Cow Horn Injury--wait what's that?!

A depiction by Sir Charles Bell of a soldier with Tetanus (from 1890)

There was a time that being in a new environment, not knowing where anything was, or not having any cell service nor maybe even wifi, was terrifying and anxiety provoking. This career in global health has helped me to release that fear somewhat; don’t get me wrong it is still intimidating and always a humbling experience but that initial fear of the unknown has started to melt away or rather transform into excitement and anticipation of what these new experiences will bring, for instance, my first experience with Generalized Tetanus. 

On my first day at Ayder University Hospital in Mek’elle I rounded in the ICU and saw my first case of generalized tetanus. The patient had a testicular injury via cow horn—meaning he was essentially head-butted by a cow. I listened on rounds as this was presented and quietly asked the student next to me what “cow horn” was…she looked at me puzzled, and answered, “You know, like a cow, ‘moo’”. Between the laughter and embarrassment I remembered the rural scene on the drive into the city and had to remind myself “you are no longer in Philadelphia”.  After that moment passed my next question was whether or not the tetanus vaccine was widely available, while the answer is yes, it seems that actual compliance in obtaining it is the difficult part especially in rural parts of Ethiopia. Men are more inclined to get tetanus than women because of the fact that most women of age have had children and it is a part of the antenatal care received. Tetanus can cause painful spasms from such minimal stimulation, the patient requires the mechanical ventilator and frequent doses of sedation. If he is to recover it could take up to 4 weeks of time!