1980: The Emergence of HIV

By David Cornish MD

Dr. Arthur Noble is a brilliant first-year medical resident in San Francisco, who has a stellar career ahead of him. However, all of Noble’s skills are put to the test when he encounters a strange new illness. The ailment seemingly appears out of nowhere, and serves its victims a most horrible and brutal death.

Noble struggles to find answers to the medical mystery, even as many researchers and society refuse to believe it is a serious threat, or that it even exists.

1980 is an authentic medical story about a disease that will eventually have an unimaginable impact on the entire world.

• Language: English
• Publisher: BookBaby
• Release date: Apr 10, 2018
• ISBN: 9781543928044

Book preview

Epilogue

14 Million, B.C.E.

Continental drift had separated the island from the African east coast 74 million years earlier. Plants and animals living on it evolved in relative isolation, with 150,000 species found only on this island. Nevertheless, fierce tropical cyclones periodically sent floating mats of vegetation from Africa to the island. These mats would occasionally carry animal passengers along with them. At least some of the small mammals inhabiting the island arrived in this manner. This place would one day be known as Madagascar.

Proto-primates had been around well before the global mass extinction 65 million years earlier, and the first true primates arrived some 10 million years later. Placental primates were expanding into nearly every ecosystem on Earth. 14 million years ago, many of the new primate species resembled modern prosimians, such as lemurs, and were plentiful on the island. One such prosimian in the family Adepidae was an ancestor of the present day Gray Mouse Lemur.

A specific prosimian on the island was a relatively large male who was eleven inches long and weighed 68 grams. It had soft fur, a long tail, long hind limbs, and a dorsal dark stripe down its back. Its round head had large ears, along with very large round orange eyes. A nocturnal animal, it lived most of its arboreal life in or near the rain forest canopy. During the night, it moved about the canopy while balancing with its long strong tail and grasping branches with its tiny articulating feet. It rarely ventured to the forest floor, but moved by hopping when it did.

The lemur ancestor had no way of knowing that it was host to something. Something very old. The animal harbored a life form so different from cellular organisms that it cannot be classified within the other three domains of life: Bacteria, Archaea, and Eukarya. Perhaps the entity inside the primate was not life as we know it. Was it alive at all? Did it inhabit the borderline between the living and the non-living? Between the living and the dead?

The entity had the ability to integrate itself directly into the prosimian’s cellular code of life (deoxyribonucleic acid…DNA). There it would silently remain for years or decades. Only much later might it present itself with deadly consequences for the prosimian. However, over tens of thousands of years, the animals may have adapted to the entity. Perhaps the entity no longer caused any harm to its hosts.

A distant descendant of the entity would leave an indelible biologic footprint on a species that would not even exist for another 14 million years. This entity would eventually be known as a lentivirus.

78,000 to 32,000 B.C.E.

During the Miocene Epoch, about 14 million years ago, a period of significant global warming occurred. As the polar icecaps melted, the sea level rose 80 to 130 feet. Many parts of the globe became warmer and considerably dryer as species adapted to climate change. Evolutionary pressures on primates resulted in the appearance of the ape-like genus Dryopithecus, which adjusted to the expanding savannas in Southern Europe. Toward the end of the Miocene, more severe cooler Northern Hemisphere temperatures caused the polar icecaps to once again increase in size. As the sea level dropped, a corridor between Europe and Africa opened along the Eastern Mediterranean Sea. Dryopithecus took advantage of the corridor and migrated south into the warmer African and South Asian habitats. By 8 to 9 million years ago, Dryopithecus in Africa had diverged into two evolutionary lines. One line led to gorillas, and the other led to chimpanzees and bonobos. Two million years later, further divergence occurred which separated ancestors of chimpanzees and bonobos from early hominins.

The entity that had integrated itself into primates millions of years earlier continued to travel wherever the animals migrated. And the entity continued to mutate. A roll of the biological dice, between 78,000 and 32,000 B.C.E, created a new entity that had a predilection for infecting monkeys and apes. This new version eventually spread throughout Africa. Over time, the daughters of the new entity further mutated into forms specializing in specific monkey and ape species infections. Some of these forms would kill the infected animals, but some would not. Even harmful mutations could witness animal resistance to their effects over millennia.

Two of these specialized daughter entities would play a unique role for a particular primate species, tens of thousands of years later.

1662 C.E.

Located in the West-central African Congo Basin, the 200 meter-wide Ngoko River flowed southeast through one of the Earth’s largest rainforests. With over 1400 millimeters of rain per year, an average summer temperature of 80°F, and abundant sunshine, the area provided plentiful plant growth that supported a large number of animal species. Primates flourished in the forest, including Pan troglodytes troglodytes; the Central African chimpanzee.

Chimpanzees lived in troops of 15 to 160 individuals. Troops held specific territories, and were aggressive against other troops that trespassed. The chimps were omnivores which allowed them to thrive regardless of seasonal weather changes, or other natural events, that could alter the availability of one food source or another. Pan troglodytes had also developed the ability to use tools, which made them formidable hunters and gatherers.

Alpha Male was the leader of a chimpanzee troop located a few kilometers north of the Ngoko River. He weighed 70 kilograms and was middle-age at 40 years. Although he usually ate various fruits, nuts, and berries, he was always on the lookout for a tasty meal of meat. Two weeks earlier, one such treat had inadvertently wandered too close to Alpha Male. Before he killed the unfortunate greater spot-nosed monkey and ate him, the animal had deeply bitten into Alpha Male’s right forearm. Blood from the monkey had spurted into the wound over the course of the chimpanzee’s between-meal snack.

Alpha Male was given more than a carnivorous lunch. Carried in the monkey’s blood was a mutated distant descendant of the entity that had spread throughout Africa 32,000 to 78,000 years earlier. This descendant would eventually be known as simian immunodeficiency virus gsn, or SIVgsn. It now inhabited Alpha Male as well.

On this warm summer day in 1662, a group of foraging male chimpanzess accompanied Alpha Male through the troop’s territory. The group suddenly heard sounds made by a red-capped mangabey in a small tree thirty meters ahead of them. Quietly, and in a planned fashion, the band of chimpanzees slowly surrounded the small tree. Once escape for the mangabey was impossible, Alpha Male jumped from a nearby tree branch, and grabbed the terrified primate. The troop leader first tore the animal’s right arm out of its shoulder socket, biting through the remaining shreds of muscle and tendons that held the limb to the body. He repeated the process for the left arm, while bending back both legs at the hips until they gave a snapping sound. With both femoral heads broken off, he then twisted the animal’s head until the neck cracked. Alpha Male threw the limbs to his comrades for their part in the capture, while he kept the torso and head for himself. His sharp teeth bit through the prey’s skull so that the brain could be quickly eaten.

The mangabey’s dismemberment covered Alpha Male with blood, and much of it landed on the two-week old deep arm wound that had not yet healed. By chance, the mangabey had within its body another distant descendant of the entity that invaded specific primate species long ago. This slightly different version of the entity would be known as SIVrcm.

Then, within the next few days, an extraordinary natural random event occurred. The genetic deck of cards dealt the two related entities within Alpha Male a statistical Royal Flush. In a process called recombination, using Alpha Male as an incubator, the two entities exchanged some of their genes between them. This is not the first time that SIVgsn and SIVrcm had come in contact with one another. Previous genetic recombinations either resulted in non-viable particles, or very rarely, benign daughter entities. But, this time was different. This time a very new and virile entity was created, and would be known as SIVcpz. It also had new abilities that would only be realized many years later.

The new entity quickly inserted itself into Alpha Male’s cellular strands of life. Over the coming years he passed the hidden entity to other chimpanzees sexually, and occasionally through blood exposures. Eventually, the entity would kill Alpha Male and many other infected Pan troglodytes troglodytes. In fact, early deaths occurred among those infected at a rate 16 times higher than the average. But, this troop lived as a small stable community with few interactions outside of their specific territory. Troop solidarity, and geographic isolation, kept the new entity confined. For now.

1908 C.E.

The Bantu people had migrated into the great rainforest of Central Africa 3,500 years earlier. They shared the area with enormous varieties of plants, such as the majestic Sterculiaceae and Ceiba pentandra trees, as well as understory thickets of Annonaceae. Over 300 species of trees adorned the forest. In addition to African forest elephants and numerous species of other mammals, there were hundreds of species of birds, fish, reptiles, and amphibians. Equatorial Africa was one of the Earth’s best examples of incredible biological diversity. The rainforest provided the Bantu with everything they needed. Little changed for the Bantu and their wonderland for thousands of years.

However, there were others who wanted to benefit from the rainforest’s resources. The 19th century brought large numbers of European colonialists to West-central Africa. The Germans established a large African colony in 1884, and called it Kamerun. By the time the first decade of the 20th century arrived, the colonialists wanted to realize a swift return on their African investments. An infrastructure was required to extract the local riches of copper, cobalt, tin, zinc, gold, manganese, diamonds, uranium, coffee, cocoa, palm oil, bananas, and rubber. To that end, 4,800 kilometers of roads, thousands of kilometers of cable, hundreds of bridges and tunnels, and multiple seaports were being constructed. As would be expected, a large labor force was needed to build this infrastructure. Bantu men began to leave their rural settings and move to places where new higher paying jobs could be found. Tens of thousands of African men began relocating into colonial labor camps. As a consequence, rapidly growing European-style cities with overcrowding were springing up along major waterways and the African west coast. These new cities were quickly changing traditional African cultures. Ancient tribal values, such as marriage, began to decline and were being replaced with sexual promiscuity and prostitution.

Still, European influences had not yet penetrated deeper into the rainforest. Many areas of South-eastern Kamerun remained untouched by outsiders, and in these places the Bantu cultures remained intact. Such was the case with the small village of Yanga, located 16 km east from the small Boumba river, and 19 km north from the major African river of Ngoko. Yanga had a few hundred inhabitants, with houses lined up along a dirt road and backed by the dense forest. The simple homes were made of dried mud bricks on bamboo frames, with roofs covered with Raffia palm fronds. Free-range goats, pigs, and chickens could be seen about the structures.

Kame M’Bala was a typical Bantu man calling Yanga his home. At 35, he lived with his wife Narolie and their three small children. The M’Bala family was of the Bantu Belti-Pahuin ethnic group, and spoke mostly the Ewondo language, with some French and English. They did not speak much German since they avoided the German colonials when they could. The Belti-Pahuins formed tight knit conservative families with a strong adherence to life-long marriage. French and Spanish explorers had introduced Catholicism to Kamerun many years before, and the M’Bala family observed many Catholic beliefs. However, they also continued their more ancient belief in animism: the view that animals, plants, and inanimate objects possess a spiritual presence.

A few years earlier, Kame M’Bala had begun to work part-time with Bantu men on German enterprises. At times, he worked with Hevea brasiliensis trees by cutting tapping panels into the bark and allowing sap to flow into bowls. The area had become a major producer of rubber for the Germans. He avoided the banana plantations where laborers were treated cruelly. But much of his time was now spent logging African padauk hardwood trees. He cut the 2-meter diameter trunks into 6-meter lengths, and prepared the several ton tree trunks for shipment.

Kame sat down for breakfast with his family on this morning in 1908, with the boys wearing short-sleeve shirts and tan pants, and his wife and daughter wearing full length colorful dresses. They ate a meal with maize, plantains, yams, and groundnuts. They talked about the day’s coming events, but Kame was vague about his work day. When the meal was completed, Kame kissed his wife and children, put on his wide brimmed hat, and departed for the rainforest. He had a special job to perform, and he did not want to go into the details about it with Narolie.

Kame had been occasionally supplementing his family’s income by providing special products to a small restaurant in Moloundou, located on the Ngoko river. There was a degree of secrecy surrounding his work for this establishment, because the products he furnished were banned by the colonial authorities in 1901. From time to time, Kame sold chimpanzee meat to the restaurant. This delicacy among the Bantu was better known as bushmeat.

Kame had been given a restaurant request for bushmeat, and he set out this morning to collect some. It was February, which is the end of the dry season in South-eastern Kamerun. He knew troops of foraging chimpanzees might be found on the rainforest floor during this time of year. They would also be closer to streams than usual. He carried with him a large net, and a 45-cm long machete that he had sharpened for the hunt. From chimpanzee feces, and their nests in the trees, he could tell how recently the animals had been in a particular area. After walking through the forest, and watching the signs carefully, he climbed a suitable tree…and waited.

While he watched for his prey, Kame thought about the payment in Spanish copper coins he would be given for the effort. But, he also thought of the hunt as a religious act. In the animism tradition, he would be freeing the chimp’s spirit and allowing some of its power to enter himself. He wanted to believe that was true, since he did not like this work very much.

Several monotonous hours passed. Kame dozed off a number of times out of boredom. Then, suddenly on the ground three meters below him, Kame saw a large male chimpanzee looking for edible vegetation. Slowly, and very quietly, he raised his net with both arms. He let the net with weights attached at the edges fall directly onto the animal. The chimp heard the net as it fell, but it was too late. The net landed directly on him, covering his entire body. He violently thrashed his arms and legs in an attempt to escape. But, the more he thrashed, the more entangled he became. Kame jumped from the tree, but twisted his right ankle with the fall. He limped to the animal in order to synch up the net and secure his prisoner. However, the chimp weighed as much as Kame did, and was stronger. The primate was able to get his head from beneath the net. As the hunter tried to grab the net drawstrings, he did not see the chimp’s head that was now completely outside the net. In one swift motion, the animal sank his long incisor teeth into Kame’s left thigh while twisting his head from side to side. This tore flesh nearly to the femur. A universe of pain shot through Kame’s left leg. He drew his machete and stuck the chimp at the neck, cutting the animal’s left carotid artery. Arterial blood gushed from the neck wound, covering Kame with it. Gradually, the chimpanzee lost consciousness from the sudden loss in blood pressure. It was not long before the chimp was motionless on the forest floor. Kame rushed to tie a neckerchief about his badly wounded thigh. The fight was over, but the job was not yet finished. While on his knees, and struggling with ankle and thigh pain, Kame butchered the chimpanzee for easier transportation.

Before returning home that evening, Kame washed off his blood-stained clothes along the bank of a small stream. At a pre-arranged time and place, Kame waited at the side of the dirt road just outside of Yanga. He gave the newly harvested bushmeat to the driver, who paid him with the equivalent of a week’s worth of logging pay. He later explained to Narolie that he had suffered a bad accident while cutting down a padauk tree. His wife would never have approved of the real cause for the wound. She tenderly washed her husband’s left thigh, and dressed it with clean linen. She told him to be more careful when logging.

Kame was not sure if the chimpanzee’s spirit had actually entered him. But, something else most certainly did. The blood of the Pan troglodytes troglodytes contained the entity SIVcpz, and it was in the process of integrating itself into Kame’s cellular DNA. And there it would live forever.

The entity had not just been introduced into a new species. It found that it could now replicate in its new host even faster than it had within Pan troglodytes. This was not the first time that the entity had crossed over into humanity. It had made the jump to Homo sapien scores of times in the past. However, the other exposures became transfer dead-ends as inhabited humans simply withered away in silence under the entity’s influence. But this species translocation was different. This time, the entity was going places.

The first of five critical factors in the rise of the entity was now complete.

Kame never knew he had become a carrier of the entity. Life was frequently short in early 20th century Kamerun. Five years after the entity invaded his body, Kame was killed by a falling five-ton padauk tree trunk. However, before his death, Kame had passed the entity to Narolie.

1923 C.E.

After Kame M’Bala was killed in 1913, his widow Narolie and her three children had a difficult time making ends meet. Still, with the support of the Yanga village, the family was able to get by. Two years later, Narolie remarried Morathi Contee, a Bantu plantation truck driver from the nearby village of Goumela. The relationship was a cordial one, but Contee had adopted more of the colonial culture at the expense of Bantu ways. He was known to have relationships outside of his marriage.

Narolie began to experience less stamina in 1916. She had progressive difficulty in keeping up with household tasks. She tried to eat more food, while slowly but continually losing weight. Tribal charlatans were unable to help her. Contee wanted her to see a western doctor with her strange affliction. But, a world war had engulfed the rainforest. Access to western medicine became difficult or impossible. The Allies eventually drove the Germans out of their colony, which now had the English spelling of Cameroon. For a time, there was little or no government to speak of.

Contee watched as his wife was gradually reduced to a living skeleton. She developed an awful cough in 1920, and died quietly one evening. Contee did his best to finish raising his three step-children. By 1923, Narolie’s children were adults and moved to other villages. Contee felt there was nothing left for him in Yanga, and decided to seek his fortune elsewhere. He paid a boat captain at Moloundou for a seat on a small vessel sailing southeast down the Ngoko River.

Exposure to the entity in Southeast Cameroon would be rare for many years after 1923. But, Narolie had passed the entity to Contee, and his extra-marital affairs had passed it on to a few other women. There was just enough person-to-person contact with the entity to allow it to survive in small populations. Many epidemiological detours to nowhere occurred as entity hosts quietly died. But, that was all changing. And soon.

Morathi Contee sailed along progressively larger rivers as he traveled down the Ngoko, to the Sangha, and finally to the great Congo River that flowed southwest through the rainforest. The Congo River was like nothing Contee had ever seen before. It discharged a volume of water that was second only to the South American Amazon River, as 41,000 cubic meters flowed into the Atlantic Ocean every second. It was also the deepest river in the world, and reached depths of 250 meters. The river was 11 km wide in one area. But, the river could be dangerous. There were 4,000 islands, along with numerous large and high waterfalls, scattered along its 14,500-km length. Contee had to leave the boat several times, and travel short distances by land.

It took Contee several weeks to travel nearly one thousand kilometers to his destination. And his destination was as impressive as the Congo River had been. 400 km east of the Atlantic Ocean, and at a widening of the Congo River south bank, was the bustling city of Léopoldville. Named for the Belgian King Leopold II, the city was becoming a transportation hub for the shipment of the region’s natural resources to points beyond. The Congo River was a conduit of life for Léopoldville. But on the day that Contee arrived, it brought something else entirely different.

The Belgian Congo was being used in the same manner as Cameroon. Belgian masters were investing in a transportation infrastructure, as Germans had invested in their former colony, so that raw materials could be sent to markets around the world. The effort required well over 100,000 laborers, nearly all of whom were men. The exploding population in and around Léopoldville was housed in very cramped rural barracks and urban slums. Enough food to feed an army had to be available to keep the labor force working.

There was another threat to Belgian Congo investments. Disease. The rainforest contained infectious agents that could quickly cripple a work force, if the diseases were not controlled. Trypanosoma cruzi, the protozoa transmitted by tsetse flies, caused the sleeping sickness syndrome of lassitude, anorexia, and death. Other diseases well known in the Americas were also present, such as Treponema pallidum pallidum (syphilis), Treponema pallidum pertenue (yaws, with its ulcerating papules on arms and legs), Mycobacterium leprae (leprosy), and Plasmodium falciparum (malaria).

To help control disease, the Belgians set up numerous medical clinics in the Léopoldville region. Treatment for these infections, and their prophylaxis, required multiple doses of parenteral drugs. To hinder trypanosoma infections, atoxyl was given subcutaneously (SC) or by intravenous (IV) injection. Mercurial salts and arsenicals were given the same way for syphilis and yaws. Leprosy sufferers were administered intermuscular (IM) injections of chaulmoogra. Quinine IV was used to treat malaria. Often the treatments were nearly as bad as the disease. However, there was another even greater problem with the use of these drugs. Thousands of doses were given each day in these clinics, with one nurse giving hundreds of doses a day. There were few hypodermic needles, and even fewer available ways to sterilize them. So, to make due, nurses simply washed off the needles with water in between patients. Non-clinical personnel called injecturs were also sent into the rainforest to deliver doses to far-flung villages. Millions and millions of drug doses were given to the Belgium Congo population each year.

Contee knew enough French and Kituba to communicate in Léopoldville. He secured a job driving supply trucks between colonial construction sites. This gave him a degree of freedom from the forced labor experienced by many of his peers. Nevertheless, he was required to receive trypanosoma atoxyl prophylaxis with a course of 36 IV injections over many weeks. With each injection, his clinic treatment card was punched in order to prove to supervisors that he was compliant.

Contee’s truck driving job also gave him a fringe benefit. He had the ability to transport black market items, like stolen uncut diamonds, from the mines to clandestine buyers. Within two years, he had enough money to rent a small flat in the Léopoldville Quartier Matonge, along the Avenue de la Victoire. He could afford to hire a house keeper, called a ménagère, who cleaned clothes, cooked meals, and also provided sex from time-to-time. Old tribal mores were being cast aside even faster in Léopoldville than they were in Cameroon. New sexual freedoms, including prostitution, were growing rapidly in the city. A new class of entrepreneurs soon emerged called Ndumbas, or fee women. Many Ndumbas became wealthy business owners, bought and sold property, operated their own bars and restaurants, and also dabbled in the sex industry. Thousands of laboring men, seeking companionship at Ndumba establishments, would spend a week’s salary on alcohol and intimate entertainment.

Morathi Contee’s introduction of the entity into Léopoldville provided it with a three-point repeating circuit. It was spread by medical clinic drug injections to men laboring in the colonial projects. The men spread it to ménagère and Ndumbas. Ménagère and Ndumbas spread it to laboring men, who were then obligated to receive injections at the medical clinics. No longer was the entity simply surviving. It was now thriving, as humanity logarithmically amplified it.

The second of five critical factors for the entity’s expansion was now in place. Still, its increase was not sufficient enough to catch much attention beyond an unexplained death here-and-there. Early deaths were commonplace in equatorial Africa. The entity was well hidden by its long quiescent nature. In the background of general population ill health, the entity killed in silence. But, it had become even more lethal in its newer Homo sapien host, compared with Pan troglodytes troglodytes. Even if slowly, it now killed 100% of the time.

1931 C.E.

The Belgium Congo city of Léopoldville on the south shore of the Congo River competed economically with a city just across the river, on the north shore. That city was Brazzaville, the regional colonial capital of French Equatorial Africa. Both cities saw a huge growth in population and trade during the 1920’s, and there was also growing commerce between the two cities. Brazzaville was therefore experiencing an increasing need for health care, just as Léopoldville was. In 1931, a twenty-six-year-old French surgeon and obstetrician traveled to Brazzaville to help fill that need. Dr. Léon Pales began work in earnest with the French colony labor force. The young surgeon with dark hair and a mustache had been educated in the best French schools, and was practicing medicine with the new 20th century approach. That is, medicine using the scientific method rather than solely opinion.

Dr. Pales wanted to know all manners of disease, and that is why postmortem examinations were his passion. An autopsy could give revelations about a patient’s illness beyond the signs and symptoms during life. Pales also had access to the Pasteur Institute and its new array of culture techniques. He was excited to use these new tools in order to find answers to clinical problems.

And, there were a lot of clinical problems in Brazzaville. Tens of thousands of men labored at railroad, bridge, tunnel, and road construction. Serious on-the-job injuries were very common, and death in the labor camps was hardly unusual. Laborers suffering from communicable diseases were brought to the clinics and hospitals in Brazzaville for diagnosis and treatment. Dr. Pales saw pretty much all of it. Salmonella, Shigella, amebiasis, toxoplasmosis, syphilis, gonorrhea, sleeping sickness, yaws, malaria, pneumococci, and non-infectious disorders such as beriberi and depression, to name just a few. The most severe chronic infections caused a gradual wasting of victims, and these were the disorders Pales found most interesting.

The young surgeon with a pathologist’s mind began to write scientific papers on the patients he studied. One such paper described fifty patients with notable weight loss. Thirteen had been diagnosed with tuberculosis prior to death, seven were diagnosed with TB postmortem, and four others had other identifiable diseases.

But, Dr. Pales could not find a cause of death for twenty-six patients in his study. Pathological specimens and numerous cultures found nothing. Still, there were similarities between the twenty-six patients. They had a degree of cerebral atrophy that is not commonly seen in young adults. Marked enlargement of lymph nodes throughout the body (lymphadenopathy) was evident. And the degree of body wasting (cachexia) was extreme, with patients weighing 30 kg at the time of death. Strangely, these patients had no difficulty eating while alive, although they had chronic diarrhea that responded to no known treatments. Dr. Pales named his new syndrome Cachexie du Mayombe, since the patients had worked on the Mayombe section of the Chemin du Fer Congo-Océan railroad.

One of Dr. Pales’ twenty-six study patients was Morathi Contee. Contee had experienced declining heath for over three years. From time-to-time he was required to take a truck by ferry across the Congo River to Brazzaville and deliver supplies there. During one such trip, Contee fell ill with a severe respiratory infection. He was admitted to a French colonial hospital where he died weeks later.

Some of the victims of Cachexie du Mayombe likely had afflictions that did not involve the entity. But, just as likely, some of them did. The local population often attributed unexplained withering deaths to something beyond medical diseases. They often believed that Palo Mayombe, the deadliest form of black magic, was the responsible party. If this were the case, victims of Palo Mayombe would be increasing far into the future.

1959 C.E.

The 1930’s through the 1950’s was a time of great social upheaval in the Belgium Congo. The population of its larger cities swelled with male laborers, as Belgium escalated its tapping of equatorial African raw materials. The huge, and growing, ratio of men to women continued to profoundly change ancient tribal mores. With these changes, the Ndumbas gained economic influence in large cities such as Léopoldville. They managed large bars and dance halls, and employed European-style sex workers who were expected to serve more than one thousand clients a year. Eventually the Ndumbas expanded their operations into facilities called flamingos that were actually a combination restaurant-bar-dancefloor-brothel. Men could find full service entertainment at a flamingo…for a good price.

Along with expanding free expression in the colony came a tremendous increase in sexual transmitted diseases (STDs). Government subsidized medical clinics attempted to control the STD epidemic. The Catholic church also financed STD clinics for the purpose of saving both bodies and souls. However, all these efforts had little effect in stopping the spread of STDs.

Also thrown into the Congo cultural mixing bowl was a rising level of social inequality. Colonial masters placed a heavy emphasis on supporting private companies and their various enterprises. This created an upper class of Europeans who comprised less than 1% of the population, but collected more than 50% of all Congo revenues. Along with economic segregation came financial exploitation, and racial segregation. Poverty was overtaking the general population, and women and children were hardest hit by it.

Yet another issue was making the Belgium Congo a global trigger point. Large uranium deposits made the colony a provocative chess piece in the Cold War struggle between the United States and the Soviet Union. Both countries sought a greater geopolitical influence in the area, and sent weapons to their allies.

Decades of oppression created a colonial pressure cooker that exploded in January, 1959. Full-scale rioting broke out in Léopoldville. Belgium had no stomach for the type of bloody civil war fought by France when its Indonesian and Algerian colonies revolted. So, the colony was granted relatively quick independence on June 30, 1960. The new name, Republic of Congo, was soon changed to the Democratic Republic of Congo (DRC).

The road to real freedom was not to be an easy one for the DRC. Regional tribal leaders held more political power than the new central government, and areas of the DRC began to secede from the Congo union. To make matters worse, the economy collapsed. 100% annual inflation devoured the people’s earnings. The citizens began to boycott businesses, strike employers, and participate in civil disobedience by not paying taxes. Further rioting occurred. The nation’s economy was sent into a downward spiral, and social chaos ensued. Post-colonial private companies sent mercenaries and paramilitary personnel to protect their interests in the country. By the end of 1960, the DRC was clearly a failed state.

In order to restore some degree of order, the United Nations sent 20,000 peace keeper troops to the DRC. But, many DRC citizens no longer believed the country was a safe place to live. A mass exodus occurred from the DRC to central Africa. As in the past, something else travelled along with those who fled the Congo.

It had taken fifty years, but the entity finally reached an epidemiologic milestone. It was efficiently spread throughout its birth-continent by the vary species it kills. This fulfilled the third of five critical factors in the entity’s rise.

1965 C.E.

By 1965, the United Nations and local militias had stabilized some areas of the Democratic Republic of Congo. The UN felt it was now time to bring in professionals to help establish a culture that could support a democratic society. This would be no easy task, since the region had never had such a society. One of the first tasks was to begin teaching children the skills needed to eventually run a successful nation. So, 4,500 Haitian teachers were brought into the former colony. Haitians were well suited for the job and readily accepted by the population. They were black, well educated, and spoke both French and English. One such teacher was Janjak Dalien.

Dalien was a mathematics teacher who was sent to Léopoldville just as the city’s name was changed to Kinshasa. He rented a small apartment in the city’s affluent Gombe section, along the broad Boulevard Du 30 Juin. Not only well versed in algebra, geometry, trigonometry, and calculus, he also read classics in Latin, French works by Gustave Flaubert, and stories written in English by the American Mark Twain. He believed his work in Congo was for a higher purpose, and he threw himself into the effort. Dalien’s enthusiasm was infectious. His students lit up whenever he began one of his lessons.

Janjak Dalien hoped to save a lot of money while working in Kinshasa, and the UN paid teachers very well for the work. But, like many of the professionals brought to the Congo, he missed his home in Haiti. Out of the classroom he was very lonely…and bored. Several weeks after arriving in Kinshasa, a colleague invited him to go along with a group of teachers to a local flamingo. Dalien accepted the invitation, and enjoyed himself immensely as he ate filet of fish, fried plantains, manioc, peas, and rice…all with large amounts of local mayonnaise and piri piri sauce. The teachers drank Heineken beer and danced to the rumba music. Dalien promised himself that he would return to the flamingo, and he actually became a regular at the establishment.

The Ndumba who owned the flamingo became friends with her new regular customer. She surely liked Dalian’s patronage, but she delighted in his charm, wit, and intelligence. He was also from the exotic Western Hemisphere, and she liked to hear his stories about Haiti and the Caribbean. Eventually, she introduced Dalian to one of her best mobikisis, or helpers, who performed various jobs at the flamingo. One of those jobs was as a sex worker. It was not long before Dalian was regularly enjoying more than Heinekens at the Ndumba’s bar and restaurant.

Dalien was successful in helping scores of Congolese children to appreciate and use mathematics. He also saved a large amount of money at his UN teaching position. By 1966, it was time for him to return home. He boarded a chartered UN plane, and left for Haiti. However, just as Morathi Contee had brought the entity to Léopoldville forty-three years earlier, Dalien now carried the entity from Kinshasa to the New World.

Back in Haiti, Dalien resumed his teaching position in Port-au-Prince. With some of the money saved during his two years in Africa, he bought a small condominium in the up-scale suburb known as Pétionville. Located in the hills southeast of Port-au-Prince, Pétionville was a favorite tourist stop because of its lavish French restaurants, nightclubs, and hotels. Dalien loved the area, with its tall trees, lush vegetation, and serenity. He liked to call it the Beverly Hills of Haiti.

Dalien continued his proclivity for the night life when he moved to Pétionville. He particularly liked the Club de Pétionville, which also had a golf course, swimming pool, and tennis courts. During one of his evenings at the Club, he met a beautiful petite waitress with short black hair and big dark eyes named Pharah Acceus. His immediate fondness for her quickly grew into love, and she in turn grew to love him too. They began an intimate relationship. However, Pharah barely made a subsistence salary as a waitress. She continued to maintain a fair number of clients in her other enterprise, the sex industry, in order to pay her bills.

Knowing his girlfriend’s financial problems, Dalien found a way to help her. By 1969, Dalien began to regularly sell his plasma to a brand-new industry in Haiti: a plasmapheresis centers.

Ten years earlier, a new technology developed in California allowed the collection of plasma for various medical treatments. Called plasmapheresis, it involved taking whole blood from a donor, separating the blood cells from the fluid (called plasma) in a special machine, and then returning the blood cells to the donor. The plasma could be frozen for its preservation and used later. One medical use for plasmapheresis required centrifuging thawed donor plasma in order to obtain Factor VIII. This factor was called cryoprecipitate. Factor VIII was given to patients with a gender-linked genetic disorder called hemophilia that does not allow sufferers to normally clot blood. The factor can be