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

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