John's visit June 14-21, 2009.

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

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?

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