"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