Many people ask about the six years I spent working in Malawi and how it's really possible to achieve anything useful in a poverty stricken country that is ravaged by AIDS. I usually reply that the teaching you deliver is just as important, and probably longer lasting, than the clinical practice. If you too are curious please join me now on my round in the men's ward of a government hospital. It is February: rainy season and hungry season. We are aiming to see 56 patients sharing 32 beds; three quarters of these patients have HIV. Our team comprises a clinical officer, a house officer, a medical student, and a messenger. The few nurses are too busy to join us. We have three hours.

The first call is to the diarrhoea side room, a sobering array of wasted bodies and sunken eyes. The floor is wet with poorly mopped spills from bed pans. Most of these men meet the criteria for newly available antiretrovirals from the Global Fund to Fight AIDS, Tuberculosis and Malaria. …