Lucia is just fourteen years young. Yesterday she suddenly lost ability to speak and also developed paralysis of her right arm and leg. Were she a lady in her sixties or seventies I would highly suspect a stroke. But a young woman in southern Africa with new neurological deficits? My provisional diagnosis is cerebral malaria infection. Now she has no fever and her first malaria smear is normal. But nevertheless, in this region of the world such syndromes are commonly caused by this ubiquitous protozoa. Above is her medical record from our tiny ER. Yes, paper. And notice how we don’t invest much time in documenting details when fifty more people are awaiting attention. How is Lucia today? After 24 hours of IV quinine she is beginning to speak and her paralysis almost entirely resolved.