What One Patient's Death Reveals About Global Health
A newly diagnosed HIV/AIDS patient—though “newly diagnosed” feels like a formality. By the time we saw him, it was hard to imagine a time when he had been well. He had pulmonary TB, meningitis, and a prognosis that had already been quietly sealed.
We were in our third week shadowing Rachel, a physician at Iringa Hospital in Tanzania. It was around 3:00 p.m., and we had seen roughly 20 patients so far that day, most of them presenting with advanced infectious diseases—AIDS, TB, and other complications of immune suppression. Rachel told us that TB often goes hand-in-hand with AIDS here, one opportunistic infection opening the door for another as the immune system collapses. Between the ICU, male, and female wards, the team sees about 30 patients daily. The male ward, where we met John, is a long room of closely spaced beds barely two feet between them. It's loud, busy, and always full.
John’s breath came in shallow bursts. His body convulsed, silent and unable to speak. His family crowded around the bed, refusing to leave even when asked. Rachel had to raise her voice—twice—before they finally stepped outside. The entire situation felt dissonant. Here was a man on the brink of death, surrounded by noise, in a room shared not only with another patient beside him but ten other men, all watching it unfold.
We listened to John’s periodic convulsions throughout our ward round, only arriving at his bedside near the end. After examining him and deciding he needed to be transferred to the ICU, Rachel suddenly paused mid-conversation while we sat in the nurse’s office: “I think we have death.” It took a second to register what she meant.
Walking into the ward behind her, I watched John’s family gather again around his bed, this time praying. They silently shuffled out of the ward when Rachel approached, hands gloved and iPhone flashlight shining. Rachel checked his pupils for reaction with the light. The small cotton ball in her hand gently caught the tears on his face. No reaction—just stillness.
She pulled a blue curtain halfway across the bed as a gesture of privacy. But the man beside him remained within arm’s reach, still watching. We sat while Rachel wrote her notes with the family beside us: HIV. AIDS. Disseminated TB. Meningitis. Pupils non-reactive. Death, confirmed by the absence of light in the eyes. That phrase felt literal—the light had left.
Rachel said the family didn’t seem too shaken. John lived alone. They were just starting to deal with it, and now it was over. She thanked them for being there. They thanked her for trying. And just like that, the workday ended. The sun was still shining. The world kept turning. It all felt a little surreal.
Death here doesn’t feel sterile or private. It’s messy. Public. Human. There’s something strangely beautiful in that, too—the quiet prayer, the cotton ball, the waiting. The light slowly leaving the eyes, witnessed by a room full of strangers and family alike. It wasn’t heroic, or cinematic, or even quiet. But it was real. Was it his late diagnosis that led to this? Or the way the system failed long before his symptoms started? Why does privacy not seem to matter as much in death here? Are there bigger things to worry about than dignity when someone is dying?