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Gives me fever

“Where is Stefan?” someone asks.

We look around the table – it is 7:45am, our morning meeting; the hour in which we exchange news, frustrations and attempt catharsis before leaping up to carpe diem. Stefan – the longest serving member of Hlabisa’s medical staff at a grand total of 11 months – is not there. “He won’t be in today,” says the medical manager, “he’s feeling a bit sickish.” We all murmur our commiserations. I secretly feel a little envious. I wonder whether what he has got is catching – I quite fancy a day in bed. A few hours of rigors would be a price worth paying.

The following morning Stefan is still sick. Apparently he had swinging fevers all night. Someone mutters “malaria”. I grab some blood tubes and needles and wander over to his flat. It is locked and the curtains are drawn. I call his mobile. There is no answer. I imagine him lying in his bed, shivering and delirious. How could his girlfriend have left him in such a state? Has she no heart?

My mobile rings. It is Stefan. He is in outpatients. He sounds remarkably coherent for a delirious man.

In outpatients Stefan looks fine. A nurse is taking his blood for a malaria rapid test. He went to Mozambique 3 weeks ago and hiked in a northern KwaZulu-Natal game park 2 weeks ago. “It is strange,” he says, “I was feverish and shaking all night and now I feel fine.” He is indeed afebrile now.

I examine him – carefully omitting anything below the hips. Nothing to find. Any rashes? “No,” he says, and then pauses. “Apart from this.” He lifts his trouser leg. On each ankle is a small inflamed area with a black centre. Any swollen glands? I let him examine his own groin. One should never examine the groin of an individual into whose eyes you need to be able to look at work the following day. Yes, there is swollen gland.

We conclude that Stefan has tick bite fever. I prescribe him a course of antibiotics and he is back at work a couple of days later. Wonder how many times I have missed the diagnosis in the general outpatients? Make note to self: long trousers when walking.

African tick bite lesion. This is not Stefan's (not his real name) groin. That would be sick.

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