Keeping Warm This Winter?

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.

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

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

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.

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.

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