Augustus was dressed in black when he walked into the admissions tent. Odd, since we were not in New York City, but then who am I to comment on Monrovian fashion?  I had made a remark to a patient several weeks ago about his slick black outfit, only to be reprimanded that it was actually navy blue and his metrosexual digs were appropriate to his profession as a tailor. So I let the observation slide.

Augustus's story was fairly typical of the patients we see. In 2003, he was a passenger in a motor vehicle accident. After the accident, he went to JFK, Monrovia's biggest hospital, and was given only tylenol for a right humerus that had snapped in half. He did not get an x-ray nor was he casted, and fortunately for him it was a closed fracture, meaning that the broken bone had not pierced the skin. His arm healed, although the bone had healed unfused, in what we term "non-union of the humerus." He was lucky in that he was neither a farmer nor a mason but rather an economist, which meant that despite having a permanently broken arm he could still write and therefore he could work.

As we chatted about his medical problems and such, I began to ask him if there was any history of illnesses in his family. "My son died yesterday, and I am in mourning," he said. Augustus Jr. was in the 10th grade, a miracle by any measure in Liberia, where I have only met a handful of people who have progressed beyond the 6th grade. On Friday, Augustus Jr. stepped on a nail on the way to school. He was brought to the local hospital and given some antibiotics and had his wound cleaned out. On Sunday, August Jr. was dead. "Tetanus," Augustus told me. Because of the war, vaccination programs had ground to a halt and many children had fallen through the cracks.

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