Just checking in...

Hello everyone...

Thanks for all you comments, support and encouragement. We appreciate it and miss you all very much. Sorry we have not written much the past week. We have been busy finishing up at the hospital. This Thursday morning we leave to travel through South Africa for 2 weeks for lots of relaxation and fun!

Clinton has been especially busy this past week. Dr. Bitchong (our favorite!) was recently appointed as Chief medical officer of the hospital. We think he will be excellent at this and will help the hospital overcome many of the challenges we have observed. This being the case, he has helped to obtain many of the supplies Clinton has needed to finish his task in the cardroom-- 2 new computers and a copy of windows XP that he had hoped for. Clinton has also been able to meet with the cardroom committee (finally!) and he has gotten several cardroom trainees and data entry personnel.

I finished at the HIV clinic early. I was a little disappointed because Dr. Kabitshwa (who I really enjoyed working with) left to South africa for a week to study, and the other doctor was more difficult to work with. He only wanted me to observe and he ignored me most of the time. It was unfortunate because this was he area I would have been most able to help in, but he would not let me see patients. I think there was some confusion about the role of a Physician Assistant. So, for the final week I am delivering babies in the labor ward and helping in the Pediatric outpatient clinic. The hospital is extra busy this week because the government hospitals and clinics are on strike because the nurses have not been paid for overtime. I think I enjoyed my time in Pediatrics most of all, so I am glad to be of help there at the end.

We had a lovely weekend. Friday night we joined the children at the New Hope Center for afternoon play time and dinner. On friday nights they celebrate the sabbath dinner. We shared communion with them, sang some songs, read some scripture, and Dr. Elizabeth did some teaching. It was nice to spend some more time with them before we left. The children are so beautiful. It was definitely one of the biggest blessings of our trip to meet them.

Saturday we enjoyed a day to the Mantenga nature reserve and Swazi cultural village. The weather was beautiful-- about 70degrees and sunny with a little breeze. We enjoyed watching the traditional Sibhaca dance. It was about an hour long dance that told the story of two swazi lovers. It was very entertaining. Then we relaxed on a hike down to Mantenga falls and sat on a rock listening to the sounds of the forest and the waterfall (surprisingly there was a small interruption from a car alarm!).

Sunday evening we were invited to have dinner with Dr. Bitchong and his wife. We had a wonderful visit with them talking until past 11pm (very rare for us to be up that late in Swaziland!). They are both sweet and interesting people. We shared many laughs and shared stories of how we met as couples. I was glad to be able to spend some time with them on a more personal level. I hope we can keep in touch.

We are hoping to write a few more posts while we are in South Africa. Clinton still needs to write part 2. We are excited at the possibility of Internet access from the hostels we stay in and there may even be high speed in South Africa!

Thanks again for all the support we have received. It was so great to hear from so many of our friends and family!

HIV clinic

I began rotating last week at the HIV clinic. I had looked forward to this the most as it is the area that interests me the most. I had just finished a clerkship at the HIV clinic at UK before coming to Africa, so I have some recent experience as well.

(read on) Here's a short explanation for those who don't know much about HIV. The virus attacks certain cells of your immune system called CD4 cells. As they have tried to explain HIV to people in swaziland, they refer to these cells as "soldiers" because they fight infection in your body. A normal person has more than 500. As a person is infected by HIV, they decrease and when they are below 200, a person is at much greater risk for developing opportunistic infections. This is when they have gone from being HIV positive to having AIDS. When the "soldiers" fall below 50, usually a person is very sick and has a much higher chance of dying.

One of the main reasons this is a good learning opportunity for me is that people here have very low CD4 counts. When I was at UK, I maybe saw 2 people with CD4 counts below 50 because most are well controlled with medicine. Here over half the patients have counts below 50. I've even seen them as low as 2. Two years ago, began to provide HIV medicines for free to all people in Swaziland who need them (usually those with CD4 below 200). The HIV rate here is currently the highest in the world at around 42%. With a population of 1 million, that would mean around 400,000 people with HIV. The clinic I'm working at, one of the largest in Swaziland, has around 2000 patients. It is staffed by 2 doctors, 6 nurses, 1 pharmacy tech, and 3 data entry personnel. Before February of this year, there were no full time doctors. The nurses were responsible for managing HIV medicines. The clinic sees about 150 to 200 patients a day. If someone is doing well, the nurses refill their medicine. If they have a problem, they are referred to a doctor. It is a very heavy patient load, and it is obvious the clinic would benefit from more staff. Not only is their current patient load hard to handle, but only approximately 10,000 people in Swaziland are followed by one of the country's HIV clinics. That barely touches the expected 400,000 who are infected. It seems an overwhelming task to provide service to so many with so few.

Unlike other doctors I have worked with here who take 1 hour for tea and 2 hours for lunch, these doctors begin seeing patients at 8 and do not break for tea or lunch until the last patient has been seen, which is as late as 4:30 or 5. I wonder how long a system like this can last without burnout. The patients do not have appointments. This seems as it might be impossible when you factor in "Swazi time". So, all the patients are expected to arrive first thing in the morning at 8. The nurses check them all in and do the initial screening and vitals to decide who needs to see a doctor. The doctor then begins the morning with a large stack of charts. Many patients do not arrive early, however, because they travel long distances (or they just sleep in). So, as you think you are making progress through the stack and may be able to go to lunch, the nurses begin bringing in one or more charts for every one patient you see. The stack never seems to decrease. It can get frustrating. Many patients are very sick and the medicine may take some time to work. It is commong for a patient to not understand that, and they will come in several days in a row with the same complaint even if they are taking all the available medicines that can help them. It only adds to the frustration to have to repeat "there is nothing else. You need to keep taking these medicines and give it time."

I have also had the opportunity to travel to some of the rural clinics during this past couple weeks. One of the doctors, Dr. Kabitshwa, has taken these as his project. He is interested in utilizing them to make it easier for people to access HIV medicines. This has been a good way to see much of rural swaziland. Clinton is writing about our rural swazi weekend, and I think that has enriched my experience at these clinics. The majority of swazis live on rural homesteads like the one we visited. The rural clinics are accessible, but primitive. Some do not even have electricity. They are staffed by nurses and a doctor comes once a month to review the more difficult cases. It almost seems futile because while the doctor comes, there is still no lab tests, x-ray equipment, ultrasound, EKG, etc... Almost always one of which is needed for diagnosis. So, the patient is told he/she needs to find a way to the city where they can have this done. Often they say they can not, and that is all. One of the most important uses of these clinics is that they are used by many women for pre natal care. Here the women can be offered HIV testing, and since many rural women give birth at home, they can bring their newborns to these clinics for shots to help prevent transmission to the baby if needed.

The doctor I have worked with the most at the clinic is Dr. Kabitshwa. He is from the Congo like many of the other doctors. He worked in Mozambique as a surgeon for many years, and 2 years ago he moved to swaziland to work at the HIV clinic at the government hospital in Mbabane. He began at RFM in February when the clinic got funding for 2 full time doctors. He says it is better because he is not as affected by the political games that were so prevelant in the capital. I think he is one of the better doctors I have worked with here. He seems to care about his patients and has developed good rapport with many of them. They bring him gifts from their gardens, and he really delights when their conditions improve. He really wants their to be more research on HIV in Swaziland. He says they started treatment 2 years ago, but have no idea how they are doing, whether or not people are getting better or if their is resistance developing. He tells me that he hopes to see me come back next year to do research. I tell him I'd love to, but I have to wait until I have more experience AND some funding. We'll see!

The Smell of Blood - Part I

A single bowl of sour, malted sorghum shared by the five of us at a market vendor's stall.... so begins our rural Swazi cultural tour. I'm unconvinced that we haven't just been conned out of 420 rand each.

(read on)
Tim, Lisa, and I sit at the market with two Swazi men: Linda and Stan. We've arranged a tour with Stan's brother, Myxo, who recived a glowing recommendation in the Lonely Planet. At about $70.00 each for an overnight trip, the outing to rural Swaziland is a bit pricey compared to our other weekend ventures, but this is something we otherwise would have little opportunity to see.

Or is it? We're just sitting here sharing a single bowl of the same cheap breakfast which three other Swazis each had a bowl of before they vacated this very table. The name of the porridge is a nasel tone followed by two clicks, and we're told that the porridge was made yesterday and allowed to ferment overnight for the appropriate sour flavor. A few spoonfuls of sugar tempers the taste of the porridge, however, and a bowl of fatcakes arrive to hold our appetites at bay. Linda runs thorugh a rudimentary siSwati lesson and we chat about some of the cultural similarities and differences that we've observed so far.

After breakfast, we walk around the rest of the market as we wait for Myxo to show up with the car. The market is nothing new to us, although we do discover that Lisa will need to purchase a wrap for the visit to the rural homesteads since it would be somewhat inappropriate for her to just go in her jeans. She's ok with this as she's wanted to buy one for some time now. We also make a quick run to Spar, the local grocery store, for the weekend's food supplies.

We head across the street shortly before Myxo pulls up in a well-worn 4x4. Myxo is wearing his trademark "poofycap". Most Swazis keep their hair closely shaved or tightly braided, but Myxo contains his 'fro in a large, colorful, and bulbous woven cap. It allows him to stand out in a crowd. He greets us with characteristic enthusiasm and explains that he needed the vehicle for other tasks earlier this morning, but now everything is in order.

He and Stan now turn their attention to opening the rear hatch of the 4x4, one pulling from the outside while the other jiggles the handle from the inside. It's a ritual we will get to know well with this vehicle as neither handle individually provides the sufficient condition for opening the door. We each toss our bags in the back, and then Lisa and I hop in the rear seat with Stan while Tim climbs in shotgun next to Linda. Linda reaches under the dash to find the dangling wires that accomodate the ignition switch, and the engine comes to life. Apparently, Myxo is not actually joining us for Myxo's rural Swazi cultural tour. Interesting.

We're headed out on the road away from Manzini to the southeast... it's a new direction for us. We stop for airtime on Linda's cellphone, as well as to fill up the spare tire sitting in the back with our bags. It's treat time, too. Tim, Lisa and myself pick up some bite size snacks from the gas station since breakfast was light. Stan picks up a 500 mL Mint Punch.

The journey is long and dusty, particularly as we leave the highway and begin climbing the dirt road into the mountains. Tim is asking question after question of Linda, and Lisa begins to amuse herself by couting them. She loses track somewhere between 30 and 40. Stan has been relatively quiet during the morning, but the more of the Mint Punch he consumes, the more talkative he becomes.

The road becomes progressively more narrow and more dusty as we wind further into the mountains of Swaziland. Linda points out various landmarks on the way, and as we pass a large tent emblazoned with the letters "WFP", he notes, "That is the World Food Program." Stan soon makes a comment in siSwati, which Linda translates for us as, "Stan suggests that we should stop and see people making traditional Swazi beer." Lisa and Tim are obliging, so we turn around and head past the WFP tent again for some homebrew. Upon questioning, a passerby lets us know that the home we're headed to is out of beer, saying, "It is finished," but suggests an alternative. We arrive at the home and stretch our legs while a young man goes behind the house to retrieve a sample. He returns with a cup the size of a small pot and asks for five rand. The sorghum brew is a foamy, opaque tan and it sloshes meanacingly in the cup. Tim volunteers the five rand and takes the first sip. With a little convincing, Lisa follows. "It tastes like someone poured beer in the breakfast!" she exclaims. Linda and Stan get a laugh from this, but neither Lisa nor Tim is willing to finish off the jug. Stan accomplishes this noble duty with the help of the young man from the house before we pile back into the car.

We continue on down the road and make an impromptu stop at a rural Swazi wedding. We wander into the tent and listen to a speech and a prayer, of which we understand little as it's entirely in siSwati. Linda gives us some brief translations and explanations before giving us the nod of, "it's ok to go now". As we walk back toward the vehicle, two of the family members accost us, wondering why we were leaving. They want to make sure we feel welcome and want to provide translation for us. We explain that we are just on the way to the village and were only just stopping briefly, but they insist, "You must see the exchange of gifts... that is very interesting." Linda agrees, and we promise to return after lunch, since there is still an hour of more of the ceremony before that occurs.

It's just a short drive up the road to the homestead where Stan lives. The homestead is a group of huts and a the skeletal remains of a maize field, fenced in just beyond a group of boulders which shelter it from the winds tearing over the mountains. There are two large grass thatched rondavels, three mud walled buildings, one exposed and one enclosed firehouses, and a small outhouse off in the lower corner. One of the mud walled buidlings is the "kitchen", which simply means that there is a table or counter in the corner for cutting food and several large containers of water on the floor. There is no electricity, no gas, and no running water.

Stan explains that he usually sleeps in one of the rondavels unless the winds become particularly strong, in which case he heads into the mudbrick houses. The day is cloudy with occasional sprinkles of rain, and the weather is cold. In Manzini it was simply a jacket day, but here in the mountains it looks like multiple layers will be needed. I try to imagine lasting the night in a straw hut with temperatures continuing to fall, particularly as Tim is the only one who has a sleeping bag. Myxo had suggested bringing one if available, but said it would be ok if not. Looking at the bare cement floor of the rondavel and knowing that Lisa and I only brought one of the hospital blankets with us, I'm not sure if "it will be ok" is the right assessment.

We are sent off to explore the area as Linda prepares lunch. We wander a bit and meet some children who are walking up the road. They immediately begin asking, "May we have a photograph?", much to Tim's delight. He begins contriving scenarios for pictures and directs the children: "Now we will all stand in front of this rock. Now we will all go way back here and run towards the camera." The kids are capivated by the images of themselves on the LCD screens of the digital cameras. The pictures, though, are that of need. Some of the children are barefoot; one of the youngest has a thin and torn shirt that she clutches to keep it from blowing off in the wind. Lisa is tempted to give this girl one of the several layers that she is wearing to deal with the cold, but she is so small the shirt would literally swallow her whole. She warms the girl's hands in her own before we are called back by Linda and must say goodbye to the children.

Lunch is simple fare: Rolls with lettuce and shredded cheese and sliced tomato, of which to make sandwiches. Cut bananna stands ready for "dessert" and a granadadia flavored soft drink serves as a beverage. We eat standing around a table outside. I kinda wish for a fire to warm things up a bit.

There will be no fire, though, because the five of us are headed out immediately after eating to drive back to the wedding for the gift exchange. Stan hangs back with the vehicle as Linda, Tim, Lisa and I walk back toward the tent. Our return is greeted with lunches packed in styrofoam containers. They apparently packed them when lunch was served here to be sure we didn't miss out. Linda takes there back to Stan and the car as the three of us are ushered back up toward the area just in front of the tent. One of the women takes us aside and explains the ceremony to us. "I visited the US, and there were so many things I wish I had someone to explain to me then," she remarks.

The couple has been married for thirty years, and they are now becoming married to one another's families. Sleeping mats, blankets, cookware, and other items are piled in the center of the group... these are the gifts that the couple are giving to the extended family. The wife is presently passing out items to each member of her husband's family. This "second marriage" apparently socially solidifies the relationship and makes divorce much harder. The ceremony is frequently done much earlier in the marriage, but because of the significant expense involved, many couples put it off until they have the resources to "do it right," as this couple has done. Once all of the gifts have been given, one final part of the ceremony remains. The wife places one of the sleeping mats out on the ground in the center of the circle and procedes to make a bed for her husband. The two of them then lay down in the bed together in front of both of their families, as well as the assembled guests. Sitting up, they share a cup of tea and piece of fruit, thus publicly acknowledging and sacrilizing marital sex. In a culture where promiscuity is a leading cause of the world's highest HIV rates, this seemed remarkably beautiful.

At this point, our translator has brought Lisa and myself (Tim is off chasing or being chased by children somewhere) into the center of the circle, sitting right to the side of the family. We have been so close that as the husband sat in bed with his wife, he smiled and waved at us. Unobtrusive escape is now impossible, so we are informed that we must say a word for the audience. The microphones which were just previously in use for the singing and dancing during the gift exchange are now being used for speeches by several of the family members, and we are to nominate one of the three of us to say where we are from and to offer a greeting to the crowd. Lisa volunteers or is volunteered, depending on your viewpoint. The three of us step up, and summoning the full range of our siSwati vocabulary, Lisa offers the traditional greeting, "Sanibonani" ("I see you all"), which is returned with a resounding "Yebo, Sis!" ("Yes, sister!"). She says a few words about us and thanks everyone for their hospitality (translated by the man who handed her the mic), before we slip back into the rear of the crowd.

The ceremony is essentially complete - additional speaches and a meal will follow, but we're headed out. Linda, Tim (still with three children in tow), Lisa and I begin the short walk back to the car.... except that the car is no longer there. Seeing that Linda is rather surprised at this turn of events, Lisa and I find the situation rather funny, but Linda is not amused. "Stan has taken the car. This is not good. Stan has taken the car, and he is drunk." Linda, Lisa and I stare for a moment more at the empty space where the car formerly sat; Tim is still trying to convince his three young tag-alongs that they cannot come with us. I'm no longer convinced that any of us can come with us. "My phone was in the car," reports Linda, "so we cannot even call. This is not good."

We begin a resolute walk back toward the road down the hill. A twenty or thirty minute walk will bring us back to the homestead, an perhaps that is our best shot at the moment. Linda's un-amusement is increasing. "I will not tell his brother. He will tell his brother, and his brother will kill him." We have made it about halfway to the road when we see the car approaching. The car, occupied by Stan and two other people, passes us and continues up the hill to where it was formerly parked. Lisa comments, "Well, that is good - now we know where the car is." Linda frowns and Lisa corrects herself under his glare: "Well, it is not good...." The car, with Stan now driving, returns down the hill to where we are waiting. There is a short conversation in siSwati before Linda takes the wheel and we all begin the drive back toward the homestead in relative quiet, quiet that is, except for an odd noise coming from the engine. Linda pulls over briefly to pop the hood and look inquizitively at the running engine. Another brief conversation in siSwati ensues, and we learn later that the vehicle will no longer start via the ignition switch; it must now be push-started to get the manual transmision to kick on. Linda seems quiet disappointed with this development, though Stan seems unfazed. The remainer of the ride back to the homestead seems like a miniature eternity.

( to be continued... )

New Hope Center

Saturday we were able to spend the day at one of the most glorious places in Swaziland. We visited the New Hope Center, which is an orphanage that was started by Dr. Elizabeth Hynd in 2004. Her grandfather is founder of the hospital I am working in, so the Hynd family is a wealth of information about Swaziland’s history and people. (read on)
She picked us up Saturday morning and drove us the 20 minutes to her center. Along the way she told us the story of how her grandfather began the hospital. She also told us a tale of how, as she states, “God came to Swaziland.” She says that about 250 years ago, on the mountain where her orphanage is now located, Swaziland’s current King was on top of the mountain sleeping and the Lord came to him in a dream. He said that white men with hair as horse tails would be coming to his land. In one hand they would have coins and in the other a book. The Lord instructed him that he was to ignore the coins, but he and his people should take the book and eat the book and they would live. A few generations later, as this story had been passed down, they heard that these men were somewhere in south Africa. (It was a Methodist mission convention.) The King sent some of his men to go and bring the men with hair as horse tails and the book back to Swaziland. The men went to the convention and told their story. The Methodist preachers there tried to explain that they had not planned on going that way yet because at the time Swaziland had not been mapped. They were going to Lesotho first. So, the Swazi’s told them, “that’s fine. But, we can’t go back to our King and tell him we failed, so we will just wait with you until you are ready.” So, the Methodists became ready and brought the book for the Swazi’s to eat.

This mountain where the new hope center is located is a space where generations of swazi women came every Friday night to pray. It was given to Dr. Elizabeth by the current king for development of her dream, the orphanage. It is truly a remarkable place. Dr. Elizabeth has her doctorate in psychology, and she has researched and thought this through extremely well. We arrived and were given the tour. First we saw the vegetable garden. Each of the 26 children has their own small plot for which they are responsible. Most of the veggies go for eating, but some are left over and are given away or sold. After the child pays a small amount for the seed, fertilizer, and other supplies needed to grow the crop, the money is theirs to keep. She says working the soil is part of the children’s heritage as Swazi’s, and it is important for them to continue it. Next we went through the grounds, the kitchen, girls and boys rooms, preschool and primary school. They provide school for the children of the center and a few other children from the community (if there is space). She says that she researched orphans in public school and found that even though the Kingdom provides school fees for all orphans, they do very poorly in the public school program. They often fail, get in trouble, and are often even blamed for trouble when they don’t do it because they have no one to take up for them. She decided it would be best to provide the schooling at the center, and so far, most, if not all, are excelling. She also puts a strong emphasis on Christian education—Christian curriculum, scripture memorization, observing rituals. Previously, I would have had many doubts as to whether or not this is appropriate in such an atmosphere (ie. Should this be forced on a child who really has no other options?), but after spending the day there, I’m impressed and would not presume to change a thing.
She told us many of the stories of how the different children came to live at the New Hope Center. Many are referred by pastors, social workers, or police. Some come by various other means. One man heard about her place while he lay in the hospital dying of AIDS. He sent the police to come pick Dr. Elizabeth up and bring her to his hospital room. He said he was dying and he had two boys. Their mother had died already, and he is not sure how they have been taking care of themselves for the past 4 months. She said they found the boys, and they had been surviving off of grasshoppers and any other source of food they could find. She says they were filthy. They probably had not bathed since their father left. She said their newest child arrived when a man dressed in his work clothes showed up on their doorstep. He said as he had taken a bus to work all week, he had passed a baby every day that had been left under a tree. He said she would be eaten out there; the animals and snakes will eat her. So, they arranged for him to be off the next day and take them to the place where he had seen the baby. They found her, a five-month-old baby girl there under a tree. They searched to see how she had gotten there and found out that both her parents had died and left her with another relative. That relative tried, but could not manage to care for her, so left her under a tree. That baby is now almost two, and as we were there we watched her roaming around everywhere in her walker and being loved and cared for by 25 other children as well as the staff.

While the stories of how the children arrived were all tragic, knowing a few of them helped me to be awed by what I saw and experienced during our afternoon there. We first went for a hike up the mountain with about 20 of the children and 3 other staff members. The hike up the mountain was a little difficult, but not nearly as difficult as trying to herd 20 children. At various points they would all disappear off the path into the guava trees looking for ripe fruit. The staff, uncles as they are called, would beat the trees with sticks and chase into the bushes to try to herd all of the children back to the path. But, every few feet there were more guava trees and the children would disappear again. Peter, one of the uncles, would “punish” the children by making them give him one of their guavas. There was much laughter. Many of the children would just walk up and grab our hands and walk away with us. The youngest boy at the orphanage, Joseph, would often walk while holding our hands, or he would take turns being carried on the backs of the older children. I had the pleasure of walking with him for a bit as he discovered the pleasures of stepping up onto a log and jumping off. So, then he had to take a jump off of every log (and stick and twig) he came across, laughing and squealing with joy at each one. We finally made it up to the top and enjoyed beautiful views. The children had a ball trying to throw rocks down the mountain while all the adults had a little stress trying to make sure they didn’t throw rocks at each other or throw themselves down the mountain. After we were all sufficiently worn out, we began the descent back down the mountain. By this time we were all hot, thirsty, and it was past lunch time. So, many of the boys ran ahead with sticks trying to kill grasshoppers and eat them. Uncle Peter says that they frequently do that, and apparently they are high in protein although he still has not tried one. Many others are saying, “I’m tired.” “I’m thirsty.” There are about 6 adults and 20 children, so we cannot carry them all. Eventually, we make it back for lunch, baked beans, wheat bread, and kool aid. It has never tasted so good!

After lunch we are entertained by Anastasia and a few other children doing dances that they have been teaching themselves to prepare for the upcoming Pentecost celebration. Then, it is time for a Saturday ritual, doing the laundry. Dr. Elizabeth told us earlier that washing together is an important social activity in the swazi culture, and they do it every Saturday afternoon. In the old days the women used to all go to the river together to wash, and then they would hang their clothes from the trees making a beautiful display of color. Clinton stated his surprise as all the children took off running when someone said, “Wash time”. This afternoon I had the privilege of helping my two new friends, Anastasia and Tirzah, with their wash. We filled watering cans at the spicket and carried them down the hill to the washbasins. Then we used bars of laundry soap. I didn’t even know such things existed. They laughed at me as they realized I was a novice. They said, “You don’t know how to wash!! Who does your wash for you?” So, they showed me the right way to hold and scrub the clothes. However, they didn’t show me how to do it without soaking myself. So, I made sure they got splashed a few times too! We had fun trying to see who could find the bar of soap among the clothes fastest, and it would slip through each of our hands. At one point Anastasia notices a bruise on my arm where I had blood taken the day before and says your green. I say it is a bruise. She says, “when I first arrived I was covered in bruises. I had to go to the hospital every day.
Everyone else got to get up and go to school, but I had to go to the hospital. But, now I’m healed.” I do not know all of her story, but I can only imagine the tragedy of her life before the New Hope center. It is so beautiful to see her laughing, loving, learning, growing, praying, dancing, singing, sharing, teaching. Later on she says to me proudly, “You know what my name means… Revelation life.” True enough. Spending the day with her has revealed more of the miracles of God than a thousand elsewhere.

After wash, we left to make it home before dark. It was a little sad to leave such a joyous place, but we were exhausted enough from the chaos that we were ready. I hope we get to visit again before we leave Swaziland, but our time is going by so fast.

Dr. Elizabeth shared many of her ideas and hopes for the future as funds and supplies are available. One of these is that she is looking for donations of used musical instruments to start Swaziland’s first orchestra with her children. If anyone reading is interested in helping in such a way, let me know.

Welcome to Student Housing

After three weeks, we had to move out of our lovely guesthouse and into the student flats in the hospital. Clinton wrote previously about our welcoming committee there. We had a different welcoming committee of sorts here as well.
(read on)First were the roaches the size of my thumb. They come out at night and sometimes as a family, mother and babies behind. They’re kind of gross, but I can get over that part. Then, after a few days, I woke up and looked in the mirror only to find the next member of the welcoming committee—a tick trying to hide among my eyelashes. I almost missed him. He was small and at first I just thought it was some morning eye gunk. But, as I tried to pull it off I realized that it had a pretty good grip on my skin. Then, I realized it had legs. I attempted to get sympathy from my husband, but he was laughing too hard to give any.

The next member of the welcoming committee made sure to pay a visit to us both. Well, maybe not a visit because we never saw him, but he definitely made his presence known. This was mister evil spider. He left a bite on each of us. Clinton got his on the forearm. Lucky jerk. Mine is on the groin. Dangerously close to my private areas. No more sleeping in my underwear in Africa. There will now be pants every night.
I must take the time here to point out my tremendous fear of spiders. I’ve gotten a little better about not being scared of every little spider, but the ones that bite you and make your skin rot off--- YUCK!!!!! I don’t think there is much that I am more scared of. And to think that one was crawling on me in my sleep!! (Over the next few days our bites are very sore. The center becomes purple necrotic tissue and begins to peel off. Now it just looks like a large scab. I guess I have survived it.)

After a couple of insect bites I’m feeling a little creepy and dirty, so I think a good hot bath might make me feel a little better. But wait—another welcome to student housing—there is no water. Throughout the week it was common to have the water turned off during the day because they were doing some work on the plumbing. But, it was always turned on again at night. Not this night. And it happened to be Friday. So Saturday morning Clinton goes to get water from a spigot elsewhere on the hospital grounds and is told that they must have forgotten to turn the water back on to our building. So we think there must be an easy solution. Clinton goes to the switchboard and explains our dilemma and asks if there is anyone who can help. Well, there is no maintenance man on call on the weekends. But, she will try to find the driver (apparently there is only one) to go pick him up and ask. To make a long story short, after many phone calls, many hours and many references to the “driver” who is never found, we discover that there is a problem with the plumbing. The piece needed to fix it was requested last week, but the funds to purchase it were not released in time for the weekend. So, maybe it will be fixed on Monday (thankfully this really meant Monday, not Monday in African time).

Monday we were able to bathe again. Clinton created us a hose to fit the nozzles on the tub so that we can even shower (kind of). However, Monday we experience our next welcome, the mysterious febrile illness. (if you hadn’t figured it out from Clinton’s blog, we’re the 2 travelers) For several nights in a row we both had fevers and chills throughout the night and in the morning (and with some ibuprofen) the fevers resolved and we felt OK, but weak and achy. As the week and the illness wore on, I was concerned enough about Malaria to be tested. It was negative, but it is often negative if the organisms are too few. So, Dr. Bitchong suggested we take a dose of malaria medicine to be on the safe side. He took me to the pharmacy Friday afternoon and we got a dose for the both of us. We haven’t had fevers since, and two days later we feel much better. Was it malaria? I guess we’ll never know.

So, now we await the next welcome…

You Be The Doctor

This is the part of the program where you, the internet audience, get to participate in the medical diagnoses of southern Africa. We will present the case, and you can guess at the malady.

The location is Swaziland; the season is winter, the time of year as colds and the flu begin to become more prevalent.
(read on)

Two visitors present with recurrent, sleep-disruptive hot and colds spells, headaches, and muscular soreness. The symptoms have been occurring over the course of a week and are successfully, though temporarily, alleviated by over-the-counter pain medicines and anti-inflammatories. While the area has negligible risk of malaria, each has recently spent a weekend in an area with low risk. Each also has a contemporaneous insect bite that has resulted in a one-centimeter lesion, consisting of a necrotic center surrounded by an inflammatory ring.

A blood test shows no noticeable malaria presence, a below average white cell count, and a low average platelet count. Local lab results are notorious for random inaccuracies.

What is your diagnosis?

a) Mild malarial infection (standard tropical/subtropical fare)
b) Severe spider bite (African equivalent of the brown recluse)
c) General viral infection (common African cold)
d) All of the above (too bad for them!)
e) None of the above (it must be something worse)

Record your answers here:

Who's Yo' Daddy?

I swear Dr. Bitchong is the black version of my father.

As the coordinator for visiting students, Dr. Bitchong has been one of our best helps in acclimating to the hospital here. Our frequent interactions have allowed me to realize the resemblance here.
(read on)

As I think on it now, a little over ten years ago, at the not-so-tender age of 17, my father sent me out to volunteer in the hospital in which his office was located, and there I got my first pay-by-the-hour job in the MIS department. So here in 2006, Dr. Bitchong has sent me back to volunteering with computers in a hospital. Two physicians, both putting me to work…. but let’s not stop there.

The point of comparison actually originally struck me as Dr. Bitchong was leading Monday morning devotions. Dr. Bitchong has a very gentle and didactic nature, much like my father, and as Dr. Bitchong was facilitating the small group who came up to the library early Monday morning, it reminded me of my father’s many Bible studies and the care he places in his teaching. I appreciate the gentle and enthusiastic style of communicating, and for both Dr. Bitchong and my father, the love-transferred-through-instruction seems to be a way of life. Sitting and listening to Dr. Bitchong felt slightly surreal as I saw my dad.

The experience which I found ironic enough to inspire my blog, though, was when Dr. Bitchong called me one night and stated, “I have an issue with my computer.” Some people simply “get along” with computers less fluidly than others. That night I sat with Dr. Bitchong for three hours as we tried to coerce his laptop into being responsive enough to at least get his dissertation project off the disk… and I thought, I bet my father could commiserate with this situation.

So for pushing me, and teaching me, and giving me broken laptops to fix…. Here’s a tribute raised to Dr. Bitchong and Dr. Graham.

Time Times Three

So today I finally got the indexing component for the Card Room application to work. At the office our general rule of thumb is “take your expectation for a project timeline and multiply by three,” because everything you expect to go wrong will do so, and then something else will as well. It is the nature of coding. Binding two dozen or so fields in four tables for an indexing application? Give me a week to get it implemented and looking pretty… or, oh, make that three.
(read on...)
The former developer left his old code, which made understanding the (non)functionality of the existing application easier. It was clearly in a transitional stage when the funds ran out and development stopped… a cross between rudimentary application code and database structure headed for sophisticated business logic. The password embedded in the datasource login fortunately also gave access to the in-progress documentation, but unfortunately revealed little more than more information on the project lifecycle. The prior application was a bit of help in understanding some of the business logic behind the Card Room, but mostly left me learning process information from my eternal questions for Dan. And time ticks away…

Of the three computers in the Card Room there were a collective zero fully-functional keyboards. One of them comes close… all of the keys work except for the Enter key. I even took them back to the flat for a washing to try to rehab them, but no luck. The mouse situation is similar, but fortunately even the hole-in-the-wall computer shops in Manzini have decent keyboard and mice in stock. The same can not be said of decent routers. All I wanted was a nice 5+ port 10/100 Ethernet router with builtin DHCP, security, and QOS management components. In the States, this would be no problem. Linksys has a quite acceptable model for about $50. Here I paid nearly $75 for a noname switched hub, with none of the above features. And speaking of hardware, add a lost day to the panic of having the laptop I brought with all my software tools crash in the middle of work and refuse to boot. So still time ticks away…

So, finally I get to coding… I’ve figured on throwing something together in Visual Basic 6, as it’s the only Win32 development platform a) that I own and can easily bring to Africa, and b) in which I feel comfortable coding without Internet access to API references. The factor I’ve neglected here is the ADO. ADO stands for ActiveX Data Objects, and is Microsoft’s library for making database access “easy”. In planning my work here, I’ve neglected the simple fact that the ADO hates me. I don’t know why, but it does. You’re supposed to be able to add standard windows elements to the screen, bind them to an ADO control, and let the ADO handle all the background work. It never works for me like that. It never has. I add the elements, I bind them to the ADO controls, and from there on out the situation goes from worse to worserer. The bound field has a DataChanged property of true, but the bound field doesn’t update. The bound field causes an error on update, and then the same bound field causes no errors on update. The bound field errors on canceling the update, and then the cancel cancels itself. Bloody heck, does anyone actually use this stuff successfully?

Time still ticks away as I recode everything to manual binding and standard screen writes, but at least the bloody code works. The next step is to provide training for the Card Room staff (who largely have no computer experience) in a development environment, so I can adapt the application to catch any bugs and prevent common data errors. Hopefully that will only take 1.5 weeks or so, otherwise I won’t be able to fit it in the 5 remaining.

Oh, and BTW, I still haven't seen a glimpse of the elusive Card Room Committee.

Three new babies

I spent Thursday evening in the labor ward. I was blessed to see 3 new lives brought into the world. The labor ward, like everything else, is very primitive. It is a room with about 8 beds. The women lie in the beds naked, each in a different stage of labor. There are no fathers for support, no family members. The family waits outside the ward, if they are here at all. Tonight, there are two women close to giving birth. There is also no pain control, so the groans of labor pain are loud and clear. I watch as the midwives check to see the progress. I’m told that after I watch 3, I have to do them on my own.
(read on) The first woman is ready to push. Her name is Nohbule. The midwife leads her through, “Kaka kakuhl, kaka kakuhl” - meaning push deep, push deep. As she is pushing, I notice the other woman, 2 beds away, begins to push as well. I also notice a large spider crawling up the bed in between. They are so common here, I’m almost used to them. Nohbule continues to push. The beds are simple thin mattresses covered in plastic. If the women have brought sheets or blankets from home, then those are on the bed as well. Nohbule gives birth to a beautiful baby boy, but there is still another yet to come. Twins. Phindile, the midwife, holds up the baby for Nohbule to see before we take him to the Nursery to be weighed and cleaned. . “A boy”, Nohbule says without any change of expression. We return to assist Nohbule with the next baby, but she is getting too tired to push. The other woman is almost finished. She delivers a baby girl. The girl is taken into the next room. Just a few moments afterward, the woman who has just given birth is getting up to clean herself and get dressed. She takes no time to lay and rest. She is looking around the room, and although her expression is as stoic as Nohbule’s, I can tell she is looking for someone to share her joy. We make eye contact and she smiles a big, proud smile. I tell her that her daughter is very beautiful, and she smiles even bigger. By this time, both midwives are working with Nohbule. She is too exhausted to push, so one midwife is pressing on her belly as the other is delivering. The second boy comes out, and the mother is able to rest. This baby is also taken into the next room and I look at the mother and say, “you did it”. She says, “yes, I am happy” although her expression remains unchanged. By this time the other woman is dressed and ready to go to the post partum ward, but first she is asking for change. She wants to make a phone call. I can’t imagine giving birth and having no friends or family there to share it with me.

I spend the next several minutes in the room where the newborns are resting. It is so sweet to watch them. In a place where I have seen and heard so many sad stories, I am overwhelmed with joy to spend a few minutes with 3 healthy new babies in their first moments on earth. It’s the first time I have actually been close to tears since I have arrived. I talk with them even though they don’t understand me. I introduce them to one another, and tell them their mothers are well and happy to have them. I pray that God will watch over them and I fight back all the fearful thoughts of the many sick children I have seen, while clinging to the hope I see in new life before me. I think this will be one of my favorite memories of Africa.

The OB/GYN routine

This week I began my OB-GYN rotation here. Monday through Wednesday is pretty much the same routine. I begin rounds in the GYN ward. Here are women who suffer from a recent miscarriage and the complications thereof, women with severe pelvic inflammatory disease, cervical cancer, and all of the previous problems complicated by HIV, TB or both.
(read on)

Dr. Bokiki rounds on this ward. He is an older doctor from the Congo. He has been here for 2 years. He has a little bit of a rough style that has taken some getting used to. He has had a bit of trouble with nursing care on the wards this week. Many patients are there for infectious processes, and there are no daily temperatures taken in the chart. Patients are without blood pressures recorded. Labs and ultrasounds that have been requested are not done. One patient was admitted to manage gestational diabetes and her blood sugar level is taken once instead of the every six hours that was requested. One day there was only one nurse on duty, which could have provided a reason. But, many days there are adequate nurses as well as nursing students, and the same problems remain. It seems to be just another illustration of “African time”. There is simply no sense of urgency or importance placed on efficiency. This is difficult for me to understand.

Like my pediatrics rotation, after rounds we go to outpatient clinic. Women come here for prenatal care and many come for miscarriages and sexually transmitted infections. At least one or two children ages 3-13 have come in daily with a police document to be examined for evidence of sexual abuse. One 3-year-old girl had to be prescribed HIV medicines to hopefully prevent transmission because she had been raped by an HIV positive man. I cannot imagine the horror of such an act. I wonder how common sexual abuse is here, but at the same time I am afraid of knowing the answer.

This week has been largely characterized by many frustrations with the state of things for women in Swaziland. For everyone really, but I have especially seen the female perspective doing a gyn rotation. There are so many sexually transmitted diseases. One frustration comes with the hospital’s lack of ability to do many tests that are common in the US. A woman comes in complaining of STD symptoms, and all they can do is put her on several antibiotics. No tests are done. I have also had a lot of frustration with the patient-doctor relationship. I am used to the current state in the US, and maybe it was even different there before I was born. Here, the doctor does not explain to the woman what is wrong with them. They present their complaints, the doctor does an exam, and then he writes a prescription, hands it to her and sends the woman to the pharmacy. No talk of the condition, no talk of prevention, no mention of the many things that we are taught to discuss in our training. I am sure this is a product of many factors. All the doctors I have worked with in GYN are men. Maybe it is uncomfortable for them to have such discussions with women. The doctors are general practitioners. None have specialized in OB-GYN. Most are working here to save money to go back to specialize in an unrelated field. This just happened to be the best opportunity for the time being. Most of them do not speak the native Siswati. Some even have trouble with English because they are from a French speaking part of Africa. Maybe the difficulty of conversation prevents the discussions. I still find it frustrating.

It is also hard to see so many women suffer from severe pelvic inflammatory disease secondary to an STD. It takes both sexes for these to be spread, but it seems as if women have a harder time with the consequences. One 40-year-old woman this week presented with a severe pelvic abscess secondary to infection and a miscarriage a month ago. She was in tremendous pain and had trouble walking. She had not been able to afford the antibiotic prescribed to her after her miscarriage, and she had then developed this infection. She was alone and unmarried. There was no one listed in her chart for next of kin. Where is the man that helped contribute to this condition? She should not have to suffer for this alone. I wonder how the women here allow themselves to be treated so poorly. I have a long way to go in understanding.

Women in Swaziland are considered legal minors. They are allowed to vote, but they are often prevented from owning land. There is still a lot of pressure for girls to drop out of school and help at home. Many girls are forced to drop out when they become pregnant. It is hard for me to understand this. I was born in the 70’s in the US. Many women before me fought for the rights of women there, and I have never had to live in an environment where I was unequal as a woman.

In many ways, however, I really admire African women. I see them carrying their children on their backs as the travel on the kombis and sell vegetables and crafts at the market. I have seen them sit at the side of their sick and dying children and grandchildren. I have seen them in the pains of childbirth. I see them continue to live and produce life in the midst of pain and suffering. There truly is a character that emerges in someone who endures hardship and this is evident in many of the women I encounter and that I admire.

Return of the ISDN

Our local net-hawker was approved for his loan, and so his overdue ISP bill is paid, giving us nearby Internet access once again. We stopped by his place earlier, fully expecting to hear the familiar and expected report of “sorry, it will be fixed for tomorrow.” We were pleasantly surprised, however, to discover full dual-channel ISDN rather than excuses. Not a bad improvement. We’re still looking at something like 500 ms latency as the Internet request travels from our little café in Manzini to a server in New York or Lexington, but I’ve decided that slow Internet is better than no Internet. Well, maybe “decided” is too strong a word. I’ll at least tell myself that for the time being. If I can’t sustain an effective 1 kbps connection, though, I do reserve the right to change my mind… but for now, it’s good to be back online.