think the problem is?’

‘It’s not just the disease we’re fighting in the countries where polio is still hanging on. We have extreme geography and equally extreme politics to contend with
as well. The situation in northern Nigeria where the predominantly Muslim population are very suspicious of vaccines from the west interferes with vaccination programmes , and the ever-changing situation in Pakistan is a factor too, not to mention the inaccessibility of the Afghan/Pakistan border regions with their mountain passes and remote villages. Apart from that – and this is a personal hobby horse – I think it actually might not be possible to completely wipe out polio simply because of the vaccine they’re using.’

‘The vaccine?’

‘They’re using a live virus vaccine. It’s polio virus that has been attenuated so it can’t cause polio any more but will elicit the same immune response and cause the body to produce antibodies which will be effective against the real thing. It has the added convenience that it can be given on a sugar lump.’

‘I think I had that,’ said Steven. ‘Are you suggesting it’s not effective?’

‘Oh, no, it’s very effective.’

‘Then . .
. ?’

‘I suppose it’s an academic point,’ North
conceded, ‘but the fact remains that polio virus can’t be considered completely wiped out if it lives on inside you . . . even if in an altered form.’

‘I see,’ said Steven, silently thinking that it did seem to be an academic point but fee
ling obliged to ask, ‘I take it there’s no alternative?’

‘Yes there is. There is a vaccine containing a completely inactivated form of the virus
– all the virus particles are dead – but it has to be given by injection.’

‘So why not use that?’

North smiled. ‘Money, doctor, money, the bottom line to so much these days. We’re talking about maybe wiping out the last one per cent of the disease on earth. Pharmaceutical companies are commercial concerns. They exist to make money. The inactivated vaccine is very expensive to make and is in short supply. Governments in places like Pakistan, Afghanistan, Nigeria and India don’t want to spend money they don’t have to and the pharmaceutical companies don’t really want to make it because none of them wants to set up a hugely expensive production line to manufacture a vaccine which will kill off demand for itself almost as soon as it’s put into use.’

Steven let out a long sigh as he saw the problem.

‘You can’t really blame these countries for continuing to use the cheap vaccine to rid themselves of the immediate problem of polio without thinking too much about the finer points of epidemiology,’ said North.

‘Are there any countries in the world where polio is a major problem?’ asked Steven.

‘No,’ North admitted. ‘Cases of paralytic polio are currently running at one per cent of the numbers we saw in 1998.’

‘So . . .’ began Steven, feeling slightly embarrassed and wondering if he’d missed something.

North smiled and said, ‘It’s all right, I’m used to scepticism. There are those who see the complete eradication initiative as an academic exercise, an ego trip to wipe out a disease which to all intents and purposes is extinct as it is. The sugar lump vaccine has I admit reduced the occurrence of polio to a mere trickle of cases a year.’

‘I suppose I can understand their point of view,’ Steven confessed, ‘I mean given the financial mess we’re all in.’

North nodded in resignation. ‘Indeed. It’s hard to argue the case for a complete wipe-out, but the fact remains that, with a reservoir of the disease still out there, it can always make a comeback. It may be confined to just a few countries at the moment but they are troubled countries and internal strife encourages population movement. When people start hitting the road it’s not only their belongings they carry with them.’

‘Immigrants and refugees . . .’ murmured Steven thinking about his earlier conversation with Tally about TB making a comeback. ‘Where d
id Simone Ricard fit into all this?’

‘She’d been working with the Med Sans
vaccination team in the Pakistan/Afghanistan border region, one of the real remaining problem areas. It’s been a really tough nut to crack.’

‘Do you have any idea at all what she wanted so badly to talk about at the meeting?’

‘I’m afraid not. As I said, we didn’t really have a chance to speak and I didn’t even go on the trip to the Strahov monastery with the others where we might have had an opportunity to talk.’

Steven nodded
, then changed the subject. ‘Your research group, doctor; do they all work on polio?’

North clearly didn’t see what Steven was getting at. ‘I suppose . . .’ he said uncertainly. ‘Various aspects.’

Steven appeared apologetic. ‘I suppose I was wondering why a research group in London was working on polio when it really isn’t a problem any more in the western world – I’m assuming that you get traditional funding from the UK research councils?’

‘Ah, I see,’ said North with a smile. ‘Well, yes
, we have funding from the Medical Research Council and the Wellcome Trust and one of our students is supported by a pharmaceutical company, so I suppose you could call that "traditional". But we don’t actually spend all our time on polio virus although there is a connection. Our main interest is in the persistence of certain viruses in the body. You know – if you get a cold sore on your lip when you’re a child the sore will clear up but the herpes simplex virus which caused it will always be with you, lying low if you like, waiting for the time when the conditions are right and then you’ll get a cold sore again, whether by exposure to UV light or perhaps through stress or worry; anything that causes a dip in your defences.’

Steven nodded.

‘Varicella, the virus that gives you chickenpox, is another. You get chickenpox as a child and you recover but the virus remains inside you until one day in later life you wake up with shingles – same virus, different condition.'

‘Ah, I see,’ said Steven. ‘Interesting.’

‘There’s also a condition called post-polio syndrome which really intrigues us. It’s a problem that survivors from paralytic polio develop in later life – sometimes as much as thirty years after the event. It’s very debilitating but has a tendency to be pushed under the carpet by the medical profession because they’re embarrassed by not knowing what’s going on. We’re not embarrassed; we’re intrigued. We’d love to know what’s going on and not just with those patients. You see, not everyone who gets infected with polio virus itself develops the paralytic disease. Only one in two hundred does. We’d like to know why that is and what the virus actually does in those people who apparently remain well.’

‘Fascinating.’

'And of course,’ added North with a smile, ‘the more you know about your enemy the better. If we understood viruses better it should be possible to design better vaccines. They’re still really our only line of defence against viral disease.’

Steven nodded, feeling grateful for the
refresher course. ‘Thank you for that.’

‘Would you like to meet the team?’

‘I’d love to.’

Steven was shown round the lab by North who introduced his group individually and invited them to tell Steven briefly what they were doing – something they did with varying degrees of eloquence
. Liam Kelly proved to be the clearest, showing an infectious enthusiasm for his subject, while others were more reticent.

They stopped beside a tall, broad-shouldered man in his early thirties, wearing a T-shirt proclaiming allegiance to an American football team. ‘This is my senior post-doc, Dr Dan
Hausman,’ said North. ‘Dan is being supported by Reeman Losch, an American pharmaceutical company. He’s working on post-polio syndrome . . .’

Steven smiled and nodded to
Hausman before following North along to the next bench. ‘Jenny Davis is uncovering the secrets of the Herpes simplex virus.’

‘I wish,’ said an attractive blond girl, pausing, automatic pipette in hand, to smile at Steven. ‘It’s like playing hide and seek in thick fog.’

‘Well, I wish you luck,’ said Steven. ‘In fact, I wish you all the very best of luck,’ he said, looking up the length of the lab. Turning back to North, he added, ‘Thanks for your help . . . and the tour. I feel like I know a whole lot more than I did earlier.’

‘I hope everything goes well at the funeral tomorrow,’ said North. ‘Simone was a special person.’

Steven felt glad that he’d come to Simone’s funeral. He’d been assuming that he would be an anonymous face among hundreds of mourners but that wasn’t the case: there were fewer than fifty people there. Although this puzzled him at first it made sense when he thought it through. Simone didn’t have a social life; she did not have a wide circle of friends. She had spent her entire working life abroad among the sick and dying of other countries. Those who had known and loved her in these far-off places were in no position to come to Paris to mourn her death. Apart from family members who comprised less than a dozen, Steven reckoned, the mourners were mainly colleagues and administrators from
Médecins Sans Frontières
with perhaps a few representatives from other aid agencies.

Simone’s father, a stooped, elderly man with a head of fine, pure white hair that seemed to respond to the merest suggestion of m
ovement in the air, spoke of a wonderful, loving daughter who had always had a good heart. Her boss spoke of an inspiration to others and the very embodiment of all that was good in the medical profession. Steven felt that the third person to speak, a friend from medical school days, hit the nail on the head when she said that Simone – much as she loved her – had always made her feel inadequate. Everyone agreed that planet earth was a poorer place for having lost Simone Ricard.

Because the funeral was being held in
Paris and not Marseilles where Simone’s parents still lived, the reception afterwards was held in a small hotel on Boulevard St-Marcel. Steven introduced himself to Simone’s father, not expecting him to have heard of him, so he was surprised when Jacques Ricard exclaimed, ‘The English soldier? Simone spoke of you. I think you may be the only soldier my daughter ever approved of.’

Steven
felt pleased – absurdly pleased; even vulnerable, like a ten-year-old hearing universal praise for the first time. He shook Ricard’s hand and nodded, indicating sympathy and thanks together, then turned to the MSF man who had spoken at the funeral, hoping that he might point him in the direction of people who had served with Simone in Afghanistan or had been at the Prague meeting. He was directed towards Dr Aline Lagarde, who he learned had been working with Simone on the anti-polio drive in the Afghan border region, and went over to introduce himself. She was a dark-haired woman in her thirties wearing an elegant black trouser suit over a lilac blouse which seemed to complement the striking colour of her eyes.

‘Ah yes, Dr Dunbar.
Simone spoke of you many times.’

After opening exchanges about the awfulness of what had happened Steven encouraged
Aline to tell him about the work that she and Simone had been engaged in. He had always been a good listener and this had served him well in past investigations. Experience had taught him that you could learn a lot about people by keeping your mouth shut and your ears open. In this case, he had to decide whether or not to mention the letter he’d had from Simone and it did not take him long to conclude that Aline Lagarde was an intelligent, caring woman who he felt could be trusted to be discreet. He told her about the letter and asked if she had any idea what Simone had meant by saying something was very wrong.

‘The letter was sent from
Prague?’ Aline queried.

Steven felt she’d asked the question in order to give herself time to think through her reply. ‘Yes.’

‘Simone had . . . concerns.’

‘Shared by you?’

‘You could say that,’ Aline seemed nervous. She considered for a long moment before going on, ‘Simone was unhappy about our region being one of the big stumbling blocks in the bid to eradicate polio. We had more cases than anywhere else in the past year. I think she was afraid that people might see it as our fault.’

‘But the Afghan/Pakistan border is a huge area; the logistical problems must be tremendous,’ said Steven.

‘Exactly,’ Aline agreed. ‘I kept telling her that. We’re also talking about the FATA.’ She answered Steven’s questioning glance with, ‘The federally administered tribal areas. It’s a wild, lawless region, a bit like the old wild west.’

‘Only east,’ said Steven with a smile. ‘But surely you can’t be the only
aid agency working in the area?’

‘No, of course not;
several other agencies are represented there . . . That’s sometimes the root of the problem.’

‘Really?’
Steven probed.

Aline
looked as if she had no real wish to continue but Steven’s unflinching gaze persuaded her to continue. ‘People like to imagine that aid agencies work together in perfect harmony, but people are people. Apart from the inevitable petty arguments and jealousies which always crop up in every walk of life, government approval and cooperation tends to vary with the country of origin of the team involved. Let’s say, some agencies are more welcome than others in Pakistan and Afghanistan.’

‘I hadn’t considered that angle.’

‘Simone always tried to rise above such difficulties. "Forget the politics and think of the children" was her mantra. She did her best to build bridges between us and the other agencies where possible and hated the very idea of having to observe strict geographical boundaries when it came to helping children.’

‘Who sets the
boundaries?’

‘It’s agreed at government level. Aid agencies have assigned territories to work in. I suppose the idea is
to stretch the aid as far as it’ll go and avoid overlap.’

‘Makes sense
, I suppose.’

‘It would if we were all working on a flat plain with everything marked out in grid squares,’ agreed
Aline, showing a feistiness that had previously been kept under wraps. ‘But the border country between Pakistan and Afghanistan is not like that. We are talking mountain passes and deep valleys and lots of uncharted areas where, if you come across a village, your instinct is to help, not wonder if it’s in your allotted territory or not.’

‘But surely everyone understands that?’ said Steven.

‘You’d be surprised. We came across a village recently where many people were ill, including children. According to the elders, an aid team had been to the village once to vaccinate the children and give out medicine but hadn’t come back. Simone got in touch with the relevant agency to ask about vaccine scheduling and was told to “butt out”. They said it was none of her business and she should stick to her own region.’

‘Crazy,’ said Steven. ‘And did you?’

‘No, Simone was furious. We collected blood samples from the sick for lab analysis and gave the children their second dose of vaccine. It was her intention that we should return to that village after she got back from London.’

‘Was that the sort of thing that Simone wanted to bring up at the
Prague meeting?’

‘I think it may have been,’ replied
Aline uncertainly.

Steven thought it strange that
Aline didn’t know what her colleague and had intended to talk about. ‘What made Simone decide to attend the meeting?’ he asked.

‘I don’t know. She didn’t tell me she was going,’ said
Aline with more than a hint of embarrassment. ‘I think it must have been a last-minute decision. As far as I knew she was actually on her way to London to seek more funding from big business. I suppose she must have thought it was a good opportunity to get a look at the bigger picture surrounding polio eradication.’

‘And maybe vent her frustrations to some of the head honchos about the bureaucratic problems you were having?’

Aline smiled. ‘That too. Simone said you were a clever, resourceful man. She said you’d been a tremendous help in giving advice about treating people under difficult field conditions. She passed the expertise on to the rest of us but always gave you credit.’

‘That sounds like Simone,’ said Steven. ‘She always did the right thing.’

Aline laughed. ‘That’s exactly what she said about you.’

Steven and
Aline exchanged contact details and agreed to keep in touch before Steven went off in search of the organiser of the Prague meeting, who he had learned earlier was Dr Thomas Schultz of the World Health Organisation. Schultz, a small, gnome-like man with grizzled features wearing a rough tweed suit was standing, head bowed, staring at the floor as another, taller man spoke insistently into his left ear while waving his arms around to accentuate whatever point he was making. Although Schultz appeared to be listening intently, Steven noticed his eyes dart to the side from time to time as if searching for an escape route.

He
was wondering how to interrupt proceedings when he sensed someone at his shoulder and turned to find Aline there. ‘You’d like to speak to Schultz?’ she asked. Steven agreed that he would. ‘That’s Edelman monopolising him, Charles Edelman, an American who oversees the spending of US government money in their international aid programme. I’ll try to give you a window . . .’

Steven watched as
Aline approached Schultz and Edelman and heard her exclaim, ‘Dr Edelman! I haven’t seen you for ages, not since the meeting in . . . where was it? Berlin, two years ago?’

As Edelman turned towards
Aline, she expertly took his elbow and edged him away, offering smiling excuses to Schultz. Steven took his cue and moved in to introduce himself to Schultz, saying that he’d been a friend of Simone’s. They exchanged a few words about the sadness of her death before Steven said, ‘I understand Simone wanted to speak at the Prague meeting, doctor?’

Schultz nodded but seemed uncomfortable with the question. He cleared his throat unnecessarily and said, ‘She made a late request but we have a very tight schedule to stick to at these meetings. It was difficult to fit her in. These things have to be decided months in advance.’

‘I take it you know what she wanted to speak about?’

‘She had something to say about territorial problems between the various aid organisations in the region she was working in.’

‘But you weren’t keen on letting her do that?’ Steven ventured. It was a gamble, based on what Tom North had said about Simone thinking the meeting organisers were trying to avoid her.

Schultz sighed. ‘I have a difficult job, Dr Dunbar,’ he said. ‘What I strive to do is maintain harmony between the various volunteer groups. Having someone from one group stand up and criticise another at an international meeting was not going to help matters so you could say I wasn’t too keen, yes.’

Steven nodded. ‘It can’t be easy . . . but I understand that Simone’s complaint wasn’t just about territorial concerns. She believed that another agency wasn’t doing its job properly . . .’

‘I really couldn’t comment. I have no knowled
ge of that and rumours along those lines could be most damaging to our common cause.’

Steven thanked Schultz politely for his time
, and the WHO man was about to move away when Steven added, ‘Do you think I could have a list of the people who attended the meeting, and their affiliations?’

Schultz’s demeanour changed. He turned with an angry look on his face. ‘May I ask why?’

‘I might want to talk to some of them.’

‘May I ask exactly who you are?’ asked Schultz coldly.

Steven told him and gave him his card.

‘And what jurisdiction do you imagine you have here?’

‘None at all,’ replied Steven. ‘Do I need it? Surely a list of people attending a scientific meeting can hardly be confidential?’

Schultz’s expression suggested he was struggling to keep his temper in check. ‘I’ll see that one is sent to you.’

‘Would it also be possible to have a list of the people who went on the trip to the Strahov monastery too?’

Schultz sighed
, then said, ‘That was arranged locally. You can ask Dr Mazarek, who is standing over there.’ He pointed. ‘He made the local arrangements. He’ll be able to help you.’

Steven looked to the tall fair-haired man
indicated by Schultz. He was in conversation with Simone’s parents.

‘What exactly is it you’re investigating, Dr Dunbar?’ asked Schultz.

‘I’d just like to know a bit more about the circumstances surrounding Simone’s death, doctor.’

‘It was a tragic accident. What more is there to know?’

‘Probably nothing, I’m sure.’

‘You give me the impression you’re looking for some kind of scandal, and that is something which could damage the cause that Simone fought so hard for. Any rumour – however unfounded – that her death was anything other than an accident and . . . well, I’m s
ure you know what the press would make of it.’

Steven nodded. ‘Believe me, Dr Schultz, damaging the cause that you and so many organisations work for is the last thing on
earth I’d want to do. On the other hand . . . Simone Ricard was my friend. If she had concerns, I’m sure they were well founded.’ Steven ended his comment with a hard stare that made Schultz break eye contact, and turned away.