My little SIM clinic protects me a bit from the real lives of so many poverty-stricken people living in Addis. All my ex-pat patients have insurance and if medical care becomes necessary beyond what is available locally they can leave the country and be treated in better developed settings – South Africa, Kenya, Dubai, India, Europe. Ethiopians employed by SIM (who form the majority of my workload) although often living in difficult circumstances at least have a job and an income, however inadequate. And SIM will pay for a certain amount of medical, dental and optical care for them and their immediate family members. Dealing with how much care will cost and having to restrict what I can do based on available funds is anathema to me when face to face with my patients - 30 years in the NHS saw to that, where necessary care is available when needed without recourse to discussions about money.