Monday, November 13th, 2006. 6pm. Hotel Desalegn, Addis Ababa, Ethiopia.

"I have to be satisfied, just prolonging someone’s life a little..."

Hmm. Let’s start with the simpler perceptions, maybe to ease a little less awkwardly into the trickier. There’s a deckchair on the balcony, and a furry soft bed and long-drawn bath in the rest of the room. Across the street, a well-meaning European Union office flutters a flag promising “We believe in partnership”, as toy car-resembling baby-blue-and-white taxis wait languidly for any spare fares.

Further down the street from this cosy-ish, Westerner-oriented hotel, broken barricades of corrugated tin occasionally back away from garish, makeshift market stalls selling scraps of cloth, slabs of greasy red meat or the ever-essential bottles of water. Rising unsteadily above there might be a token attempt at a modern-day building boom, a half-formed monster of concrete dominated by tree-twig scaffolding and more resembling the blasted-out skeleton of a multi-storey car park.

A few jam-packed white vans veer across and alongside the occasional cab fortunate enough to find a paying customer, but the pedestrians comprise the heavier traffic, heavily bearing on shoulders a haul of fruit, a swinging timber ladder, or a a swaddle of shawls that must surely house a baby somewhere inside. Modestly paved and signposted highways suddenly swerve into rocky dirt tracks, the only coherent clues offered by shoddily-plonked French language pointers for invading foreign ambassadoires.

So, here I am in Ethiopia, that apparent by-word for starvation and suffering, pity pity and yet more pity. Caught in an uneasy clash of instincts, between wanting to project a more optimistic, forward-looking, famine-downplaying image - read all about it, the latest trade deal signed with, say, China, or France, in the parched-dry Government-led propaganda Press - and yet of necessity acknowledging the many, many human catastrophes every day, every where you look, thanks (thanks) to relentless epidemics; never-ending shortages of essential supplies, sanitation and medication; corruptly-misspent millions; and tokenistic international ignorance.

The Ethiopian embassy in London complains about the “unhelpful”, “negative images used by the media”. Solomon, one of our guides for this Tearfund-led trip, bitterly points out footage of the 1984 famine is still being passed off as present-day by some media organisations. There are the rich-ish coffee, cotton, sugar and gold to be mined here, the recent surges in cereal production, coffee exports, school access and attendance…

Ah, but then there are the doomed babies’ faces and fragile, flailing limbs - or the actually-older children yet so riddled with disease they could easily pass for newly-out-of-the-womb. These are the harder to see, to think of again afterwards - the in-and-out-and-in-again patients at the Zewditu Memorial Hospital - a former US mission facility, later confiscated by the 1974-1991 Communist government, yet now hailed by this regime as a national flagship, despite looking and feeling more like a grim, neglected old council estate - stale air and despair struggling through each cramped corridor and narrow crowded staircase. Some 600 children are regularly being treated on the mould-encrusted wards, where waste bins overflow with used needles and inter-mingling gunge.

Here, heartbreakingly, is two-year-old Mersi Kassahum, a chubby, uncomprehending face on a bizarrely barrel-chested torso yet a stick-spindly pair of drip-fed legs - HIV+ just like 23-year-old mother Nardos, both condemned to the disease by a father and husband long since fled, leaving them and a ten-strong extended family abandoned on the outskirts of the capital.

Nardos seems jarringly philosophical, even cheery as she poses patiently for necessarily-posed photos - but there also seems a tinge of denial as she insists: “I don’t want to really worry very much about HIV. What’s done is done. So I have to live with it, for myself and my daughter. This is the only outlet that could mean my child survives. It’s not important to worry about something that’s already been done. It’s not worth worrying about my husband now he’s left. There’s nothing I can do about it.”

But the unstinting aid workers out here are determined that something, much more, can be done - especially before infection, before it’s too late. Prevention of mother (or parent) to child transmission seems to be the keynote theme this year for Tearfund, especially in the run-up to World Aids Day on December 1.

One 200mg tablet of Neviraprine for the mother as she enters labour - plus a 2mg/kg dose of the same for baby up to 72 months of delivery - can apparently vastly reduce the risk of an HIV infection being passed on. Such treatments can cost less than $10 per mother - yet many still go without, in a country of between 180,000 and 200,000 HIV+ pregnancies every year and up to 80,000 babies born with the infection. Some 25,000 children died due to Aids last year, according to Ministry of Health records - but many believe thousands more are going unreported.

If a mother is HIV+, her unborn child has about a one-in-three chance of inheriting the infection - of the 35 per cent who do, 15 to 20 per cent are infected during pregnancy, up to half during delivery, and about 33 per cent through breast-feeding. The dangers linger for some months.
So much for the statistics. Mersi was here for her sixth admission to hospital. In another white cage bed, blinking and grimacing under fluorescent light, 16-month-old Amanuel is here for the first time, and has been for just a few days. Brought in for diarrhoea, tests quickly revealed a more devastating diagnosis - HIV+, like both his parents - as well as associated tooth and jaw corrosion, and ominous patches of sores across his tender skin.

Paediatrics director Dr Wondewosen Desta sighs: “Nistartine would be the right drug for his oral problems, but it’s too expensive for us - we have to use a $2 oral gel instead, and hope for the best. It’s all so frustrating, for us and for the family. My friends are giving up their jobs - it’s too much, to see 50 or 60 per cent of your child patients with HIV. Most of them have repeated admissions. I have to be satisfied, just prolonging someone’s life a little. If we treat this child properly, he may make it to school one day. But more than one-third don’t get to celebrate their first birthday if we can’t treat them.”

Sometimes the gender roles are reversed - not often, but once or twice, here or there. Engeta Muhamed, 30, watches phlegmatically over toothily-grinning son Nudana, six years old but looking more like a baby, swamped inside regulation hospital green sleeves and rolling charming, cloying eyes at the camera. Engeta says his wife left him to bring up Nudana alone - a hard task anyway for a more-often-than-not unemployed labourer whose best daily wage would be $1.50, barely adequate for food and often forcing him to go begging instead.

“He’s still coughing, he’s not feeding well,” Engeta explains. “I know he’ll probably have to stay here for a month - after that, who knows? Of course I’m worried. I’ll have to leave my boy here and go out looking for work - but I can never earn enough. Every life’s like that here - everyone has to beg.”

Nor do the staff escape, both emotionally and physically - a flimsy, sloppily-slipped-on surgical glove, offering too little protection from cuts, or a grisly and deadly splash of blood to an eye: such accidents have ultimately claimed the lives of at least five workers in this department alone in recent years.

The illustrated children’s posters on the wall look merely sad, hopeless gestures: “Clean Face Prevents Trachoma” - “Let us make child vaccination our culture.”

Hopefully, a few rather more assuring signs of hope amid all the misery might, might just emerge over the coming days...