The_Invention_of_Surgery

that causes malaria. The nocturnal routine is always the same, where
every inhabitant unfurls the twisted-up netting to cover all four corners of
their sleeping area. In the morning, the process is reversed, and the white
nets are wound up with a dozen twists and moored to a corner of a bed.
I arrived late last night from another outpost hospital in the western
provinces of Rwanda with our team of American doctors and nurses and
Rwandan surgical residents. I have traveled to Central Africa to mentor
the young physicians, always heeding the advice of a veteran surgeon
before my first trip overseas years ago: when you prepare to teach in a
third-world country, throw your modern textbooks out the window. They
are outdated in two respects: the proposed treatments are based on
current technology and newfangled gadgets (which are not available in
developing countries) and the diseases are distinctive (namely, TB is still a
major problem around the globe, much less so in America). A much better
approach is to find a fifty-year-old textbook, where TB of the bone is
addressed and simple tools are used to solve everyday problems.
Waking early, I join the local medical staff in the outdoor atrium for
morning rounds. Men, women, and children are all housed in the main
ward, which is surrounded by massive trees, heavy vines, and exotic-
sounding birds. My team and I (joined by a Rwandan orthopedic resident,
Paul) enter the main ward, where I witness most of the patients twirling up
their mosquito nets. Some patients are listless, and I’m told that there has
been a gastrointestinal illness that has been rampant through the region in
the last few weeks. Along one edge of the building are the malaria
sufferers, obvious to the trained eye, owing to their utter catatonic state
and complete lifelessness. In medical school, I had learned about the flu-
like symptoms, including headache, fever, joint pain, and even convulsions,
but seeing malaria patients up close, suffering so severely, has given me a
profound respect for the little plasmodium that causes malaria and a new
fear of mosquitos.
Paul and I walk along one aisle of patients, flanked by little cots in neat
rows. Most Westerners want a private hospital room; here there are sixty
cots in this high-ceilinged, open-air ward. As we come to the end of the
row I spot a young man, probably twelve years old, who is lying on his
back, propped up on his elbows, with a few blankets under his back and
head. The nurse here at Kibogora Hospital tells me that Joseph has been
here, in that cot, for two years. His TB is so severe it has spread to his