Chapter 2: Diagnosis and Denial

After I check am, I talk, "This one no be eczema."

I talk am gentle, make the boy no feel insulted. For here, if you too blunt, patient fit take am personal.

The boy just turn, pull shirt down, protest, "No possible. Na eczema I dey treat since, e dey work before."

Na there wahala start. If e dey work before, why e no work now?

For Naija, people believe say once solution dey work, e suppose work forever. Dem no quick gree say body fit change.

If something change, e get reason. Sometimes na village people, sometimes na lifestyle. But for doctor eye, everything get explanation.

As he dey doubt, I no talk again—no need argue.

Experience don teach me: If patient dey in denial, too much talk no go help. Na result go open eye.

I continue, "You get allergy before? You wear any new cloth or underwear recently?"

I dey consider allergic rash. For here, some people fit react to new detergent, some to cheap lace from Balogun market. I dey tick box one by one.

The boy answer, "No. I don do allergy test before—mites, egg, crayfish, dust, over ten things. Doctor talk say I no get allergy."

He dey proud small, like say allergy test na degree. Naija people like to show say dem don do big man test.

I reason, maybe na herpes. The rash resemble am too.

The stubbornness, plus the type of rash, dey point me towards herpes. But for Naija, you must tread gently—no too quick drop STD matter.

I wan order herpes virus test, na so the girl lean close, dey whisper, confused:

"...check, check am."

Her voice low like market woman dey beg meat seller. She dey try balance her boyfriend ego and still find solution.

I look up, see as the boy face don red, ear dey hot, lips tight.

The way him red, I know say wahala don land. For Naija, man no like hear say im fit get disease from woman matter.

The girl still dey whisper, eyes full of worry, dey pull his shirt like say she dey beg.

Love dey, but fear dey join. The tension for the consulting room dey hot, like NEPA just bring light after long blackout.

I no send, I continue dey write order. The girl burst out loud:

"Doctor, e get am for down there too."

As she talk am, silence land for room. Even the intern look up like person wey hear plot twist for Nollywood.

"Ehn?" I shock small. E fit really be…

I compose myself quick, talk,

"Pull your trouser, make I check."

For here, you act sharp and professional—no dey form embarrassment. Na so dem go trust say you sabi your work.

I call the intern, tell am,

"Observe these small small papules for perineum, see the collar-like scale for the tip. Make you remember am."

I dey try teach as we dey work—na so dem train us. If you no see case live, you go dey do theory forever.

The intern wan lift shirt higher.

She dey eager—wan see everything. I quick tap her: "Wear glove! Your hand no clean—no dey touch patient like that. Go wash hand."

Interns dey rush, but for here, if dem no learn hygiene now, tomorrow fit be another wahala.

I dey suspect STD.

The moment I see the rash, my mind don settle—this one pass eczema. For Naija clinic, STD na everyday matter.

No need test for herpes virus—na classic scaly papules be this. I just order STD panel straight.

From experience, if you see papules like this for groin area, no waste time—order full test.

Herpes zoster and pityriasis rosea fit resemble each other; person fit miss the diagnosis.

Even me, I don miss one for house officer year—na so dem call meeting for ward. That lesson, I no go forget quick.

Small gist: For skin clinic, STD dey steady.

Even small pikin wey mama carry come sometimes na sign of house wahala. Nigeria no dey short of story for clinic.

Plenty STD dey show for skin first—HIV rash, syphilis rash, HPV join.

Sometimes, na rash go cast the story. For this country, many people dey run from test—na skin go expose the matter.

So, na syphilis rash or HIV rash?

For my head, I dey arrange all the options. Naija get all the diseases wey textbook talk, plus e own join.

I sabi the answer, but as doctor, I no fit talk am direct like the intern—I go wait for lab result.

Because for here, if you talk am raw, e fit cause fight or make person faint. E better make result talk, no be your mouth.

I remind the intern, "No jump to conclusion till result come. Calm patient, no cause wahala."

I always tell interns—Naija patient dey quick vex if you rush diagnosis. Soft talk na best medicine.

Syphilis and HIV rash different, but none clear pass the other.

For here, textbook picture no always match real life. You need sharp eye.

To balance, I order both syphilis and HIV tests.

If you no check two, you fit miss one. Our teaching hospital motto be that—"Leave no stone unturned."

As the boy see test order, he jump up, eye wide, shout, "Syphilis? HIV? I come here for eczema o! You no fit just give me cream? Why you dey order all these test?"

The way he take stand, you go think say person wan fight conductor for Oshodi. Shame and fear dey mix for his voice.

The girl calm pass am: "Listen to the doctor."

Her voice soft, she hold his arm tight, like say she dey beg make he no disgrace her. You fit see love and small fear mix for her face.

I explain, "No be ordinary eczema—especially the rash for your private part. E fit be STD."

For here, if you no explain well, dem go think say you wan chop extra money. I break am down like mama wey dey teach pikin.

The boy look me, shock, then keep quiet.

E shock reach bone, but as e see my face serious, e no talk again.

As I see say e dey shame, the girl rush talk:

"No possible, doctor, my boyfriend no fit…"

She wan defend am, but fear dey her voice. For Naija, shame dey attach to STD, especially if your boyfriend na person wey people sabi for area.

I cut her gently:

"We need to check. If your boyfriend get problem, you self suppose check."

For my mind, I dey pity the girl. For Naija, if boyfriend get wahala, na the girl people go first blame. I no wan make she carry blame for waiting she no know.

Everywhere quiet for some seconds.

The silence thick, like say NEPA just take light. Only ceiling fan dey creak. Outside, I hear generator dey hum, and smell small akara from roadside seller wey dey fry just by the gate. Nurse dey shout patient name for corridor—Yoruba accent strong: "Akinwale! Next!"

As dem talk, na who stone hit, na him know pain.

For this kind case, na only person wey the thing touch fit understand.