When is a disaster not a disaster? In the male medical ward of this ex-mission hospital 400 km north and inland of Durban—right in the heart of Zululand—the answer is easy to find. It is defined by the disaster management posters on the wall: a disaster is a fire, explosion, bomb, war, flood, earthquake, volcanic eruption, tornado, mass food poisoning, hysteria.

More recently these posters have been joined by elaborate swine flu protocols. Strictest standards of barrier nursing and high dependency care are advocated. The hospital management has described swine flu as “a crisis, a disaster.” In total there has been one suspected, unconfirmed, case in these wards.

In contrast here in KwaZulu, as the HIV pandemic has taken off, admissions to medical wards have increased 300% in the last 15 years. Average age of patient, length of stay, and survival to discharge have all plummeted. National life expectancy has fallen from 62 years in 1992 to 50.5 years in 2007. Statistics South Africa1 indicate that all cause mortality in adults aged 25-49 has increased from …