He lay in a mud-hut in Kenya, ill from surviving on cow's blood and milk in a place with the world's most dense concentration of pathogens. He was surrounded by mothers and children dying from illnesses caused by AIDS. Between them, they carried hundreds of rare and vicious infections.
It didn't matter that Dr Michael Elmore Meegan speaks a dozen languages, or that he has been published numerous times in the prestigious medical journal the Lancet, or that he is a consultant to the Elton John AIDS Foundation. It didn't matter that his description of a dying child with AIDS had stunned readers of the Journal of the American Medical Association.
What mattered, at that moment, was that he was blind and his legs were paralysed. What mattered was that he was dying.
Thousands of miles away from Western medicine, Dr Meegan began to fall into what he was sure would be his final sleep. His last thoughts were of gratitude. Nearly two decades previously, he had dedicated his life to helping people for whom there was no help and he succeeded. He had made a difference to the quality of dying for mothers and children with AIDS who could hardly dream of fresh water, much less medical miracles. He had saved the lives of thousands of babies, by befriending their tribal elders, informing them about disease, then letting them decide for themselves whether to change tribal customs.
In the nick of time, Dr Meegan was air-lifted out by the medical community to a hospital in London. The cause of his baffling condition was never found, despite dozens of medical tests. One day, the disease simply disappeared, as suddenly as it had struck.
Today, he continues to live with the people he serves. His community is made up of young families without parents - some of the 40 million African children orphaned by AIDS. In Africa, 10-year-old children are the sole carers of mothers with AIDS and of their smaller brothers and sisters, who are often sick, too. "People in Ireland cannot conceive of the scale of deprivation," says Dr Meegan.
The suffering, he says, is "unimaginable" to people in the West. He has often had to relinquish his desire to help improve the quality of life of these young families, simply to help to give them "a quality of dying".
Dr Meegan is writing a book with David Werner, author of Where there are no doctors. It will be called Where there are no parents - such is the devastation of family life.
He has also tended to young male victims of torture, who have had their eyelids removed, testicles bitten off and hands sliced off before being crucified and left to slowly bleed and be eaten by flies. The only treatment is oblivion with a dose of morphine.
The horror which he must deal with from day to day is so great that a medical college in London, where he lectures, asked him not to use his slides because they traumatised the students. He uses them anyway.
The viral pneumonias and other infections that thrive in these places, where toilets and clean water may be non-existent, are so sinister that Dr Meegan refuses to allow anyone from the West with young children to visit where he lives and works. The danger is too great that a visitor could bring home an infection that would kill their own children.
To maintain his own health, Dr Meegan has upgraded his living accommodation from a hut made from dung to a corrugated steel dwelling, and he lives on conventional food. A graduate of Terenure College and Trinity College, Dublin, Dr Meegan is director of projects for International Community for the Relief of Starvation and Suffering (ICROSS). Over the past 15 years, ICROSS has published 38 articles on issues such as the prevention of diarrhoea; safe motherhood; risk behaviours in HIV/AIDS transmission; culturally acceptable health promotion; nutrition in pastoral populations; the role of belief systems in development; and donor policy and the need for evaluation.
ICROSS, which received £55,000 this year from the Irish Government, has been in east Africa for 19 years. What makes it different from traditional aid organisations is that it believes that the only way to improve the quality of life of people living in the Kenyan bush is to see the world from their point of view. That means respecting and capitalising on the knowledge and good intentions of their own teachers and healers, rather than airlifting in educated Westerners in 4x4s and white coats who usually can't even speak the language.
Using the elders and grandmothers as the main educators is what makes ICROSS different from other aid programmes, says Dr Ronan Conroy of the Royal College of Surgeons in Ireland, who has co-authored several articles with Dr Meegan. The interventions that the two men champion are "low-tech, low-cost, sustainable and can make a difference".
Getting the scientific proof that an intervention works is the only way to proceed responsibly and influence international policy and planning, Dr Meegan believes. For example, the Lancet will shortly publish the results of their successful effort to save the lives of Masai babies. At birth, Masai babies traditionally had their umbilical cords painted with cow dung, resulting in tetanus and a death rate of one baby in 10. Cow dung is important in Masai culture, because all Masai wealth - their food, clothes and houses - comes from the cow. Even their huts are made from cow dung. Over the years, Dr Meegan and his team talked with the Masai elders about the meaning of the cow and gradually convinced them that if cows cannot survive without water, then water is as precious as dung. The result: elders now "christen" the umbilical cord with water and the death rate among infants has plummeted.
Dr Meegan and Dr Conroy have also impressed their peers in the West with another low-tech tool: empty plastic bottles. They have disinfected water by putting it in plastic bottles in the sunlight. Also, in a major study which is being considered for publication by the Lancet, they used plastic bottles to trap flies, catching 200-300 a day in each bottle by giving the bottles "fly appeal" with baby "poo" and urine. What sounds disgusting to us in the West can save lives in the bush. Flies feed on children for water. They also spread disease. Photographs of children who at first appear to be covered in raisins show on closer inspection that the "raisins" are flies.
Along with offering low-tech solutions, Dr Meegan challenges Western assumptions that Africans need high-tech medicine to survive. Retroviral drugs, which combat AIDS, should be available to every African, according to international media publicity. But retrovirals are actually of no use in the bush, says Dr Meegan. An entire medical support network is required if retrovirals are to work properly, and people living in the bush in mud huts don't have that. They haven't even got clean water and toilets, never mind doctors. "Western agencies have dislocated themselves from understanding the problem. NGOs non-governmental organisations depend on money from donors, but because donors are living on four-year cycles linked to terms of office, all their policies are short-term. You can't change health, disease and awareness of behaviour in that short time-frame."
Only by living long-term with people and becoming part of their culture can you truly understand their problems and help them to find solutions. You cannot impose Western moral values on Africans, he believes.
Sex workers have been the target of Western efforts to reduce the transmission of HIV/AIDS, but Dr Meegan's research has shown that sex workers aren't the real problem. The women working in prostitution are not "receptacles for bodily fluids". They are "strong, highly intelligent" women who are merely supporting their families. They may have three or four sexual contacts per week.
It's the adolescent boys - who have on average 18 sexual contacts per week - who are more likely to be spreading HIV.
Dr Meegan has also focused on female circumcision, in which a young girl's clitoris and labia are surgically removed, with the wound stitched tightly. Potentially lethal infections (including HIV), devastating keloid scarring and problems in childbirth result. Dr Meegan chronicled the consequent damage in hundreds of thousands of births and was able to convince tribal elders that there had to be a better way. As a result, their behaviour around female circumcision has "changed radically". While the practice has not ended completely, those performing the procedures are no longer removing the clitoris and are far more conservative in their surgery.
"Rather than preach to them and blame them and antagonise them, you allow them to see the evidence for themselves," says Dr Meegan. "These are grandmothers performing female circumcisions and they care about their grandaughters and great-grandchildren. You have to let them assess the evidence and decide for themselves."
In the 20 years that he has lived in Africa, he has seen mothers and babies descend into hell while Ireland has soared in an atmosphere of "self-centred consumerism".
"Many of my friends have become Machiavellian. They are what they own. In Africa, I live with very, very poor people who are happy, while many of my Irish friends are being treated for depression. They feel nervous and anxious despite their great wealth."
Contact ICROSS on 01-6704744