Diary Prequel Package — page 26

how many children got HIV-infected years ago before blood screening by these transfusions given for malaria. The faces of the patients were haunting. They were very quiet; no one made a sound, even the most ill. The Kalisizo hospital was staffed by 3 MDs whose training was medical school and 1 to 2 years of house staff training. These people did everything that did not absolutely require secondary and tertiary care. They performed deliveries, Caesarean sections, abdominal surgery (including bowel resection and anastomosis), fractures and other trauma as well as some types of chest surgery. With all due respect to their dedication, I thought at the time and still do now that despite the fact that on-the spot training is critical, these people could not be highly skilled surgeons since the only formal training that they had before they came to this place was a course in "surgical techniques" in medical school. This involved resecting bowels of sheep and other animals. There was no senior attending here supervising them. An important point about the visit was the extraordinary sophistication and dedication of the staff of the Rakai Project. They were amazingly organized in their system of following patients on study. They had a large number of counselors and field workers who went out into the field and tracked and counseled their patients. They went out by truck, motorcycle or on foot. They were mostly young Ugandans who were clearly dedicated. The success of the projects clearly depended on them. April 19 - The meeting entitled "AIDS Care in Africa" started today and I gave a brief opening address that I had carefully prepared with a written statement and slides that I had asked Greg Folkers to immediately post on the NIAID Website after the talk (please see copy of speech). Given the tidal wave of enthusiasm of getting antiretroviral drugs to Africans, there was in the global community immediately prior to this meeting a major dichotomy between those who were concerned that providing treatment would suck off resources from prevention and other activities and those who felt that we should proceed vigorously towards treating African with anti-retrovirals now that the prices of drugs were markedly decreased. It was clear to me from my reflections before the meeting (see my speech) and from my 2 days of observing first-hand the situation in Kampala that there needed to be a balance between treating Africans and accelerating the prevention measures. Also, and extremely important was the fact that as mentioned above, there was hardly any health care infrastructure in Uganda (which was better than most African countries). I stressed that we must act in a comprehensive manner by building sustainable health care and research infrastructure and by also considering other basic health care issues such as clean water; treatment and prophylaxis for malaria, TB; vaccinations against childhood diseases; treatment of diarrheal and acute respiratory diseases. My remarks were extremely well received and clearly the meeting organizers and participants were pleased that I was there and were looking to me for sober leadership in this difficult problem. An interesting event transpired at the morning session. Ugandan President Museveni was scheduled to speak immediately before my talk. He was late and so I gave my talk and chaired the session for about 1 1⁄2 hours. Just at the end of the question period, the President walked into the Ballroom of the Sheraton Hotel where the meeting was held. He was accompanied by his Chief Deputy Dr. Ruhakana Rugunda. Everyone including myself left the stage to make way for the President. I took a seat in the first row of the audience. Just then, Dr. Rugunda stepped down from the stage, grabbed my