How to summarise a week in East Africa. Well, one thing that was certain, I didn’t want to do anything but relax this weekend. Whilst most of the group went trekking on Saturday I decided to take it easy and visited a lovely local swimming pool, and then did the same again on Saturday.

I’d forgotten how tiring Africa can be and in particular, Moshi. Sadly, Moshi isn’t the safest place –you get hassled all the time and there have been a few attemps, some of which occurred in broad daylight, to grab bags / money etc from us. Hence the opportunity to escape for a day without hassle was inviting enough.

On reflection, the first week was amazing and way beyond my expectations. What has struck me is the structure of the hospital and how well it is run. If you take away the obvious i.e. that we are in one of the poorest countries in the world, you still have a hospital with a library, lecture theatre, grand rounds, housemen and registrars, and even the same politics.

What I do take away with me however is the cases I see here on the wards every day. Today was a day dedicated to ophthalmology which took me back to my days in Budumburam – the refugee camp I worked at in 2004, in Ghana. Day in and day out, we tested and treated people who had poor eyesight, and distributed the hundreds of pairs of glasses we had collected prior to our trip. I still recall the look on patients’ faces when we were able to correct something as simple as short-sightedness, so easily.

Sight is something we all take for granted (to quote my colleague Dan today, when he tested my acuity – “Farhad, do you realise you are blind according to the WHO” which was true since i barely scored 1/60. BUT. The big difference is that I have had the opportunity to do something about my eyesight, and I suffer no deficit as I can afford to get tested and get glasses.

The single largest cause of blindness in Africa is not trachoma, or river blindness, though this is what makes the news. It is refractive error (short and long sighted-ness) and cataract. Both are treatable, and essentially a “non-issue” in the developed world.

My afternoon on the wards was once again an eye opener and a reminder of why i got into medicine. I ask my colleagues from East Africa – “don’t you get depressed, seeing child after child with preventable conditions, and many of whom die in your care”. I mean, several of them have to pay for treatment which they can’t afford, and in the end – they die. The answer was, “of course we get depressed, we cry.”

What can you do? One third of the UK’s drug budget is consumed on Antiretrovirals for HIV / AIDS treatment, and the majority of the epidemic is driven by, non-heterosexual and non-vertical transmission. And yet here, day after day, I am seeing case after case, especially in children, who have contracted the disease from their mothers, who are often orphaned, and who often have such severe complications by the time we see them that there is little hope. If only they had access to the incredible resources we have in the UK.

This afternoon we saw a 21 year old boy with 5cm tumour of the left nostril. He was HIV positive and this was probably Kaposi’s. Who back home would let things get to this stage before presenting? Sadly his parents were both dead, and the boy will get little more than a full blood count paid for by the hospital. Chemotherapy and antiretrovirals are what he needs however.

Similarly, a lady in her twenties with classical Kaposi’s sarcoma affecting the nose and palate. We line up to see these patients who obediently agree to our requests in poor Swahili to examine them. How frustrating must it be to know however that you’re only hope for a bit more time and some quality of life is a relative with some money coming out of the woodwork, who may pay your treatment fees.

Other cases seen today – Suppurative lymph nodes secondary to probable TB (for once, HIV negative), Massive Splenomegaly (possibly due to Chonic Malaria or myeloproliferative disease), Hepatomegaly and ascites (possibly due to Vertically Transmitted Hep B) and a man who had had massive haematemesis (? Schistosomiasis).

Each afternoon we turn up on the ward, which is usually lined with beds either side, and then down the middle, and then trolleys in the corridor. There is little room for anything, especially not us. Families perform most tasks such as feeding and bathing. Often they share the patients’ beds. There is little privacy and it is very difficult to maintain patients’ confidentiality and dignity, in the same way that we try to usually.

What is strange is that I have been here before, in the sense that I have worked in India, Ghana and Azerbaijan, and in conditions worse than this. I did not however, in those settings, ever appreciate what a toll HIV had had on ordinary peoples’ lives.

Here, 7% of Tanzanians are affected. I.e. 1 in about 14 people in the whole country are infected. In parts of South Africa, this figure is more like 50%.

So virtually everyone who comes into hospital here gets an HIV test, and a large number of them end up being positive. Sadly, many slip through the net, and they go on, getting ill outside hospital, and never getting tested. They pass the condition onto their husbands and wives, and then onto their children. Often by the time that their children are born, their parents are often dying, or dead.

This is no exaggeration of what is affecting this continent today, a land where a taxi driver / nurse / teacher will earn little more than £100 / month, and yet  a loaf of bread costs what it does back in the UK. Yet there is no safety net – there is no social security, or national health service.

HIV medicine was once the realm of specialists, but it is the bread and butter of physicians in Africa, who come face to face with it daily, with almost every other patient who ends up in hospital.

What am I saying – well, in summary, we have two very different epidemics here. Let us not try and simplify things.

We have what is happening in the “West” and then a very different, more sinister epidemic, which I am witnessing today. 

What does it need ? – in my opinion, universal testing for EVERYBODY, and treatment. And we need to perform “outreach” measures to get to everybody and not just rely on people to attend only when they are sick, and it is often too late. People are most infectious when they are infected but unaware, and not on treatment.

We must abandon this outdated view of at risk groups, and to quote one of the most outstanding people I’ve worked with, Dr Rob Davidson, “There are only two risk factors for being HIV positive – one is being male, and the other is being female”.

How we get there is sadly not going to depend on physicians or the millions of healthcare workers and volunteers who work tireless in these disease stricken areas, but on the politicians and policy makers who hold the purse-strings.

We can do our bit, but we cannot do it alone. Perhaps one day, we will look back, just as we have done on so many issues, with the benefit of hindsight, and wonder why mankind stood so still in the midst of an epidemic that is taking so many lives?

Thought for the day: “Be the change you want to see in the world”. Mahatma Gandhi