The intern is presenting the history of an “elderly man” who has lost the use of his legs over the past three days. And while he talks, I worry that my anguish at the minimal prospects of neurological help for such patients may evolve into resigned acceptance, as my time as a neurologist in London becomes more remote. We are on the morning “post-take ward round” in Mbarara in the south west of Uganda. It is supposed to be the dry season and our patients coming in with headache and fever will have cryptococcal meningitis. Or at least the majority will have that condition and be faced with a 40% risk of not surviving their hospital admission. However there has been a lot of rain recently, which means the likelihood of a surge of cerebral malaria among our febrile admissions with headache. The number of patients’ attendants I see camped outside adds to that expectation.

The day began well. Every day begins well, with spirits rejuvenated each morning by the clockwork return of the African sun with its wondrous golden light and mellow warmth in the dawn. I know this will seem corny to you, and the fingers of the editorial pen will itch to delete it, but it is vital to the restoration of hopefulness each day. No less important is the warmth and generosity of spirit of the Ugandan people. Not for them the lowered heads and personal preoccupation of the people of London as they hurry to work each morning. Here there are four different morning greetings, each expecting of a proper response. And the vibrant colours of the patients’ laundry, washed by the attending families in the hospital grounds and draped over every available surface, add to a tableau waiting to be claimed by an East …