This morning I arrived to find this man, who arrived with a history of weight loss (check out the cheek bones), abdominal pain, and cough for three months. One of the greatest challenges of ‘practicing medicine’ in this setting is the lack of testing available. In North America, he would immediately have a CT scan, abdominal ultrasound, chemistry 100, and a host of bacterial cultures. But out here, where most people earn in the range of $50-100 per month, such special exams are unaffordable and non-existent except for the rich who live in cities. So we virtually rely on history and physical exam, which is quite limited, but just the way medicine was practiced before the 1960s. One of the greatest challenges for healthcare professionals who come out to such low-resource communities is learning to work with very little!