'Something doesn't seem right.'

Cuddy, who had been crouched over her paperwork, looked up, her right hand resting on her left shoulder. House was standing at the foot of Natalie's bed, his cane hanging from the footboard as he watched the woman sleeping. She had been a little more lively since they began treatment a day and a half earlier, sitting up on her own to dangle her legs off the side of the bed. Her fever broke soon after a vaguely normal fluid balance was restored and the muscle pain was decreasing, but she had suffered two more nosebleeds and the rash covering her face and now her shoulders and back maintained its tenacity. It seemed as though she was bruising more, but when Anna mentioned it, Natalie assured her that she was always an easy bruise then immediately changed the subject to whether or not Anna was planning to do her job and go out to do house calls. That was what Cuddy was preparing for -- as House was still recovering from malaria and was prone to just sort of dozing off, they decided as a group that Cuddy was going to be the doctor this time around. She was sincerely hoping that nothing was labeled palliative.

'What do you mean?' she asked after an extended pause.

'I just feel like she should be improving more than this,' he replied, crossing his arms as he stood on his left leg to decrease the use of his aching right leg. 'I must have missed something.'

She watched him for another moment before returning to the paperwork.

'We should run a CBC,' he said. 'Surely the hospital in Damongo can do that. Will you be driving through Damongo today?'

'You'd have to ask Anna,' Cuddy replied.

'Maybe she could run one here,' House said quietly.

Cuddy looked down at Baring as she began thumping her tail under the desk before walking over to Natalie's bed. The dog half jumped so that her front paws were on the siderails, looking expectantly at the now partially awake Natalie. Natalie closed her eyes again and yawned before slowly sitting up straight and leaning slightly forward with her hands folded in her lap. She opened her eyes to look at House, both staring at one another until House leaned closer to narrow his eyes at her. He fumbled for the penlight in his pocket, clicking it on as he kept his focus on her.

'Open your eyes more.'

She sighed, reaching up with both hands to hold her eyes open with her index fingers and thumbs. He held the light up and studied both eyes before echoing her sigh.

'Conjunctival hyperemia,' he said as he looked at the power button at the top of the light, clicking the button over and over again before throwing it back in his pocket.

'Probably just conjunctivitis, House,' Natalie replied dryly.

Without even thinking, Cuddy slightly turned her hands away from Natalie and House leaned back slightly.

'We can try some cipro eye drops and if that doesn't work, then we know it's hyperemia,' said Anna from the door, holding Martin by the collar as she walked in. 'Are you ready, Dr Cuddy?'

'I think so,' she responded as she began closing the files in front of her; as she closed the last one, she looked up at House. 'Do you still want the CBC?'

'No,' Natalie said dourly. 'If you're so talented, figure it out on your own.'

They all looked at her but none were willing to start a clinical battle. Anna tipped her head forward slightly as she brushed her hair behind her left ear.

'We'll just continue monitoring her fluid balance,' she said with a shrug. 'Adzoa can handle this, Dr House. You should lay down.'

House didn't seem to even entertain this idea, instead moving over to sit in a chair across the room from Natalie so that he was in a position to watch her, look at the whiteboard and thumb through a few of the books he'd looked at earlier. Cuddy stood, gathering the files in her arms and turning to Anna.

'I'll just drop these in the office on the way out.'

Anna nodded, stepping aside to let Cuddy out.

'Anna,' Natalie said, reaching up and scratching her face with her right hand as she looked down at the self-contained pulse ox on her left index finger -- she waited for it to beep and read the sats before continuing. 'Go to check on the Mante infant first.'

'They may be the only family we're able to see today due to the weather,' Anna said, reaching over to pluck one file from Cuddy's arms.

'A large family -- just go ahead and make sure everyone is fine until next month,' Natalie replied with a yawn before waving Anna off.

'Okay,' Anna said with a quiet nod before following Cuddy.

Once they'd left, Natalie pat the bed and both dogs jumped up with her, cramming themselves on either side of her. She soon fell asleep again, leaving House to synthesize a new solution.

---

It was pouring by the time they reached Buipe, 1:29 according to the analog watch that Anna had hung from the rearview mirror. Cuddy watched the seconds click away on the white background, the second hand actually being a rising sun plate ticking about over the face. They hit a pothole and muddy water sprayed on Cuddy's window; she looked over at it for a few long moments before turning back to the book about practising medicine in an area where there is no doctor. It had been a very long time since she did anything even vaguely resembling a peds case aside from overlooking the OB/GYN department at Princeton-Plainsboro, so the thought of dealing with something as fragile as an infant in a still-unfamiliar area was slightly nervewracking.

'The Mante is a family of one man, his three wives and a combined total of six daughters and four sons,' Anna said -- by this context clue, Cuddy was able to relax with the knowledge that Anna only came along on the 'palliative' cases of Catholic family, which this family apparently wasn't. 'The main patient today is the newest son, whose chart was among those you were looking at earlier. To save time for us later, I grabbed the rest of the family's files so we can go ahead and deal with any other minor complaints. They live pretty far out, so it's best to get them all in one fell swoop.'

Cuddy closed the book and looked over at her.

'Where are the other files?'

'In my bag in the back, but really, there aren't a lot of medical complaints in the family,' Anna replied. 'His second wife, Enyonam, worked at the district hospital before marrying Kwame.'

Cuddy considered this for a moment. 'Isn't the doctor in Kumasi named Kwame?'

Anna nodded. 'It's a pretty common name, a day name. They were both born on Saturdays.'

'Ah,' Cuddy said as she ran her right index finger nail down the outside edge of the cover of the paperback in her lap.

'Anyway, she's good at determining if we're actually needed to come in and intervene medically. She knows it's a long drive.'

They were quiet for a moment before Anna continued.

'Natalie was at their house when she had her first seizure,' she said, then realised the need to be conditional. 'Well, the first seizure that she's had in Ghana.'

Cuddy seemed slightly taken aback. 'It seems like that would have been a good thing to mention to Dr House. Had she spent a lot of time there prior to getting sick?'

'No more than she does with any other prenatal patient, and she's had three in the last two months.'

'All in the same area?'

'If only it could be that easy,' Anna said with a sad laugh. 'They're in all different directions.'

'What are the demographics of those families?'

'How is that relevant?'

'It's just a question,' Cuddy snapped back, and Anna looked over at her seriously.

'Both of the others are in single couple families. One has three children and the other has five,' Anna said. 'The mother of the three is in her early thirties and the one with five is nearing forty.'

'How old is the Mante wife?'

'Ama is his youngest wife,' Anna replied. 'She turned sixteen a few months ago.'

Cuddy raised her eyebrows but said nothing.

'Secretly I agree, but it's not my place to judge,' Anna said in a small voice as she made a sharp turn onto a road that appeared to consist entirely of sludge.

It was another thirty minutes before they turned into the millet field -- the total drive had been well over an hour. Since Natalie had been there a little over a week earlier, the millet had grown thanks to the sudden influx of rain. It was still too early for a hearty crop, but the weather made a good harvest seem increasingly likely.

'She rode her bike here that day,' Anna said, looking sideways at the rain-soaked stalks of millet. 'It was such a miserably hot day. It was really dry in February and the early part of March but we'd had a lot of good rains for a week or so mid-March only to get slammed by more dry weather. We'd thought that the Harmattan was going to end early this year only to have Harmattan, part two.'

'Did those storms leave a lot of stagnant water for the mosquitoes?'

'Not particularly,' replied Anna with a shrug. 'The mosquitoes haven't been that bad this year, to be honest. We've been lucky so far, but these rains might change that shortly.'

As they came up to the house, Cuddy saw some of the Mante children setting out large tin bowls to catch the falling rain, all of them laughing loudly enough for Cuddy to hear them over the roar of the motor. One of the older daughters stood directly in the rain with her arms outstretched, her face turned toward the sky with closed eyes. She tipped down her chin slowly as she heard the Defender's approach, turning her neck slightly to say something to her siblings. Another girl stood up from her bowl, looking at the car before heading to the door. The older girl was at the door of the car as soon as Anna turned the engine off, immediately sticking her hand out when the door opened. Anna shook her hand, snapping against the younger girl's thumb and index finger as she dropped down to the muddy ground. Cuddy slipped out of her side, arms clasped tenaciously to her chest, and came around, her hand held at her forehead to shield her eyes from the rain.

'This is Tabitha,' Anna said. 'She's the oldest daughter. I'll gather the supplies if you follow her into the house.'

Tabitha took Cuddy's hand, leading her past the bowls, all of which had turned into lesser versions of temple bells. As they walked past, Cuddy could hear each raindrop reverberating against the tin, the sound creating the slightest of hums, each lapping against the dozens of others occurring at around the same time. There was the shush of the wind through the millet as they reached the door, the breeze bringing the previously static collected rain rushing down the grooves of the tin roof, one of the streams drizzling down on Cuddy's left arm as she stepped onto the stone slab where Tabitha stopped to study her muddied feet for a moment. Cuddy pressed to the damp outer wall of the house as she found herself glancing down at her now muddy and squeaking flip-flops. Tabitha opened the door, rubbing her feet on a reed rug as Cuddy removed her shoes and did the same. The family had gathered in the central room, the younger children who had been playing outside having obviously entered the house from the back door. All were still soaked, wrapped in threadbare towels as they watched the oldest of the wives pour steaming soup atop a large ball of fufu that was set on the table in front of her. Once the pot was empty and the fufu thoroughly doused in liquid, she picked it up and put it in the circle of the four children old enough to feed themselves. A murmuring of small voices down one of the hallways was enough for Cuddy to ascertain the location of the five other children.

'You must be Dr House,' the woman said as she stood -- all of the children looked up at Cuddy.

'Oh, no,' Cuddy replied. 'Dr House is my associate; I'm Dr Cuddy. Dr House is working with Dr Chase today.'

'I hear she isn't well,' replied the woman.

'I'm afraid not,' said Anna as she entered the house. 'Mma aha, Enyonam. Wo ho te sen?'

'I'm fine,' Enyonam said, giving a smile and understanding look to Cuddy. 'How are you today, Anna?'

'Wet,' she replied as she walked over and set her bag in a chair pulled up to a strong wooden table.

Tabitha laughed lightly before breaking away from Cuddy and heading over to the kitchen where she picked up a bowl of rice and poured some of a different soup upon it. She walked over and sank to the ground near her siblings, taking a few bites of her dish before handing it to a girl around her age. They continued sharing the bowl rather than turning to what the others were eating.

Anna watched them for a moment before knitting her brow.

'Where's Kwaku?'

'Ill,' Enyonam replied. 'I knew you'd be coming today, so I didn't make a special call.'

'How long has he been sick?' Anna asked worriedly.

'Two days,' she responded. 'It seems to be the grippe.'

'Seems a little out of season,' Anna replied, shifting on her feet with her arms crossed. 'Are you sure it isn't malaria?'

'It doesn't seem so to me, but I will leave it up to your judgment,' Enyonam said as she reached out and put her hand on Cuddy's upper arm. 'Come, I will take you to him first.'

'I'll check on everyone else while you're in looking at him,' Anna said as she fished a stethoscope and thermometer from the bag and extended them toward Cuddy.

Cuddy looked down at the files in her hand and plucked out the one for Kwaku, setting the other files next to Anna's bag before taking the proffered supplies. Enyonam smiled at her once more before leading her down the hallway. They shuffled along together, the sounds of the chattering children fading into the tapping of the rain on the tin roof. The sounds faded once more as they came upon a duo of women engaging in bavardage. When they stopped at the door, Cuddy saw that the older of the two was nursing two very young children and the younger was nursing a tiny newborn as two other children sat on a reed mat playing with a cowrie-webbed gourd. The younger woman didn't look that much older than Tabitha.

Enyonam said something quickly to the two of them before leading Cuddy to the next doorway, which was covered by a piece of batik hanging lazily from waxed twine. She slid it to the side, stepping in before Cuddy to pull away the curtain to let in some light and then strike a match to light the lantern next to the boy's bed. He groaned softly and put a hand to his face.

'Kwaku, this is Dr Cuddy. She is here in the place of Dr Chase.'

He carefully lifted his hand slightly to look at her, but the emotionlessness on his face did not change. After a moment of looking at her, he dropped his hand again.

'Have you been able to take his temperature?' she asked as she walked over and sat on the edge of the bed.

'No, but it has been high enough that he has been shivering.'

Cuddy nodded lightly as she pulled out the probe of the thermometer and shoved a cover on it before edging the probe into Kwaku's mouth.

'What other symptoms has he had aside from the fever?'

'Very tired, pains, headache when he is in the light too much.'

Cuddy knit her brow before speaking softly. 'It does sound like the flu, doesn't it?'

The thermometer beeped and both looked down at the screen -- it read 38, a moderately low-grade fever. Cuddy drew her mouth to the side in exasperation before taking the stethoscope and putting the earpieces in. She warmed the diaphragm before setting it on Kwaku's exposed chest and listening bilaterally to his lung sounds.

'Stomach pain,' Enyonam offered, and Cuddy closed her eyes for a moment to synthesize this new information.

'How old is he?' she asked as she took the earpieces out, not opening her eyes to look at the patient file on the sheets by her knees.

'Ten,' Enyonam replied.

'Influenza B,' Cuddy offered after a moment. 'All of the symptoms of the flu with stomach pain in children. He'll just need plenty of liquids along with some paracetamol. Make sure he coughs and deep breathes multiple times daily until his lungs clear to decrease the risk of pneumonia.'

'I'll have one of the other children collect one of the water bowls we've put out in the rain for him to have very fresh water.'

'Good,' Cuddy said with a nod as she examined Kwaku's arms -- there were a couple of bruises, but none out of the ordinary for a young, active boy.

Enyonam was quick about closing the curtains and turning off the light, kissing Kwaku's forehead before leading Cuddy out into the hall once more. As they walked back toward the living room, Anna was coming toward them.

'It looks and sounds like the flu to me,' Cuddy said.

Anna bit her bottom lip with a nod. 'Seems odd, but a lot of things are around here.'

'You've already looked at all of the children?' Enyonam asked.

'Just a quick overview,' Anna replied. 'They all seem to be doing very well. I'm about to go check on the baby and the other four.'

'I'll help,' Cuddy said to her, coming one step closer to her.

'Okay,' said Anna with a light laugh.

'I'll have one of the others get the water for Kwaku,' Enyonam replied before brushing past them to go to the main room.

Once she'd gotten to the older children, the two clinicians stepped into the room. Anna directed Cuddy to check the women, accurately picking up her discomfort regarding the treatment on young children. The younger woman wasn't one for English conversation, but the older one was very chatty. The examinations were cursory as both women seemed healthy, so Cuddy was finished before Anna. She sat down in a chair next to the younger woman, looking down at the baby for a moment before scanning the room. There were piled tin bowls, folded reed mats and lengths of dusty fabric lining the walls. As she looked closer, she realised that some of the reed mats were shredded in areas as though knives had been taken to them. She sat up straighter in her chair in thought before Tabitha walked in.

'We need another bowl for water,' she explained as she crossed the room and reached up to grab a bowl off of a shelf.

Unfortunately, as she reached up to grab it, she pulled down the entire stack of six bowls without adequate support. They fell to the ground, clanging horribly before coming to rest on the dusty ground. The younger children cried as the others ran toward the noise to see what had happened. Tabitha began sheepishly piling the bowls until reaching the fourth, which had turned over. As she lifted it, Cuddy saw some of the missing reed mat material at the same time that she saw three rats scurry away from their nest. The room exploded into even more mayhem as everyone started screaming, Enyonam and one of the other girls whacking the things away with reed fans as Cuddy and Anna instinctively moved to pick up the two younger children who were sitting on the ground. The unusual clamor woke other rats up, the small mammals scurrying from the shelves and out a fabric-covered window hole. Anna and Cuddy stood on the reed mat staring after them in stunned disbelief.

After a few minutes, it had growth quieter again. Cuddy and Anna watched as Enyonam and Tabitha took down everything from the shelves, checking every corner for other rats. They spoke angrily the entire time, batting at nonexistent rodents as they cleaned. The bowls were laid out in front of Cuddy, awkwardly stacked but ratless. One of the younger children walked in and said something slightly sheepishly and Enyonam replied before the boy grabbed one of the bowls and started to walk out of the room. As the inside of the bowl reflected oddly in the light, Cuddy reached out and grabbed his shoulder.

'Wait,' she said, squatting to put the younger child down before taking the bowl from the boy's arms.

She held it in the light, tipping it from side to side with furrowed brow before looking over it to Enyonam.

'Do you clean these bowls well before using them?' Cuddy asked. 'With bleach or Oxo or Key?'

'Just water,' Enyonam replied.

'Only when there's enough water,' Tabitha said, and Enyonam looked over at her.

'Always wash the bowls, Tabitha.'

Cuddy looked at the bowl once more before looking over at Anna.

'It's not influenza,' she said in a solemn half voice as she looked down into the bowl again. 'And it's not dengue either.'

---

A/N: Augh, I'm so sorry about the delay! A thousand things have happened in the last month and Occlusion sadly had to be put to the side for a moment. Here's to hoping for better, faster updates again!!