"Of all the forms of inequality, injustice in health is the most shocking and the most inhumane." - Dr. Martin Luther King jr.

I made a mistake today. Well actually it was made yesterday - I only found out today. It wasn't a big one - in fact back home it would be correct clinical practice - here, not so.

The patient must be 25 years old. He has been representing continuous for year - same symptoms. Treated and retreated nothing seems to change.

So today I treat and sit back and ask him if he can afford an x-ray. We discuss and conclude he will confirm how much it will cost him and if he can afford it he will get it done, if not he will come back.

So he arrivs X-ray in hand today. Looking quite happy he opens the door

"How Much" I ask before he gets to sit down.

"1500 shillings" he answers

"Ohhhhh!" I say "That is a lot"

"yes but it'll be worth it" He replies.

I take them over to the window and immediately can see they are not normal. Trouble is that it raises more questions than it answers.

I confirm that he needs more tests.

I turn to him "You'll need more tests to see exactly what is going on" I explained.

Angrily he responds "WHAT?"

But I have already paid the $1500 shillings - I have no more for tests. This was it.

My heart sank. I knew I had done it. I hadn't explained the chance that the x-ray wouldn't find the diagnosis. Now he was stuck.

No doubt he was sick - he knew it, and so did I, but we had reached the end of his expenses.

The gap between first and third world health care is immense. Can we really continue to congratulate ourselves with our advances while these chasms widen? We have probes looking for specific sequences of DNA, MRI machines that can map evey 1cm of human tissue, and surgery that promises to correct the vast majoriy of physical ailments.

These people have to scrape together enough money, using realatives and friends - just for a simple chest x-ray. The are almost dispensed at will in Australia.

For me I guess it is a cleansing gift to be awake to what the rest of the world does't have.

Doesn't help my patient though.

I discuss it with the nurse and waive all fees and charges from our end.

The tests go on.

"But tell me, this physician of whom you were just speaking, is he a moneymaker, an earner of fees or a healer of the sick?" - Plato - The Republic

Refugees

"When you were born, you cried and everybody else was happy. The only question that matters is this - when you die, will you be happy when everybody else is crying"
-Tony Campolo

Clinic was busy today. One after another they came. Typhoid, pneumonia, HIV, tonsillitis, more pneumonia, miscarriages...even the standard foreign body in childs nostril.

My Swahili is starting to improve - which speeds things up. Unfortunately my brain seems to make these adjustments to a new language poorly......but most of you probably already know this. It has to be one of the hardest things working in this environment.

An example occured with one of the refugee clients today.

Funnily enough however you can always pick the refugee...even before they speak.

Walking in they always carry themselves low; as if carring a weight. I guess most are. Sometimes you can see this in their eyes.

This one sticking in my memory was this Congolese guy. He must have been 23 or so. After struggling for about a minute with my Swahili, I found out he spoke french only. yes hilarious!

So I get my Swahili nurse and his friend (who speaks only french and swahili) to form a four way conversation.

He speaks to his friend, his friend tells the nurse, who then tells me what he said. I ask a question, she relays it to the friend who uses his french to ask the patient. My first experience of chinese wispers in Africa seemed to work pretty well....

Both of us were using this broken language must have looked strange to any one else. Chatting later to his friend I hear a little more of why he is in the country.

It would be nice to think that his story was the exception to the rule, but I have seen already enough to know that this isn't true.

Father mudered in front of him the patient was chastised then to become a part of the fighting force. He fled as they attempted to take his life too - running he lost sight of his mother. His rejection caused his sister to be left a cripple by the guerillas - now she is unable to walk, living in the hospital, and his mother he has no idea.

It is a sad state of affairs that the pain doesn't end once they arrive in Kenya. Here they are looked after by numerous NGO's with minial money to support them all. They drink the worst water in the slum, eat whatever they can and sleep in cramped rooms side by side. They are the sickest too. This I can attest to working at the dispensary. Blows my mind how these people keep fighting on. But they do......and even manage to smile.

"Try not to become a man of success, but rather try to become a man of value."

"Albert Einstein"

"Too much abstract thought makes a man cruel" - Dostoyevsky

As I sat yesterday in a tin hut, beads of sweat dripping from me, mouth parched, I couldn't help but think of advice I was given before leaving Australia.

Surely this advice was given out of good intentions.

'do not to give hand-outs. Attempt to arrest the idea that the 1st world is the only way out. Plus it is not sustainable to keep giving. They have to learn that we are not the caregivers.'

'We do them an injustice by continually giving all the time.'

At the time I agreed.

It is not right that we should be seen as a vacuum of prosperity. They have to learn to do it for themselves. Africa has far and away enough resources to lift itself out of its predicament. They do need a bit of tough love. Plus there are bigger and better ways. Lobby parliment, stop bribery, increase education, better public health measures.

Every educated person knows this is how real change occurs. Trouble is that the educated person is not looking into the eyes of those in desperate need.

Coming to Kangemi again I realise that slum life is a struggle. You have to fight for every day. Give in for a brief hour and it could see you loose everything to the sly thief trying to make his living.

In th hut the heat was getting a little unbearable. Seeing I was struggling one went off to purchase some cool lemonade - perhaps they were feeling it too.

I remained and decided to do the maths in my head as we chatted.

I thought it through .....For any well paying job you earn $280 a mnth. That works out to be about $9 a day. Pay $180 in rent for your tin hut; leaving only $100 for food, electricity and education for your children. Oh and I nearlly forgot, you are the only one working in your extended family so they need some money just to eat too...... In the end you are struggling each week just to keep your head above water. Any investment in the future is impossible and buying your way out of the rent cycle and hence the slum - never! Remember this is for a WELL PAID employed individual - a rarity in the slum.

She arrived back pouring the coke (there was no lemonade left) and sat and watched as I drank. The kids so excited that mum had bought some 'soda' started running around.

We sat and chated for a while longer.

I told them of my house in Australia.

"How many rooms do you have?" They asked excitidly. And do you have a bathroom in the house? I didn't know exactly how to respond.

It was at that moment that I realised Australians have everything. Can I say this is because of something I have done? I mean I have never worked as hard as these people. It is a gift of nationality.

Thinking again of the words from Australia - the words of those educated amoung us.....I realised I could walk out and justify myself - it would be actually quite easy to disengage my heart and engage my brain, but really when you put yourself in their shoes, in their tin hut, in their family situation, in their job, - justification is the last thing that you want to do.

Being educated allows us to form a detachment towards reality. You can easliy tell someone the best way to employ change is to lobby government to employ best practice public health measures etc, but this isn't what the individual needs.

They need your love right there in the heat of the daily struggle.

My first 7 days have been interesting to say the least.

It has included a touch of malaria....well maybe a bit more than a touch, some heart wrenching cases at the clinic, and calls for charity that one struggles to ignore.

I learnt last time hearing stories of the locals is one of the more enlightening/enriching experiences.

This time has been no different.

Aroada is a lady supported by the Jesuit Preists here where I am staying.

She is a mother of one child who is ten years old. She also happens to be HIV positive. Give this disease by her husband he then turned her out, left to fight for herself. Funnily enough so did her mother and father as soon as they learnt that she was positive. Left on the street she had no choice but to turn to crime.

This as she recalled to me with tears in her eyes is something that she regrets. Ostracization by your family is common when you are diagnosed with HIV.

I have had to learn this at the clinic.

I would appreciate being able to screen everyone I see for the disease, not only because it can present in so many different forms, but because it would surely limit its spread. This I cannot do for a number of reasons. People would not turn up knowing they are to be screened automatically for the disease. Why would anyone risk most certainly being pushed out onto the dusty street by yourself for the rest of your life.

Further the cost is prohibitive. Each patient can barely afford the 50 shilling fee for the consult let alone a barrage of tests to screen for diseases they may not have. All they want is treatment there and then and 'the cheapest cost please'.

It is a dilemma I face everyday.

The patient has Symptoms b, d, and e.

In Australia you would do a test, charge Medicare and tell them what they have.

In Kangemi you have to guess. Guess the test they are most likely able to afford, guess the right disease from the limited information gathered from the wrong test you had to order.

Then you have to guess the treatment and ask them to return if/when it doens't work.

Medicine is different in Africa.

Back again....

I am spending a few weeks in Nairobi, Kenya. This is my second time.

I was here last in 2006 and worked for a period in a slum clinic. This was located in a place called Kangemi.

Kangemi is on the western side of Nairobi and estimated to have approximately 150,000 people on the 2x2km Sq area of land. Unfortunately it is also home to everything humans bring with them.

From Typhoid to HIV, muggings to murder, the slum is not a place you ever wish to live.
These streets lined with corrugated iron huts, and trenches filled with foul odours are also filled with people.

Most are trying to earn enough to live, to eat, and to sleep in a 1 room tin hut.

Most struggle to do even that and a fair amount of people have to live without a door (a punishment distributed by the landlord for not paying the rent that week). If they are lucky they will make it through the week without getting stolen from and then will earn their door back for the next 7 days.

I have been staying in Kangemi for the last week. Coming back has shown me how quickly one can forget. I forgot the vile stench, the masses of people the flies and dust.

Don't get me wrong the place isn't devoid of anything good, just that you struggle to find it amid the desperate poverty.