I arrived in Lusaka on the Tuesday morning after a twelve hour flight. It was suffering from the edge of the cyclone which had been battering Mozambique and it was showering. As we landed you could see the spray from the runway shooting in the air.

Customs was simple and I was met by Prem Kulleen, who had organised much of my visit to Lusaka. Prem drove me to the place I was staying and we spoke in the car, me a little incoherently as I hadn't slept that much. I was staying at the Blue Crest Guest House. Prem dropped me off and arranged to come back at 14.30 to take me to my first appointment, at the University Teaching Hospital, and Professor Bhat, a much respected former head of Paediatrics.

With me still a little groggy from the flight, we reached the hospital and I proceeded to a meeting with Prof. Bhat and Doctor Shakankale, the current head of Paediatrics. The assault on my senses started as they reeled off figures for patients admitted to the hospital in general, Paediatrics in particular and the country as a whole.

Approximately 250 children are seen daily. This is mainly due to malaria, T.B., malnutrition and dysentery. The last three (of 1 above) are all presenting symptoms of HIV/AIDS.

In a recent case study 30% of parents from admitted children were either ill (one or both), or dead (one or both). In another recent study, 27% of pregnant women were found to be HIV+. These were in the 16 - 45 age group and the most sexually active.

In one typical day on the children's malnutrition ward, there were 62 admissions. Fifteen died the same day. This was due to poverty, HIV and small percentage negligence.

• It costs about $1.50 to feed a child in the hospital.
• Between 70% and 80% of the population live in poverty.
• There are over 500,000 orphans in Zambia (of a population of 10,000,000).
• There are over 3,000,000 people who are HIV+.

As the above figures started to sink in I thought of other figures I had been given for other countries in Sub-Saharan Africa, and Cameroon in particular.

The week before I left I had been present at a talk given by Dr Peter McCormick of Kettering General Hospital based on his work in Cameroon. He had stated that official statistics showed that 15% of all truck drivers, soldiers and prostitutes were HIV+, and that 1,600 babies are born HIV+ every day. In the N.W. province of Cameroon, with a population of 1,200,000, there were 74,000 orphans. AIDS is now the single biggest cause of death at both the hospitals he works at. Cameroon has a particularly virulent form of HIV (HIV2) and it is spreading at an alarming rate. Zambia ONLY suffers with HIV1.

Prof. Bhat started to show me around and it was easy to see the despair he felt as we entered the admissions ward. We saw a mother and her baby waiting by some scales for a nurse to take down details. Prof. Bhat placed the child on the scales and checked the child's weight against previous measurements. The child had lost two kilos in two weeks, it now weighed 6.3 kilos. Unless a miracle happened this child was not long in this world. We walked through the room to a corridor beyond. I stopped and looked left and then right, a long stream of mothers were queuing, waiting in line for their turn to have someone look after their baby. The hospital is generally the last line of support for all medical cases anywhere in the world, for these mothers it might just come down to the fact that the child is malnourished.

We entered one of the wards where mothers, fathers and guardians kept watch over their children. With 500,000 orphans it is often the grandmother who is found watching over a child. Children gaunt, emaciated, with eyes that reach into your very being as they hope that this white man may be the miracle that they need, line the wards, one after another. It seems endless, like a rabbit warren, a left turn here into another ward, then right and another, straight on and even more.

This child has malaria, this T.B. This child has been admitted three times in two months. Each admission brings death closer as the body grows weaker.

Where is it's mother? She's dead. The father? He's dead too. Or maybe this time he may have disappeared hoping the spectre of AIDS will be left behind - not much chance of that.

One nurse tells us that she knew the mother of this child, being cared for by her grandmother. Once we realised who the mother was we figured out what had happened. She had many boyfriends. One boyfriend too many.

We meet the Chief Nursing Officer who tells us that the hospital is frequently running out of food itself. The children have a mixture of powdered milk, oil and other ingredients which bring their strength up quickly. The budget is small, but they do what they can. We need food, she says again.

Violet, the AIDS counsellor, tells me she has to deal with the parents who are diagnosed as HIV+. They don't know, and often don't believe, that this can be the case. How can they be HIV+? The father frequently refuses to have a test, the mother frequently agrees to be tested. In a few cases the man returns later to be tested privately.

Our penultimate stop is in the malnutrition ward where the previous day fifteen of the sixty two admissions had died. Some children look no more than bones with skin wrapped round. The tube intravenously feeding them looks bigger than the body it is fixed to. The ward is in four sections, entry through to exit. This is for those which survive. I am there just as visiting time starts. People start to flood through the door.

Our final stop is to a young boy who has abdominal cancer. His gut is swollen to the size of a football. Prof. Bhat says a few words to him. I say to Prof. Bhat that he cannot be in a position to treat this child, and he says that is the case. This child will just die. Hopefully they will have something to ease the pain. There is no guarantee.

As a physician it is a difficult to stand by and be able to nothing. As an onlooker it is just emotionally painful.

We return to Prof. Bhat's office and arrange to meet again on Thursday.

After a meal with Prem, his wife and friends, I am relieved to go back to the Guest House and sleep. Not sure how well I slept as my dreams were not the most pleasant I have ever experienced.

The next day dawned bright and sunny, and the rain seemed a long way off. I had a meeting with the Family Health Trust which had been operating for more than twelve years. Mrs Matake and John Musange were my hosts.

They started by explaining how they had a three pronged approach to the work they do:

• Anti-AIDS project.
• To prevent the spread of HIV in young people.
• Home based care for people with AIDS.
• Local family/community based projects.

Anti-AIDS project

This policy is one designed to stop HIV spreading even further. Teachers go out into schools and colleges and explain the dangers involved with HIV. This work starts when children are in primary school and runs through to University entrants. It is also structured to realise the differences between urban and rural societies.

It is believed that currently there is a fall in HIV cases in urban communities and an increase in rural ones. No one can quite say why.

There is also a project run by over two and half thousand clubs in which seventy five thousand young people belong who interact with each other, while the leaders of these groups act on a one-to-one basis with children their own age. This is a very useful peer-to-peer facility.

The use of theatre and symbols (as I explain later) is another useful function and is widely used to overcome illiteracy.

Home Based Care Although rudimentary, ten nurses look after 600 families, and this excellent scheme takes medical staff into the community to give support through counselling and nutritional advice. Of course, with a great deal of malnutrition prevalent due to one or both parents either dead or dying, the onus falls upon the extended family system which has responded well in the past. However, due to the sheer weight of numbers this is now collapsing. This has also given rise to "children headed families".

The nurses have been training volunteers, who are answerable to the nurses, to work within communities to lighten the work load. FHT have also introduced an I.D. card for HIV patients so that they can go directly to hospital, bypassing time consuming bureaucracy. They work closely with the hospital and believe that 80% of all admissions are AIDS related.

Local family/community based projects FHT believe, rightly in my opinion, that the first line of defence is with the family, and they have looked at ways to make the family unit more sustainable.

To this end they have identified the three basic needs for each family so they can become self supporting, i.e. food, shelter and training. The first two are obvious, the third is to enable people to earn money to supply the first two.

They are doing this by mobilising communities (more easy in rural settings) and have the local elders directing the community in a particular way, based on their local needs. Even simple things such as making sure a child goes to school becomes the responsibility of everyone in the community. Hopefully this will expand to ensure that children are fed and housed, and where an extended family does exist support is given by all.

Again working within the communities, children are told of their rights so they cannot be taken advantage of because of their particular circumstances.

Also within this scheme is a Women in the Community project where widows are given support. It is a familiar problem, there is no breadwinner, but there are children, HIV and loneliness. Again volunteers with the community arrange to visit to offer support on a peer group basis.

Because the economy is stagnant, FHT also tries to equip youngsters and their "guardians" with some form of skill that they may eke out a living. They are looking to build a training centre in order to produce maids, carpenters, bricklayers etc. One training centre may help over 250 children per year. We are waiting to hear from them how much money is needed.

They also told me of a group of villages in the Eastern Province which has schooling, hostel and farms, and is run on a co-operative basis, with any money made going to help the orphans within the community. They need a lot of support for this and I will be visiting here during my next visit in July. This is a very proactive group of people which is very keen on the community being able to help each other.

Our meeting was drawing to a close when, at this point, another woman arrived, Bernadette Sikanyika, from the Society for Women and AIDS in Zambia. A tall, deep black, statuesque woman in her sixties, who turned out to be a matriarch of the highest order.

SWAAZ had been formed about ten years ago to assist HIV affected and infected women. They look after about 5,000 women, and these are part of the thirty five chapters of the organisation.

Bernadette was another one to talk about skills training, although for her this was wrapped up in an holistic approach from education (prevention), through to support and then training. She spoke about the housing programme they had implemented as well as the food programme, where they gave families food parcels which were made up of rice, powdered milk, soya beans, beans, veg oil, soup and sugar. She also said that they were desperately in need of food.

She was quick to point out that one of her main tasks was to empower women, in a male dominated society, so that they could actually take control of certain aspects of their lives.

Bernadette wanted to show me a compound and we agreed to meet the next day. I had been invited back to FHT as there was a meeting the next day when the Norwegian Ambassador was to sign an agreement for finance for the next three years.

My lift arrived and I was whisked off to a Zambia Red Cross facility which looks after street children. On the way we picked up Prof. Bhat's wife (Mrs Bhat!) who works with this project.

The compound was an enclosed area about fifty metres square. There were children running around everywhere, many playing football (which appeared to be a bundle of rags tied up with string). The children were barefoot, and the ground was full of protruding rocks and stones. I worried they would hurt themselves. These children undergo terrible hardships, with many not having anywhere to sleep, and I worry they will hurt their feet!

While I was being shown round I was introduced to a young English girl who was filming for a project for the Red Cross. A Belgian girl was also there helping as a volunteer. I was shown the cooking facilities, the classrooms and the tailoring class. The older children are taught to be tailors and a group in Lusaka had donated twelve sewing machines, and one was given to each successful student ready to start their business.

No one lived at this site. It was used simply for feeding and teaching - and let's not forget the play time.

Off I went again, this time to the Mother Theresa Organisation's centre.

We entered the building, the usual guard patrolling the heavy gates to let us in, and went straight to meet one of the sisters in charge.

She led us to the nursery where there were large numbers of young children, aged from a few days to about six or seven, in different rooms. We were greeted with a song and lots of smiles.

Some of these children are HIV+, some are not. Some of these children have mothers and/or fathers sick in another part of the building. It was a nice place for these children to be, safe within the walls of the nursery with the kind sisters looking after them, making sure they have somewhere to sleep, food to eat and a chance to be educated.

The sister took us outside and we opened umbrellas to walk in the rain to another building further into the compound.

We reached a large building and entered. In front of me were beds, masses of beds, with a small passageway between, and on each bed was a body. All of the patients were men, some emaciated, gaunt, eyes staring at you, watching your every move, each one knowing that death was close. Some were within a few days, others a few months. There was no joy here, no hope.

I asked how many men were here and was told fifty two.

We walked around, I tried smiling, some smiled back, others just stared. Back at the entrance we walked back onto the veranda, and then turned into another entrance and here, in a room the same size as that I had just left were masses of beds, only this time women were upon them. Still the same emaciated bodies, the staring eyes, the half smiles, the puzzlement, the despair.

They were short of beds, there are more women patients, and some women have to sleep with mattresses on the floor.

We walked around, back towards the door from which we entered this place of death. The room smelt of death.

I was pleased to be out in the rainy light of day. The freshness of the plants and the air.

Prem took me back to the guest house and I walked into my room and closed the door. I closed the door on death, the smiles, the smells, the looks, the fear. I asked why I had to see this suffering? I have asked it before, and I know I will ask this question again.

The next day I arrived back of the FHT building in time for the signing ceremony when the Norwegian Government agreed to give them approximately US$700,000 over the next three years.

I spoke to some journalists, had my photo taken, was told my interview would be on their web site (it wasn't).

Bernadette was to take me to the hospital where I was to meet a group of doctors and nurses to discuss what I had seen and if we could help them. Then we were to visit a compound in Chawamba, a district of Lusaka.

I attended the meeting and asked them to tell me what were their priorities, what could we most do to help. I made no promises, promises in such situations can be dangerous, but did say that I would do everything in my power to obtain things they required. We all shook hands and I left, escorted by Violet who was to show me the short cut to the next place, within the hospital, I was going.

This old hospital, once a colonial show piece, had deteriorated greatly, and was full of decrepit old buildings, leaking roofs and broken paving.

I reached my next destination, which was where I was to meet Bernadette, and we left for the compound.

The compound we were visiting was home to some eleven thousand people. It was much as I had imagined. Overcrowding, huge pools of water (ideal for mosquito breeding), enormous ruts in the road, mud, grime, children, rubbish, loud music. We drove though and past it all until we reached a walled building.

We entered through the gates, the car stayed outside, and immediately two women started playing drums and another started to dance in front of us. This is a traditional welcome, I am told. The welcome stops and I am shown where the food is cooked, the children are fed, where simple lessons are given. I am led inside and enter the room where counselling, for both HIV prevention and AIDS consequences, is given.

The women start dancing again.

When they stop I ask about the symbols which are placed as figurines on the floor. It is explained to me that these women are respected elders of their community and they bring in women to tell them of the dangers of HIV/AIDS, but the women they are talking to cannot read or write so they use the symbols to describe the events which can lead up to contracting HIV. The one I liked the most, and which sticks out in my mind more than any other, is the final symbol. They tell the women that if, after all the advice, they contract HIV it is like swimming in the river with a crocodile coming up behind you - there is no escape. Then they hold up the carved crocodile symbol to reinforce the point. In the northern province of Zambia they tell the same story only they use a poisonous snake, from whose bite there is no cure, to make the same point.

Many infected and affected women and children come to this building for help. It is explained that this is helping to reduce the number of HIV cases in the community. They are trying to help local women find some empowerment.

Bernadette asks each woman in the room if they have been affected by HIV/AIDS. Each without fail says yes, and explains who they have lost. Bernadette herself also tells how she lost her sister, who was forty years old, and a son.

We walk outside again and they proudly show me the toilet which had been recently installed. It is explained that this was a fine addition, but then I am shown a large hole three metres away and at the bottom it is full of water. The water table is very high in this place, and with the recent heavy rains it has risen even further. Soon the water, which people drink to survive, will reach the same level as the sewerage, then there will be cholera.

There is a general acceptance that this is the way of life.

The next day, after a fond farewell to Prem, who gets scant mention here but without him my trip wouldn't have been as smooth as it was, and after waiting for the visiting dignitary from Malawi to land and acknowledge the full military honours waiting for him on the airport runway (causing our plane to be one hour late taking off), I leave Zambia for South Africa. Pretoria to be exact.

I arrived on a hot day in Johannesburg and was met by a driver who took me to Pretoria. My meeting the next day was with an Englishman named Father Barry Highes-Gibbs, and I felt ahead of time that what I would see here would be the blueprint for the work we may be able to do in southern Africa.

Father Barry is an interesting man who has had a varied and colourful life. On speaking to him for the next three hours or so I realised that he was just an instrument.

The unit he is in charge of is attached to a hospital in Pretoria. It is a small children's home, where all the children are HIV+, and the aim of the centre is to offer:

Poverty alleviation programmes, including food and clothing distribution

• Job creation and training programmes
• Hospice for infected and affected children
• Counselling services
• Health training and education programmes

We spoke at length on what they do, encapsulated above, and what we have done to date, and he showed me around the facility, which is on three floors.

As it was the weekend many of the children were absent, visiting weekend foster parents, but a few remained, and it was the same round of sweet, smiling faces, comfortable in the their little beds, within the dormitory which was home. The unit was excellent with a very nice feel to it. Bright, colourful, everything a child's home should be.

In broad terms Father Barry was doing nothing different to the people I had met in Zambia, only he had structured it in a way that brought more pieces of the jigsaw together within one place - and it could be easily explained through the use of a well thought out flow chart.

I saw the gardens in which they grew their own food, and listed to Father Barry explain how he would like to see similar projects for infected/affected people in order that they may be able provide for themselves and also sell some of the produce for extra cash.

Sustainability is the word now. How best to use the money raised. He had been approached by the government to work with them in creating other centres along the same lines within South Africa. This is an excellent thing to do and hopefully we may be able to do something similar ourselves.

I was right, this could be our blueprint, and he would be prepared to work with us to make something happen smoothly and quickly.

I left the good Father and was back in my hotel where I was to stay until I left for Cape Town the next day.

Last year we gave approximately £3,000 ($5,000) to a facility which looks after women who come from abusive situations in their family lives. This was, in part, to help them build an enclosure within one of their units in which children could play safely without the father being able to reach them. It would also buy some play equipment.

I was taken to Carehaven by two Soroptimists (a female group like Rotary Clubs) who had told us of the situation and asked for our help (one of them is a friend) and once there we met the woman in charge, a Salvation Army officer named Mary, and her two new, young volunteers, recently arrived from England.

We looked around the facility and I could see where the wall would be built and it looked a well run and efficient unit. I could raise no enthusiasm for the project. I had seen so much suffering and this seemed like so many other homes I have seen elsewhere. I shrugged off my lethargy and started to understand what the unit was fulfilling and they took me to another facility where women in great danger were housed.

We arrived at the building, which had railings around the perimeter fence. It was explained to me that the railings were thought to be a good idea because you could see who was outside the gate. The problem was, the gaps in the fence allowed someone to shoot through the fence at the people inside. A concrete, bullet proof wall was erected twenty metres within the compound.

We were shown round the excellent facilities. Places for women and children to sleep, eat, rest and play. The small nursery school which acts as a platform for the small ones to do well at the primary school. Women who work must contribute to Carehaven for their protection. They find comrades here and many leave together to lessen the burden of rent outside.

I expected to find it mainly black women staying, but it was about a 60/40 split, black/white. I saw their plans for the future and the playing area they would like to develop. It would be nice to help them.

We left Carehaven and went to a place called Nazareth House, a unit run within an old persons home for children who have AIDS. It is another church sponsored project. There are 35 (of 43) children who are HIV+.

We were shown one young girl, who was eight, and it was explained to us that she had been very ill and was only expected to live for another couple of days at most. They were surprised she had lasted so long. She looked very lovely as she sat on the lawn eating lunch with the other children. You could see if you watched closely that she was rocking from side to side and wasn't interacting with the other children as much. She was losing her focus on what was happening around her.

The other children played and ate and we went inside to have a look around. It was a very nice project and well supported by people from Cape Town.

I looked at the remembrance board and looked at the ages when the children died. One, one, three, six, four, two, one. Even with good care children don't last long when AIDS erupts. Although more recently many had lasted until six, seven and even eight. They were well cared for and loved.

This is the end of my first journey to southern Africa, although I would now enjoy a few days in the sun, and I make no conclusions at this time, as to what we can do, when and where. There is so much work to do, for so many people.

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