Fri 060526
Around 10:30 last night a thunderstorm came rolling through, complete with hail, which sounds rather loud when sleeping about 3 feet away from the sloping edge of a thatched roof! Jeff was kind enough to run outside and take a picture. (Hail in Eswatini is uncommon, I have learned, and hail in Winter in Eswatini is even more unusual since this is the dry season.)
The storm didn't last long, however, and this morning was bright and beautiful, as we walked over to the coffee shop (the morning meeting place where we meet up with the vehicles taking us to our locations for the day.) This pic is looking out the door of the coffee shop.
The HBC teams go out into the rural areas to provide medical care for those who have significant need and difficulty coming to the hospital. For example, they met with an HIV+ elderly gentleman who was living alone and hadn't eaten or taken medications for a long time and has difficulty ambulating. So many issues that need addressing, they cannot all be "solved", but a home care visit can provide some support and assistance.
The PDI group went out on a home building project. The family (mother, father, 6 children) lived in a mud/stick home on land that was not their own (squatters). After consultation with the chief, land was identified where PDI could build them a new (one room) home. Ground had already been cleared of brush, so the team today helped with carrying stones of the appropriate certain size from around the land to one location for use in the foundation. Then they went to visit the family in their current home to drop off food. The mother has cancer and is mostly in a wheelchair, dad is not around much, the older 4 children were at school, and so mom was home with the two younger children, cooking rice and beans for lunch. One of the young (not even school age) children was tending the open fire/adding firewood since mom has limited ability to walk. Again, many needs here, but what hope and encouragement PDI is providing for this family!
While Denise and I waited for Anita, who had gone back for something, I walked around and found these garbage cans outside the cafeteria with some scavenging cats.
The hospital was very small, with a maternal wing (above), a male medicine section , and a female medicine (non-maternity) section. There were maybe 6 male rooms and 6 female non-maternity rooms. Each room had 4-6 beds which were pretty much right up against each other. There were quite a few maternity patients/newborns, but the rest of the hospital did not have many patients. I learned that it used to be more busy, but since the government hospital expanded, some people now go there instead. There are two general medicine doctors (to cover inpatient services, ED and clinics), 2 OB/GYN doctors, one pediatrician, and one surgeon. That's it. No anesthesiologists (nurse anesthetists cover the surgeries), pathologists, radiologists, psychiatrists, or any other type of specialty doctor).
Anita introduced me to Dr.Gaza, who I would be with for the day, and later I met his intern. I asked both of them where they went to medical school. Dr. Gaza - Ethiopia; the intern - Ukraine. I assumed that Dr. Gaza was from Eswatini originally and that the intern was from Ukraine, but I learned later in the day that both assumptions were incorrect.
This is the first patient I met, and she kindly allowed me to take her picture. She came in due to swelling and discoloration of her hand and was found to have liver function abnormalities, with long history of diabetes and HIV. Her hepatitis B surface antigen testing was negative. Dr. Gaza and I discussed other possible causes of liver failure. I asked about her Hepatitis C status. Dr. Gaza said they can't test for that there (their lab doesn't have that test and it would take too long / be too expensive to send it out). Other possible causes of liver failure like schistosomiasis, etc were discussed, but a liver biopsy is out of the question. Even if a biopsy could be done, it would take several months to get a result back....It will be hard to restart antiretroviral therapy (ART) with the significant liver function abnormalities present. She couldn't remember why she had stopped the ART....(The gangrene on her hand is secondary to uncontrolled diabetes and will require an amputation but need to get liver functions normalized first.....)
I asked if they could monitor a patient in their ICU unit remotely, from the nursing station, and was told that this table in the middle of the room IS the nursing station. (The nurse manager for this unit is in red, next to her is the intern, and Dr. Gaza is the third person).
This is the Emergency Room (three beds).
Next we went to the new building, just opened last year!! This is where the laboratory, radiology, and the newer clinic space is. There is a smaller clinic next to the ED in main GSH, where patients can go if they cannot pay. In the old building, patients come into a general waiting area (without appointments) and are assessed, than assigned to either the clinic or the ED. In the new clinic, there are also no appointments - patients just wait in the hallway until the doctor can see them.
Give me Your eyes for just one second
Give me Your eyes so I can see
Everything that I keep missing
Give me Your love for humanity
Give me Your arms for the broken hearted
The ones that are far beyond my reach
Give me Your heart for the one's forgotten
Give me Your eyes so I can see
(Brandon Heath - Give Me Your Eyes)
This is the entrance to the old ED/clinic (back side of hospital building),
If you turn around from where I was standing to take the above picture, you can see the NEW clinic/lab/radiology building below. What a beautiful bright, new building!
Dr. Gaza (knowing I am a hematopathologist, asked if I would like to see the malaria smear. I said YES!!, so we walked over to the lab. This is the inside of the lab - spacious, clean, and nice. The lab techs were very friendly also. They had the various benches labeled - chemistry, hematology, flow cytometry, blood bank. They do have microbiology also, but it was in a different room. I was excited to see that they had a flow cytometer ( a fairly expensive piece of equipment). When I asked about it, however, I found out it wasn't working and even when it was working the only test available was a CD4 count (for the HIV patients). But now they cannot even do that.
Here are the lab techs (on the left) and the intern (on the right),at the microscope . I took a picture of the malaria smear and started discussing with them how what I am used to looking at is a thin smear where the red cells are not lysed. They said they did the thick smear (which UIHC does in the microbiology department) which lyses the red blood cells. I was super excited to be looking at the smear with them and having such a great discussion about it. I took a picture of the malaria smear and then both the intern and Dr. Gaza (who rarely even go in the lab) wanted to look at the slide.
The picture is not great since it was taken by holding my cell phone up to the ocular of the microscope, but the small dots are the malaria and the three large blobs are the white blood cells.
Next we went to the new clinic space and I sat in with Dr. Gaza as he saw patients. There were a lot of patients here. Many of the problems are the same as in the US - hypertension, asthma, diabetes, headaches, osteoarthritis, etc. But many of the patients had HIV (maybe 70% or so) and many had a history of prior TB infection. Also, many came in with VERY high blood pressure or VERY HIGH blood sugar.... There was a man who was blind due to diabetic retinopathy - so preventable if his diabetes could have been better controlled. I noticed that when Dr. Gaza asked if a patient was on say diabetes medicine, they might say "yes, metformin". One might think that meant they were taking metformin. But then when he asked when their last dose was, they would say "several months ago". They just run out and don't refill due to cost or difficulty coming to the hospital to get it refilled. (but yet they still consider themselves to be "on" the medicine...)Same for HIV medicine, blood pressure medicine, etc.
From 1-2pm, we took a lunch break. Anita had said I could eat in the cafeteria, so when Dr. Gaza asked if I had a plan for lunch, I said "yes, I brought a lunch and I was going to eat it in the cafeteria." Then he said "where's that?" which was a little disconcerting, but I assured him I could find it because Anita had shown me where it was (I was thinking of saying "well, it's by where the cats hang out in the garbage cans", BUT I DIDNT)
When I got to the cafeteria, it was empty, but Anita had said it might be empty, so I just went in and sat down and started eating my lunch. (There was a sink in one corner, with soap, no paper towels, but hey, air dry is fine).
As I was eating, the girl in the pink hat below came in and started eating so I asked if I could join her. She said sure. We talked and I found out she is a secretary at the hospital. She has a degree in "science and technology", but couldn't find a job, so she went back to school and got her certificate to be a secretary. She also previously volunteered at the NGO called "Pads for Girls" which distributes menstrual pads to girls who cannot afford them. After a while, two of her friends came in and they started up a game of cards. I had finished eating, so went outside for a while and found a nice stump to sit on in the sun. After a little while, Denise wandered by (she had been in neonatal/delivery/pediatrics all day). We talked for a while, then I went back in to meet Dr. Gaza. Denise was pretty much done for the day, but the plan was to meet at the gate to the hospital at 3pm. I said I would call Philani prior to leaving the clinic since he was going to come give us a ride back to Mabuda (the guesthouse where we have been staying)
Back in the clinic, Dr. Gaza and I saw more patients together. Throughout the day, the intern (who was seeing patients in another clinic room and also various other people would just come in to consult with Dr. Gaza about their patients or situations that had come up. At one point, someone from the ED came in (while we were meeting with a patient) to talk with Dr Gaza about a woman who had come into the ED after a suicide attempt (via ingestion), to discuss how best to treat this patient.
Back in the clinic, Dr. Gaza and I saw more patients together. Throughout the day, the intern (who was seeing patients in another clinic room and also various other people would just come in to consult with Dr. Gaza about their patients or situations that had come up. At one point, someone from the ED came in (while we were meeting with a patient) to talk with Dr Gaza about a woman who had come into the ED after a suicide attempt (via ingestion), to discuss how best to treat this patient.
Language was also an issue, because although many of the patients spoke English some did not. Some (older patients) only spoke Siswati, and for these Dr Gaza needed an interpreter (which was how I figured out he was not from Eswatini. He is from Ethiopia, where he did medical school, and only came to Eswatini after. Sometimes the intern served as his interpreter (because she is from Eswatini, and only went to medical school in Ukraine). There were other patients who came from Mozambique, and for these he needed the Portuguese interpreter (who only is there certain days - not sure what Dr. Gaza does when she is not there...)
There was one young Swazi female (who spoke English) who presented with left sided abdominal pain. He discussed with her the possibility of pregnancy, but she said that's not possible. He asked if there was any chance at all, was she 50% sure, 100% sure, 150% sure?) She said there was no chance - she was 100% sure. No actual pregnancy test was done (not sue if it is available), but he moved on to other differentials. and after further questions eventually was thinking that maybe she had peptic ulcer disease. She flat out said "I don't have symptoms of peptic ulcers". He said "oh? you know the symptoms of peptic ulcers? What are they?" Now she was a little taken aback but said "uh, a feeling of fullness..." "Yes" he said "what else?" She said "abdominal pain..." He said "didn't you just tell me you are having abdominal pain?" Eventually she went off to ultrasound for a scan (once they discussed the price and she determined she could afford it). I wasn't there to hear the followup of that.
There was a different patient for whom Dr Gaza suggested colonoscopy (which would have to be done elsewhere since it is not performed at GSH), but the patient burst out laughing when the price was discussed, and said that was not going to be possible. He was constipated x 3 weeks and had significant weight loss, so colon cancer is a strong possibility.....The patient just wanted a medicine to help with the constipation and another medicine to help with his appetite.
Pretty soon it was time to go.
At dinner, Sibrian, Sam, and Nate (Nah'tay), our caterers, each shared their story (Sibrian is next to Kasha below, and Sam is next to Sibrian.)
Sam shared how their catering for Anita all started because he loved to cook, and he had been asked by a church if he could cater for a church gathering of about 100 people. He said sure. They said - BY YOURSELF? He said, no he had friends who could pitch in and help him. They did this several times and eventually he met Anita, who uses their catering services whenever she is at Mabuda.
I asked the woman at the desk if she could please call Phalani for me, which she did on her cellphone (It's a Swazi number, so I couldn't use my phone). But he didn't answer, so I went to meet Denise at the gate and maybe try to call again later. When I got to the gate, Denise was not there, so I hung out there for a while. At one point one of the HBC drivers was pulling in through the gate, so I walked over and said hello. He said he had just dropped off people from our group at Mabuda, and I asked if he could call Phalani for me, which he did, but again no answer. He offered to give me a ride back, but I still wasn't sure what happened to Denise so didn't want to do that. But as I looked up, Denise was walking up the road from the hospital toward us. She had gone back to the labor and delivery area and had just watched a birth, so that's why she was late. Since we were both there and Phalani wasn't answering his phone, we accepted the ride from the HBC driver. As it turns out, Phalani was delayed in picking up Shane and Kasha from the hotel, so he was still driving them to Mabuda when we were trying to call him (and he is not supposed to answer his cell phone while driving). As we pulled up to the coffee house, we saw Anita in our other van with Ndumiso driving, so we waved at each other. They were just about to head over to GSH to pick us up - good thing they didn't because we would have passed each other on the road!
Beautiful flower outside the coffee house....
Laura presented the devotion tonight, based on this verse -
Matthew 18:3: “Truly, I say to you, unless you turn and become like children, you will never enter the kingdom of heaven."
We talked about how WE want to be in control, but God wants us to be "like children" - totally dependent on Him and looking to Him the way a small child looks to his parents. We talked about many examples in our lives of how we couldn't see how things were possibly going to work out, and then they did in ways we would not have predicted. It is not just chance or luck. God sees and provides solutions in ways that we would not have imagined.
Sam and Nate.
Nate also shared about his new NGO - Umboon'du Care and Connect. (Umboon'du means community in Siswati). He met Anita when he was serving on a HBC team and saw Anita going into a mud/stick home to remove a massive termite infestation in the dirt floor of the house with nothing but a shovel to dig up the mounds and take them out, still swarming with ants. He grew up in the city and did not know that such poverty existed in the rural areas, but when he saw it, he knew he had to do something. He started by contacting farmers to see if they would be willing to give the left overs from their fields to the poor if he came to collect it. He found many who were willing. He since has expanded to also providing firewood and donated used clothes to the poor, then teaching them gardening skills and helping them get a small garden plot started so they can be grow food for themselves. He also started an NGO garden where they grow cassava and other crops high in nutrients to help supplement a typical rice and beans diet.
Nomsa Gemedze also joined us for dinner. She is essentially alone at the NGO Operation Hope (but is currently training in another worker). The aims of this NGO are similar to PDI, but they serve different parts of the country. She was raised by her grandmother and had a child before marriage, so she knows firsthand the complications that result from that situation and wants to lead other young girls in a different direction. She became a born again Christian, and started offering to take people to church who couldn't get there on there own. She believes this is the life of a Christian - to love and serve others as Christ loves us and served us on the cross.
She listed many things this NGO does with regard to both family -centered goals (building houses, helping people gain business skills and start a small business, assisting people who were born at home but now need a birth certificate in order to get a job, providing school uniforms - sometimes the only barrier someone has to going to school is lack of money to buy the uniform!) and community centered goals (building schools, including building an outhouse of brick with a separate space for boys and girls and making sure there is toilet paper in it for a school that only had a single mud and stick outhouse without a door, to be used by both boys and girls and they were using old school books for toilet paper since there was no TP available. Also building administrative space for the principal, who was working out of his car, and so many more examples.)
This is Nomsa with Anita and Shane.
Both our caterers and Nomsa stressed the importance of assessing the community needs first and not just barging in with your own ideas. Clearly these are people who have a servant heart. People who have opened their eyes to the many needs of the people in these rural areas living in abject poverty. People who live their lives not for themselves, but do whatever they can to help end the cycle of poverty.
If you pour yourself out for the hungry and satisfy the desire of the afflicted, then shall your light rise in the darkness and your gloom be as the noonday (Isaiah 58:10)
Lord, as you open our eyes to the needs of those in the rural areas of Eswatini, we give you thanks for the work of these NGOs, for these servants of yours whom we have met who have not been daunted and who have not walked away from the needs of those living in abject poverty and suffering in ways we cannot comprehend. Be with the workers at these NGOs. Strengthen them, uplift them, give them ingenuity to battle the many problems of the people in Eswatini. May we be a support for these servents of yours who tirelessly work to better the lives of others in their communities.
Amen.
Give me Your eyes so I can see
Everything that I keep missing
Give me Your love for humanity
Give me Your arms for the broken hearted
The ones that are far beyond my reach
Give me Your heart for the one's forgotten
Give me Your eyes so I can see
(Brandon Heath - Give Me Your Eyes)
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