Out of control

Abstract

The author is a medical missionary in southern Africa. He describes the human devastation wrought by HIV/AIDS in the region. The adult wards remain filled with young, wasted males and females with persistent coughs and other manifestations of tuberculosis (TB), generalized lymphadenopathy, Kaposi's sarcoma, pyogenic infection, and neural and ocular manifestations of HIV infection. The main reason for admission to the wards is to exclude or identify treatable infections, especially pulmonary TB. The lack of physical and other resources, however, result in the early discharge of terminal and untreatable cases. Deaths which do occur in the hospital are most commonly caused by untreatable TB or profuse diarrhea combined with chronic wasting and anemia. The children's ward is largely populated by babies and toddlers with a combination of pneumonia and failure to thrive, while outpatient clinics simply providing a preview of future inpatients. The author points out that this heavy toll of AIDS-related morbidity and mortality does not exist in a vacuum, but in the context of many other long-standing diseases. Many AIDS patients die in a state of denial. Finally, there are numerous personal, social, and psychological ramifications associated with each case of AIDS.