Some things never change.

As a surgeon in the United States, I had forgotten the treatment for Malaria more times than I had learned it. It was crammed into my brain just long enough to pass whichever exam I had needed it for, and then promptly lost once again.

I'm definitely not in the United States anymore, and malaria is not just for the medical doctors. A patient comes in with abdominal pain and fever. Check malaria first. A patient spikes a fever post op. Check malaria first.

In the United States, every resident, every intern, even every medical student rotating through their surgical rotation knows the 5 W's of post operative fever (Wind, Water, Wound, Walking, Wonder drugs). I confessed to the residents here that the 5 W's are not adequate. To which it was suggested we could turn the M in Malaria upside down and make it the 6 W's of post operative fever. Whatever works, but, either way, check malaria first.

There are many differences between healthcare, prevalence of Malaria being just one, ranging from pathology to treatment. This was expected, and has been as anticipated. That being said, the past weeks have not been without their own special surprises.

The other morning a nurse comes up to me needing my services for a small child with a foreign body up his nose. Despite attempts overnight to remove said foreign body, it remained stubbornly lodged deep in the child's right nostril, and further attempts had been abandoned to await my expertise. The round yellow bead was easily enough extracted and the child returned to his mother's arms. With all the different pathology I had been expecting, I was caught off guard to be reminded that kids are kids, whether in the United States or Togo, they stick small objects in their mouths, noses and ears.

Shortly after bead was removed from the nose of the aforementioned small child, the same nurse came up to me again needing my assistance for a patient that had come to the hospital overnight. He had been in a traffic accident; it was explained to me. I asked if there were any injuries or complaints, to which I was told no, just the traffic accident. Confused as to why my services were needed, I interviewed the patient. Awakening him from where he lay sleeping off the effects of the previous night, we found that his story now had changed. He was afraid someone had bit him the night before. Whether lost in translation, or just washed away by alcohol, the story was unreliable, and I resorted to my own physical exam which revealed neither traumatic injury, nor bite mark anywhere. I was again caught off guard, surprised even, by what I had not expected. The status quo. The fact that people drink to excess and end up in their local EDs. People are people.

Some things never change.

Much Love.