In a small town in Kenya’s Western Province, sugar cane is king. Two giant sugar cane plantations provide jobs and generate heavy truck traffic that fills the hot air with dust. In the center of town is a small strip of shops and businesses: vegetable sellers, a tailor, and a bar. Tucked in among them is the town’s primary private health clinic, which serves up to 20 patients a day. The simple cement structure has two rooms with a pit latrine in back, worn bench seats, paper registers—no computer, no laboratory—and a very basic “pharmacy”: some plastic medicine bottles on a bookshelf.
Although the clinic is very modest, the aging physician who owns and operates it is a dynamo. Dr. George (a pseudonym), who retired from the public health system after 20 years of service, is an energetic, committed man who speaks quickly and emphatically. He knows the town and its inhabitants well; this is where he grew up and has remained for most of his 60-plus years. His mission is to serve his neighbors, but he is intensely aware that despite his years of experience, he needs more training to help his clients who are infected with HIV.