Diary Prequel Package — page 25

discharge home to her mother. It was tragic! Again, I could barely hold back tears. A similar case was that of a man in his 30s with obvious HIV disease and likely disseminated TB. Again, no specific therapy. It hit me like a truck! We were here in Uganda talking about the possibility of AIDS care now that drugs would likely be available at markedly reduced prices for Africa (see other discussion regarding tidal wave of movement to provide drugs). The problem that was clear to me was that even in the Mulago Hospital, which is one of the best in Africa there was not even basic health care! Imagine (see below) in the rural areas where there are hardly any doctors. In addition, what kind of training were the house staff getting when they could not definitively diagnose and certainly only rarely treat anyone? It became clear to me that we must use the enthusiasm about providing AIDS drugs to Africans to catalyze an effort to address fundamental health care in Africa. Even in the best of places (Uganda), there is hardly any health care infrastructure. April 18 - Visit to Rakai. Went with Jack Killen (who was with me throughout the entire trip). Leading the trip was Nelson Sewankambo, David Serwadda, T Lutalo, and F. Wabwire. This was one of the highlights of the trip. NIAID funds, in collaboration with Makerere University, Columbia University, and Johns Hopkins, a project in the Rakai district of Uganda (southwest of Kampala towards the border with Tanzania and Rwanda). The project has been going on for about 13 years and has been the source of many major papers including most of Tom Quinn's work on the role of STDs in HIV transmission, the relationship between viral load and transmission in discordant couples, and the protective effect of circumcision on transmission of HIV, among other studies. The site was inspiring, particularly the dedication of the staff who were mostly young Ugandan MDs, PH.Ds, technicians, nurses, etc. Also included among them were a few dedicated American expatriots who were either permanent or doing a fellowship (usually out of Hopkins). Of note, were Noah Kiwanuka, a Ugandan, born in Rakai, who went to medical school in Kampala and received his MPH from Hopkins. He was as good as they get and clearly was in command of the project. Also of note was Mary Meehan, an American wife, mother of 3, and a scientist who had been living with her journalist husband in Uganda and working at both the Uganda Virus Institute in Entebbe and the Rakai project. Of particular note on the trip was the level of available care in this district, which made Mulago look modern. I visited the Kalisizo hospital as well as a "subdistrict" antinatal and general medical clinic. There was almost no physical access. The best of the roads were almost impassable. There were large ruts and gigantic potholes in the unpaved road. Even with a four-wheel drive van, we barely made it since it was the rainy season and segments of the road were partially washed away. I will never forget the patients that I saw at Kalisizo and the rural clinic. There were benches full of patients waiting to be registered and hallways full of people waiting to be seen. Some patients were tended to by their families and were lying on the walkways and hallways or on the lawn without a bed. The pediatric ward had 2 children per bed. I was told that among their other diseases such as HIV and TB, the majority of the people in the wards, especially the children, had malaria. I say several children being transfused for malariainduced anemia. Now in 2001, the blood supply is well-screened. I can only imagine