A few months ago we visited a local health clinic and were shocked at the rudimentary facilities and lack of equipment. Today we took one of our street children to the local doctor and the clinic there was little better.

The open office doubles as waiting room and surgery. Patients have a choice of sitting on a sofa which has seen better days and a wooden bench. Consultation begins with the patient’s health insurance details and the exchange of money. The immediate suspicion was malaria and we are offered two tests – one taking twenty minutes and costing RWF2,000, the other taking forty minutes and costing RWF1,000. We opt for the quick test and our lad is taken into a grubby cubicle by the nurse. A minute later he emerges looking even unhappier than on the way in, now nursing the finger where the blood sample had been extracted. A while later, the assistant passes a piece of paper to the nurse who proclaims, yes, malaria.

The treatment is a heavy dose of four tablets twice a day for the next three days, some paracetamol and anti-malaria tablets. These are duly dispensed in a brown paper bag. The system may be simple but it appears to work and the costs are little different to our own NHS prescription charges. To us they are affordable. To the locals on an income of perhaps RWF2,000 a day, a test then medicine on top is prohibitively expensive.