in Eastern Borneo and the Sulu archipelago) presentedfollowing a fall, with penetrating injury through the axillacaused by a stilt pole, exiting at the supero-anterior aspectof the left shoulder. Due to the lack of comprehension ofmodern medical treatment and poor language skills, theparents refused to consent for detailed radioimagingstudies, nor surgical removal and exploration in theoperating theatre. The removal of retained stilt pole wasdone in casualty area in Hospital Tawau, followed by localexploration under sedation and local analgesia. Despite thehorrific injury, there was no limb-threatening neurovascularinjury sustained. Management of such injury in the nomadicBajau Laut population provides valuable insight and aboutthe challenges and decisions of management.