She started by writing down the official date of the start of the outbreak in 2014, when Ebola had been confirmed in a small village, although she reminded herself that all dates were unlikely to be accurate because of slowness in reporting — the more remote the village the longer it would take to attract attention — and also slowness in getting lab confirmation that the disease a patient was suffering from was actually Ebola.
Tally found herself drawn into the full horror of a major Ebola epidemic, the tragic stories of whole families being wiped out because of their insistence on looking after their own rather than accepting professional help and consequently all of them becoming infected and dying. Even then, the tradition of close personal contact with the deceased in a last display of love and affection from friends and neighbours caused yet more infection. Villagers fled with predictable consequences for neighbouring villages and so the circle widened.
Tally plotted the spread to new locations using dates and checking the locations on a map of the province, checking if the limited availability of vaccine at the time had made a difference. Not much, she concluded as she watched what she saw appear as a traditional spread of an epidemic on the rampage and then... it all went wrong.
Tally couldn’t believe her eyes. Ebola suddenly appeared to have broken out all over the place... all over the country... and in neighbouring countries. She checked the dates over and over again and then the locations and then re-checked the numbers, but, unless there had been a monumental screw-up in the data she was looking at, there was something awfully wrong. There had to be some simple explanation but she couldn’t think of it. It really looked as if the people responsible for the report statistics had stopped collecting data and made the whole lot up.
Tally could feel a pulse beating in the side of her neck. She shook her head and searched for that simple explanation she felt must be lurking somewhere. ‘What am I not seeing?’ she murmured, throwing her head back as if searching for inspiration. Start with the facts! Always start with the facts, Tally.
She was looking at an epidemic that had ended two years ago; there were lots of facts. It was true that the epidemic had spread far and wide and into neighbouring countries. These facts were beyond dispute, it was the kinetics of the spread that had thrown her. They were all wrong... but two years had passed since the end of the epidemic. She didn’t know when the report she was looking at had been released, but surely someone else must have noticed this... or didn’t it matter? Maybe it didn’t, was her awful conclusion. This was Africa... eleven thousand people had perished in an outbreak of disease... eleven thousand African people to add to the thousands who had died of starvation... the thousands who had died in civil unrest... drought, famine... the list was endless. Perhaps the only thing to concentrate on in the WHO report was the fact that that particular epidemic was long since over. She should move on. None of the eleven thousand were coming back, least of all to re-plot themselves on the graph.
So much for epidemiology, Tally thought with a wry smile. Studying the spread of the disease had not helped at all in this case. She couldn’t explain what she was seeing, but, on the other hand, the rapid end to the current outbreak suggested that epidemiological help wasn’t needed. An effective vaccine and a well-organised force of volunteers had done the trick. But somehow, she knew that the numerical puzzle was going to stay with her.
Tally held her get-together two days after the outbreak in Equateur Province was declared over in the third week of July. It was an easy and relaxed affair with all the volunteers feeling both relieved that they come through unharmed and looking forward to returning home after a one-off experience or at least having a break before answering their next call as was the case with those who served with the major aid sources like Med Sans Frontierès, the Red Cross and World Health Organisation.
Tally managed to snatch a quiet moment just to observe the fifty or so people from her area laughing and chatting. It was a very long way from being a sophisticated cocktail party — plastic cups and plates, warm beer and various snacks brought over from the main WHO control centre by Marcus Altman — but no one was complaining; no one was bitching about anything. Everyone was happy.
Marcus Altman saw Tally standing alone and came over with his young colleague, Hans Weber.
‘A big success,’ said Altman.
Tally had to agree. ‘Thanks to you,’ she said. ‘You must tell me how I pay for everything.’
‘Forget it,’ said Altman. ‘I should have thought of doing this myself.’
‘But you have lots of areas to look after,’ Tally protested.
‘Please forget it,’ Altman assured her.
‘We need a celebration for the aid volunteers in the whole province,’ said Hans, ‘like the Munich beer festival.’
‘My God, the press would have a field day with that,’ said Altman.
‘Bastards,’ said Hans, quickly apologising to Tally for his language.
Tally dismissed the need for apology with a shake of the head. She could see that Hans was enjoying the beer, warm or not.
‘Are you finished with the WHO report on the 14–16 outbreak?’ asked Altman.
‘Oh yes, sorry, I didn’t realise you wanted it back,’ said Tally.
‘It’s just that it’s the only copy I have, but if you chucked it, don’t worry, it’s not important. I don’t suppose you had time to read it?’
‘I did, actually,’ said Tally, ‘did you?’
Altman smiled and said, ‘Reading reports is for politicians, not for people on the front line. Why? was there something wrong?’
‘I’m not sure “wrong” is the right word. Come, I’ll show you.’
Altman and Hans followed Tally inside to the table where her map was laid out. ‘The epidemic followed the usual rules of spreading up until this happened,’ she pointed to an end to concentric circles and the appearance of her crosses all over the map. ‘All the figures go haywire; they’re all over the place.’
Altman looked closer before announcing triumphantly, ‘Rivers.’
‘Rivers?’ Tally repeated.
‘You’ve overlooked the relevance of rivers. They are used as a major form of transport in African countries with little in the way of roads. Your early circles represent the spread of disease from the small villages where it started across land where there are often no roads at all. It’s quite slow, but people carrying the disease can be many miles away very quickly when travelling by river and new cases suddenly appear in the destinations of their river journeys.’
‘Ah,’ said Tally, ‘that would explain it. Thank you, Marcus. I’ve just learned that traditional epidemiology shouldn’t be employed when so many rivers are involved.’
‘Let’s join the others,’ said Hans examining his empty beer cup.
Tally did her best to circulate through the groups of volunteers, many of whom she hadn’t had to the chance to meet face to face with during the relatively short time she’d been here. She was pleased at the response she got when introducing herself. Everyone seemed pleased with how she’d done her job and spoke of how efficient everyone had been in interacting with each other.
Tally was pleased to come across Mary Kelly and they hugged before Tally thanked her for being so kind to her when she’d first arrived.
‘It was a pleasure,’ said Mary, ‘and you’ve been a big success.’ She asked about Tally’s plans for returning home.
‘I haven’t made any yet,’ said Tally. ‘There are one or two things I have to do before I get down to it. I thought I might go and see Monique Barbet and hear what she thinks about the way the latest outbreak was handled. I got the impression she wasn’t too impressed with aid efforts the last time Ebola struck.’