Comfort Dolls

Here are some photographs from some recent visits with our Home Based Care team at Good Shepherd Hospital. We visit 22 different communities on a rotating basis, we try to visit each community once a month. Most of the care we provide is for patients with HIV/AIDS, TB and
some other chronic diseases for the homebound patient. The dolls were donated through St. Philips Church in New Hope, PA.




This is a young boy in the community adjacent to the hospital who has had this rash for most of his short life. We had him come to GSH clinic and he received antibiotics and steroids and the rash has much improved.


















A young girl we met when making home visits in January. Her mother is on ARV's.



















Another child from one of the homesteads. Her mother is a patient who is on ARV's (anti-retrovirals).

















Again children from a rural home visit. Their mother has TB and HIV/AIDS.
















Now there are many poor people that we visit daily but this particular family is one of the very poorest. The mother has active pulmonary TB and HIV, she is not on ARV's yet, she must complete this course of TB medication first.












Child from above photo.

















This is Siphesihle with her younger brother, she is the one on the right. Siphesihle and her brother are all dressed up to come to the ARV clinic at GSH to be reassessed for ARV's. Her liver function tests are quite poor so she is not able to start taking ARV's. I did not recognize her because she looked so different from when I saw her at her homestead. The Swazi people take great pride in their appearance so when they come to clinic they wear their very best clothing.

Again, child from above photo, I did not realize that I had included him already.

David with family on a homestead about 30 km from Good Shepherd Hospital.

A gogo with her orphaned grand daughter, the gogo is our patient and on ARV's.

Siphesihle on the road near her homestead, this photo taken during a home visit, she is still unable to start her ARV's yet.

I want to thank the women at St. Philips Episcopal Church in New Hope, PA and others in the area, including Christian Winslow, for the Duduza Dolls that you have sent to us here in Swaziland. The time, effort and love that you put into making the dolls and shipping them to us is very much appreciated. The children have really loved receiving them. Many of these children that we visit daily on their homesteads here in Siteki rarely, if ever, get a gift of any kind let alone a handmade doll from America. David and I have distributed the dolls to both the girls and boys, orphans, children of patients and patients themselves. I hope that you enjoy the photos, included is any specific information that I can recall regarding the specific child or patient.

Much Love,

Scott

Wet from head to toe.

Yes, I have literally been praying for rain daily. Not necessarily for it to rain every single day but frequently would be nice given that it is the rainy season. Well the rains have come and now we are knee deep in mud before finishing our first home visit. Yesterday we got an early start only to be hampered by the rain, mud and poor traction of our HBC truck. The wheels just keep on spinning and spinning flinging mud in all directions, on us, the patients, their homesteads and the random cow or goat that happens to get too close. I must admit that I take a cavalier attitude toward driving, afterall I have been driving for too many years to count and experienced the ice and snow of the northeast. Of course, as well all know, all men are great drivers so there you have it. So I feel pretty confident in my driving skills whether this is justified or not is negotiable. There is little hesitation on my part when it comes to following a request to head down a saturdated dirt road with no room to turn around and expecting to be able to get out as easily as we have entered. Well that was not the case. We became stuck on our first visit, the rain was coming down in every which direction. The kind of rain that an umbrella is of little or no value. It was a rather soft but steady rain, it came from above, the north, the south, the east and west carried by a fairly good wind current from Mozambique. Please note that with the rain there is usually a heavy fog to make navigation that much more difficult.

The look of horor on the face of the old gogo in that very first homestead as she watched me from behind the nearest large tree was priceless. I asked the team to apologize right off, saying that I was sorry that I was making huge tracks outside her hut. The team assured me that it was truly of no concern to the gogo, her big concern was whether or not she might have to share some of the food parcels we had just delivered if we became stranded for the night. So tireless I moved back and forth and back and forth a foot or two at a time. The team offered to push but there was nothing but slipping and sliding and I feared that one of their arms or legs would become the needed traction to free us from the homestead, so I asked them to keep their distance. Matron Zwane remained in the front seat, directing me at every turn or attempted turn while reciting the Hail Mary continuously. After 45 minutes she enlisted all of the saints and a few apostles to help in our endeavor and sure enough with the help of Saint Ann (her patron saint, why she waited so long to enlist her help I have no idea), a couple of dozen rocks, the branches from several trees, and a big push from the team were we on our way up the hillside at rocket speed. It took another ten minutes for the rest of the team to meet us at the top, giving Matron Zwane enough time to thank God and Sipho (Sipho is the Swazi name given to me by the team last month, it means 'gift' in Siswati) and to recite the Our Father in both English and SiSwati. As the team reassembled in the truck we had a good laugh and decided to be more cautions as the day progressed. Fortunately, Matron Zwane gave the order to go down the hill so there was no blaming going on because she is the eldest and therefore gives the final say on most matters of concern to the team.

We drove another 25 or 30 kilometers before the inevitable happened again. By this time we were literally drencehed from head to toe, making our visits as qucikly as possible. As you may or may not know, all patients, everywhere, want to have their time with their nurse and/or team. So as much as we tried to keep a good pace there was more resistance from the patients not move on too quickly. Fair enough, we were already soaked to the bone, the patients need our attention and the rain is no consequence for them whatsoever. The photo the homestead I have attached is the location of our next frolic in the mud. We were basically stuck before we even arrived, so the team went into see the patients without me while I shifted gears from first to reverse and back again about a thousand times. We ended up with mud splattered in every direction possible. There wasn't a piece of grass along side the dirt road that survived and I nearly took out a fence on either side of the road in the process. I must have been making quite a commotion because a couple from a neighboring homestead came to our rescue. Both the woman and man were dry and clean but still offered to help push us out. The team came out of the homestead as well after completing the visit and one and all started to heave and hoe, push and sweat and of course pray up a storm. I have never heard so many Hail Mary's and Our Father's in one day since practing to make my First Communion forty years ago. Well, it all came together after another 45 minutes and we were once again freed from the mud and knee high grass alongside of the road without the destruction of the nearby fencing. The above photo is of the aftermath of the team and our good samaritians. We rewarded them with food and E50 from my pocket, money well spent and greatly appreciated by the couple.

I hope that you are enjoying the attached photos. As many of you know I am basically computer illiterate so it has taken some doing to make it happen. David has spent a couple tutorials here in the internet cafe with me and yes our friendship has survived. Before I forget I wanted to let you know that David has started keeping a blog as well. Here is the information for it: http://www.davidinswaziland.blogspot.com/ I hope that you enjoy it. I must confess that I have not read it yet because I do not want it to influence my blog or my interpretation of events here. So if there are inconsistencies I apologize, they are not intentional but rather our individual perception of life here in Swaziland.

Peace,

Scott

School Fees and New Hope from across the Atlantic.

It has been a short work week but a full one just the same. Tuesday was most exciting with the departure of Bush and the advent of Obama. We celebrated the Obama innaugeration at the Siteki Hotel. It was broadcast live here in Swaziland and everyone I spoke to that has a TV watched along with the rest of the world. We gathered at the Siteki Hotel with about 30 other people from Good Shepherd Hospital. Many in attendance were wearing the Obama hats that we had brought from home and all were very excited to see the first Black American become our 44th President. There were many African countries respented at the gathering including the Congo, Eritrea, Swaziland and Uganda to name a few. Everyone had their own country's and personal interests in mind. Universally it is believed that Obama is the answer to all of the world's problems. Needless to say we spent a better part of the evening cautioning restraint in this belief and that change will come but it will take time and alot of patience. There was an article in the local Swazi paper the next morning that there had a been a cease fire in the fighting in the Congo, this was attributed to our new president by a reader from the Congo. In response to this optomism I responded that 'one can only hope'. It seemed best that it is better to let people believe what they will and continue to hope for miracles to come true. I must say that as we sat in the hotel lounge and had drinks, watched the innaugeration, cheered, laughed and cried with our coworkers, priest from the local parish and other friends that it was so gratifying to feel proud to represent America here in Swaziland and on the African continent. Yes, Africa is a continent and not just a single country (if anyone up in Alaska is reading along). Obama has truly made some significant changes already beginning with the world's preception of Americans and what is possible if you believe that dreams can come true.
Now that I have been here in Swaziland for nearly two months we have been seeing some of the same patients over again. We go to about 22different areas so now we are back at the beginning seeing some of the patients from last month and of course new patients as well. It is not uncommon to find out that several of the patients that we planned to see have now died. I am not familiar enough with the patients to know which ones died but I have been able to recognize some of them from last month. Although, I was so overwhelmed with all of the newness, suffering and unfamiliar territory that I do not remember as many patients as one might expect. As the past couple of weeks have progressed I am finding that I do remember more than I had the previous weeks. We went to Sitsatsaweni again, this is where I was traumatized by the young orphans, the 11 year old girl taking care of her three younger siblings. Unfortunately, I did not see them again but was assured by the RHM (Rural Health Motivator, a person in the community who helps keep track of the patients and assists with their care (occassionally) and encourages compliance with medications) that World Vision had taken over the primary care of the children and were providing food on a regular basis. We had the RHM bring them some milk to provide a little addtionation support. I will continue to try and follow up with these children over the next several months. The goal here in Swaziland is not to remove the orphans from their homesteads but to try and provide some support for them at home. There is financial support for schooling provided by the 'King's Fund', to help orphans to attend school but it is often not enough and very difficult to access.
This had been a stressful week for many here in Siteki and Swaziland in general. Schooling is not mandatory and in order to attend school children must pay school fees which often exceed what their partents make in a year, that is if they are able to find work and have an income. School fees go from anywhere from E2000 a year to E10,000 and often much more. Please note that the average daily income in Swaziland is about E6, that is certainly not enough to live on let alone afford school fees. Now, not everyone is that poor here and it is an average, 40% of the population has jobs, that leaves 60% unemployed with very little hope of finding work. Fees vary depending on the school, what year the child is in and if there is any financial support available. The financial support is very difficult to access especially for the very poor who need it most since the parents are often uneducated. I should probably say 'parent' since I have seen very few if any two parent homesteads, more often than not one parent is absent or more commonly has already died. The very poor children, most of whom I see when visiting the HBC patients do not start school until they are 10 years old if at all. I will be able to tell which children are in school starting on Tuesday becuause that is the first day of school here for the first trimester of the school year, so the children that remain at home will be those who cannot afford schooling. It is really a disgraceful situation that some basic schooling is not provided for all children but I will not eloborate on this point since I want to keep my visa.
Anyways, many mothers have spent this week looking around for money for school fees. They frequently come into the HBC office looking for assistance or through an organization called Young Heroes that David is working with, or any number of different avenues. It is not uncommon for those that work to help support other family members with their school fees or to assist orphans with theirs. Most all of the nurses I work with pay some school fees for children that are not their own. As well as support provided from the states through Friends of Good Shepherd and HBC, two very special people in New York City also provide an amazing amount of support for the children here, I will not name them but you know who you are. So it is not unexpected that word has gotten around that HBC does support as many children as they can therefore mothers come asking if we can help their children as well. It was common place to have a mother in the office this week sobbing because she could not afford the fees and requesting help.
While visiting our last patients on Friday afternoon, a homestead that I remember from last month we were presented an opportunity to provide some needed help.
David and I had been discussing that we wanted to help a child or two with their school fees or a family with food and financial support but had not started to do so because of all the adjusting we had been doing ourselves and having to pay a mortgage in New York because my apartment has not rented yet. I know that this story is going to sound somewhat, if not competely unbelieveable but here it goes. The homestead is headed by a Gogo (grandmother in Siswati), she cares for her son who is in his early thirties, paralyzed on one size probably from toxoplasmosis and therefore chairbound, has AIDS and is receiving ARV treatment. He was in the exact position where I had seen him the previous month, sitting in a chair in the doorway of the homestead looking outside with these big doe eyes and drooling up a storm. He is quite well cared for, very clean and fed but remains cachectic. Additionally, the gogo cares for her two orphaned grandchildren (their parents, the gogo's daugher and son-in-law both died of complications related to AIDS) Nosipho and Mancoba. I believe that Nosipho (the girl) is 14 yrs old and Mancoba is 11 yrs old, he is HIV positive and on ARV's, I am uncertain what the HIV status of Nosipho is. To make the whole situation even worse the gogo has AIDS and is receiving ARV treatment. So there I am assessing the gogo, who looks as if she is in her late 80's but is actually in her mid-fifties. While talking in Siswati to the other team members she bursts out crying, not just crying but sobbing and heaving with these huge crocidile tears streaming down her charcoal colored face leaving a steam of salt water on her face, I was just stunned. I said to the team (there were 4 others present) what is wrong? Have I done something to hurt her? The response was no, she was crying becuase she did not have the school fees for her grandchildren to start school on Tuesday. Their aunt, the gogo's other daughter usually paid them but that she was unable this year because her husband was dying (yes, from AIDS)and no longer could work and support his own family. Well after composing myself, I took a quick walk outside, I asked how much the fees were and when they were due, stating that I would do what I could but had to speak with David first. This was enough for the all present to see that there might be some help in sight and again, the gogo starts crying and this time Mancoba starts wiping tears from his eyes and Nosipho was grinning from ear to ear. Instantly the gogo and children as well as the team started saying the Our Father in SiSwati giving thanks that help had presented itself. It was very emotional and moving to say the least. Fast forward to Saturday morning at 8:00am and David and I are standing in line at the Swazi Bank (school fees are paid through the local banks) for an hour and a half and paying the children's fees for the year. I must say that it felt good to be able to help and know that the children will be able to get out of the house and have some normalcy in their lives. Monday morning David is going to meet the children with me at HBC and take them shopping for school supplies and possibly a new uniform. I wish that I didn't have to work and was able to go with them but I imagine they will do just fine without me being present.
Another week has passed and with it nearly two months in Swaziland for us. The experience continues to shock my existence, I really don't know how else to put it. Again I am sending my love, know that your thoughts and presence back home are felt and appreciated.
Peace,
Scott

St. Lucia Estuary, South Africa

Hippos in the estuary; let me tell you, those teeth and that mouth are huge. Good thing that they only eat grass and other greens. Although they responsible for more human deaths in Africa that all other animals combined. On land, they can run up to 40 mph.! Below, me looking a bit too serious for as much as I was enjoying the boat trip. We saw an endless array of birds, dozens of hippos and crocidiles.

We are on a roadtrip to South Africa this weekend and yes I know that it is probably seems odd to look for an internet cafe while away but there was no line here and the connection seems in good working order. Friday was amazing, for many reasons, one of which is the incredible heat and humidity. It was near 40 degrees celcius on our drive down from Siteki in the late afternoon, the heat continued through Saturday afternoon until a thunderous storm moved in and poured down rain upon us, providing great relief. I literally thought that I might melt as if I were the Wicked Witch from the West! One should not even consider wearing anything other than a bathing suit in such weather while walking around on a boardwalk with a cocktail and an ocean breeze at your back. (Did someone mention Fire Island?) Not so in this case, just the heat and humidity without all the other ammenities.
It was quite a challening day in the bush especailly with the heat and my stepping into a giant pricker bush early on in the day. I pulled prickers out of my shorts, socks and shirt for the remainder of the day. Seeing 25 patients with sweat dripping off your forehead and nose do not make for a pretty sight. Some of the patients and homesteads were quite challening especially on the olfactory system. One unfortunate gentleman had colon cancer and had had a colostomy placed. Well that is actually quite fortunate for him but difficult as well for those around him given that he does not have any collection bags for his colostomy and he continously leaks stool and blood. The only collection aparatus he has is an old rag and a few banana leaves, not much help by any standards. I did my best to give him a thorough assessment and breathe as little as possible in the mean time. It is really quite shocking to see how the various cancers I have seen progress without any or very little treatment. Last week I saw a patient with oral cancer that had filled most of his oral cavity. We were able to get him money for transportation to the hospital to get some liquid morphine for pain control, which was very rewarding. It amazes me how we can see patients in these very remote homesteads and make referals for the clinics and they are actually able to come and be seen by a physician. Getting to these places with our truck can be incredibly challenging and it seems as if we are a million miles away from anyplace or anywhere yet the locals can manuever quite well with the bus and coombie system that exists here. On Wednesday I was visiting a Gogo (grandmother) who has HIV and had lost her son and daughter-in-law to AIDS, not very unusual at all. What was unusual was that she asked if I would assess her grandson who was about 6 years old (a double orphan, children are catagorized by being a single or double orphan, one or two parents who have died) and had a swollen testicle. It was indeed quite swollen and not painful at all so I fear that it is cancer. We had asked the gogo to bring him to the hospital on Friday but they had not showed by late afternoon. Given that about 80-90% of our Home Based Care patients have HIV/AIDS it seems a bit surprising to find other illness including cancer, diabetes and hypertension.

Anyways, back to the weekend. We are staying in a small touristy town called St. Lucia. I think that there about 600 residents in the off season but thousands abound in high season. Fortunately, we are at the end of high season and most of the tourists have retuned home to send their children back to school. I am very grateful for the school calendar year.

There is a giant estuary here and many game parks as well as sand, shore and the glorious Indian Ocean. I am not sure if this is my first plunge into the Indian Ocean so I will have to explore a map more carefully to determine the answer. Regardless, it was absolutely heavenly to thrust myself into the ocean, the healing, wet, salty, revitalizing and cooling sea. The waves were mercilessly pounding the shore with a fierce rip current to match. So we were not able to swim all that freely but there was a large outcropping of coral where we were shielded from the powerful waves and able to lounge freely in the sea. I really do love, love, love the ocean/sea and basically most any body of water. Being on the beach again and in the ocean reminds me of just how much of an important role water plays in my life. The sun and surf are a vital necessity to a full life for me. Swimming in the Indian ocean for David brought back memories of his earlier years in Kenya so it was great to hear some more of those stories of his childhood adventures by the sea.

On our drive to the ocean we passed through a large game park and were entertained by many new species. We saw some huge Water Buffalo upclose and personal. This one large male had the most devilish looking red eyes that I have ever seen. Other creatures included Nyala, well worth looking up on the internet if you have never seen one, monkeys, Impala and so forth. Now the most profound sighting was that of a Leopard and that was during the day. What a spectular cat! Amazingly it reminded us very much of a domesticated cat that you would see in anyone's home the way it laid there and cleaned herself, licking her paws to wipe her eyes and just yawning, rolling around a bit and not doing much of anything else. Not that I have a cat at home to compare it with given how allergic I am but it reminded us of a cat you would see in a store window, you know those people who love cats and take to petting stray ones on the street or in shops and adopting them in pairs, it seemed as if all of this were possible but of course it wasn't. The leopard laid there in the bush, about 25 feet from our car and just kept cleaning itself and yawning and staring at us. We felt safe in our Mazda and were able to take a bunch of photos and admire the big cat with or without the assistance of our binoculars. The leopard really is one of the most beautiful creatures that I have ever seen and that even includes those at DBG, on 8th Avenue or on the F or L trains. We spent a good thirty minutes in awe before driving on, it was certainly a memorable thirty minutes. The game wardnes we spoke to said that it was very unsual to see a Leopard during the day lounging on the ground instead of hidden up in a tree somewhere off the more beaten track. The spots were outrageous, so very beautiful and meticulous and perfect in their design. Evolution is just numbs the mind it is so facinating.
This evening we are going on a Hippo and Croc tour, just your average night here in St. Lucia. We will be on a flat bottomed boat in the wetlands skimming across the top of the water looking for these giant prehistoric looking creatures. There are so many things that I have done in the last two months that have shocked even me. I love that, I am really learning to savor the unexpected. I feel as if I went into this journey with very few expectations and that has added to the impact of all the new highs and lows.
I must say that I am still diligently working on meeting the world where it exists and not where I, and how I perceive, it should be. Trying to be patient and keeping an open mind is constant work. It is so easy to fall back into old ways and standard ways of thinking and seeing the world and its people through my limited field of vision. This awareness and concept is something that I am really praying for and spending time reflecting on it. Your support is allowing this to happen for me, not as quickly as I would like but hopefully moving forward most of the time.
Peace,
Scott

Moving day in Siteki.

The photo on the left is our new home at Mabuda Farm. Our unit comprises the two large windows on the left. My bedroom is on the left and David's is on the right. The french doors belong to another rental unit for the B&B.
The pink building to the left is our former abode at The Deaf School. Our apartment was on the left side of the building. The SUV out front is our delicious mode of transportation and our way to escape to new surroundings when necessary.

I must say that we are thrilled to be moving back to Mabuda Farms today. We call it the Garden of Eden of Swaziland. There are lush fields of corn and other crops for as far as the eye can see and numerous fruit bearing trees within arms reach. The view is spectacular from the front of our place, you can actually see all the way to South Africa. There is a mountain range in our sight that does stretch down and across the South African border. The farm is owned and operated by Jono and Helen Pons. They are both originally from South Africa although it was Helen's father who helped to write the first constitution for Swaziland. Needless to say he was, and they are, very affluent members of society here and their estate is quite amazing. The Pons live in a giant home by any standards but especially by Swazi standards. Their home is a two story reddish stone house with an amazing thatched roof that covers it like a mushroom cap. There are many working fireplaces in the house, 20 foot ceilings, numerous bedrooms (more than their four children could ever use even if they had two rooms each) and the heads of a dozen or so stuffed game hanging on the walls. There is also quite an amazing library in the home, it is like something you might imagine from a scene of Out of Africa. Needless to say, it is where David feels that it is his birth right to live and spend his free time being creative and reading from dawn to dusk. Helen home schools her children there before they move onto boarding schools in Durban for their high schools years. Helen really is an amazing person, very smart, worldly and a devout Christian. She has made a good life for herself and family here.
The farm is a working farm, they grow corn (mealie) and raise cattle amongst other things. Helen inherited the farm from her father, so they are very well known here in Siteki as well as everywhere else in the country. Dr. Jono Pons is the only eye surgeon in Swaziland so his position at Good Shepherd Hospital is much needed and he is basically legendary in these parts. Dr. Pons has arranged for donors to sponsor his work at Good Shepherd Hospital which is a benefit to the community and to the hospital. The Pons are incredibly generous with the community and are involved in many charitable organizations. Additionally, they have been very generous with us too. They and Ina (I will tell you about her another time, she is the manager for the bed and breakfast and is so sweet, gentle and kind, somewhat of a mother figure for me) have arranged for us to stay in one of the bed and breakfast units at a very reasonable rate and for that we are most grateful, especially since we were having such difficulty finding a place to stay. Now we will have running hot and cold water and more reliable electricity. The farm is also very safe. They have 6 large dogs that run loose and guard the grounds. While we were staying there last month a couple of the dogs became quite friendly with us and were comforting to have around.
We are becoming more comfortable with eating the local fruits and vegetables. Yes, we wash them with soap and water and rinse and dry them before eating them. Mangoza, or mangoes, are in season now. Basically everywhere you turn people are selling them. There is even a young man who comes by on a bicycle with a high pitched bell and rings it for you come out of your home and buy the mangoes. He is a very sweet kid and speaks quite good English. I think that he is about 16 years old, always wearing tattered clothing and a huge smile. He sells the mangoes for two emalengeni each or about a quarter. So needless to say we have mangoes on a daily basis. Interestingly most people here eat the skin although I find it a bit bitter. Please feel free to send any recipes for mango dishes that your grandmothers may have had. I am still hoping to make some sticky rice to go along with the mangoes but have not found any coconut milk yet. OK, I know, enough about mangoes. Remember we have no TV and minimal computer access, so please indulge me.
Well I must sign out now. Know that life here continues to be one new experience after another. Yes it can be quite bleak and depressing at times but simultaneously it is all new and I feel very invigorated and grateful for all that I have.
Much Love,
Scott

The impromptu clinic.

Well, it is practically a thousand degrees today. The heat from the day woke me a 5:15am, yes much too early. The sun has been beating down on us all day today with little relief in the shade or from the lack luster breeze. We were able to take refuge from direct sun while we parked beneath a large tree and had our lunch. I had my usual power bar (or two) and some gatorade, thanks to Karen Wong's gorgeous care package. I know that many of you will take great joy in knowing that I am hot and sweaty (that's part I do not mind) and dirty from head to toe, even my finger nails are filthy, which is quite distressing. We are without water again, since yesterday afternoon. David was kind enough to pour a bucket of water, (that we had saved for such circumstances), over my head this morning so that I wouldn't frighten off my patients with a very slick looking hairdo. Oh, did I mention that David and I cut each other's hair a couple of weeks ago? It might be best if I find a barber before 6 weeks have passed. David will have to report on his own hair cut I am a bit too bias. I must say that it was really nice to cut each others hair, something that is certainly out of the ordinary for us and kind of fun but admittedly more stressful than fun.
Anyways, we had a good day in Home Based Care today. My recent goal with the team has been to motivate them to move along at a quicker pace in the morning so that we can see our patients and return to the hospital at a reasonable hour. Yesterday and today I was successful, so God willing the trend will continue. It takes a lot of coaxing and deep breathing (which is 'perfamula' in Siswati, one of my few physical assessment words) to make it all happen but it really was rewarding to get back by 4pm yesterday and today. Much better than the two hours later on our usual day. Tea time is a very very important event in the morning here in Swaziland, as it is many other places, so I have been getting the team to go have their tea earlier while I continue to prepare the truck for the day. There are numerous potential obstacles to leaving on time which do not include the direct team so when we leave on time is is truly a small miracle. Possibly Mother Theresa is helping me out, which will lead to her early canonization I would hope.
We saw 25 patients both today and yesterday. The particularly nice thing about today was that a group of patients saw us parked at a homestead in their area and came to us rather than us having to drive from one homestead to the next. We had seen a husband and wife with HIV and then walked about 200 feet to the next homestead to see an old 'gogo' (grandmother) with hypertension (she was one of two patients today that we saw that was not HIV+). So, when we returned to the truck which was parked in the first famalies homestead, 7 other patients had gathered. We basically had our own mobile clinic there on the ground under a shade tree. (My very favorite tree here is the 'acacia tree', it looks like an umbrella.) A couple patients brought their own mats and the rest of just sat or kneeled on the ground while I did one assessment after another (keeping it all orderly, of course) and perscribing some very basic meds. I have been quite surprised how the patients here seem to have very few opportunisitc infections to go along with their TB and HIV/AIDS, which, is of course, enough to kill them all on their own. The impromtu clinic was actually quite enjoyable, most patients think that I am a doctor, some days I clarify, others, especially hot days, I figure no harm done. After about 45 minutes of assessments and drug handouts it was then time to hand out the food. Which I must say is quite nice, everyone is so grateful and you go away feeling like Santa Claus. I find it very interesting how defferential the team has become to me in regards to assessments and choosing medications to give to the patients. Yes, I am certainly learning a lot but I have a long way to go.
The most frequent medication that we give out and in no particular order or quantity are; vitamins, Bactrim, paracetemol (tylenol), diruetics, aldomet (antihypertensive), cough syrup, Penicillin VK, ibuprofen, tylenol with codeine, aspirin, mebendazole a deworming medications, flagyl (for paracites), an anti-itch medication that I cannot remember the name of right now, ketconazole (when we have it), and nystatin. Many times I am at a complete loss of what to give the patient so we encourage them to go to the hospital and if they cannot not afford it, which is the norm, we try and give them bus fare if we have any money available.
One clarification, the sidonono (corn soya) is from the World Food Program and is a gift from Japan, not produced in Japan, it is actually produced in South Africa.
Alright, I am off in search of a shower now or even a sponge bath. Be well and keep us in your thoughts and prayers. Also, in general I am able to sign into my personal email account, which is ubescott@gmail.com, if you care to send a private email as opposed to placing a comment on this blog site. Either and/or both are very much appreciated. Glen F. it was so wonderful to hear from you and I hope life in China continues to be rewarding.
David and I continue to do well and more importantly, moving day is Saturday, back to Mabuda Farms!
Peace,
Scott

Cloudy again but not much rain.

The New Year has brought lots of new clouds, some quite threatening but unfortunately no new rain. It has been overcast for nearly two weeks now with only one day of rain thrown in. It is really frustrating to see all of these dark bulbous clouds yet not to have them produce any percipitation. I think that last day that it rained on was my birthday. The crops and fields really respond well to the rain. Some of the corn is well over two feet tall now and looking quite healthy but much more rain is needed for a sucessful crop. It appears that most all families plant crops, everyone plants corn and others also plant potatoes, carrots, lettuce, beets and so on. Most homesteads have some space to plant even if it is a very small lot, say 10 by 20 feet. From what I can gather that this is their main food source. I am not sure how they store the crops once harvested, I believe that the corn is dried and turned into a powder to be stored.
We (the Home Based Care team) supply the patients we see with whatever food is available. Generally, they receive a 5 kg pack of mealy meal, which is powdered corn. Also we distribute corn soya blend (sidonono) which is a complete food source (protein, carbs, fat, fiber, vitamins and other nutrients)this is supplied by the World Food Program and is a product of Japan. Additionally, we have milk (they receive 2 liters if we have it and yes it spoils almost immediately given the heat but the Swazis have taken a liking to spoiled milk, I tried it this last week and found it very difficult to swallow) and Meal Packs (2 kg of beans, 1 kg of peanuts, 500 g of salt and 500 g of sugar) only patients on ARV's get these and it is only one pack per homestead regardless of how many people are living there, it can range from 1 to 30 people per homestead. The meal packs and mealy meal are donated by a gentleman in Britian, anonymously. There use to be bleach (to help to purify the water) and cooking oil but the prices of the food has gone up so they have been cut back. Unfortunately, without the bleach there has been evidence of more diarrhea and parasites in the patients which is most debilitating. It appears that most of the very young children die from dehydration secondary to the diarrhea. Basically, during our home visits we have to make an on-the-spot assessment of the level of poverty of the patient and then give them the food. It appears to me that 99% of them need us to just go ahead and empty the contents of the entire truck for them and be on our way. Obviously, we cannot do that so frequently we have to deny the patients request for food. Then there are the people who see our truck and just come up asking for food, which may be even more painful since at most we can give them a small amount of mealy meal or some milk. Last week these four children came up to the truck while we were parked seeing another patient. The oldest was an 11 year old girl with her three younger siblings. They were talking with one of the other nurses in Siswati while I was assessing another patient. The nurse asked me to give them some corn soya, mealy meal and milk, which I was happy to do but found it a bit unusual to be able to be so generous with the food. Quickly, I greeted the children (I had my camera so I took a couple of pictures of them) and gave them the food and a piece of candy that I bring with me daily to distrube to the kids. As we were packing up to move onto the next patient I asked about the young girl and the little kids with her. I was told that they were orphans, both parents had died (the father within the last week or so) and that they had come up begging for food. I couldn't believe that we just continued to get back into the truck and drive off as they disappeared into the bush. I asked who was going to care for them and the response was that the neighbors would check in on them but that they would have to live on their own. I really cannot understand how this can be and the thought of these poor grieving children living on their own, so vulnerable and weak has been very haunting for me ever since. I am hoping that we will be able to find them next month when we are back in that area again and find someone or an organization to assist them.
Many of the mission programs are trying to provide care to orphans, housing and schooling but it can be very difficult to get them connected in a timely manner with the children. I really have been quite impressed at how many religious organization provide humanitarian relief to the people here, it appears that most other organizations have pulled out of Swaziland. At home, often we do not see all the good that our local church is doing or other parishes in the area. It has been very evident here to see how people live out their faith and belief in God, in very concrete and compassionate ways.
I am in the process of compiling a price list of the corn soya, mealy meal, bleach, oil and meal packs for those of you that are interested. As I look at the situation here, the HIV/AIDS, TB, opportunistic infections, lack of water etc., my mind races from one to another, considering the options and what to do and where our help would be most beneficial. Some days it is more medications, other days more food and others more water and so on. I certainly do not have any answers but I know that there is more that can be done, figuring out what and acting on it is the obvious challenge. I am going to try and post some photos on this site soon so that you can have some visuals, the children are especially beautiful and endearing.
Please take care.
Peace,
Scott