Africa wins again.

Abstract

For the scientists standing in their thousands world-wide to face this pandemic, Africa is the crucible. Here in the mass of tragically infected people are also found the selected few who by naturally resisting the infection provide a lead in the search for an end to all of it. Africa is the epicentre of AIDS and also the furnace from which will surely emerge the solution.The scientific and other imperatives exerted by this epidemic have been recognised. Multiple sources of funding are accessible to investigators in Africa and their collaborators in the USA and Europe. A particularly good source is the Wellcome Trust Tropical Medicine Programme. On good days, like the one with which I began, I cannot imagine working anywhere else but there are problems.First, the land of physical contrast can break anything. ‘A.W.A.’ we say (‘Africa wins again’) as the freezer melt spreads a year of collected isolates over the floor. Or again, ‘the Malawi rule of two’ which states that in order to have anything working all the time, two must be kept ready — be it fluorescent microscope or flat iron, PCR block or plumbing wrench. People break too, and some very quickly — like the surgeon I remember years ago in Uganda who spent his first African night operating on an injured young woman. She later died in the ward for lack of a blood transfusion and he went home on the next plane…A.W.A.Second, the awful is often more immediate than the awesome. There are days when we spend and spend and spend in the laboratory while the patients die and die and die only yards away for lack of medical support. The awesome and elusive scientific answer seems somehow shabby and unworthy beside the immediate suffering. Never was this more stark than when my tissue incubator and microscope occupied an isolation ward while patients lay on the floor outside.Thirdly, Africa is remote. Not in the physical sense that the name evokes either — more like when you find the library shut when you need that journal today. The library is shut in Africa every day. Work hard here and get fewer results for more effort. Come home ill-informed, de-skilled and underconfident.In return, though, Africa will give you more physical and intellectual space, more freedom, more life. I'm going to drive down from England to spend four more years with alveolar macrophages, AIDS and Africa. May be we won't meet there — but I will be in the right place.