Scott in Swaziland

Dreams Do Come True.

2009-08-22T14:01:00.011+02:00

During the month of July we had visitors from northern California. David's parents, David and Jane Haproff, came to stay with us in Swaziland. All of our friends and extended family here were very pleased to be able to meet David's parents. Soon and without any prompting they became known as Mukhulu (grandfather) and Gogo (grandmother) Haproff. Our friends here were very taken with their incredible warmth, sense of family, and understanding and deep love for Africa. Jane and David had spent three years in Kenya forty years ago as lay missionaries, and it showed by their quick understanding and intuitiveness of the local culture. Many days were spent visiting the patients and families that we have gotten to know here, and they really considered it an honor to get to meet the matriarch and patriarch of the Haproff family. Additionally, they made home visits with the Home Based Care team, and that was one of the highlights of their stay for all concerned.
Soon after their arrival we took them to meet Elsie, Siphesihle, and the family. It was love at first sight. Jane and David made it a priority of theirs to find out what could be done to help this family. Shelter for the family became an obvious starting point and plans were made to build Elsie a home that would provide lasting shelter for her family. We enlisted the help of Mnendisis, who is a young local builder and contractor. He has built several homes for needy Home Based Care patients and their families. The vast majority of the materials for building the house we purchased locally from Swazi owned businesses. Thus helping to provide support for the local economy. The plans for the home were sketched, pricing of materials and labor were provided and it was time to buy the materials. We wanted to begin construction as quickly as possible so that David and Jane would be able to see the project through to completion. It took a lot of time running errands, buying supplies and providing transportation for the builders but the fruits of all of our labor payed off. The construction of the house was completed before David and Jane's departure and the painting and finishing touches soon thereafter.
A great deal of gratitude is owed to Mukhulu and Gogo Haproff. They completely funded the project without hesitation and asked for nothing in return. Many tears were shed by Elsie and her family at the great gift that they received, a new home that they will have as their own to keep them warm and dry for a lifetime to come. This home was truly a labor of love. A lasting gift of love, support and compassion for those less fortunate than us. Thank you Jane and David for making this dream come true.

Elsie with great joy in her heart as construction of her new home was about to begin.

Gogo Haproff with Siphesihle at her homestead as the project is about to begin.

With Elsie and Siphesihle's old home in the background, clearing of the land is initiated. As you can see their old hut was in desperate need of improvements.

Above, measuring the floor plan for the new home. The hut to the left is one that Elsie built almost single-handedly this year, it will last for many years to come. Elsie has five surviving children of seven born to her, so the space is much needed when they are all at home.

Below, the river sand arrives. The sand is mixed with the concrete to make to go further and to save on expenses.

David and I moving some of the concrete blocks used in the construction. Before our arrival Elsie has already moved 90% of th blocks, but we showed up in time for the photo op.

Above, David Sr. surveying the project on the first full day of construction. Standing with David is Mncedisi who was our builder.

Evening is falling and all are pleased with the progress made already.

Below, David and Jane saying goodnight to Elsie, Doris and Siphesihle.

Fast forward to about a week and a half later. Below, the blocks are all in place and soon the concrete floor will be placed and skim coating will begin.

Two days of skim coating and all if looking good.

Below, David checking out the site of the much needed outhouse. It certainly appears deep enough and should last a good 10 to 15 years.

The outhouse has taken shape and will be ready for use in a day or two.

Below Mukhulu and Gogo Haproff visit the nearly completed house the day before they left Swaziland. Having to say goodbye was not easy. Many tears were shed and lots of love exchanged.

The following Saturday we spent the day applying a coat of primer to Elsie's new home. Below, I'm taking a break after spending most of the morning applying primer.

Painting time at Mzilakazi. That is name of the area where Elsie's homestead is. David had to do much improvising in order to reach the higher areas without a ladder.

Below, Elsie's young son Thembekhosi having a rest while overseeing the painting being done on his new home. This has become a favorite spot for him to take it all in.

Elsie applying the final coat of paint to the inside.

A rear view look at the completed home. Elsie has a really nice view of the surrounding area.

Home Sweet Home. The Haproff House is completed and Elsie and her family have a safe and lasting shelter thanks to David and Jane.

Peace,
Scott

Birthday Wishes

2009-07-29T07:25:00.023+02:00

We celebrated Siphesihle's 7th birthday with her last Saturday, July 25th. Although there were just a few of us present, many others were there in spirit. Siphesihle wore her white dress donated by Tran Luong, a nurse and old friend from 11 Long at UCSF Medical Center. It is her favorite dress and now she has been able to wear it on Easter and for her birthday. The dress is saved for only special occasions and she looks very cute and festive when she is allowed to wear it. David's mom made the birthday cake and it was quite delicious. Presents included a beautiful doll sent from Corona, California by David's sister Andy. Siphesihle immediately named the doll Annie, I know its not a Swazi name by it was her choice. A good time was had by all and it was certainly a memorable day for the birthday girl. Oh no, am I sounding the a proud parent who talks way too much about their children? I will stop now and share some photos with those of you who are still interested.

Siphesihle was up with the sunrise, bathed and anxiously awaiting the party to begin. When we arrived she was dressed in her very best dress, reserved for special occasions.

Siphesihle and I photographed on her homestead. The hut in the background is her current home until the new house is completed. David's parents are having a new home built for her family.

From left to right, back row first. Thembakhosi, Elsie and David. Front row, Bandi, Siphesihle, David and Jane.

We sang Happy Birthday (in English) inside what is going to be the new home when it is completed.

Some wishes do come true, Siphesihle stared on her ARV's on Tuesday after a very long and arduous effort by us and and her mom.

Annie, the newest member of the family, thanks Andy.

Gogo Haproff reading to the children after the cake had been enjoyed by everyone present.

Little Annie being fed her first meal.

I am always very happy to see Siphesihle and be able to spend time together.

David with his buddy Bandi. Whenever we are visiting, Bandi is sure to be by David's side.

Bandi and Siphesihle, they are first cousins and attend
St. Boniface school together.

Siphesihle carrying Annie around in true Swazi fashion.

After the party was over, the children walked us up to the road. A great time was had by all. It was really a pleasure to have such a joyful afternoon and be able to escape the many unpleasant realities of life here.

Peace,
Scott

Vanna Siphesihle White

2009-07-25T08:37:00.016+02:00

Many people have asked what kinds of food we supply to various patients and their families. So, yesterday we did some shopping and before delivering the food we decided to take some photos and make a price list to share with you. In very Swazi fashion, as we were taking the photos Siphesihle happened to walk by where we were parked and became our willing assistant. I asked her if she felt like Vanna White, and she gave me a very blank stare, so I assumed the obvious -- that my question was a rather poor attempt at humor with some pop culture thrown in. (Side note, Siphesihle turns 7 today and is scheduled to start on her ARV's on Tuesday.)

We do most of our shopping at Shoprite (a fairly large chain of grocery stores from South Africa) because the prices are the most economical and not because we enjoy the pushing, shoving and maneuvering required to get to the check-out. Yesterday we stood in line for about 2o minutes amongst all of the madness of food shopping on a Friday late afternoon. You would think that in a town of about 6,000 people that there wouldn't be such chaos getting to the check-out but that is not the case. One has to side-step the heaps of food, carts, and baskets left behind by other shoppers who became impatient or miscalculated how much they had to spend. Anyway, I digress, so on with the story. First of all I want to thank all of you who have sent money for food. It has really helped supplement the money we are spending and has made for more abundant and frequent food deliveries.

If anyone else wants to support this effort then please let us know. You can email myself (ubescott@gmail.com) for information on how to get the money to us. Basically, you can send Karen Wong a check and she will deposit it in my account in the states and then I will draw on it here with my ATM card. That is the easiest and quickest way to get the funds here. Unfortunately the Emalengeni (whose value is directly tied to the South African Rand) continues to climb in relation to the dollar. The value of the dollar in relation to the Rand has fallen by 30% since our arrival. This has made it more difficult to make give the same level of support that we were initially able to.

Following are some photos of some of the basic food items we provide for the families we are helping support, along with their prices in Emalengani. At today's exchange rates, one US dollar is equal to 7 Emalengeni or Rand.

Mealie Meal (ground corn), which is what most Swazis eat everyday. It accounts for about 90% of their diet, rich in carbohydrates, but significantly lacking in protein. It can be purchased in many different quantities i.e. 5 kg, 10 kg, 25 kg.
This 5 kg package costs E27.99.

Sugar Beans, 2 kg E19.59. The main source of protein for most Swazis and used to supplement the mealie meal. These beans are grown locally as well as imported from South Africa, as most goods and services are here in Swaziland. The beans must be boiled with water for many hours before eating them.

10kg of rice, a very welcome change to eating just mealie meal, the Swazi staple, is E70.00

Raw peanuts: a 2kg bag is E29.99. Another good source of protein, but quite expensive for most families. The beans are placed in a cast iron pot over an open flame and roasted before eating.

A small bag of iodized salt (500g) is E1.59

Jungle Oats oat meal, costs E19.99

Emasi, or sour milk, is a favorite of most Swazis, and a good source of protein. A 2 liter container is E12.99.

Breakfast porridge: 2kg of Mabele Meal is E13.99

Sunny soap, used for washing clothes E6.99

Raw or Brown Sugar 3kg E16.99

Dried soup packets E3.49 each.

Sardines in tomato sauce, which is a luxury for most of our patients and very well liked, is an excellent source of protein E11.99

Baked Beans, another good source of protein E4.29

Cooking oil: 2 liters costs E25.49

Farm fresh eggs, one and half dozen: E23.49

A welcome treat for the children, which we try to provide once in a while, are cookies: E3.59 per package.

Peanut Butter, 1 kg E28.49, is rather expensive by local standards, so rarely purchased by the patients we see. Obviously an excellent source of protein and well liked.

A loaf of bread 800g is E7.29

Lion brand matches: E3.29, and candles: E9.99. Most of our patients lack any source of electricity. Matches and candles provide a way to have some light in their homestead once the sun has set.

Peace,
Scott

John's visit June 14-21, 2009.

2009-07-22T18:18:00.000+02:00

We had a whirlwind visit from John Kanis last month. He was visiting from Australia and it has taken the last month to try and digest all that happened. Immediately, John just jumped in with both feet to our lives here in Siteki. He arrived on a Sunday and by early Monday morning he was gathering supplies with me to make visits with the Home Based Care Team. Needless to say, he charmed the team with his Aussie accent and friendly personality. John made home visits with the team on Monday and Tuesday and then went on many other home visits with David and I to families that we support.

During our home visits to Sitsatsaweni on Monday, John met Khulile and her son Ndu. As you have read on our blogs, this is a family that we support with food and medical care. It was love at first sight, Ndu was mesmerized by John and his designer sunglasses, muscular build and smile. Ndu latched onto him and was not wanting to ever let go. The feeling was mutual, John was instantly taken by Ndu's smile, frail little physique and need for adequate medical care. On our visit we tested Ndu (he is 6 years old) for HIV and he tested positive. It was very traumatizing for all concerned, as this all too familiar scene played out and especially for John. You could see that the weight of the epidemic here in Africa fell hard and fast upon his shoulders with a crushing blow. Ndu had now tested positive, his father is long gone, his mother is on ARV's and two of his siblings have died already. It was a lot to take in on your first full day in Swaziland. After the initial shock we composed ourselves, counseled his mother and drew more blood for a CD4 count. Then we moved on to visit our other patients in the area.

By Wednesday the CD4 results were in and it became clear that Ndu needed to be admitted to the hospital for malnutrition and to assess if he was a good candidate for starting ARV therapy. We drove back out to Sitsatsaweni on Thursday, spoke with Ndu's mom and she allowed us to take him back to Good Shepherd Hospital to be admitted. Ndu was quite willing to go back with us, getting a ride in a car was something new for him and of course very fun for a six year old. John held him the whole way back and then became a constant companion at the pediatric ward. Unfortunately, John had to leave on Sunday to return home. It was really difficult for him to leave with Ndu still hospitalized and his ability to start ARV's unresolved.

Well we kept a close eye on Ndu and his care. After numerous trips to the pediatric ward, various doctors and the ARV clinic at the hospital we were able to have Ndu staged for his HIV/AIDS diagnosis. He received a World Health Organization staging criteria of Stage III. This made it possible for him to be eligible to start ARV's. Although nothing is that easy or cut and dry here. So Ndu returned to his homestead after 10 days in the hospital without starting his medications. The story is much too involved and painful to retell it any great detail at this time. In short, after many visits to the hospital and clinic by Ndu, his mother, David and I, and lots of pressure on our part Ndu was scheduled to start on his ARV's this past Tuesday. Unfortunately, we were out of town on Tuesday so we will not know for sure if it was successful until tomorrow. We are hoping for the best.

Here are some pictures taken during John's visit. I hope that you enjoy them. His visit was not all stress and heartache. There was a lot of joy had by many and it was very heartwarming to see John connect so intimately with our friends and lives here in Swaziland.

John with children from Sitsatsaweni primary school, before the madness began.

John started giving out pens to the children and a moment later there was nearly a stamped. The classroom doors of the school flew open and the children immediately followed. We barely got out alive.

John first meeting Ndu at his homestead.

Walking back to the Home Based Care truck from Ndu's homestead.

Up and over the hills we go. It is hard to believe that Ndu will be turning 7 very soon.

John quickly noticed that the most common advertisement here is for coffins.

Visiting the Mambane Care Point. David supplies the food for feeding the growing population of children at this care point. There are nearly 70 children on a daily basis now who attend.

Group shot of Thabiso and his cousins with David and John.

John and Thabiso delivering building supplies to Elsie and her daughter Siphesihle to help complete the home that Elsie is building single-handedly.

John, Elsie, myself and Bongani inside the home that Elsie is building. Elsie collected all the rocks and sticks to build her own home. John funded the rest of the project and it is nearing completion.

John pictured with Siphesihle and her cousin Bandy. We cover the cost of both of their school fees.

Elsie and the kids with her new roof now in place.

Myself and John, pictured on Mabuda Farm.

Visiting Ndu (in the background) and another patient at the pediatric ward. The child in the forefront is an orphan who was abandoned at the hospital, he is awaiting permanent placement.

Ndu, sporting his new clothes and battery operated car. We have seen Ndu many, many times since this photo and he still wears his new clothes every time he comes to the hospital.

Peace,
Scott

Clay Pots

2009-06-27T17:42:00.011+02:00

I am at a bit of a loss for what to write about lately so I thought that I might share some photos with you. There is a theme to the pictures. Everyone who is photographed is a patient (or a patients family member) of the Home Based Care team. Additionally, they are recipients of food parcels provided by an organization called Claypotts. We distribute the food to our patients and their families during our home visits. The food consists of mealie meal (which is ground corn), peanuts, beans, salt, sugar, cooking oil and milk. It varies from patient to patient, who receives what but it is some combination of what is listed as well as corn soya from the World Food Program. All of this is provided by an anonymous donor through the Claypotts Trust.

The patients are always pleased to receive the food during our home visits. Often donated money from our (David and my) family and friends goes towards supplementing the food distributed by the HBC team. It never ceases to be heartbreaking to see so many people without enough food to feed themselves. So, I want to take this opportunity to thank the Claypotts Trust and all of the rest of you who have provided donations for food for our patients. Know that your donations are greatly appreciated and very much needed. I hope you enjoy the photos and captions.

This is a typical pot used by the Swazi's to cook in. Most cooking is done outdoors, either in the open or in a stick and stone structure. In the colder weather many people cook inside their huts to keep warm and yes it gets very smoky.

An elderly woman with mealie meal and corn soya sitting next to a water barrel.

A young boys carrying his 2 liters of milk to his homestead in the back ground. The milk is most often consumed after it has spoiled. This is a personal preference and due to the lack of electricity to keep it cool.

A couple of chilren in front of their homestead. We were giving out Comfort Dolls this day as well.

More children on their homestead. It was a rainy day a couple of months ago. As usual, the girls do most of the work (carrying the food here), while the boys are at play.

It was a cold day when we visited this gogo, that is why it is so smoky in her hut. Unfortunately, she died before our next visit to her community.

All the children are very cute but this young girl was one of the most adorable. She was a bit terrified of me so I had to keep a good distance from her although she did like getting her picture taken.

This young patient is one of my favorites. He has the best smile and he is very affectionate. As you can see, he was very pleased about getting the lubise (milk).

This girl had a baby boy about 8 weeks ago. She asked me if I would like to be the baby's father. I thought it best to decline. We made a home visit to her homestead yesterday and so far the baby appears to be healthy.

Old mukhulu (grandfather) here has many wives. I could not get a clear answer about whether this woman is one of his wives or not but it appears that way from the way she cares for him.

This old gogo had quite a rash all over her body when I first saw her. I prescribed some medication that worked pretty well and now she is always excited to see me. She claps her hands and says hallelujah whenever we make a home visit.

This young man runs to greet the truck whenever we visit. Our visits are unplanned although about every month or so. Even so, he hears the HBC truck coming and is there to greet us at the gate of his family's homestead whenever we visit.

David photographed with a family and their supplies. The littlest child standing is holing soap that we distribute whenever it is available.

These children were living with their father who has active TB. They have now been relocated to live with another family member so I do not see them any longer. Their's is one of the poorest homesteads that I have seen, so I am pleased that they are living elsewhere.

Peace,
Scott

Keeping Warm This Winter?

2009-06-13T09:03:00.015+02:00

Winter is certainly upon us here in Swaziland. We are weathering the very cool nights, windy afternoons and dusty days. While most of you are enjoying the warm spring and soon to be summer breeze of the Northern Hemisphere, much to our surprise and dismay, it does get quite cold here in the Lubumbo Mountain Range.

But we truly have nothing to complain about, short of intermittently having cold hands and noses. The vast majority of our patients do not have it so good. Most of their homesteads are made of stick, stone, mud and thatched roofs. Additionally, since so many families are no longer intact there isn't anyone to maintain their homesteads. Frequently we encounter crumbling walls and thatched roofs that no longer keep the wind and rain out. To say that it can get smoky in one of these little huts is an understatement. During the winter months, often the Swazis will cook inside their huts in order to benefit from heat generated from cooking. One has to part the smoke in order to find our patients and be able to tend to their needs.

It can be very challenging to make a home visit and have to leave knowing that your patients are going to have a long cold night ahead of them with no heat. Blankets are a luxury for many and more often than not the whole family sleeps in the same space (usually on a grass mat placed on the floor) in order to keep warm. No need to worry about hearing the baby crying from down the hall, or falling out of their crib when you are sleeping next to each other on the floor. There are benefits to leading a very simple life but being cold is not one of them.

Fortunately, members of the Mission Team from Highland Park Presbyterian Church in Dallas, Texas took it upon themselves to donate blankets. Over the last week we have distributed them to our Home Based Care patients. It has been very gratifying to hand out the blankets over the last week since everyone was so pleased to receive them. Nothing like being a good will ambassador from America and in turn being the recipient of so much gratitude and good will.

I want to personally thank all of you who donated the money for the blankets. Our patients were very touched and incredibly happy to have a new warm blanket during this cold and windy season. Your generosity is acknowledged and appreciated. The attached photos show some the people who received the blankets but it does not fully capture how grateful they were. Be assured that the blankets are in the hands of those in need. Attached are photos of some the people who received the blankets, I hope that you enjoy being able to put a face to those you are helping.

The three children pictured here are siblings. Both of their parents are very ill, hopefully they will not be orphans soon but that is unlikely.

Siphesihle, always with a great smile. Her birthday is July 25th, she will be turning 7 years old.

This young patient was more concerned with getting his sweetie than having his photo taken.

Pictured is a Gogo with her mentally disabled granddaughter along side her. Another grandchild, who is our patient is on her back. Gogo is the sole caregiver for the family.

A young woman photographed with her new blanket and food parcels from Clay Pots.

Thabiso keeping warm and with a big grin. He was on his way to his homestead from school when he received his blanket.

Make Maphosa with one of our patients, he is able to wheel himself up and down the hill behind him with just one functioning arm. He is incredibly strong for having such limited use of his arms and legs.

This is a young man, from a community called Magugu, which is very close to Good Shepherd Hospital. He is a double orphan and patient of ours. He raises vegetables in his garden and then he sells in town to support himself. Only 14 years old and already such a hard worker and quite the gentleman.

This old Gogo is wearing a black piece of cloth tied around her neck. This generally denotes the death of a child or family member, usually within the last six months. Most likely the fabric is marking the death of a daughter. If she were all in black it would represent her husband and the loss of a son would be signified by a black shirt as well.

This woman make quick use of her new blanket to secure her child to her back. In Swaziland, children are carried on the backs of their mothers or caregivers.

Peace,
Scott

Lax, yes but not relaxed.

2009-06-03T19:34:00.008+02:00

I know, it has been a very long time since my previous entry. There are a million and one excuses, but that would only help me to feel better (about my lack of communication) and no one else would care or possibly believe the ones that I chose. What I have really wanted to do was to rant, and who wants to hear me complain? Well the answer was many of you, so here it goes.
November 24th, 2008 was our departure date from New York. David and I have completed six months of our one year volunteer commitment. Unfortunately, I have to report that I have not been able to change Africa (and in particular Swaziland), to my liking in that time. It feels as if the more work that I do, the less some others around me do. No matter how subtly I push and prod, the results remain about the same. There is a very slow and yet chaotic pace here, especially to the outsider. That pace, I have not been able to penetrate. I am having to accept that I am not going to change this world. This vast land with all of its rich, strange, exotic, foreign and lively traditions, cultures and experiences that has made it what it is today. This little country called Swaziland has existed a hell of a lot longer than I have. Many Kings (and their numerous Queens) have come and gone, procreated and ruled such a small country from afar without leaving its borders. No matter how noble my intentions are, no matter how pensive or frustrated or angry and inpatient I get, nothing changes.
I like to tell myself that it shouldn't matter. I am a foreigner in a foreign land. Volunteering to help others and myself as well. Maybe I am trying to right some racist tendencies of my own, or just trying to live up to the ideals of the Sisters of Saint Joseph who so deeply formed and molded who I am today. Possibly just trying to change up my life a little and do some distant traveling and meet people that would never have crossed my path on West 23rd Street. It is highly unlikely that I would have met any Swazi's while having dinner at Tre D'ici or working out at the gym or even while making home visits with the VNSNY Hospice Care. So why I am so deeply pained by what I am seeing here and cannot change?
I miss the efficiency of New York. The New York minute and all that it entails. The ability to make a request to have labs drawn for a patient at 10:59am, one minute before the cut off time for same day lab service and know that it would happen. It didn't matter why the labs were being drawn or even if they were necessary, it was about customer service and getting results. If the customer service representative on the receiving end of the phone call did not want to process the request then you would just talk with their supervisor and again you would have results. The list could go on and on. Here on the other hand, life is quite different.
A response to a request made here can be quite interesting, here are some of the responses that you may get:
"That is humanly impossible."
Or how about, "The CD4 machine is broken come back next week."
Or "Let me see if I can get to that by next week sometime."
Or try this on for size, "I am at tea, come back in a half and hour."
Or maybe, "The Outpatient department is closed for lunch, have the patient wait outside."
Or one of my favorites, "The chemistry machine is broken, come back in a month and a half."
We could go on to play the matching game, matching the request to the response but I do not think that I have the energy to relive it all. OK then, just a couple. The questions may consider some paraphrasing.
Number one: I need to start my ARV's and to do so I have to get these labs drawn. I am a 29 year old man, I weigh only about 90 pounds, my CD4 count is 6 (yes that is a single digit), I have traveled 25 kilometers on my own, I had to borrow the money for the transportation, I have not eaten yet today and I need to know where the labs are drawn. Do you give up? The correct answer would be "The chemistry machine is broken, come back in a month and a half."
Number two: Could you please photocopy these four sheets of paper for me?
I know that is an easy one but here it is anyways. The correct answer would be "That is humanly impossible."
Number three: This is the answer to anyone who wants to get their CD4 count drawn on a Thursday afternoon or anytime on Friday. "The CD4 machine is broken, come back next week."
For over two months the chemistry machine at the hospital was broken. Time and time again patients were sent home and told to check back later, that the initiation of their ARV's would be delayed. Not exactly the right answer for me. There was consideration given to drawing the labs anyways and sending them to another hospital to have them 'run' on their machine but it was too difficult to determine which of the six full time drivers at the hospital would be required to take them and in turn get the results. Yes, I ranted and raved, one of my favorite responses from a physician was, "Well we shouldn't be starting ARV's on anyone with a CD4 count of less than 100, they are going to die anyways, in my country we don't bother." Or, "The protocol calls for liver function tests and if the machine is broken there is nothing we can do." Yes, I am taking several deep breaths because reliving it is nearly as painful as the first time.
Now where was I? I get rather forgetful when I am all worked-up. Another part of my discontent is the immense suffering that I see. I really cannot begin to tell you how many young women and men I have made home visits to that have since died. With a life expectancy of 32 years, that is the reality of life here. It is not my reality and I want people to react. To say, this is enough, I am not going to let another child of mine die. I am not going to see my grandchildren orphaned. I am not going to bury another husband, brother, sister, child, parent, friend or countryman. HIV/AIDS and TB are literally killing this beautiful, peaceful, unemployed, uneducated, poor, male dominated, polygamist, Christian, land locked kingdom.
I keep asking, "Aren't you angry?", "What is going to happen to this country?", "Doesn't something have to change?" The common response is that "this is Swaziland, nothing will change, you just have to live with it" or more common than not, die with it. Here is a question to ponder. How can a hospital that has 225 beds and services 350,000 people continue to have so many empty beds? I digress.
All of this said, I still think that we are making a positive impact here. How else can I make sense of it all? This positive influence has been on a very individual basis. Not grand like my dreams and hopes. Many more children have had their school fees paid. Dozens more patients have been seen by a physician that didn't have the money to do so on their own. We have heard many voices tell their story and shared their grief, sorrow and joy. Many medications have been administered and patients have been seen the following month to find that the medication suggested did in fact help to alleviate their symptoms and enrich their lives. Some orphans are finding their way to a safe haven, with food, shelter, education and emotional support provided free of charge. Thabiso is home safe again with his aunt and uncle and their children. This evening after running away again last night and spending the night in the bush. It took a lot of searching and chasing and talking, talking, talking but he his home safe and now I can sleep.
I just want a better life for many of the people I encounter on our home visits and in the community at large. That does not mean that I want them to have a TV, running water or electricity. Although I do want them to grow up with their own parents, to go to sleep at night with their siblings, have food to eat and who knows, live until forty. There is a lot that has to change. Traditions, ancient belief systems and cultures alike. Realistically, that is not going to happen overnight. HIV/AIDS and TB has pushed this continent much faster than it is able to react and because of that I too suffer. Timing, location, education and access to adequate health care are what is needed. I am not sure if there is enough time to help this country and her people.

Siphesihle, she is still waiting to start ARV's. We are hoping to get this accomplished by her seventh birthday on July 25th.

Siphesihle and her mother in front of their home. We are going to try and raise money for a new permanent home for the family.

Make (mother or Mrs.) Matsenjwa's attempt at building a new home for her children. She continues to collect the wood and stones but cannot even afford the nails to continue construction.

Peace,
Scott

Recent Road Trips

2009-05-03T10:01:00.016+02:00

A few weeks back we saw Thabiso along the roadside (as we often do) on his way to school. David and I were heading to Good Shepherd Hospital. Thabiso flagged us down and it turned out to be report card day as the first semester of school for the Swazi children had come to completion. Thabiso asked David if he could go with him to get his report card, of course David complied. So there were, David and Thabiso and all the other Swazi children with a parent or guardian lined up to receive their grades. Thabiso was very proud of himself for having attended school for a full four weeks without missing a day. Much to our surprise Thabiso had done quite well in school given that he had missed most of the first half of the semester. Not that he didn't come close (see David's blog for more information on the trials and tribulations of Thabiso, davidinswaziland.blogspot.com) to missing a day or two but we were able to get him to school late but better than not at all. His teachers and the headmaster at his school told David how very impressed they were with Thabiso's new-found ability to get to school on a daily basis, pay attention and do well.
As a reward for his good behavior David and I told him that we would take him anywhere in Swaziland to celebrate. Which generally means going to Simunye Country Club to go swimming and have lunch or dinner. The country club is associated with the large sugar cane company of the same name that is about 50 kilometers outside of Siteki. Instead of choosing Simunye, Thabiso asked if we would take him to Big Bend to visit his little brother Machaha. After Thabiso's mother died he went to live with an aunt here in Siteki and his little brother Machaha went to live in Big Bend with his grandmother (gog0). Often Thabiso has commented on how he misses his little brother so we of course were more than willing to comply with his request. After getting permission from his aunt, Make Sacolo, we planned our trip and brought along two of Thabiso's cousins. The following are some photos from our trip to Big Bend.

Thabiso, always wanting to be in the front seat and very anxious to learn how to drive. Fortunately, that will be several years off. In the back seat is Lindelane, Thabiso's first cousin on his father's side of the family. Thabiso is now being raised with seven of his cousins. The family is headed by his auntie Make Sacolo, Thabiso's father's sister. She often comments on how much Thabiso reminds her of her brother who died when Thabiso was a toddler.

Thabiso with his brother Machaha. In the back ground is their gogo. They live in Big Bend on the grounds of another sugar cane company. The gogo is raising four of her grandchildren (in a one room home) she had four children of her own, all of whom have now died. The remainder of the grandchildren are spread out around Swaziland. On this visit we found out that Thabiso had four siblings, we had only known about three up to this point.

Me holding Machaha. It was so sweet how quickly he came to both David and I. You never know how much a child will remember. I am sure that it helped that Thabiso was with us.

David with the boys; Buhlebezwe (on the left) the kids call him Mkhulu (which means grandfather) because he is so much taller than the other children. Lindlelane on the right and Thabiso in the center.

David and the boys at the entrance to the sugar cane company grounds.

Thabiso saying goodbye to Machaha, who looks none too happy at the moment. Yes, it was absolutely heart breaking to have to see them part again. Hopefully Machaha and his gogo will be coming to Siteki soon for a check up at Good Shepherd Hospital. Machaha has not had any testing done since his mother's death. We have arranged to cover transportation costs and medical expenses thanks to some generous donations.

Our next road trip was this past weekend. We went to Bulembu, which is in the northwestern part of Swaziland on the South African border. Bulembu is the sight of an old mining town. Formerly, there were some 10,000 residents there until the mines closed (the Havelock asbestos mines) about 10 years ago. Overnight it turned into a real life ghost town with only about 100 residents and dozens of abandoned corrugated iron houses and Art Deco buildings which are nestled into the mountain sides. It is a beautiful setting and very remote. A group of concerned investors from South Africa, Canada, America and Swaziland bought the whole town and are transforming it into an all-inclusive town that will support orphans from across Swaziland. There are over 200 children there now and there will be space for two thousand orphans when it is completed. The children will be housed, clothed, fed, receive medical care and schooling right in the town. It has everything needed to raise children in a safe setting and is staffed in a large part by volunteers. The school and the housing is by far some the very best that we have seen in Swaziland. The organization is a non-profit set up to meet the needs of Swazi orphans. You can read more on their website, bulembu.org.
During our home based care visits we often encounter orphans. Most of these orphans are absorbed by relatives or the local community. Sometimes the children will remain in their own homesteads without any direct adult supervision, local persons in the community will check in on them periodically. Other times they are left completely alone, making them very vulnerable. There are some 60,000 orphans in Swaziland, which is an overwhelming social concern. In order to find out more about Bulembu David and I took along some of the other HBC team members and made the 3 1/2 hour journey (each way)up and over many hills, mountains and bumpy dirt roads. It was exhausting but well worth it.

Some of the school house buildings. The school is staffed by volunteer teachers from the United States and Canada. The children speak very good English but unfortunately their SiSwati is lagging behind.

Deborah Maphosa, Valerie Kulangero, Promise Maphosa and David taking a tour of Bulembu.

A new playground being built by volunteers. In the background you can see employee housing, further up on the hillside is more housing for the orphans. Generally there are eight orphans per two bedroom house with a make (mother) to oversee them, teach them how to care for themselves, prepare their meals and provide emotional support. Families of children are not separated, they are always housed together.

Some the children playing soccer and other games in one of many playing fields on the grounds.

View of one of the hillsides in Bulembu. The houses are painted many different colors making for a scenic view from the school yard.

A mural outside one of the classroom buildings. Left to right, Promise, Valerie, Deborah and myself.

A list of the students names in one of the classrooms. Note the beautiful Swazi names interspersed with the new Christian names.

Inside one of the classrooms. This school decor is leaps and bounds ahead of any other school we have seen so far. Most school rooms in Swaziland have little or nothing on the walls, very few books and certainly no carpeting as there is here.

David's newest friend, Timothy. He just wanted to be held the whole time that we were with him in his new home.

Another one of the children posing for a picture and saying goodbye. The kids like having their picture taken almost as much as David.

This is one of the Makes, or surrogate mothers, who live with the children. The children are divided into homes of eight children per house. Bulembu strives to keep siblings together. The Makes in all ways act as mothers to the children, providing love and emotional support and teaching life skills, such as cooking, cleaning and taking care of themselves.

Hopefully we will be able to refer many children to Bulembu. It seems like a good solid alternative to living without any family or structure. We have to contact a social welfare worker and take them to the homestead of the orphaned children in order for them to process the case, which can be a lengthly process. David will be following up with a social worker on Monday to address the needs of a couple of homesteads in our area with many orphaned children in need of support and a safe haven.
Peace,
Scott

The Home Based Care Team

2009-04-12T19:08:00.002+02:00

I thought that it was time to introduce you to the Home Based Care team that I volunteer with. Usually people here call it the Home Base Care team, although hitting a home run here in Swaziland is difficult at best and nearly impossible given the million obstacles to providing effective and sustainable health care. Whether you are in the hospital or out in the field, the complexity of the situations you are dealing with easily becomes overwhelming. I am always amazed when established goals are achieved. You start out on a visit envisioning that you are going to do some basic symptom management and end up finding that there is a new orphan on the homestead who wasn't there on the last visit, or that the patient has now contracted TB to go along with their HIV, or that the patient you paid for transportation to the hospital to have her CD4 count done arrived only to find that the CD4 machine was 'not working' and basically spent an entire day only to find out that she needs to come back again. The idea of providing holistic care in rural Swaziland is beyond me, once a new psychosocial or physical symptom has been identified there doesn't appear to be anywhere to turn for assistance. The systems in place are completely overwhelmed and the traditional culture and family that functioned quite well forty years ago no longer exists with an HIV/AIDS infection rate of 42% and life expectancy of 32 years.
The language barrier is also a huge issue. Having to rely on another person to translate while hoping that he or she is not inserting their own value system along with what you are saying can be a great obstacle. Even not knowing the language it is often clear when someone is not understanding what you are trying to relay. For example, when you ask to have it translated that you must get to the hospital to try and get started on ARV's or TB treatment or it is likely that you will die in the next several months and the patient has not altered their expression then you know that your concerns are not being heard. Given the level of frustration and obstacles presented we as a team are still able to provide some medical and psychosocial care and a needed parcel of food. It is very rewarding when you review a patient's medication card and find that they are taking their medications as prescribed or the child you treated for worms appears to be less bloated or that the woman with all of her facial bones and ribs protruding has now gained a couple of pounds. When this happens, it makes it all worthwhile and it helps me to return the team the next day.
Some of the team members have been doing Home Based Care for many years and it truly amazes me that they are able to keep returning to the field. I have to congratulate them for their efforts and their strong commitment to what they are doing to help their countrymen and women. Kathleen Hartman RN from NYC and Anna Zwane RN from Good Shepherd Hospital started the HBC program informally in 2001, gathering whatever medical supplies were available and buying food at the local market to distribute to home bound patients. This was long before any ARV's were available in Swaziland, and what they faced was an epidemic of dying men, women and children with nowhere to turn for hope of viable treatment. Over the next several years the team became formalized at the hospital with its own staff, supplies, vehicles and oversight. Currently, there are 22 communities that are visited on a revolving basis, serving anywhere from 20 to 30 patients and their families daily. There is a movement within the teams organization now to serve fewer patients more thoroughly and holistically, although we can never turn our backs on a patient who walks up to the HBC truck looking for care.
Here in Swaziland it is very important to identify who has what role and to identify them accordingly. Nurses are referred to first by their title and then their surname. It is rare that you ever hear anyone being addressed by their first names if they have a position of authority at the hospital. Even when we ride in the truck to make home visits the most senior member of the team sits in the front seat and is basically referred to as the decision maker. What follows are a brief description of the team members, volunteers and visitors.

Sister Jelle.
Andrew Jelle is an RN. Sister is the traditional title given by the hospital for the role of manager of the team or department. Obviously this title has been carried over from the days when all the nurses were nuns or lay women.
Andrew oversees the team now, making most managerial decisions. As a measurement of time, Sr. Jelle has benefited most by my presence as a volunteer here. He rarely makes home visits any longer although he continues to manage the team.

Matron Zwane.
Her title as matron comes from her previous role as the Director of Nursing for the hospital from which she has retired. She came out of retirement, I believe that it lasted for all of a week, to be instrumental in starting the HBC team. Anna Zwane is basically the heart and soul of the team. She is tireless in her efforts to serve the patients and people of Swaziland. She has the greatest knowledge base of the history and needs of the community and is generally right on target about what patients to see, when and what their needs might be. She also has an incredible sense of direction, directing the driver of the truck (me) when and where to turn, stop and start, often down foot paths that you would think could never accommodate a pickup truck.

Although you would be hard pressed to believe it, Matron Zwane will be turning 70 years old this year as well as celebrating her 40th year of nursing in July. While making a home visit we came across a group of boys playing soccer and Matron Zwane joined them for a couple kicks of the ball, much to the boys' amusement and joy.

Below is Deborah Maphosa. Make (pronounced ma-gay, which means mother or Mrs.) Maphosa as she is referred to in the community and by the team and our patients. She is standing outside of our HBC office, and behind her you can see the line for the Out Patient Department that has formed in the early morning. Make Maphosa is incredibly sweet and sensitive, she connects very well with the patients and their families and can personally relate to their issues and sorrows. She is the head of her household, 10 family members live with her, she raises several grandchildren who have lost their parents and is the only person working in her family. Deborah is a nursing assistant, although she takes on the role equivalent to an LPN in the States. It is not unusual for Make Maphosa to break out in prayer when it seems most needed. She sings and prays beautifully with her whole heart.
In the following photo are Valerie Kalungaro, a registered nurse from the Congo, our patient who we refer to as simply Mkhulu (pronounced ma-kool-lu, which means grandfather) and Anna Mary another nursing assistant, again who would function as an LPN in the States. First a brief description of Anna Mary, the woman on the right. She lives in Manzini and has an hour commute to work every day, which indicates to me her commitment to the HBC team. Her strength lies in her ability to counsel patients in the field, often encouraging patients to get tested to determine their HIV and/or TB status. Often she is the nurse along with Make Maphosa who sees our patients on the wards and again does counseling and follow up for their anticipated hospital discharge.
Our friend and patient, Mkhulu, is always pleased to see the team and often requests a kiss from the women, especially Anna Mary. He lives alone on his homestead, takes great pride in keeping it clean and orderly. He is suffering from congestive heart failure and has the most appreciable heart murmur that I have ever heard. I am always surprised to find him alive and kicking each month. He has lost a significant amount of weight in the past couple of months and is generally quite fatigued.

The above photo of Valerie really seems to capture her spirit. She has been the most welcoming person and is always willing to explain what is happening and is tireless in her commitment to work. She is the first person to get out of the truck to open a gate, chase off the stray dogs and to always carry more than her fair share of supplies. We constantly squabble over who will carry more, she or myself, most often I win. She promises to visit us in New York, so hopefully you will get a chance to meet this amazing woman. Valerie and her husband (who is an doctor at the hospital) are from the Congo and have been living in Swaziland for about 3 years now. She had to learn English and SiSwati at the same time and has managed to do very well. Now she is basically fluent in 7 languages: her top two are a dialect from the region she grew up in and French. We often share French phrases between each other, although she thinks that David's French is much better than mine, so she's not perfect. Many of her sentences start with 'in my country' and often end with a contagious laugh that basically has little or nothing to do with what we are talking about, and it always brings me great joy. We have fostered a close relationship with Valerie and her husband, enjoying occasional drinks and meals together. Our initial connection was fostered by her admiration for President Obama and the hope that he will be able to stop the fighting in the Congo so that she might someday return to her family, children and grandchildren.

Kathleen Hartmann RN. As I stated earlier, she was instrumental in starting the HBC program at Good Shepherd Hospital. Additionally, she was a CMMB volunteer and the person who first made me think about volunteering here in Swaziland. It is her commitment and love for the Swazi people that led me the HBC team. Currently, Kathleen is here at GSH helping to support the team for six weeks.

Karen Wong RN, (our dear friend from San Francisco). While she was visiting she instantly became apart of the team, making numerous home visits with us. She immediately connected with the team and the patients as only Karen can do in such a short time. Here Karen is pictured with an old Gogo during a home visit in a neighboring community.

David sitting on the back of our HBC truck with one of our young patients. Frequently, but not often enough for me or the other team members, David comes along on our visits. The children especially like his salt and pepper hair, how tall he is especially compared to the Swazi's and like to stroke the hair on his arms; it is really cute to see. Generally we put David to work distributing the food parcels and keeping the log of patients seen that day.

Here I am on a home visit with a couple of children from the homestead we are visiting. The child on the left is a patient of ours while the one in pink is the infant child of one of our patients. The children are most endearing. Here, and in Africa in general, children are much more visible than in the States. Besides running freely at the homesteads, you often see them on their own along the roads going to and from town, school, or running other errands, a very unfamiliar sight back home.

Peace,
Scott

It's all about extremes, isn't it.

2009-03-23T20:19:00.000+02:00

It seems as if its been a long time since I have sat and written about life here in Swaziland. I know that it's an old cliche but I really do not know where all the time goes. In many ways our life here is much less complicated and busy than it was in NYC. Many of the things that occupied our time are not accessible here; no movies, no theater, no gym, none of our usual friends to hang out with and share a meal and good conversation with but the time still escapes me just the same. I certainly spend more time reading, reflecting and trying to make sense out of what we are seeing and experiencing here, time has not allowed for anymore answers, just more questions.
With all of these question marks I am made to feel more uncomfortable about the way the world should work, what my role in it should be and generally how to act. Will my actions just create more problems? Is it the right thing to be here or are we just interfering with a culture and lives that should be taken care of by their own people and government? Are we helping to create a 'dependent culture' that will never be able to care for itself or are we here to help those less fortunate than us, doing the work that the nuns at Catholic school told us we should do, treating others as we would want to be treated.
At times, the demands seem endless. Around every isle in the grocery store, or every new homestead we visit, or while watching a soccer game, there is great need expressed and no one is shy about asking for help. The challenge has become how to respond in a caring manner, with respect and dignity and still be able to say no much more often than you can say yes. No I cannot pay your school fees, no I cannot get the ARV's you need to stay alive, no I cannot get you into to see the doctor any quicker, no I cannot give you the food you need to feed your family, no no no. Fortunately, there have been numerous times when we can say Yes, thanks to the support from family and friends back home and for that we are very grateful. Your contributions of late have provided for many visits to the doctor, food for starving children, bus fare to the hospital and clinic and so forth. Time and again we hear, Thanks God for America, and no that is not a typo, it's Thanks God, not Thank God. Wow, it's no wonder that I am waking up at 4:00 am !
Anyways, here are some photos and captions to try to give a glimpse into what the past couple of weeks have been like. There is no chronological order, just various images and thoughts to go along with them. On a higher note, our dear friend Karen Wong arrived a couple of weeks ago and it has been wonder to have her here, sharing our new life and all that make it what it is. She has fit right in, especially with her nursing background and her extremely caring nature. She is certainly one of the most generous and caring people that I have ever met and the locals have taken to her immediately.

Karen being surrounded by children at a primary school just outside of Siteki. We were making a visit with Home Based Care to a couple of orphans at the school who are on ARV's. I do not think that any of the children had seen a Chinese woman before. It was great fun to watch the scene unfold, most of the children just wanted to touch her, it was very endearing to see such curiosity in motion.

Children from various homesteads receiving clothing that was donated. Everyone loves getting something new even if it is handed down and over and across the ocean.

A favorite view of mine, so peaceful. Captured while making home visits.

Children enjoying their new Comfort Dolls. The young boy, third from the left is one of our patients.

Breast feeding is encouraged for all new borns regardless of their HIV status of their mothers. This young woman is a patient of ours and he child has tested HIV negative so far, she will be required to be tested two more times in the next year or so.

A chicken that has seen better days. Now I know where those skinny little chickens in the grocery store come from.

The World Food Program provides Sdinono, which is a complete food source for every patient receiving ARV's, each patient gets 6kg per month when they pick up their medications. The sign on the door reads that 'we have run out of Sdinono', we were left without any supplies of the food supplement for about two weeks.

Marula is a local fruit that grows in abundance here in Swaziland and South Africa. During the harvest season the locals make their own fermented Marula drink and yes there are many a person who is drunk from the local nectar. Each family is supposed to give an offering of their own Marula to the King. This woman is a HBC patient who stated that she was 'doing fine today' as she processed the marula.

David and I visiting two of the orphans that we support. Nosipho and Mancoba are always anxious to show us their school work, they are both in third grade and are such sweet kids. We often comment that 'we have two kids that are very sweet and two that are the wild ones'.

A young new mother who is a patient of the Home Based Care team. She and her newborn will both be followed by HBC.

The Wild Ones; Thabiso and Senzo, both of which find it very difficult to make it to school more days than not. Often we find one or both of them in town or running around along the roadside on the way to the hospital, we then try and escort them to school, not always successfully. It is amazing how an eleven year old can make you believe just about anything. Thabiso's mother died two weeks ago today and he is expected to move on like nothing has happened. Thabiso is eleven, his father died many years ago and now he is a double orphan. Since his mother's death two weeks ago he has lost not only her but his home and his little brother that has gone to live with another relative. Thabiso is living with an 'auntie' now and his walk to school is now a good half hour longer than before as well as being 20 minutes away by foot from his best buddy Senzo.

A beautiful young woman who is seen by the HBC Team. She has beat the odds up to this point with the help of a very attentive mother and extended family.

How amazing the human body is, what it can survive and how easy a microscopic organism can bring it down.

David and I posing with Thabiso, he really brings a lot of joy to our lives, even with all of his sorrows and struggles. His personality is contagious and he is a very bright and intelligent boy.

Much Love,
Scott

Gogo gets a new home.

2009-03-05T21:47:00.000+02:00

Gogo, sitting on a heap of sand that will be used in the construction of her new home. She is looking the best that I have ever seen her. Since my arrival here I have seen Gogo three times, usually she is quite grumpy, wanting to know when her new home was going to start being built. Well that day has come and Gogo is the very happiest anyone on the team has ever seen her.

This will be her new home, one door, one window and four walls. Her homestead has about 10 or 12 people living on it in several different huts, they are various extended family members, many of which I have yet to meet.

This is Gogo's current residence; the roof leaks, it is slanting a bit and the walls are about to crumble. Her new home is coming just in time. It is being built by funds raised for the Home Based Care Program at Good Shepherd Hospital. The construction should take about six weeks, depending upon the weather. The biggest chore was getting the blocks, sand and concrete delivered, now the construction is well underway. Often we (the HBC team) drop off the guys doing the construction on our way to making home visits in and around the area.
As you can see, her new home is about ten feet away from her current hut.

David and I are going to Johannesburg tomorrow for the weekend to pick up Karen Wong, our first visitor from abroad! We are thrilled that she is coming and both of us are looking forward to showing her our new life here in Swaziland. We hope to do a fair amount of traveling over the next month with her including Cape Town and Kruger National Park in South Africa.
I am hoping to be able to keep up with my blogging on a more frequent basis. Getting to the internet cafe has been more challenging than ever for me this past month or so, but I shall try to do better. Anyways, I hope you are all well. David and I are doing fine.
Peace,
Scott

Sleepless in Siteki.

2009-02-23T15:49:00.000+02:00

I woke this morning well before dawn, most unfortunatley, dawn comes at about 4:30am. As I lay there awake, a bit restless and congested from the fan blowing on me all night I debated whether to take the half of a Xanax on the night stand (you know the one that is there for just these times when the mind refuses to be silenced) in hopes of getting a couple of hours more of sleep. Instead of taking the assistance of the little blue (or sometimes white) pill I opted to let my mind revisit life in New York and what my previous days use to be constisted of and how much it has now changed and remained the same. I still worry and fret about many of the same things and like-wise find great joy in what I have always found joyful. I could go on and make a long and arduous list of my worries and concerns and also people, places and events that give me great joy. While some of you might find it quite interesting as many would find it boring and unnecessary and then I would leave someone significant out and potentially hurt their feelings so I will just move on and share someone of the highlights of last Saturday with you.
David and I started out with our usual breakfast (cereal M-F and eggs and such on the weekends) at home. Well, the vast majority of all of our meals are at home. We have been cooking more in these last three months than we have in the previous seven years. No, I really don't think that our cooking has improved much but we are certainly more grateful for the food that we do have.
Anyways, two Saturdays ago one of our little friends from here in the community came up to us here in town and solicited our help. By 'little friend' I mean a very casual acquaintance who has befriended us so-to-speak, seems to always know our whereabouts and greets us with a great big smile and handshake. Thabiso is a ten year old Swazi boy, who is quite friendly, always hungry (as young children are) and always in need of a good bathing, he speaks quite good English especially for his age. It is certainly good enough to gets his needs known to those of us who do not speak his native language. He immediately shared with us that his mother was sick and needed money to see the doctor. Now this is nothing unusual, we are very often comfronted with such requests and it certainly comes as no surprise given what we see when making home visits to the homesteads. So we asked Thabiso some more questions about his mother and who was at home with her and so forth. In short, within a couple of minutes Thabiso was climbing into the back seat of the car, although he much prefers the front seat with David or I driving, he hasn't expressed a particular preference for who drives although I wouldn't be surprised if he did so sooner rather than later. Thabiso had said that his mom was at home with his younger brother, the 18 months old toddler who can eat an ear of corn in no time and given that none of the children wear diapers here, he thinks nothing of urinating right in front of you onto the ground while you are saying hello in your limited SiSwati. It still makes me laugh to see how free the children can be with their bodily functions. It took me holding about three different babies out on the homesteads, for me to figure out that the wet spot that they had left on my t-shirt was urine. Now, I generally hold them with their back resting against my chest or side rather than holding them face to face. Anyways, Thabiso gave excellent directions to his homestead, showing us the water hole where he fetches water along the way. Fortunately, there was water to be had at this water hole, unfortately there were two cows drinking from it as well.
We reached his homestead after about ten minutes, driving through waste high grass and up and over many rocks and minor ditches. His mother was in their one room homestead, basically unable to come to the door. She was febrile and weak, quite pale and rather dazed, wondering where these two white men had come from. We explained how Thabiso had asked us to come help her and her initial reluctance faded rather quickly, possibly from the amount of fatigue she was suffering from. Busisiwe was not willing for us to take her to the hospital at the time but said that if she was not feeling better by Monday then she would come to the hospital. It was clear that she wouldn't have the energy for the walk to Good Shepherd Hospital so we arranged to come by their homestead Monday morning to further assess the situation.
After several trips to Good Shepherd Hospital, the ER, the clinics, the X-ray department, pharmacy, waiting rooms and on and on, what came as no surprise Busisiwe was diagnosed with pneumonia, a urinary tract infection and HIV/AIDS, with a CD4 count of 150. We haven't even considered addressing the medical needs of the children yet given how overwhelmed she is, the children will need to be tested but we have to be patient and stablizer her situation first if there is any hope of moving forward with the childrens health care. Busisiwe is feeling a little better, she is taking her Septra/Bactrim and erythromycin as ordered, I made a little chart for her to keep track and it seems to have been effective. David and I have committed to providing our support which will consist of obtaining counseling for her regarding her HIV treatment and ARV's, getting her TB test arranged, helping her to navigate the chaotic medical system here and making sure the family has food to eat. Which brings me back to what I started to write earlier about being in town on Saturday morning to do some shopping for Thabiso's family. We have found that it is often better to do the shopping on our own rather than have a family member present because to becomes too obvious to those in the store and community that we are providing assistance and we unable to get out of the store without being asked by another two or three people for help with food and it just gets overly complicated. Additionally, we have enrolled Busisiwe into the Home Based Care program to assist her with her medical needs.
Well, I have now run out of time here at the internet cafe. This isn't the story I planned on telling you about it's where I have ended up. So in short most of the last couple of weeks have been occupied with work and maneuvering the medical system or lack there of here in Swaziland. I will finish up later.
Peace,
Scott

Down and out-of-it.

2009-02-09T09:28:00.000+02:00

This past week is most memorable for David coming down with our first tropical disease. He has Typhus, better known as Tick Bite Fever. The fever part is debateable but many of the other symptoms have been present; malaise, muscle aches and pains, joint pain, headache and a large swollen and reddened area on his left forearm where the bite occured, complete with an eschar center. I have photo journaled the whole gruesome process of his illness and recovery to be shared with one and all upon our return. No need to hold your breath but there is a couple of good close-ups of the bite site that should not be missed. The doctors at Good Shepherd Hospital have been most helpful, he received two home visits and numerous phone calls over the past week and a half. The needed antibiotics were part of the trunk loads of medications that we brought with us so our Boy Scout motto of being prepared has paid off once again. That is not to say that the hospital pharmacy didn't have the doxyclycline in stock as well. As far as nursing care provided to our patient, that was exemplary, at least for the first week of his illness until I came down with a 'common cold/flu', not nearly as glamorous as Typhus so I am a bit envious. Friday was spent in bed coughing and sneezing on my part and David forged ahead reading Madame Bovary with his ear plugs in. Fortunately, we are both on the mend and yes Mr. Haproff does make a very good nurse when called upon. As part of my recovery process I am taking today off as well, no need infecting the patients in their homesteads, they certainly have enough to deal with without having the flu besides.
Well the rains have come and stayed. It basically rained for the past week and a half. Not torrential rains but a good steady rain and pouring rain that lasted for days on end. Only the main roads here in Swaziland are paved, the rest are these red dirt, clay-like roads, so when it rains they get very slippery and muddy. The mud was literally two to seven inches deep. I would step out of the truck and sink in mud at each and every home visit. In order to get back into the truck without dragging in five pounds of mud I would have to clap my feet together to dislodge some of the wet dripping mud from my hiking shoes. Working in all of that rain was quite and ordeal. We were not able to use our usual truck for home visits because it does not have four wheel drive and the four wheel drive vehicle only has a front seat so there were just three of us making the visits rather than the usual four or five. I spent three of the four days that I worked last week being soaked from head to toe all day. I guess it is of little wonder why I got the flu.
I must say that these Swazi women are incredibly strong and tough and just keep on working no matter what the weather conditions are. So picture this, there we are, myself and two other nurses in our truck, basically sheltered from the rain and we are at an impasse. The road is basically washed-out and there is no hope of reaching the next homestead. So, Anna Mary, one of the nuses on the team rolls down the window and hollers out at the nearest homestead in SiSwati. There was no sign of anyone at the homestead since the door and windows were closed in hopes of staying dry. I ask her what she was doing and she tells me just to sit and wait. It appeared that she did not find it necessary to explain something so obvious. Well a couple of moments later a young woman appears out of the nearest homestead in the pouring rain, she has a little chat with Anna Mary and then off she goes down the impassable road on foot, with no rain jacket or jacket of any kind, getting soaked from head to toe and covered with mud. She had gone to let the patient know that we were there but unable to reach the homestead. Ten minutes later our next patient arrives with her 'papers' (all of the patients have paperwork that has their TB or ART number on it with information from their clinic and hospital visits as well as home based care) there was no sense that she was bothered by the rain and mud and was quite pleasant and seemed pleased to be seen by the team. There she sat on the tailgate of the truck, in the rain with me assessing her and calling out my findings to Anna Mary (to record them in the patients papers), who had no intention of leaving the dry comforts of the front seat. I dispensed a few medications, some tylenol for the aches and pains and nystatin for her oral thrush. Next the patient took the food we supplied, in all about 25 pounds of powdered substances and off she went with it all balanced perfectly on her head. The rest of the day continued in this fashion, at times there were several patients standing out in the rain, waiting to be seen and not showing any signs of annoyance. In fact, one of the patients who had an umbrella came by my side and held it over me while I assessed another patient. After I had finished I moved her over next to me so that she could be out the rain for a few moments and she seemed so embarrassed, she smiled from ear to ear and laughed out loud. She was so sweet and kind and obviously not use to be the recipient of such kindness.
The following day was much of the same although with more mud to deal with. At one point, again the roads were impassable so we sent another girl from a nearby homestead out into the rain to get the nearest Rural Home Motivator. The RHM as I have said helps to monitor patients in the community, they get paid a very minimal sum, something like the equivalent of $10 for the whole month. Anyways, twenty minutes later the RHM shows up, at least she was wearing a rain jacket, bare footed and basically soaking wet and covered with mud up to her knees. We explained that we could not reach several patients who lived in her area and she offered to bring the food to them for us and to have them come to the clinic if there were symptoms that needed to have medical attention. So there were are, on the side of the road, it is raining with dense fog allowing us poor visability and air temperature is quite cool. Well this very strong and eager RHM pulls a large plastic bag from her jacket and gets ready to load it up. We (actually I, the others are keeping dry in the cab of the truck) hand her 3 packages of Corn Soya, 3 packs of Mealie Meal, 3-two liter containers of milk and 3 food packs (containing sugar, salt, peanuts and beans). Each cornsoya weighs about 15 pounds, the Mealie Meal 12 pounds each, the milk 2.2 pounds each and the food packs another 8 to 10 pounds each. Doesn't she pack all of this into her large plastic bag as I look on in amazement as I keep repeating to the team 'how is she going to get this to her homestead'! My question went unanswered once again, no big surprise there. But I was assured that I should not be concerned and just be patient. Anyways, there was little hesitation on the RHM's part, she was going to lift that bag, in all about 110-120 pounds, onto her head and be on her way. Well we had to remove one of the corn soya in order to steady the bag but she remained determined to carry the load on her head. So I helped her to lift the bag in place, yes on top of her head, then handed her the other bag of corn soya to carry in her left hand while she stabilized the bag on her head with her right hand. Sure enough, off she went into the rain and mud with everything in place, thanking us for bringing her the supplies. She was starting off on her 20 minute journey on foot with a smile on her face and me bug eyed at the whole scene. Once again I was left standing there, in awe at how the world works so differently here from what I am use to in the states. Somehow I cannot see this scene playing itself out on West 23rd Street.
Peace,
Scott

Comfort Dolls

2009-01-30T16:04:00.000+02:00

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.

2009-01-29T15:06:00.000+02:00

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.

2009-01-25T13:32:00.000+02:00

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

2009-01-18T13:25:00.000+02:00

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.

2009-01-10T10:51:00.000+02:00

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.

2009-01-07T15:40:00.000+02:00

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.

2009-01-03T11:38:00.000+02:00

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

New Years Eve

2008-12-31T15:11:00.000+02:00

Well, I cannot believe it myself, finally internet access and yes I have been trying for 12 days now. Thanks for all of the birthday wishes and please do not forget that my birthday will be on December 28th again next year. Gifts (beautifully wrapped), cards, French food and a gorgeous celebration will be in order. It is quite painful I must admit to be numerically older than David for the next 6 months but I have learned to adjust on a yearly basis. We are mobile and loving it. Frequently we just get in the car and take long rides out into the rural areas, huge valleys and plains and cows and goats most everywhere. Occassionally we pass a stray monkey or warthog and even a giraffe and rhino the day before yesterday. It is nice to see another side of Swaziland, one that is quite peaceful and shielded from what may lie within. I guess that it is the same when you are doing any traveling or sightseeing.
My birthday was most divine. We celebrated the miracle that is me and what a special day it was. We sat around with our Peace Corps friends and Susan (she runs the TB program at Good Shepherd Hospital, she is from Britian) and she resembles my sister Susan, anyways we had a nice dinner, a home made cake from scratch (quite an accomplishment and very good and chocolatey, thanks Kristin) a few cocktails and good conversation. The conversation was focused on me, you know how I hate that but seeing how it was MY birthday I figured, why not.
Christmas, well it was like no other. Midnight mass started at 9pm, yes that is 3 hrs before midnight and get this...it lasted until 6am. David and I stayed until 1:00 am, yes four hours. The mass had its ups and downs, lots of kneeling I might add on solid pine kneelers with no cushion. These old knees had a rough time of it. Seeing how we were celebrating the birth of the Baby Jesus I figured that I would suffer in silence, up until now that is. The manger at the church was quite ecceletic. There was the ususal Joseph and Mary and of course the baby Jesus (who was nearly the size of the manger and at least 5 times as big as his parents) and many wise men, apparently there were a dozen or so here in Africa as opposed to the three that we are use to. Addtionally, there were several statues, some plastic, of saints and I believe a pope or two thrown in for good measure. It was really quite the display, very endearing I must say. Above the manger (I do not think that I am spelling that correctly) there was the only Charlie Brown tree, it was about 3 feet high with branches that stuck out about 4 feet on either side, and fake as well. There was only one string of lights with about 12 of the bulbs working and a silver piece of garland about 2 feet long strung from the top of the tree and swooping west as it cascaded down. Needlesss to say I have spent many hours just sitting and admiring the whole scene and finding it most enjoyable, remebering of course that it is the thought that counts.
We drove to South Africa on Christmas day (just across the boarder) past endless fields of sugar cane (now I know where all the water in Swaziland is going) and very small towns. It was a great ride and we topped it off by having Chrismas dinner at KFC. Believe it or not it was fantastic (going down that is and a bit difficult to digest after not having fast food for so long) certainly a day to remember.
Well I am out of time, hopefully I can sign in again later. Have a wonderful New Year! Know that I love and miss you.
Peace,
Scott

Lions and Tigers and Bears, Oh My.

2008-12-19T16:14:00.001+02:00

Well, we finally made it to a game reserve and it was like being a kid again. I remember watching many animal and safari shows on TV as a youngster and dreaming of the day I would get to see the wild animals. The day has come and it was last Monday. As soon as we arrived at Hlane game reserve we went right to the closest watering hole (we were on foot) and sure enough there were 2 giant Hippos and one younger one about half the size as the other two and about a dozen Rhinos, it was really great. We sat/stood and watched them for a good 30 minutes before one of the Rhinos charged at us but was stopped by the electric fence. Little did he know that he could have gone right through the fencing and reached his target with very little effort. Soon thereafter we got into the car and had an amazing ride through the park. We saw this Ostrich who had imprinted on one of the game wardens soon after it was born so it just follows him around daily. We saw the ostrich standing on the side of the road and it just stood there while we stopped. It all seemed very curious until we looked up in the nearest tree and saw the game warden perched high above us. He said that the bird truly never leaves his side whenever he is at work. The day was full on, we saw lions, warthogs, giraffe (we were within 15 feet of two of them), hippos, rhinos, gazelle, antelope, to name a few. The only disappointment was that we had not seen any elephants. A few hours had passed and the park was getting ready to close for the day trippers so we headed for the exit. We found the exit to be gated, so we sat in the car for a couple of minutes before another game warden came out to let us exit. She seemed rather rushed and waved us in through the exit and then pointed behind us. There stood a herd of elephants, a couple of bulls, females and several little (I guess little is relative) baby elephants. It was so cool, well at least until the alpha male started to come toward us. Fortunately he too was put off by the electric fence as we scurried around the otherside of the car. The warden said that he was particularly aggressive and that it was best to keep our distance. It was the perfect end to my first game park experience.
It was a four day work week for me. The King decided to make Monday a public holiday to honor the completion of the Incwala festival. It was a unplanned holiday in part. It was not announced until Friday night so we were not sure if we would see patients on Monday until Saturday morning. Well the whole country came to a screeching halt, well not so screeching given that it never moves that fast in first place. All the stores, shops and government offices were all closed. A real holdiay for most everyone. After Incwala the King goes into seclution for many weeks and again this signals a vast slow down for the country until late January. Many public services close as well, like the offices that serve the local orphans. Our Peace Corps friends do some work with the local orphans and said that there will be no food distribution or services for the next several weeks. Fortunately our Home Based Care program continues although two of my coworkers will be on vacation for a month starting on Monday. The hospital is open although serveral physicians go on holiday. The ENT doctor and his wife who is a physical therapist are both away for the next 6 weeks so both of those departments will close down until they return. It is amazing to think that when the only person who works in a department is off or on vacation there is no fill-in, they just close the department all together.
We had a great night with Andrew and Kristin last Sunday night. Dinner and drinks and good conversation at our house. They were very impressed with all of our luxuries, runnning cold water, an indoor toilet and electricity. Neither of them moved away from the fan all night and said that they had their best sleep since coming to Swaziland 5 months ago. So no longer feeling sorry for myself for not having hot water,it clearly could be much worse.
The shortened work week was most agreeable. I really get worn out by the end of the week. We see about 25 or so patients a day, sometimes they just line up waiting to be seen. I have a lot to learn about skin rashes, KS, ringworm, severe thrush, fungal infections and abdominal pain. Next week I am going to meet with one of the doctors in the Outpatient Department to see if I can spend a couple of days a week with him to learn more about the treatments for local diseases. Also we are going to discuss if there are any other medications available for us to take out on our home visits. The big draw back to spending time in the outpatient department is the lack of ventillation in the OPD, there are about 200 people waiting at any given time and there is TB everywhere, much of it resistant to antibiotics. I have been wearing a mask when necessary but it is incredibly hot and my whole face just breaks out in a sweat. So I need to think this over a bit more before deciding if it is worth the risk or if there is another option.
Big news, David bought a car in Manzini yesterday. It is a 1995 Mazda Levante something or another. It has four doors, four wheels, is green and looks like a small boxy version of an old SUV. Hopefully, we will have it in our possesion on Tuesday, in time for the Christmas holiday. Freedom on wheels, I can't wait. We are so looking forward to getting out of town and seeing more of the country side, South Africa and Mozambique.
I guess that is all for now. Know that we are well, enjoying life and each other and are very much alive with all that is new around us. The journey is certainly on an up note today and for that I am most grateful. We hear that there is a new independent film coming out in the states soon about Swaziland and is in part focused on a Home Based Care team. Please let me know if it comes to New York or San Francisco and what the name of the film is.
Peace,
Scott

Sunday December 14, 2008

2008-12-14T13:25:00.002+02:00

Umjani, which is a common greeeting here which means 'how are you'.
My first whole week of work has come and gone and it appears I have survived it. I must say that I am greatly challenged by the very slow pace here. I have gone from 'being the boss' to not being familiar with any of the culture, sights, smells, chaos, slowness, medications (even the generic names are different), proceedures or basically any of the routines. Our day starts quite early since the sun rises at 4:30 am, by 6:00 am I have had a cold shower (the water has been flowing all week!) and have started the coffee and had a big bowl of cereal. Carbohydrates are my life now, please do not tell any of the boys at David Barton Gym, I am sure that they would be horrified. (In case you are wondering, Zone bars are our favorite protein bar, the chocolate and caramel or chocolate fudge.) Protein is very difficult to come by, the poor little dead chickens in the store couldn't be any thinner and the red meat is completely unrecognizeable. Back to the start of my day. I can look out our front window, while eating my Corn Flakes, and see the beautiful valley in the distance. Now instead of just seeing all the beauty I am overwhelmed by what lies hidden in the homesteads.
The degree of suffering is just starteling. During one of my home visits this week I saw a young man who was 35 years old. His face was grostequely swollen from Karposi Sarcoma and he had numerous other lesions all over his body. The flies were all over him and his infant son who was dressed in rags. The only medications we had to offer was Tylenol with codeine (only 8 mg of codeine, instead of 30 mg or 60 mg) and some ibuprofen. One of the other nurses thought that I was giving him way too much medication, it took all of my strength to explain that he was not getting too much medication and be able to remain respectful to my colleague. The women that I work with have been doing this for many years and the fact that they just show up for work and are witness to this sitaution is quite amazing. They are all very strong and committed to their work and are somehow able to manage day after day, year after year.
The earth is quite unrelenting here. They have been in a drought situation for many years. Often it clouds up at night and there is a tremendous amount of lightening and thunder with little or no rain to follow. I pray that they will receive some rain because many people have to grow their own food to survive. The corn is only 10 or 12 inches high and it should be four feet high by now. Corn is their main source of food and without a good crop I really cannot imagine what the winter will be like when the rainy season has come and gone. We often spend our day making home visits in the valley that lies directly below Siteki, I am not sure of the direction it is in but I do know that it is 10 to 15 degrees warmer that where the hospital is. The average daily temperature has been about 34 degrees celcius or 94 degrees. As we drive down into the valley you can feel the heat rise and the air becomes drier. As we drive from one homestead to the next we make quite a dust cloud, there are only dirt roads to travel on once we leave the main road. Along the roads there are these bushes that have very large prickers on them, they are at least an inch long and every branch is just covered with them. Needless to say I have no idea of where I am going and often the others forget a turn or two so we have to back track often, doing a U-turn while trying to avoid the pricker bushes, cows and large ruts in the road can be quite challenging. Our gas tank sprung a leak yesterday but we were able to make it to all of our home visits. By the end of the day I am covered with sweat and dust and dirt and I feel a bit paralyzed but what we have witnessed. I guess that it what I have been stuggeling with most. Why here, why these people, why do I (we) have some much and how can I make a real difference. I think that I am here just to simply bare witness to the situation, the suffering as well as the joy on the faces of the patients when they see our truck and know that they will get some food and attention. We have very limited medications, the food we supply only lasts a couple of days but the the people are so grateful and gracious for our visits. Just being heard and seen and touched seems to make a difference. I am working hard to open my heart and soul and to see clearly the human being who is in front of me, and give them the respent and dignity they deserve and is possible during a five, ten or twenty minute visit before we have to leave to see the next patient. I have to look past all of the choas, inefficencies and lack of structure. I am rather entrenched in structure and organization but I am open to learning. People often come up to our truck to receive care, which can be both helpul (less traveling involved) and a hinderance. Thursday a woman and her 6 month old child who could not have weighed more than 8 or 9 pounds came up to me and handed me the child. He had a terrible case of thrush and he just cried and cried, neither his mother or I were able to calm him. Both parents have HIV/AIDS but the child had not been tested yet. Luckily, we were able to give them some nystatin and money for bus fare to come to the hospital the following day.
Yesterday, Saturday, we were able to get out of Siteki and drive (we got a ride from a local kid called Thando, his mother works at GSH) into the town of Manzini to do some shopping and just have a little getaway. Manzini is a city of about 50, 000 people, I think? The main street has many shops and is comprised of cinder block two story buildings with shop after shop in them. Most of the shops are run by Indians rather than Swazi's. It kind of looks like something you might see in a poor neighborhood of Los Angeles or what you might imagine in an African city. We have been plagued with electrical problems. I plugged the short wave radio into the 240 current outlet and it basically burnt up. David's cord for his computer shorted out and now my camera has stopped working. So we are looking for some replacement parts and places to fix them, wish us luck. Karen has already sent off a new cord for the computer so soon we may be able to see a movie on DVD, which I am quite looking forward to.
Tonight we are having a couple of Peace Corps volunteers over for dinner, they are Andew and Kristen (married), in their mid twenties, from Boston and really quite nice, so we are looking for good conversation and a few cocktails. We have yet to see much wild life. There is a game reserve about 40 minutes away by car but have not managed to get there, hopefully soon. David is well and again I am so grateful that we are here together.
I am so impressed by how many people do this on their own. Kathleen Hartman RN started this Home Based Care program many years ago (2001, I think) and I am so impressed with her commitment and compassion and ability to work with the system and create a helpful evironment for the patients. She is such a strong person, an amazing nurse and quite the humanitarian. The work she has done is so very impressive! She has been quite the role model for me and a great mentor as well.
I hope that I have not been repeating myself too much. I am not trying to complain, we are doing fine, there are numerous adjustmements but that is just part what we have signed up for. The journey has been amazing already and it will only get better I am sure. Just another quick story before I sign off. Behind our house, oh about twenty feet away is the trash can for the houses that are next to ours on the grounds of the Deaf School. Well, day in and out the can got fuller and fuller and then overflowed onto the ground. So the locals would just empty their trash on the ground next to the can because there was no more room in the can. We started saving up our trash inside the house waiting for the can to be emptied (Lord knows I do not like a mess), well that day never came. One morning the lady next store simply took a match and some gasoline to the pile of trash, now the trash is gone and we are left with a pile of ashe and soot. The job is done, not exactly how I had imagined it but completed just the same.
Peace,
Scott

Back again on Saturday Dec 6, 2008

2008-12-06T13:06:00.000+02:00

Hello again,
They have decided to keep the internet cafe open for us, so here I go again.
Our house is on the Deaf School campus, it sits on the side of a hill and we have a decent view of the coutry side and of Good Shepherd Hospital. The children at the school are incredibly sweet but want to come by and talk/sign and write with us. Their summer break starts next week so it will be much calmer where we are living. Food wise, we are surviving. Lots of pasta, eggs and grilled cheese. Fortunately there are a couple liquor stores in town so we are able to make a cocktail in the evening. And yes, they have Coca-Cola here made with realy sugar so it is most delicious and I do appreciate it.
It is considered very unsafe to be out after dark. So once the sun sets at around 6:15pm we are in for the night. There is no walking outside anywhere in town because it would not be safe so that has been a drag not being able to be out in the evening breeze. We have a fan that helps with the heat and mosquito netting to keep the bugs at bay. David's bedtime routine is quite complicated, imagine adding netting, the proper fan positioning, bug spray, security concerns to name a few to the already neurotic night time routine, most of you will understand. We have spent a fair amount of time reading and just rehashing the days events and falling deep asleep by 10ish. We have two bedrooms but only one bed so the locals are very concerned that David and I have to share a bed, (for some reason it has not been so concerning to David and I, we adapt rather quickly at times) the administrator at the hospital has promised another bed but who knows when it will arrive. The administrator at the Deaf School, Rose (who is very sweet and helpful) feels quite bad for us the we have to share a bed but not at all concerned with the lack of water. Yesterday she said the water may come back on tomorrow or the next day, in Siteki you never know. Thank God for Old Spice Deodorant, although the locals do not use any deodorant at all and boy can it be quite overwhelming on a hot day, which is most days.
Queen, thank you for organizing my going away book at work, it has been so wonderful to read and savor. Thank you all for your kind thoughts and wishes and prayers. Mary M., I have been using the rosary and I very much appreciate your parting with such an important object in your life, I do cherish it. The church we are going to is just incredible. What gorgeous voices the choir has. The mass lasts a good hour and a half, the church is nearly full, very hot with an occassional breeze blowing by and the service is completely in Siswati. Obviously we do not understand a word yet but it was very fulfilling spiritually to be present and sit quietly and peacefully at the mass. We are able to follow along after forty years of Catholic masses so we are not missing out. We are looking forward to tomorrows service.
Jim P. there are many here that would believe as Shirley's caregiver did about rocks. Girl, there are rocks in abundance here! Seriously, the soil is very rocky so growing crops is quite a challenge especially in the drought conditions here of the past several years. Most homesteads have a very small plot of land, say 10 x 20 feet or less, to grow some crops in although the soil of late is very dry and does not produce much.
The hospital looks as one would expect from movies that you have seen about Africa or other poor countries. The hospital has about 24o beds although they do not all seem to be full. Some wards are full while others have a few empty beds. On the weekends there are very few staff around and on my first visit the wards I was shocked and horrified at the preceived lack of patient care. Nothing happens quickly here, learning to be patient is going to be one of my big lessons here. The hospital has 9 doctors now, the most ever at the hospital to date. The only eye doctor in all of Swaziland is here at GSH and has given sight to many of the old men and women of Swaziland and is very well respected as are all of the doctors and nurses here. Most people think that David and I are doctors, there are several male nurse here and they are called Sisters, isn't that appropriate and a bit campy. The busiest part of the hospital is the Out Patient Department, by 7:30am there is a long line of over two hundred people to be seen, many more on Mondays and Fridays. They must pay 15 Emalengeni each to be seen which is equal to about 3 days wages, if admitted the costs just escalate and is very prohibitive to most of the population. Although in the midst of it all there are some private rooms at the hospital for those who are well off financially. The patients arrive by bus/coombie or in the back of a pickup truck. It is not unusual to see a mother bringing her cachetic child in their twenties or early thirties for their first visit to the hospital to find that they have acitve TB and AIDS with very few T-cells remaining. If the patient is well enough to go on ARV's then they must make the journey to the hospital at least two more times before they can get their meds (which are provided free of charge) to show that there is a chance that they may be compliant. Unfortunately, many cannot afford the bust fare to come back so basically go home to die. There has not been an outbreak of Malaria in this region in many years, I am still taking my doxycycline since I am making home visits in the Lowveld area where there is a higher risk and more ticks and chiggers looking for a place to lay their eggs or bite you.
I know that it sounds so dismal here but there is also alot of joy here. The people are incredibly friendly and they just open their hearts to you immediately. We have learned a few greeting in SiSwati and the locals really appreciate the effort. I, of course do not understand more than a word or two of their response but give a big smile and a hand shake. Amy, thanks for the information on how to shake hands and to show respect to the elders, it has been most helpful and very well received.
Please tell the others about my blog because internet access is so limited and I am unable to respond individually to emails at this time. Also, please do not email any attachments because it usually makes the computer 'freeze-up' and I loose what little time I have on the computer. It is best to respond to this blog, it is most accessible for me. All of the internet access we have is dialup and is very slow.
Last weekend we went on a drive around Swaziland and ended up in Ezeilwini Valley (not spelled correctly) where the royal family lives. We went to the Incwala celebration which gives thanks for the new crops and the King appears, eats a pumpkins and tells his people that they can eat the new crops to come. I have very mixed feelings about seeing the king but really enjoyed the ceremony. David and I both danced, barefooted and with sticks, it was something that you would see on the Discovery Channel where you would say 'look at the silly white boys trying to dance' with all of the warriors. They were all dressed in tradition garb, animal skins, feathers, shirtless etc, Daniel B. you would have been in heaven. The Incwala was really great to participate in and kind of spiritual I must say.
I am out of time. Sending lots of love to you all.
Peace,
Scott

Saturday 6-12-08 Siteki

2008-12-06T12:42:00.000+02:00

Yebo,
I have finally been able to find internet access after multiple attempts. So my lack of keeping in touch has not been for lack of trying. I had my first two days doing home visits. I truly do not know where to begin. The depth of the poverty and suffering is truly overwhelming. Once you think that you have seen the saddest situation ever you move on to the next homestead. We drive around in a white truck with seats in front in back. There are 5 of us going on visits, they have allowed David to come along for the first couple of weeks to assess the needs of rural Swazis in person. That has been a great comfort to me. In the pickup part of the truck we bring medications and a few supplies, food...which consists of soya and corn meal, some milk that spoils quickly but the people are happy to have the curdled milk, some beans and that is basically it. Unfortunately, we always run short on the food before the day is finished. We bring enough for about 15 famalies or so but could use many many more food packs. Eightly percent of the patients we see have HIV/AIDS and 50% of them have TB, it is really bleak. It is not uncommon to see a homestead that is run by a 16 year old girl with AIDS, caring for several children (some her own, others who are orphans) usually the mother has already died and if the father is alive he usually abandons the family. Young orphans line the road when they see the truck looking for any available food, most often they have to settle for a smile and a Swazi greeting.
It is quite hot all day with the sun overhead as we travel across the rocky soil and hills. There is no water to speak of, we must 'wash' our hands with sanitizer and hope that it does some good. The homesteads vary from one to another, most are made of sticks, rocks and mud, it really is quite shocking. I am nearly out of time for the internet, they have decided to close early today.
David and I are now living at the Deaf School which is two kilometers from the town and the same to Good Shepherd Hospital. We do lots of walking. We have no hot water and often no water at all, it has been out for the past two days. I should not complain given that we have food and shelter.
Hope you are all well. Missing you madly.
Peace,
Scott

My first entry from Siteki, Swaziland

2008-11-28T15:59:00.000+02:00

Hello,
This is going to be quite an adventure. Just to get here and start typing we had to walk 35 minutes, try two different internet locations before we ended up at the Siteki Hotel where I am using their computer in an office space. The landscape here is most beautiful, incredible rolling hills and mountains and the soil is so red! The air is fresh with a good breeze most of the day.
Our only transport so far has been walking. The locals giggle to see us white boys walking along the roadside sweating. Everyone is incredibly friendly and greets us constantly. The children are so beautiful and sweet and there are lots of them, many in their school uniforms.
The food situation is most challenging. We did some shopping yesterday and became overwhelmed with the lack of familiar food that we basically left with some potato chips, bread and cheese. There were lots of chicken feet available but I guess we were not in the mood.
Finding housing a going to be quite a chore as well. We have a couple of leads but nothing certain. Most often people say come back later or tomorrow. There are not many places available to rent but it will work out.
The electricity keeps going off so I am going to sign out before I loose what I have written already. We are both well and very wide eyed and up for the experience. Please keep in touch.
Here is my cell phone number 675-5234, the country code is 268 so I think from the states you would dial 011-268-675-5234 although you may need another zero before the 675 but I am not sure. The other volunteers here say Skype works quite well or try nobelcom.com to get a phone card of sorts.
Peace,
Scott