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I need this like a nail in the head!

Year: 1994
Setting: Chevron hospital in the Highlands of Papua New Guinea
Position: Chief Medical Officer

2 a.m., a nurse wakes me up: Doc, there is an emergency! I crawl out of my still half-humid bed to the bathroom and splash water on my face, readying myself for another horrible medical condition among the nearly 10,000 villagers we are providing care to. As part of another social program, Chevron has also built hundreds of miles of dirt roads in the most hostile terrain, linking -- for the first time -- forsaken places and tribes to the rest of the world. The roads bring new trade opportunities to the villagers, and the money obtained from the sale of craft objects and agricultural produce is primarily invested in generators to power coveted television sets and refrigerators that cool Australian beers.

As I enter the waiting room, I cannot believe my eyes: A New Guinean man in his mid-30s is standing in front of me with a nail planted in the middle of his forehead. I stifle a shocked expression. He is volunteers his main complaint: "My head aches." I must admit that some of my first thoughts were: (1) There will be no differential diagnosis this time and (2) This etiology of headache is not mentioned in Harrison's textbook! From the consultation, it is obvious that the patient is drunk, as soon as he proceeds to relate the story behind his problem. He and some family members and friends were celebrating a fruitful hunt with bows and arrows, drinking beer in a hut, when one of his cousins proceeded to hang the picture of a female relative on his face.

The lesson for the doctor: Expect the unexpected in a new environment, and keep your composure and medical focus when it happens!

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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