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Adjustment is the Achilles heel of overseas ventures

Year: 1986
Place: Lome, Togo
Position: Consultant in tropical diseases, Pitie-Salpetriere Hospital in Paris

I have been sent to West Africa by a French multinational drug company to share information from recent clinical trials about a new anti-emetic compound. It is late November and I am in Togo, midway through a tour that includes Senegal, Ivory Coast, Cameroon, Gabon and Congo. The day I land in Lome, I take a much-needed break by hitting the tennis courts with a local physician. We have to settle an old score. He beat me the last time I was in town and it cannot be my last showing. Next to us, two French architects are intensely competing as well. They reached the Togolese capital that same morning for an international congress and are enjoying the summer-like weather at a time when it is freezing in France.

Suddenly, a shower breaks out, as it is customary in the evenings at this time of the year close to the equator. The games stop and everyone runs for cover. After half an hour or so, the clouds move on and crews dry the courts with sponge rollers. My partner and I wait for the surface to be fully playable, but the architects resume their battle. We see one of them running toward the back fence to retrieve a lob when he slides on a wet patch. We hear a snap that sounds like a gunshot. The player falls on the ground like a rabbit hit in full flight by a bullet. He lies there in acute pain. I rush toward him and, upon physical exam, the diagnosis is obvious: Achilles tendon rupture. He is transported to the hospital and flown back to Paris on the first plane available. He has not even spent one night in Africa!

Lesson for the doctor: People can often injure themselves when their competitive juices are flowing and they don’t pay full attention to their new surroundings.

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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