Last summer, I volunteered as a physician in Durban, South Africa, hoping my experience treating HIVers in New York City could be of use in the coastal Kwazulu-Natal (KZN) province. The former seat of the great Zulu Kingdom, KZN has an infection rate of 36 percent. Its leaders have been the country’s most outspoken in challenging the government for not providing HIV meds through the public health system.

On my first day at a nongovernment clinic called Sinikithemba (“We give hope”), a center of excellence for HIV care, I was touched by the doctors’ warmth yet taken aback as each encounter with patients was mediated by what they could afford. Despite subsidies, the hospital must charge minimal fees to keep afloat amid the AIDS influx. The words stuck in my throat as I’d tell a crestfallen patient unable to pay for HIV meds, “Let’s talk about what else might help you today.”

Princess X., 51, arrived with a cough; her partner had died last year. “Do you have 100 rand [about $14] for the CD4 test?” No. “Twenty rand for a chest X-ray?” Yes.

Pretty P., 31, with a CD4 count of 14, had been on HAART for two months. Her husband is positive, and so is one of her two little girls. Her family, who joined her in the clinic, could afford to treat only one of them. Mom was sickest.

Thembo, 27, gaunt from his second bout of TB, had lost his job. No, he could not afford HIV meds. The physician told him we are all on earth for only a little time, and if he stayed close to Jesus, he would be in His arms for eternity.

I sank into despair. I needed to focus on what was doable—to find some peace with being a drop in a torrent. Then, in August, the government announced a forthcoming drug plan—a glimmer of hope. In my last days there, two home-care hospice women led me to a rural mud house where a sick baby with AIDS drank black tea in squalor. For them, the new possibility of going into the community with treatment rather than only comfort was truly a miracle.