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A tale of two cities

BMJ 2008; 337 doi: (Published 12 August 2008) Cite this as: BMJ 2008;337:a1285
  1. Rosie Wellesley, medical registrar, University Teaching Hospital, Lusaka, Zambia
  1. rosie_wellesley{at}

    It is Friday, which means we are the medical team on call. In the next 24 hours we are responsible for the medical patients who will come into the University Teaching Hospital, the country’s tertiary referral centre. Except that here I have no bleep. Instead, when I snatch a few hours’ sleep in the night it is a polite, insistent rap on the door that wakes me up. This is Africa. London seems very far away. It is not ale they drink here—but millet beer, as much as five litres a day. Our take list doesn’t read like those I am used to. There is not one case of chronic obstructive pulmonary disease. No patients with acute coronary syndrome—let alone an electrocardiograph with which to make a diagnosis. No elderly patients with dementia or a urinary tract infection.

    Instead we have bed after bed of patients with meningitis—young boys with necks so stiff that they raise their whole torso off the bed rather than let their chin flex an inch. A patient with haematemesis is more likely to be a teenager …

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