In the small, curtained cubicle at Outpatients, William Gambe lay long,
thin, and silent on the bed. Th e young health extension offi cer (heo) who
saw him was shocked by the protruding swollen nodules that covered Wil-
liam’s body. William, however, claimed his problem was not the skin nod-
ules, which were not painful, but the severe back pain that had now been
troubling him for two weeks. Unable to make any connection between the
back pain and the skin disease, the medical student admitted that he could
not make a diagnosis. Obligated to fi ll in the admissions form, he wrote
only a “provisional diagnosis” of “syphilis” at the bottom of the page. He also
noticed that William’s skin was very pale, particularly around his fi ngernails
and eyelids, and so he also wrote down “anemia” and ordered iron supple-
ments for William.
Th e admissions form was placed in a yellow fi le with William’s name and
home village written at the top. Th is fi le would go to the ward with William
and would continue to collect other pieces of paper as further examina-
tions and investigations took place. Meanwhile, the student took a blood
sample from William’s arm and fi lled in the form requesting a full blood
count, which he put in a tray to be carried to the laboratory by a nurse. He
then fi lled in another form ordering a chest X-ray and an X-ray of William’s
back. Th e medical student helped William’s wife and sister, who had brought
him to the hospital, heave him from the examination bed on to a trolley.
Th e yellow fi le and X-ray form were balanced on his chest, and his relatives
wheeled him slowly along the uneven walkways to the X-ray unit.
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