Third world disease.(Guest Editorial)

As part of our work on expanding health care in Africa, my wife and I were invited to visit Queen Elizabeth's Central Hospital in Malawi. It is one of the most amazing places in the world for me. I will never forget it.

On one side of the hall was an outpatient clinic for 400 or so AIDS patients who could afford the $1 a day for antiretroviral medicines. These patients were doing quite well, since the clinical response to these AIDS drugs is excellent.

Literally across the hall was the "Medical Ward"--an ironic misnomer because there were almost no medicines there. A sign on the wall said "Occupancy 160 beds." That day, there were around 450 people in the ward, all of them dying, mostly from AIDS.

Have you ever seen three dying strangers assigned to one bed, other than in a picture of a concentration camp? I had not. I never imagined that in this day and age there would be hospitals where two dying AIDS patients--strangers--would be head to foot in a bed, while a third patient would be put under the bed, either directly on the ground or on a piece of cardboard.

The same doctor treated both the clinic and the ward patients, but there were no drugs for the second group because these patients didn't have the $1 a day for the medicines. That's not surprising; in Malawi, the per capita annual income is $200, so $1 a day translates to a maintenance cost that is almost twice the average annual income.

This is but one example of the life-and-death difference a few dollars can make. Another example is in East Africa, where thousands of children die each day because they don't get effective drugs to treat malaria--for around $1 per treatment with the new and effective artemisininbased combination therapies (ACTs).

We spend a lot of time on sophisticated theories about why these children aren't getting the treatments they need, but the fact is, international donors simply don't provide the very modest levels of financial resources that could make all the difference. It would cost the nations of the developed world about $3 billion to finance a major reduction in malaria morbidity and mortality. That's what the U.S. government spends in less than a month on military operations in Iraq. A major antimalaria effort could save 1-2 million lives each year, maybe even more.