A couple of images, for the medical folks

	Severe osteomyelitis in a young child. This little guy has been to Hagen and had his periosteum stripped, as well as having been on antibiotics for the better part of a year. Not much else we can do. There are holes in his bone, and bone grafts tend not to do well around here because of patient compliance.
	This is a you-tell-me, because I don't know: a purpuric skin rash in a Sri Lankan man, age about 30, no significant medical history. He was seen in Mount Hagen and they got labs: cholesterol normal, WBC about 8K with a normal diff, Hgb 13, platelets 225, sed rate 45. He was placed on high-dose prednisone and the rash resolved. He's been off steroids for about a month now and has noticed over the last week the rash recurring. It's on both feet and legs, his buttocks, and his flank. I sent him for labs, and on his return I also noticed a large bruise where his blood draw was done. Lab results here were similar except for a sed rate of 68. It's not ITP; he's not septic; the rest of his exam is normal - no lymphadenopathy, no dyspnea, no abdominal pain, urine normal. I told him to go to Port Moresby, home of the only CT scanner in PNG, and maybe on to Australia to find a dermatologist or rheumatologist and get a biopsy and maybe platelet function studies. I think he has something autoimmune.
	And for all the med students out there: This is what temporal wasting looks like. This gentleman has some kind of liver disease - I just rounded on him this weekend for one day, so I don't know the whole story - but I took 3L of ascitic fluid off his abdomen with a 14-gauge angiocath and some IV tubing. It was very exciting.