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Voodoo doll?

Year: 1983
Setting: Branch of the St Francis hospital in Lagos, Nigeria
Position: Private general practitioner

The air conditioner roars and rattles, and the waiting room is bustling with people as usual. It is quite a diverse crowd: Yorubas, Hausas, Ibos, Fulanis and expatriates. An obese Muslim couple walks into my office. The husband tells me the story of his wife's illness. When I want to probe into some aspects of her illness, the husband frequently does not relay my questions to his wife and answers on his own, even when I am trying to quantify and qualify her pain. Next comes the physical exam. I ask her to lie on the table, but he interferes and prevents her from doing so. When I ask why, he states that for religious reasons I cannot see her skin nor touch her. He then proceeds to pull a doll out of her bag. It contains a few needles pointing to where she has been experiencing pain since the beginning of her symptoms.

Realizing that I won't be able to inspect and palpate the patient's abdomen frustrates me. At this point, we are in strange territory. They both can see the bewilderment on my face, and I can feel their uneasiness. None of us is sure what will happen next. At that moment, I wish I had received a more in-depth briefing on the various local cultural beliefs and practices of my patient population!

I remain calm, collect myself and thank them for their contributions. I know that I have gathered sufficient information to highly suspect that the woman has a gallbladder stone. I can move to the next step and request an ultrasonographic exam, which confirms my diagnosis.

Lesson for the doctor: Cultural adaptability is a key to successful medical practices.

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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