DISLOCATION

"Hey, Justin, you ready? Let's get going." I shout over my shoulder as I reach in the window of the Scalded Dog to open the door. The outside door handle hasn't worked for months. I've just changed into scrubs to look a little more official and gave a pair to Justin as well. He hops in, I fire up the Dog and we bounce out of the gate of the Moundou Adventist Surgery Center.

A Chadian man is accompanying us to show us the way. He'd come that morning after a call from one of my patient's, Ferdinand. I'd operated on Ferdinand months ago for a open tibia fracture. Three days ago, apparently, one of his relatives in a village outside Moundou had gotten in a car accident and now has a "deboitement" which just means a deformity. It could mean anything, but an xray they took the same day reveals a left hip dislocation. They'd called in the traditional bone setters who hadn't been able to reduce it. I sent Ferdinand out to buy two pairs of gloves, a bottle of Ketamine, two ampoules of Diazepam and some syringes.

We lumber along the uneven road past the soccer field to the one paved road in Chad's second largest city and economic capital. Turning right we pass the brewery on our left, a petrol storage facility on our right, the regional medical offices on our left and finally the Cotton Chad plant before crossing the one way bridge across the Logone River. A few kilometers outside of town we turn right off the road just in front of a huge pile of sand and enter a small village with an active little market. Halfway through the market our guide speaks up.

"Turn left here!"

Easier said then done. There is an old woman blocking the path with piles of twisted firewood in bundles. She is cantankerous and loud and refuses to budge. Everyone around is laughing and finally I'm forced to skirt her off the path and around the wood. We twist and turn through various mud huts with thatched roofs before pulling between to buildings into a small courtyard filled with drying millet, chickens, firewood and trash.

Our friend leads us through a low door into a tiny, dirt floored hut. Lying on a lumpy, cotton mattress is a young man in his twenties in obvious pain. His left leg is twisted and shortened. In the corner, at the foot of the bed are four sacs of millet in Nigerian produced bags. A small rickety desk with some papers reveals that the patient is probably a student. Four other male relatives squeeze into the room with Justin and me.

"Bonjour, mon ami," I greet the young man. He manages a weak smile and extends his hand in the obligatory greeting. I call for water and prepare the syringes with the drugs. I wash off both thighs and stick Diazepam in one and Ketamine in the other. As Justin and I chat with the other relatives we watch the medicines slowly take effect. First, our patient stiffens up a little and his eyes start to wiggle back and forth. Then his raises his head slightly and moves it slowly from side to side as he puckers and unpuckers his lips. Then he starts repeating phrases loudly and drunkenly in Ngambai as his mouth grimaces in all sorts of hilarious positions. His eyes bug out and continue to flutter back and forth.

Justin and I can't help but laughing but I can see the relatives don't know exactly how to react. I calmly reassure them that this is typical for Ketamine and it only means the medicines are working.

Finally, he seems completely out of it so I ask Justin to grab the left foot and lean back into it to let his body weight act as traction. I grab the knee and gently rock it back and forth. Suddenly, there is a satisfying pop and the hip slips back into its socket. The leg is now back out to length and straight. I move the leg back and forth and around and it moves freely confirming that it's back in place. I externally rotate it and abduct it and tell one family member to hold it in that position until he wakes up.

We chit chat with the family for 15-20 minutes until I'm reassured that the patient won't have any complications from the anesthesia and Justin and I head home. Our guide accompanies us as he left his motorcycle at the clinic. The crowd that has gathered outside the hut is talking excitedly and waves a cheery goodbye. Arriving back at the clinic, our friend seems like he wants to say something more. Finally, he gets it out.

"What about the costs of fuel and your visit?"

"Don't worry about it, I'm happy to help."

"No, you went out of your way to help us, how much?"

While I really don't want anything, I realize he wants to express his gratitude and this is how things are done here."Ok, you decide."

He reaches in his pocket and pulls out three 2000 franc bills which he gratefully presses into my hands. I'm touched by his gesture and we warmly say our farewells as I give him final instructions.

Three days later, Ferdinand calls me to say the young man is up and walking normally without pain.