So I found myself in Lobatse today...

Today I began the day by picking up two med students and driving to Lobatse. The drive is beautiful this time of year as everything  is green and lush. As i came across a small rise where the speed limit changes from 120 to 80km/hr I took my foot of the pedal and was slowing, but not soon enough as the local cops got me on radar at 90. So I got waved over and had to pay a fine of just P80, about $10.00. I HATE the latest toy these guys have, the video radar gun. If the enforcement was consistant, OK guilty as charged even though I was all of 6mph over the limit and was slowing. Simmer...

In Lobatse we began at the hospital, the oldest in the country with wall that are 1/2m thick and wards of 8-12 beds. Rounds there and in other hospitals are a grnad time as the nurses participate and the discussion falls to how much they are a huge help. Yesterday we saw a woman in Mochudi with Toxic Epidermal Necrolysis from anti TB medicatoin. This is a blistering desquamating skin condition that is often deadly unless the nurses and docs are all on the same page, paragraph, sentence, word. There were 10 nursing students, two docs, a med student from Penn, and your truly. It was a great time to empower the nurses and reinforce how they are the ones that get the  patient better while we just write the orders. It was a lively 30m discussion at the bedside.

This morning we discussed the next epidemic that will hit this country (diabetes 2) and then went top a local clinic where a doc, Armstrong (named after the astronaut), and the three of us spent five of the best hours to date seeing and teaching/learning. It was great. The diagnoses spanned the spectrum: VSD, dermatographism, dystonia-dysautonomia, somatization, lung neoplasm, Parkinson disease, a real full and fascinating day.

We then returned to the hospital to round in the afternoon on some of the more complex cases and WOW did we find one. We were introduced to a woman who had been on Haldol for agitation and now had a fever of 39, was rigid, comatose, and near death. The students examined her and raised something I had not seen in my career but was starring us in the face; neuroleptic malignant syndrome. We got busy. If she lives she owes her life to two fourth year students from Penn.