“That’s Africa”, or words to that effect, have been directed at me a number of times recently as some form of justification of things not working. Africa is broken and we have to work with what we have got, is the idea. Is this acceptance of the way things are a way of surviving and working in difficult environments or is it actually wrong and medically negligent to accept substandard practice? In many ways, this dilemma can be applied to any part of the world, both developing and developed, but it is most acute in Africa.

While observing medical ward rounds in a public hospital in Malawi, I came across two kinds of doctor. One kind would accept the way things were and work within the constraints; the other kind would always be battling against the constraints. I was told that “we can’t give an intravenous infusion because the nurses cannot count the number of drops …” Really? Why can’t they count the number of drops? I see no reason, aside from a complete lack of time (which of course does occur). This attitude included everything from delivering blood samples to the laboratory to accessing drugs. …