Before coming to southern Sudan, Ketamine was a drug that anesthetists used. I remember getting it for the extraction of my wisdom teeth, a pleasant memory where I was dissociated from my body and floated above the operating room. Here in southern Sudan we use Ketamine for many minor procedures: draining abscesses, debriding burns and wounds, dilatation and curettage, aligning broken bones.
He is about 8 years old and he was fighting with his friend. During the fight, he tried to break a fall with his hand; that is how he was injured. His left elbow is very swollen over one side and he is unable to completely bend his arm. He doesn't want anyone to touch him. We start an IV and give him ketamine and a small dose of Valium. The child drifts gently off to sleep. I can now examine the elbow and try to reduce the fracture. I feel for the bony landmarks of his elbow, for deformity or the crunch of broken bone. Suddenly, there is a 'clunk' and I feel the fracture re-align to its normal anatomy. We cast him with some Plaster of Paris.