May 28th, 2015
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Threatened Hope PEPFAR and Health in AfricaCows, chickens, and patients lounged outside the clinic in the blistering heat of a waning South African summer. From the window, I watched them gravitate to the shade of a giant jacaranda tree. The electricity was out for the fourth time that morning, and beads of perspiration dotted our bodies as we waited. It would be hours before the x-ray machine, lights, and air conditioner returned to life.Doctor, you have another patient, the nurse announced, though I was neither a doctor nor supposed to be seeing patients. I was a fourth-year medical student posted to a rural district hospital for a research project. Titles were inconsequential to the local nurses, who sought anyone who might help control the tide of patients.The nurse ushered Mr. C. into the exam room. He was clearly a man aged by his life circumstances: deep depressions etched his temples, darkened skin clung to his ribs. He carried an oversized fluorescent-yellow duffle bag shaped like a sneaker; it would help me identify him months later and hundreds of kilometers away.Mr. C. was like most of the clinic's patients: malnourished, frail, and breakable but with a tenacity that had sustained him through his diagnosis of HIV infection and his first bout of tuberculosis several years earlier. He lived with seven family members in a single-room rondavel and searched unsuccessfully for work in an area where unemployment approached 80%. Many young men like Mr. C

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