"We are working under very difficult conditions. It's like we are in a war", laments Robert Lapyam Ayella, the only doctor at Mulanje District Hospital. He's one of the few African doctors who hasn't moved to the West, where they can earn 200 to 300 times more. As Robert goes from bed to bed, patients and staff clamour for his attention. But there are too many people for him to see and he lacks the proper drugs and equipment to treat them. "You reach a point of frustration and just say 'what am I doing here?'" In some Malawian hospitals, clinical officers without the proper training are working as doctors or surgeons. "I usually work 24 hour shifts in the emergency department", states clinical officer Stanley Chimabaui. Malawi's few remaining health workers also have to battle an AIDS pandemic. And the problem looks set to get worse. Approx 25% of the country's health staff are expected to die of HIV/AIDS in the next decade. Facing these problems, it's not surprising entire medical classes decide to emigrate to the West. As one expat Malawian doctor states: "I earn a good wage in England. Why should I go back to Malawi to suffer?"