Due to the shockingly candid details given, the doctor has asked that we delete any comments that might reveal the author's identity. Warning: What you are about to read is extremely distressing.

South Africa, February 2001-"The main reason I can't wait to get out of here is that my personality is suddenly altering. They say it's called, 'becoming a doctor.' In South Africa, that means your main emotion when a patient dies is relief.

"The AIDS down here is becoming alarming. Most of our beds are filled with HIV+ [HIV positive] patients. They talk about the 'package deal' down in the emergency department. An extremely skinny patient comes in, coughing, complaining of tiredness. On examination, they have oral thrush, often so bad that even their lips are covered with a white fungus, as it climbs out of their mouths. And immediately, you know that they have HIV, TB and oral candidiasis.

"We go through the motions of testing them, but I don't know why. We admit them, rehydrate them, and all that we succeed in doing is prolonging their death by a week or two. We are now at the point where we refuse to give them any active treatment (antibiotics, antifungals, even blood), which includes resuscitation. It's quite simple-even with active treatment, the only difference you make is a few weeks. (They always wait until they are terminal before arriving at the hospital.) So, why waste money you don't have to begin with?

"The other day, I caught myself saying out loud that we should start refusing to admit HIV+ patients, since we're only prolonging the inevitable. We're turning away patients with asthma and diabetes, patients with controllable diseases who could contribute to the economy, because AIDS patients are taking up all the beds.

Playing God

"And then, it hit me, 'I'm playing God.' If we start doing that, we might as well start denying medical care to old people and premature babies, because they no longer contribute to society. We might as well start turning away patients with other terminal illnesses, like cancer and multiple sclerosis, because we're only prolonging the inevitable.

"You have no idea what kind of hell it is to do ward rounds in [the name of city where the doctor was working when this was written] in the morning. You walk through rooms of skeletons, their chests rattling with each cough. The sisters, too, are beyond caring. Many of the patients lay in beds [soaked with] their own urine, because the sisters never get around to washing them unless it's 'that time of the morning.' Their lips are caked with white fungus, their faces mottled with blood-flecked sputum. They watch you from their beds, their eyes often the only body parts they can still move. Some of them still beg with their eyes for help. And we do nothing.

"Some are beyond caring. Their eyes are already dead, which is why you check each patient's pulse before discussing them. "We use pseudonyms like 'retrovirus' or 'high five' for HIV and 'Koch's bacillus' for TB in an effort to maintain privacy. But they all know the telltale wailing following the post-test 'You have HIV' speech.

Haunting experience

"Not all of the deaths here go unnoticed. One of my patients will always haunt me. As I mentioned, most of the AIDS patients have pretty typical appearances (skinny and coughing).

Some (especially the children) never reach that stage. This particular young girl (19 years old) didn't fit the typical profile at all. She was educated, eloquent and still looked very healthy. She had known she was HIV+ for three years prior to her admission. (Her boyfriend had told her that he was monogamous, and so he was. Unfortunately, his previous girlfriend had not been.) She came after she suddenly started battling to breathe, rather like a severe asthma attack. In well-fed HIV+ patients in Africa, this normally is due to pneumocystis pneumonia. This was the diagnosis in her case.

"If we could pull her through the pneumocystis pneumonia, she could still have a few good years left. So we put her on oxygen, nebulisations and antibiotics. For two days, I had to walk into the ward and watch her struggling to breathe. For two days, she couldn't sleep for fear of forgetting to breathe. The nursing sisters were unfortunately 'forgetting' to give the full dose of antibiotics. On the morning of the third day, she looked worse than ever when I arrived. I can't describe the feeling of powerlessness when you realize that you can't give anything to 'make it go away.' The only option left to us was to give her small doses of opioids to make the struggling for each breath at least seem less painful.

"When we came round later in the day with the consultant, the patient had finally fallen asleep. He was impressed by her improvement and decided to forego the opioids. As we moved on to the next patient, I suddenly knew that I would never see her alive again. She died that night.

But for the grace of God

"Most of all, you wander between the patients and know that, but for the grace of God and a single needle-stick wound, that could be you.

"I'm beginning to hate medicine in South Africa.

"Diagnostically, it's no challenge, because they all have HIV. Therapeutically, it's no challenge, because we do nothing. Emotionally, it takes you to places where you simply don't care about life anymore. And still we work…a full day plus after hours for no pay and the constant danger that the next time you draw blood or put up a drip, you could get HIV. And, the state doesn't give a [care].

They no longer even provide us with free anti-HIV drugs (AZT, etc.), following a needle-stick injury.

Most of us are studying on loans, earning no money, and they expect us to dig out 3,000 rand a week for drugs following a needle-stick injury treating their patients. We can't afford that.

"And…they wonder why we're leaving the country.

"I hope [these letters get] people thinking twice, whether it's about unsafe sex or an awareness of human fragility." (End of doctor's letters. Emphasis added throughout.)

No easy way to say it

There's no easy way to describe the desperate situation gripping Africa. A recent South African government report revealed that one in every nine of its citizens and nearly 25 percent of pregnant women are HIV positive. The same report forewarned that, by 2016, the country's population would begin to shrink, because the number of deaths due to HIV will surpass the number of births.

A single faint glimmer of hope appeared in statistics that show a marginal decline in HIV infection rates in regions where there have been sex education campaigns-no easy task, given the centuries-old taboos and traditions.

Promiscuity alone is not the reason for the rapid spread of AIDS on the African continent. Many diseases that have been largely controlled in the West by advanced medicine are rampant in Africa. They include malaria, syphilis, gonorrhea, tuberculosis and pneumonia. Diseases that involve open sores and exposure to bodily fluids boost the proliferation of AIDS.

In December 2000 the United Nations announced its estimate on the African-AIDS condition. It said 24.5 million people in the sub-Saharan region are HIV positive. Contrast that with the total figure worldwide of 34.5 million infected. More than 7 out of every 10 cases in the entire world are in the sub-Saharan countries of this plague-stricken continent.

A race to develop an AIDS vaccine is underway in the international medical community. Billionaire philanthropist Bill Gates has personally donated $100 million to the research, challenging other wealthy people to contribute generously as well. Mr. Gates' Microsoft Corporation has raised nearly a quarter of a billion dollars for the project so far.

AIDS drugs are notoriously expensive, literally out of reach for the average African government or private citizen. However, there are cheaper, generic versions of the patented drugs available.

Fearing a huge loss of revenue, 39 pharmaceutical companies filed a lawsuit to block South Africa from importing the cheaper generic drugs, a blow that would be fatal to what feeble attempt the nation could mount against this insidious enemy. Thankfully, the pharmaceutical companies withdrew their suit in mid-April.

Even if an effective anti-AIDS drug is developed and made available in generic form to the afflicted African nations, could AIDS be stopped?

No one to run between the dead and the dying

Numbers 16:4-48 tells of a plague that struck Israel, when Moses and his brother, Aaron, governed it. At Moses' urging, Aaron literally ran between the dead and the dying with the means to stay the plague.

African governments do not work as efficiently.

Michael Ledeen, who spent many years in sub-Saharan Africa and saw AIDS firsthand, wrote in his March 27th column that distributing medicine through African governments would never work.

"There is no infrastructure capable of delivering medicine to those who need it, nor to ensure that patients take the full course of treatment" ("Fighting AIDS Is a Losing Proposition").

Unless the West virtually creates and imposes the missing infrastructure, Mr. Ledeen continues, "No matter how generously we donate medicine to Africa, a huge bloc of Africans will never receive it…." African leaders, he warns, would enrich themselves by selling cheap medications at a markup. Further, they likely would use medicine as a political weapon. Those who ally themselves with the leaders would receive medication, while those who did not would be frozen out of any supplies. Witness that type of political manipulation in the distribution of food relief in famine-stricken African countries.

"Is it hopeless, then?" Mr. Ledeen asks. His answer: "Most likely, it is, at least in the sense of 'solving the problem.'"

Hope for the hopeless

We sincerely hope that Mr. Ledeen is wrong, and that there will be ways to bring relief to the millions suffering from this dread disease. However, our hope doesn't rest in man's capabilities.

The example of Aaron mentioned above is a type of the coming Christ, who will interpose Himself between the dead and the dying to bring healing to the nations. Clearly, two kinds of healing are needed-an immediate intervention to restore physical health, along with a spiritual healing of the character of individuals and their governments that have brought on the dark days in which we live.

A messianic prophecy in Isaiah 52 and 53 foretold that the blows that marred Jesus Christ before His crucifixion would bring about the healing of all people. Is this but a spiritual allegory, announcing spiritual salvation? No doubt that is the main reason Christ gave His life. Yet the additional benefit of physical healing also was purchased by the stripes whacked across His body (Matthew 8:17). So that we would not fail to comprehend and hope in this blessing, He intertwined physical and spiritual healing by restoring the health of a paralytic with this postscript: "that you may know that the Son of Man has power on earth to forgive sins" (Matthew 9:6).

Therein lies the hope of Africa. God speed the dawning of that day of healing. WNP