Leaving Tanzania. I think perhaps I stayed here one day too long. My last two days have been easy compared to Jane's but I have dragged my way through them. Finally the heat is too much, the endless onslaught of people too much, the haemorrhaging of money that comes with being a Mzungu, the impossible foreignness of it, all too much.


On my last day there are a few people who I want to see just one more time, people who have done very well on their first remedy but now need the next step. This “second prescription” has been a Holy Grail for me and a puzzle since the time I first started prescribing 25 years ago. The first prescription is the beginning of the journey but being able to continue without losing your way when you hit the first hurdle and then the second and third, being able to negotiate around the obstacles, sticking with the person around all the bends on the road to recovery is the only way to help them to be really well.


The first prescription is often the “Wow” one, especially in someone who is very ill. To give a remedy to someone who can no longer walk to the door, someone who has given up hope because they can no longer work which means they have no food, someone who is in terrible pain and despair and then watch them turn around and head back towards life can really look like a miracle. But the real miracle is all the hard slog which comes next; sticking with them, possibly for years, as they slowly untangle their health. People who are HIV have the incentive to keep coming back for treatment because they see their CD4 count going up and up and up and they actually seem to get better very fast but it is the same for anyone, we all have the challenge of our own long term health, often our most important challenge.


On my way to today's home visits I reflect that I have loved driving with impunity through the areas of Moshi which are maybe a bit rough, I've had a place here because I was on my way to one of the outreach clinics or doing home visits. It has become normal to travel through people's lives on their intimate streets. But today is different, I am marked out for home now. I will leave and the gap that had me in it will close in a moment and life will go on.


In Moshi you can drive across the tracks to the other side of the town, it is quicker than driving around. There is one place where there is a gate which a man might open for you. It is the strangest gate because there is no fence or wall only gate posts and woven around on every side are cycle paths or piki piki motorbike paths or paths made by feet, running and weaving like ribbon or tangled hair. Only the cars or the lorries or the carts must go through the gate, everything else winds around. The obstacle is the track itself and some buildings with not quite enough room to get around though the piki piki's fly through giving the illusion of free passage.


When, after a wait, you do get through with your lumbering car you climb up onto the track which has no trains but is a straight die highway full of people walking, clamber down on the other side then make your way along the woven piki piki paths to the clinic which is back on an actual road. This must be what it is like to travel from the left to the right side of the brain; on one side the grid of the proper town, on the other the wild chaos of the cycle paths which made themselves up as they went along.


I have done a lot of driving around on this side of town and even remember my way but my comfort here is illusion; Roger tells us of a robber who was hacked to death a few weeks ago by the owners of the shop he was robbing, or our local piki piki driver in Shanty Town who, only this week, gave two men a ride across these tracks and got beaten up for his trouble. Motorbike stolen. End of his career as a piki piki driver.


Jane has had a much heavier few days at work than me. Because we have been away the busier clinics got put off until this week and it's only Tuesday but she has seen nearly 50 people. Our limits keep getting pushed like this; you think it's impossible and then you do it, if it is necessary you do it. Mind you she did come home from work today and buy herself an iron, it must have felt as if sanity and calm might be possible if only her clothes were ironed. Clothes are washed by hand here, then wrung out and dried fast in the sun and end up very crumpled and possibly infested with mango fly eggs which we kill with an iron, when we had an iron. Comforts are small and important. She must get up in the morning and start again. Me and Davy get on a plane.

I have loved it though, no matter how hard it is, I am very glad to have had this chance. I am very glad to have made friends I don't want to leave.  Jeremy and Camilla have been stunning in their generosity and friendship and I was very sad this evening to say goodbye to Amy and Noga and Ike who have been especially good friends to Davy and me.

Davy washing our clothes to come home