The next patient climbs up the step into the porta-cabin that serves as my consulting room at the clinic. He looks pretty well – the last patient required the help of four relatives to lift her into the room, following which she gradually slid to the floor. You develop a talent for spotting the ones that need hospital after a while.
The man sits down and I ask the problem. There is a brief conversation with the translator.
“He has a lump on his back.” He takes of his shirt and sure enough there is an enormous hump over his left scapula. I palpate it. It is, for want of a better word, squidgey.
“How long has he had it?”
“5 weeks.”
“And what started it.”
“He first had a chest infection. Then the lump appeared.” I scratch my head trying to think of classic medical associations or syndromes that link a chest infection and large squidey lumps. None spring to mind. Perhaps I could invent one.
“I will see what is inside the lump. Tell him I am going to stick a needle in and see what comes out.” She explains as I take a syringe and large needle. I insert it under the skin into the centre and pull back on the plunger and am rewarded by a trickle of thick gloopy brown-green pus. I fill one syringe. And another. And another. Then I take some saline and inject it into the lump. I squish it around in an attempt to loosen up some more. And I fill another syringe. And another. By now we are all a bit breathless.
I scratch my head.
“Is their really nothing he can think of which started this?” The nurse asks. There is a long silence and then he begins talking again. A slow smile crosses the nurse’s face.
“He got the chest infection…”
“Yes?”
“Then he went to the sangoma [traditional healer]…”
“Yes?”
“And the sangoma stuck porcupine quills into his back and then the lump appeared!”
The man looks embarrassed as I write him out a course of broad-spectrum antibiotics – I have no idea what might live on porcupine quills but I imagine they will hit it.
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