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With the distractions of Christmas and New Year behind me, suddenly it’s only a matter of days until I fly again to Oliver Tambo International, Johannesburg. Second time in South Africa I’ll be met by (the good) David Cameron who has kindly offered to put me up in Pretoria for my first two weeks on assignment. In 2011 my objective was to help to get NIM-ART (Nurse Initiated and Managed Anti-Retroviral Therapy) off the ground in the primary care clinics of Graaff-Reinet and surrounding district through clinical mentoring. Three years later I’ll be helping to evaluate the impact of NIM-ART and NIM-ART mentoring in four districts in Gauteng and Limpopo provinces. Linda Murray has made the interesting suggestion that I use some of the flight time to list my expectations so that I can reflect upon them at the end of my assignment… Janet Hearn has advised me on antimalarials as it’ll be hot and humid with Anopheles mosquitoes keen to bite my parts in parts. Janet gets posted by Médecins Sans Frontières to more challenging locations than primary care clinics in north-eastern South Africa: Darfur, Turkish/Syrian border, etc. She describes her pre-assignment feelings as “terror coupled with excitement”. I’m happy to say that I am not experiencing terror. However South Africa’s violent crime statistics are widely reported – in the words of one of my South African patients, “there are so many car-jackings” – so in order not to end up as another crime statistic I’ll be sensible. I’m looking forward to it; a little daunted but in the sort of good way that’ll put me on my mettle. What’s changed? Most obviously, on 5th December 2013 Nelson Mandela died. On a cold Sunday afternoon on the Sussex coast I watched Mandela: Long Walk to Freedom. Scenes of his birthplace in lush, sun-drenched Transkei heightened my desire to get back there and I thought that the movie was as good a representation of his autobiography’s 784 pages as is possible in 152 minutes with strong actors convincing as Nelson and Winnie Mandela. In other changes, South African HIV treatment guidelines have embraced new antiretrovirals in new classes – welcome a second protease inhibitor, atazanavir and an integrase inhibitor, raltegravir – opening up the possibility of effective third-line therapy. A recent study has reported “astounding” results from the South African HIV treatment programme: The roll-out of antiretroviral therapy (ART) in South Africa has achieved “astounding” results, a mathematical model published in the online edition of the Journal of Infectious Diseases shows. Each person who started HIV therapy between 2004 and 2011 had an individual gain in life expectancy of 11 to 13 years. The estimated population lifetime survival benefit for all people initiating ART in this period was 21.7 million life-years. Increasing the number of people linked to care and expanded access to second-line therapies could increase the gain to 36 million life-years. In 2011 I left my caseload in the capable hands of Caron Osborne; on Friday I’ll leave it in the capable hands of Heather Renton. At home, Steve and Chris are at universities, leaving Angela in a quieter house. Without Angela’s blessing and her being prepared for some quiet times at home – plus the support, interest and good wishes of so many others – it would be harder to go. Thankyou all.