After six days of clinic encounters the old pathways are opening up. Today the puzzling question was neck and spine pain, and could these ubiquitous symptoms be from a low grade shistosomiasis infection. It would be a naive question for a tropical disease physician, but one has to think all the time about just what might be missed in this makeshift environment. There are health initiatives in the world un-served by modern medicine and health fairs in the western world. The former challenges groups like doctors without borders, the later requires education and entertainment. It is the emerging economy with an emerging public health and scientific capacity that is not yet capable of dealing with the challenge of extensive untreated pathology that requires diplomacy and political savvy. We are dealing with about 40% anemia, 50% diabetes II, and 25% hypertension, mostly under-treated or not previously recognized. Tomorrow will be the first day off and time to reflect. The challenge is to write orders and opinions that do not shame the local provider, or show one's ignorance for that matter --- more to follow.
The Devil promises a utopia of worry-free egalitarianism beckoning you to an Orwellian hell of despondency. Its a matter of giving or taking. Work for your family and community supporting the common good, or take from the wealth of those who produce and promise benefits to those who do not and those destroyed by the theft of their own creation.
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