Like everything else that I come across in Africa the hospital seems full of contradictions.  The resources are scanty.  There are insufficient nurses, and few doctors, the medical function being carried out by clinical officers who undergo 3 years of training for the role.  Many are excellent, others less so.  Patients come to hospital with a guardian (normally a relative) who performs much of the basic nursing care.  A smoke filled communal cookhouse just outside the hospital, and a small market provide facilities for the guardian to prepare food to be carried in to the patient.  Often the relative sleeps on the floor beneath the patient’s bed.  However, on the ward I work on there are often more patients than beds, the less fortunate being assigned a mat, or blanket on the black concrete floor.  Lines of ants and other assorted arthropods roam largely unchallenged, and children crawl or toddle between the sick.  Some patients are extremely well cared for by their guardians, but others appear dirty and unkempt.  Perhaps the guardian too is unwell – so many in this country have AIDS or TB.  I am told that many of the patients and guardians have travelled long distances to get to hospital, and their absence from home can have dire effects for the family and home they leave behind, as crops go unattended, and a carer for the young or elderly is absent.  A nurse may have 40 or 50 patients to look after, so is completely reliant on the guardians as part of the system, making the nurse’s role very different to the western one.  But amid these scenes, which can be rather shocking to the western eye, the African spirit of hope and endurance survives.  Here the patient will receive much needed medicines and treatment for their complaint, in a country where rural health care is still largely provided by witch doctors.  The staff, in their pristine white uniforms, are mainly professional and committed to their work.  Through the long hours of pain and adversity, the guardians bring companionship and a link with home to the patients as they wait together and endure as only Africans can.