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

Sleepless in Siteki.

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.

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

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




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


















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



















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

















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
















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












Child from above photo.

















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

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

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

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

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

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

Much Love,

Scott

Wet from head to toe.

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

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

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

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

Peace,

Scott

School Fees and New Hope from across the Atlantic.

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