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Personal Views

Out of control

BMJ 1995; 310 doi: (Published 03 June 1995) Cite this as: BMJ 1995;310:1475
  1. Richard Rigby

    After working in southern Africa for two months I still feel overwhelmed by the daily emotional and medical demands generated by the AIDS epidemic. I do not know whether my experience reflects that of other doctors, but perhaps an anecdotal report will convey the personal and professional impact of a disease better than a statistical presentation.

    Considerations of HIV affect almost every decision of my working day—the male and female wards are continually filled with young, wasted adults with persistent coughs and other manifestations of tuberculosis, generalised lymphadenopathy, Kaposi's sarcoma, pyogenic infection, and neural and ocular manifestations of HIV infection. The main reason for admission is to exclude or identify treatable infections, especially pulmonary tuberculosis. The pressure on beds demands early discharge for terminal and untreatable cases despite a hopelessly overstretched home support network. The horror at the magnitude of the problem is compounded by the inadequacy you feel when confronted by another patient deteriorating with a swinging temperature without the resources to investigate or treat the opportunistic infections associated with HIV. Every extra month of health salvaged from this disease is a success for the family and community as these are all parents and bread winners in a society where a hospital stay at planting or harvest time guarantees a malnourished family later in the year. Those deaths that do occur in hospital are most commonly caused by uncontrolled tuberculosis or …

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