My professor in Nursing school, affectionately known as "Ma Barker," had a favorite saying: When you hear hoofbeats, think horses, not zebra. The meaning? Common diseases happen commonly. A patient with nasal congestion is much more likely to have a cold than Wegener's granulomatosis. Obviously! But I had a thought yesterday, as I reviewed my textbooks in some clinic down-time. What if you live in Africa???

There is a whole host of diagnoses that aren't even on my radar because they're such 'zebra', and yet here a fever is more likely to be a potentially fatal malaria than a virus. A sore knee is often septic arthritis. I've seen chicken pox for the first time in my career (!), and I have to think about diptheria, measles, and tetnus as possible diagnoses. Stomach "bugs" and coughs could be caused by all sorts of nasty worms that I can hardly think about, lest I get nauseated. (Did you know that one of the common parasitic worms travels through the feet, up the blood stream to the lungs, where it then requires the host, aka us, to cough them up and then swallow them into the stomach where they can finally lay their eggs?) I tell you, when it comes to tropical medicine, sometimes ignorance is bliss.

At least it was...now I hear zebra everywhere I turn!


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