Since returning from Angola, I’ve been caring for patients at Research Medical Center, here in Kansas City. Very often, they present with fever. Here, the causes I first think of are influenza, bronchitis, and the common cold. But in Angola, I’d first be concerned about malaria, typhoid and pneumonia. Knowing what’s common in a given community is one of the first adjustments to promoting health in a new context. Another challenge is adopting to limited diagnostic assistance. At Research, I’d can readily reply on a rapid influenza test, chest X-ray, and blood cultures, for example, to sort out the causes of fever. In Angola, these tests are rarely available. Or if they are available, they are very expensive, and even then the reliability of the results may be questionable. Therefore, clinicians like myself are usually left with basing our diagnoses on findings gathered from history and physical exam, complemented by an understanding of what are the common diseases in those particular communities.
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