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Madagascar is a very poor country, with most of the population living on less than $2.00 per day.

From a public health perspective, there is currently an outbreak of plague, which has killed over 100 people in the capital, Antananarivo. Parasitic diseases are common, with malaria and schistosomiasis being endemic and ongoing. Tuberculosis is another fairly common disease, and I have already seen patients with skeletal manifestations of TB. For the traveler, gastrointestinal illness is a constant hazard.

Orthopaedic problems are common, with neglected trauma forming a large part of the workload. I am hoping to operate, in the next week, on two chronic ankle fracture/dislocations, a chronic elbow dislocation, a femoral fracture (caused by a gunshot wound), as well as some congenital/development childhood deformities.