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In this article, I recall two young patients, one with HIV associated Guillain–Barré syndrome, and the other with drug toxicity from treatment for human African trypanosomiasis. I had encountered them while working in Africa in the 1990s. While both cases were highly informative and influential in forming my subsequent attitude and approach to management and research, the prognosis in the two cases was very different. Current treatments for these two conditions vary in their efficacy and toxicity, and these reflect varying levels of pharmaceutical industry input into diseases of subSaharan Africa.
Most doctors are probably influenced more than they might think or admit by a few vivid experiences during their career which in retrospect can be clearly identified as being hugely important in shaping their lifelong approach to clinical practice or research. While most of these experiences tend to occur early in a doctor’s career, either as a medical student or a trainee doctor, sometimes they occur in mid-career, and this was certainly the case for me. Just over a year after I had obtained the Neurology Chair in Glasgow, I began in 1988 to visit East Africa every year, primarily as part of our sleeping sickness research programme and sometimes to teach young doctors and scientists as well. There have been several memorable experiences during these visits, but two in particular come to mind as strongly influencing my attitude to patient care in developing countries in one case, and to research priorities in the other.
The first episode was almost 20 years ago in an African country that I have only visited once. I had been attending an excellent international conference that focused particularly on HIV infection of the nervous system which was of great interest to me at that time. This was a period when HIV infection was …
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