Harsh Reality

The wards are very sad.  Diagnoses and conditions that we view as extreme or rare are the norm.  At least half of our patients have HIV, several have TB, and cancer, when present, is rarely at an early stage.  I have never seen a case of Kaposi Sarcoma in the US, however have had four patient here with the disease in only four days.  When we admit critically ill patients in the US, we can be comfortably optimistic, though always guarded, about their recovery; here I have learned to expect death as the more likely outcome.  I do not want to imply that most, or even a majority of patients here die; rather patients who would have survived an ICU admission in the US often die here.  It is a harsh reminder of the reality of medicine in most of the world.  Ashiah.