Tuesday, November 25, 2008

My last Monday at GSH

Mondays in any medical setting are notoriously busy. I always start Mondays here with a sense of dread. Who died over the weekend and what new admissions await me?
Yesterday was by far the worst Monday I have experienced so far. Rather ironic that it just so happens to be my last. I had 16 new admissions over the weekend and this was in addition to the 20 or so that I already had on the ward. All the new patients had HIV, all were critically unwell and all required complex management plans that took me hours to organise. For the first time ever, I started to get really cranky at my nurses- something I have always prided myself on not doing. During the ward round, two of my patients died. One was 20 years old, had AIDS and presumably died of meningitis. Her neck was so stiff that when I went to lift her head off the bed, the rest of her body came up with her. The medical term for this is nuchal rigidity and I have never seen it quite as profoundly as what we see here. The second patient, also in her 20s also died from an AIDS related illness. I wish I could eloquently describe the feelings that emerge inside of me when I face days like this, but I am unable to put into words the series of emotions that leave me with an utter sense of despair.

Last night, as I lay on my bed, just staring at the ceiling, I started to think about what constitutes a “disaster”. When a bus crashes and people are killed, the news headlines read “Disaster”. When kids in China are poisoned with melamine, we call this a “disaster”. When the economy crashes and people have to tighten their belts a bit, we call this a “disaster”. I don’t want to trivialise these issues, because to the individual, these are important- but what do I call what’s happening here?
I’m working in a hospital where 100% of my patients have AIDS. They are suffering shocking conditions that we don’t always have the resources to adequately investigate or treat. We are now overcrowded and have to turn sick people away because we have run out of beds and floor space. We’ve even run out of sheets to put on the beds. Now most of my patients are between 20 and 30 years old. Most have children that will be left without a mother when my patient dies. Even if I manage to improve my patients’ condition, they are discharged home where they struggle daily to access food and water. They often can’t afford the medications that I prescribe them to keep them well. They can’t afford to pay for transport to come back for a review visit so that I can try and keep them well.
So I ask you, why then is this not on the front page of the newspaper and quoted to be a “disaster”? What needs to happen further before we realise that the lives lost here are just as important as the lives lost anywhere else in the world? I don’t understand why the world is not screaming out about the injustices that allow almost 50% of a population to be afflicted with the one disease.

Then I am faced with my own sense of guilt, because I am abandoning what I consider a disaster. Does this not make me as guilty as the rest of the world that chooses to turn the other way instead of facing the reality of this disaster here in Swaziland? But the reality is, I cannot face the pervasive smell of death any more. I’m not sure when the time will come when I can close my eyes at night and not see the bodies of my patients, emaciated, covered in fungal skin conditions and languishing in their own excretement. I don’t know when I will not be able to hear their cries and their desperate pleas to me to ease their suffering. I don’t know when I will ever truly state that I have any sense of hope for Swaziland.

I usually spend Monday evenings with the Pons’. I called them and told them that I wasn’t able to make it last night. I felt so completely depleted. At Helen’s insistence, I ended up going and I am pleased that I did so, because I felt a lot better afterwards. The Pons’ have been incredibly kind and generous towards me during my stay in Swaziland. Helen has become a particularly valued friend and she has provided me with a great deal of compassion and comfort that I will always be grateful for. At the end of the evening I brought home a companion called Ginger. He’s the kitten that belongs to the youngest Pons- Ruth. They are going away for a few days and they asked me to care for the tiny animal. He’s ginger (duh!) and has the most magnificent blue eyes. He is about 5 weeks old and no bigger than the size of my hand. I am completely in love with him and I think he feels the same way about me. I really like cats, but I have resisted the temptation to get my own as I have always felt that this would cement my future as a spinster. It seems that in my experience, all spinsters tend to have a cat and I am determined not to follow a similar fate. I do, however, feel that this is only a temporary arrangement and therefore unlikely to have a negative impact on my marriage prospects. However, I went back to check on him after my ward round and I was rather disturbed to find him playing with the strap of my bra that I had left out to dry. Whilst you may not find this anything to be disturbed about, this actual event is not the first time that an animal has taken a liking to my unmentionables. Last year, I looked after a dog, called Patrick, when his owners went overseas for a holiday. Patrick had the rather disturbing habit of going into my wash basket, selecting out my underwear and distributing it throughout the house. I believe he actually buried one of my particularly expensive bras, because I searched everywhere for that item and it was never to be found. So, it is with this new piece of animal evidence that I have concluded that the reason I can’t attract men is the fact that I must be secreting a pheromone that attracts animals only. Now I thought Africa was the only thing that had problems……

Sunday, November 23, 2008

New contact details

The computer at Good Shepherd has a virus and has crashed in a big way. I can no longer receive emails at
If you would like to contact me, please email

Saturday, November 22, 2008

One more week to go at Good Shepherd

It seems that despite only having one more week at Good Shepherd, I am going to be challenged right up until the very end.
It’s been a disastrous week in terms of what has been happening on my ward. Multiple deaths on a daily basis. On one day, I had 4 die within hours of each other and I was devastated. I started to question my ability and started wondering what I was doing wrong. In a moment of clarity, I was able to recognise that all these patients were incredibly sick with advanced AIDS and horrendous complications and no matter how much I fought for their lives, they were going to die anyway. It still doesn’t make it any easier.

I gave my nurses their last tutorial on Friday morning and I can’t help but feel that I am “abandoning them”. We have worked hard together and we have developed systems that have truly had a positive impact on patient care. I know that this will all inevitably fall apart once I leave as there will only be one physician to run both male wards/female wards and outpatients. An almost impossible task.

Julia returned to the USA on Thursday and we feel like we have lost a member of our family. She was one of the most incredible people I have ever had the privilege of meeting. At 23 years of age, she finished nursing school and came straight to Swaziland. An enormously courageous and selfless thing to do. She had been here for 12 months and during that time she integrated herself into the Swazi community by learning their language, immersing herself in their culture and dedicating herself to caring for the sick and destitute. She was also an incredible friend to me- her support and encouragement was invaluable. We shared many laughs and many tears and I feel a connection with her that will last a lifetime. I am so excited to see what her future holds as I know she is going to embark on more adventures that will lead to a truly extraordinary life.

By Friday, I was starting to feel completely depleted of any reserve to continue caring for my patients. I finished my ward round and then retreated to have a good cry. Thankfully, Susan informed me that she was going to Mbabane for a meeting and she asked me if I would like to join her. Being a volunteer, I have the freedom to say “I’m not coming to outpatients today”, so I happily accepted her invitation and we made our way into the capital city. We had a pleasant lunch and then made our way to one of the big hotels that was hosting a guest speaker from the USA. Her name was Dr Wafaa El-Sadr and she is the international director for ICAP (International Centre for AIDS care and treatment programmes). She is an infectious disease specialist who works at Harlem Hospital in New York under the auspices of Columbia University. She is an international expert on AIDS. She was giving a talk on AIDS and anti-retroviral treatment and she discussed the recent results of a huge international study called the SMART study. I listened to her in complete awe. It has been so long since I have been in an academic environment and I relished the opportunity to hear of her talking about disease, epidemiology, drug treatment and hopes for the future of AIDS. She must have noticed my enthusiasm for what she was saying because she came up to me after the talk and I introduced myself as an Australian doing my small part against AIDS here in Swaziland. She was very gracious and polite (and tried to convince me to give up emergency medicine and become involved in public health) and I found myself to be quite overwhelmed by being in her presence. I know this will sound absolutely ridiculous for some of you, but in medicine, there are some people who we consider “gurus” and I know she is one of them. I felt like I was in the company of a “super star”.
Susan and I felt re-invigorated that despite the hopelessness we see here, on an international scale, there is still a lot of passionate work being done to combat this disease.

By this stage it was about 7.30pm and we faced the dilemma of whether to drive back to Good Shepherd or stay in Mbabane for the night. We have been constantly advised not to drive in Swaziland at night as it is considered extremely dangerous. Despite the normal dangers of poor roads, the ever present cattle and goats that meander across the roads and the fact that no one here pays any attention to road rules or speed limits, we were also faced with poor visibility. However, I have not received any income since the beginning of July and my finances are starting to dwindle, so I was reluctant to stay in a hotel overnight. Susan was also keen to get home and she thought she was capable of safely navigating her way back to Good Shepherd. So we set out in the dark and I have to admit I was hyper-vigilant and nervous. Susan was extremely careful and as we made it closer to Siteki, I started to feel reassured that we would be OK. The reassurance did not last for long. We were within about 10 kilometres from home when a car recklessly came out in front of us and Susan had to suddenly slam the brakes and swerve off the road to avoid a collision. It was simply terrifying and we were physically and emotionally shaken. The rest of our trip was in silence as we both reflected on what could have occurred. There is no doubt in our minds that if Susan had not been so alert and her reflexes not so quick, we would have been in the midst of a disaster. There are no ambulance services here in Swaziland. The facilities here at Good Shepherd- if we had made it to a hospital alive- would have been inadequate to deal with severe trauma. We have run out of blood here, so if we needed a blood transfusion, we would not have had any blood available. I know these are all “ifs” but the reality is, we came close to tragedy that could have been avoided. I cannot imagine putting my parents through the agony of coming to Swaziland to collect my body and I am just so grateful that we escaped this event without us being hurt. I vow that for the remainder of my time here, I will not get into a vehicle at night. It’s just not worth the possible consequences.

I’ve decided to have a quite weekend and stay around at Good Shepherd. My tasks for this weekend are to write my Christmas cards and start packing some things up in preparation for my departure to Bulembu. I’m not exactly sure how I am getting to Bulembu, but at the moment it looks like I will be going on a truck that will be taking maize from Siteki to Bulembu. I’m just appreciative of any mode of transport. I will be coming back to Good Shepherd for a few days in December. I have offered to do ward rounds from the 22nd-25th of December whilst I am here with my family. It will give my family the opportunity to witness first hand the work I have been doing here and I know we are extremely short staffed during this time and my assistance will be appreciated.

It’s hard to believe my family will be here in 3 weeks. I know they are incredibly excited. Graeme (my step Dad) has had his bags packed for a month already and my mother is trying her best to get everything organised so that the various donations that she has received can be transferred here safely. She tells me that a number of you have been extraordinarily generous and I just cannot tell you how much I appreciate your generosity. Pleased be assured that you are truly making a worthwhile contribution and your donations will have an enormous impact.

Monday, November 17, 2008

Royal Swazi Spa

Yesterday marked exactly 4 weeks until Mum, Graeme (my step-dad) and sister, Rachel arrive. Let me tell you, I am counting down the days. I cannot wait to see them. Not only will it be great to show them Swaziland, but it will also mean that I am one step closer to going home to Australia. I am ready to go home. I don’t know how much more fortitude I have left. I’ve even decided that I’m probably not even going to bother telling you of all the despair I see on a daily basis- you’re probably tired of it. I know I am.
The weekend was good. Saturday was Julia’s last weekend in Swaziland and we wanted to make it special for her before she returns to the States on Thursday. She rented out a cottage on Mabuda Farm and she invited Chris, Susan and I there as well as 6 local boys (aged 8-16). She has held a “games night” every Friday for these boys for the past 12 months she has been here and she wanted to give them a treat as her departing gift. They swam in the pool (I just potted around with the horses, cows and kittens) and then we all had a braai (African style BBQ) for dinner. Susan brought her laptop and iPod along and we were able to listen to some music. I cannot tell you how uplifting it was for me to hear music- it has been a very long time and I miss the enjoyment it gives me. Susan had some Motown on her playlist and I actually got up and had a little dance. I was just so happy! The beauty about my time here in Swaziland is that I have been completely uninhibited in just being myself. I can listen to daggy music and my friends here still think I’m pretty cool. I can openly admit that I think “The Sound of Music” is the best film ever made and no one rolls their eyes. I wear my ordinary clothes and my nurses think I have the most fashionable wardrobe in the country. The love my friends have for me is unconditional and it’s liberating to just be myself without having people trying to “improve me” or show me how to be more fashionable or what music I would be “cooler” to listen to.
We had fun with the group of boys- we simply had a few balloons that we spent ages trying to keep in the air. We danced and I even taught them Australian anthem and “Give me a home amongst the gum trees…”

On Sunday, 6 of us crowded into Susan’s small, 5 seater Micra to go to Manzini. Incredibly dangerous, but given that the locals pile into the back of utes and trucks etc- when in Rome…..
Thankfully we arrived safely. Kristen and Andrew had to go to a Peace Corp function whilst Chris, Julia, Susan and I went onto the “Royal Swazi Spa” Let me tell you, this place is not representative of Swaziland- it is over the top opulence and it was fabulous. It just screams luxury and I actually felt somewhat out of place. This discomfort soon vanished when I was served my cappuccino in the fine china (hooray- my stomach has now settled enough tolerate it) and then I enjoyed my salad with grilled houlumi cheese. The piece de resistance was the spa. I was desperate to have some waxing done and I took my chances to see if they had an appointment at short notice. I nearly jumped for joy when they took me into the sanctuary where the lighting was dim, soft music was filtered through the rooms and the colours all muted and inviting. It really is a shame that instead of having a massage, facial, total body exfoliation or body wrap, I had hair ripped out of me, but let me tell you- I felt like a new woman afterwards. I felt somewhat ashamed that such an unnecessary indulgence made me feel so good, but it has been hard on me not having me usual creature comforts I have back at home (I suspect it has been hard on my local beauty salon back home not having my regular patronage). It really was a lovely day and something I will remember fondly.
Shame I had to come back to work….

Thursday, November 13, 2008

A day with Home Based Care

Today I had the unique experience of joining Julia on her daily routine with a programme called Home Based Care. I did my ward round and joined her team when they headed out later in the morning.
Home Based Care involves going out to local homes and providing basic medical care and food to the disadvantaged who don’t have the means of getting to Good Shepherd or who have chronic conditions requiring a nurse to check up on them. We have similar care in Australia, the UK and USA. However, like everything here in Swaziland, it’s a little different.
Firstly, the people we visited were simply the poorest people I have ever seen. They have nothing- a few rags they use as clothing, a few basic items that allow them to make a fire and cook food, but otherwise- not much else. They walk kilometres everyday to obtain water and their existence truly is based around survival. And yet, despite these extraordinary circumstances, they always had a smile to share with us and it warmed my heart to see their courage and stamina.
Their homes are made out of sticks and mud. The floor is made out of cow dung. In fact, in one of the homes, I was able to watch one of the women “relaying the floor”. You mix cow dung with water and compact it down to make a smooth surface. Once it dries, it actually makes quite a stable surface. It has been raining a lot here recently and I am continually caked in mud, but these floors seem to resist being formed into a mud pies.
The houses are very smoky because people have open fires in them which they cook on. (the fires are also responsible for the large amount of burns we see here at Good Shepherd). Sometimes, if they had more money, they had a mattress to sleep on, but this is not always available.
Many of the people we visited had AIDS. As I have mentioned previously, if you are poor and have AIDS, the World Food Programme provides you with some staple nutrition (however, the WFP doesn’t reach everyone and we must not forget that many, many people here are starving and malnourished.). We handed out packets of corn-soya, maize meal, peanuts, salt, sugar and soap. Some lucky families were the recipients of some milk. Whilst it is very satisfying to be able to provide medication to the sick, I have to admit, I found it more fulfilling to give food to the poor. We all take food for granted and yet these people don’t know from one day to the next if they are going to eat. I can’t imagine what that must feel like- especially for the AIDS patients who do happen to be lucky enough to be on ARVs- these drugs can make you feel awful with debilitating nausea, so I can’t imagine what it would be like to have the side-effects from these drugs and also be hungry….
There were a lot of children around- almost all of them with little pot bellies that are a sign of Kwashiorkor (a diet that is deficient in protein). They were simply delightful and loved having their photo taken. Again, extremely impoverished- some without clothing. Continuous stream of nasal discharge that attracted the flies and yet they seemed happy enough. Perhaps it was just the excitement of seeing our vehicle and knowing it was bringing food.
I actually got to tend to some sick people. Very different circumstances to what I would experience in a clinic or hospital. I sat on the floor to examine them, took blood pressures whilst sitting on a log and I even examined a man’s penis behind our truck. He had some genital lesion that I didn’t have a clue what it was, but I was able to give him some basic antibiotics. We told him that he needed to use a condom otherwise he would infect his wife. He told us that he went to a nearby clinic and that they had run out of condoms! They wonder why Swaziland has the highest incidence of HIV in the world??!!
We were also able to administer simple analgesia, basic antibiotics, multivitamins and some other basic health care supplies. All of this was free thanks to kind Americans who donate to support this programme. These people would receive no other health care otherwise.
I came home exhausted, covered in dirt and yet extremely humbled that I was privileged enough to be part of this programme- even if it was only for a day.

Wednesday, November 12, 2008

Some divine intervention

I think I have begun every blog entry recently with “It’s been another difficult week”. I wonder if you are getting bored with my constant tales of misery and despair.
The abdominal pain has settled somewhat but I am still unable to eat certain foods. Of most concern is my inability to tolerate coffee. I tried it on Monday and found myself rolling around in agony. I know I initially complained about the coffee here, but thanks to Courtney and my step-Dad sending me copious amounts it, I have been able to enjoy my only real “vice”. Up until now that is.
I spent all weekend in bed and had plenty of time to reflect on my time in Swaziland and what the experience has done for me. Unfortunately at the moment, I am consumed by the daily despair I pay witness to and it has taken a huge toll on my mental health. I can’t remember feeling this depressed before. I know that once I get home to my familiar surroundings and support, I will look back on this experience as being one of the greatest of my life. It has challenged me and no doubt enriched me as a person. I just can’t really appreciate that at the moment. The truth is, some of my despair comes from the fact that I had such high expectations of Swaziland. I thought that by coming to a third world country and serving the poor, I would find my purpose in life. I would be able to justify why at 30 I’m single and childless. I truly believed that I was in this situation because there were “big plans” for me and these plans required me to be footloose and fancy free.
The reality is that I don’t think I can do this job long term. I feel like some of my soul has been destroyed whilst being here. My innocence and enduring optimism has been eroded somewhat. It’s ironic that last week Susan described me as “Chicken soup for the soul” and yet all I could think about was how I had lost mine.
Nevertheless, within 24 hours of emailing a friend and having a major catharsis of emotions that I think made me look like a raving lunatic, I find that an opportunity has opened up that will allow me to leave the despair of the female ward a little earlier.
Bulembu is hosting a massive project called “Swazi 1000”. I’m not entirely sure of the exact details but I do know that about 1000 college students are going to descend on Bulembu to devote two weeks to reconstruction of houses that will eventually house orphans. With such an enormous undertaking and some of the projects potentially dangerous, they require a doctor and the Board members have asked me to be there for the two weeks. I am delighted to help out. I will step back into my role as an “emergency doctor” and I will be on hand to manage anything that happens to the group of people who will be aged 16-24. This means I will be treating healthy people who don’t have AIDS. I will also get to see this massive project unfold which will be exciting and give me further hope for this project that I am passionate about. I will also be able to go and cuddle an orphan everyday and I think this will be the best therapy for me at this time.
I now have two weeks left at Good Shepherd and hopefully I can make the most of my short time left here.

Saturday, November 8, 2008

It's enough to give me an ulcer....

It had to happen sooner or later- I have been so lucky so far, but this week, I got sick.
It started by waking me up at 2am on the morning of the election. My stomach was aching and I had overwhelming nausea. I couldn’t even eat the pancakes that Kristin and Andrew made me. For those of you who know my eating habits intimately, you would know that this was a clear signal that things weren’t right- pancakes are one of my favourite foods.
Anyway, for the rest of the day I couldn’t eat. My abdomen ached in a way that I have never experienced before. It was a deep boring pain and associated with shocking nausea. Anytime I attempted to eat food or drink liquid, I would be rolling around in agony about an hour later. So I stopped eating and I stopped drinking. All I could do was lie in bed- but only in one position because if my stomach came into contact with the back of my abdominal wall, I was in agony.
Chris came over and examined me. My abdomen was distended like a balloon and when Chris palpated my abdomen I nearly jumped off the bed. We both came to the conclusion that I may have a stomach/duodenal ulcer. She went in search of a drug called omeprazole and by some miracle, she was able to put her hands on some. It was difficult keeping the drug down but I managed to get a decent dose in. I woke up the next morning feeling a little better and I foolishly went in and did my ward round. By the end of it, I could barely stand. I was in agony. Chris and I started to worry a little bit and we made contingency plans of what to do if things got serious. I was adamant, that despite the fact I had developed some very mild malaena (suggesting that I was bleeding in the stomach), I did not want a blood transfusion even if I was really unwell. I am not morally opposed to blood transfusions- I simply don’t trust the blood here to be free from HIV. We would not stop for help in Swaziland but simply go straight to South Africa. Thankfully, we did not have to enact these plans, because regular doses of the omeprazole seemed to work over the next two days. I stayed in bed, remained nil by mouth and slowly improved. Chris checked on me regularly. Last night, she was absolutely gorgeous. She made me a clear soup and I was able to tolerate a few mouthfuls. It was delicious, very simple and very much needed because I was dehydrated and weak. It was this simple, random act of kindness that helped improve me dramatically. I’ve been able to have more and more of this soup and I now feel much better. I still have a constant, dull ache in my stomach but I’m able to get out of bed, I’m able to tolerate fluids and I feel much better within myself. I think I may have dodged a bullet….
I am very well aware that this presumed ulcer is probably due to stress, otherwise it could be a big parasite growing in my stomach…..
I’m not sure what to do about the stress. I certainly have tremendous support from my friends here. Courtney emails me everyday and I get a great deal of comfort from her predictable contact. I just think that what I witness here is stressful. For instance, I often have people join me for my ward rounds. Kristin and Susan (both nurses) have joined me and both have been incredibly distressed at what they witnessed. I have a young Swazi girl who has completed a Bachelor of Science and has applied to do medicine. She asked to join me on my rounds so that she could get a taste of what medicine is like. I have tried to be an enthusiastic role model for her, but she has often been reduced to tears at what she sees. Other people have vomited on ward rounds and earlier this week, I had a young girl from the Netherlands faint whilst we were seeing patients. I think these reactions are normal for what we are seeing here. It is distressing, it’s almost surreal and the reaction we have to the suffering is visceral.
Also contributing to my stress is the ever present fear of snakes. A huge Black Mamba was found in the female ward earlier this week. Thank God I was not there to witness the chaos and hysteria that ensued.
Last night, one of the security guards knocked on my door and he warned me that a huge snake was found behind my house yesterday. He warned me that I need to keep all my doors and windows closed and make a lot of noise as I exit my flat.
If that isn’t enough reason to develop an ulcer, I don’t know what it.

Wednesday, November 5, 2008

Hoorah for Obama!

Hallelujah, the world, for a small amount of time made sense again!
I was woken early by Susan this morning. Her friend in San Francisco called to say that Obama had won the election and Susan immediately called me. I wasn’t entirely convinced at first as it seemed pretty early to be making an announcement, but within an hour, I was in front of a TV watching the broadcast on CNN. Kristin, Andrew, Susan and I were in high spirits as we made pancakes and watched the coverage. We saw the re-run of Obama giving his acceptance speech and we all knew that we would probably remember this moment in history for the rest of our lives. Susan was crying and I was just mesmerised. I actually find men who are smart, articulate and good public speakers to be absolutely intoxicating and despite the fact he’s a married man- I LOVE OBAMA! A few of you will be perplexed by my enthusiasm for an American President, but I really feel that we live in a global community and what happens in one country (especially one as powerful as the US) affects us all throughout the world. Here in Swaziland, where there is no hope, I desperately needed to hear the message of hope and I think Obama delivered that for me. I also know that my best friend Courtney, and her family and friends have the comfort of a promising future and that’s really important to me.

So it was with this renewed enthusiasm and hope that I entered my ward to do a delayed ward round. All that hope and enthusiasm disappeared within minutes and I was confronted with the stark reality of my existence in Swaziland. I have some really sick women on the ward at the moment. Women who just consist of skin, bones and a vacant stare that signals that their time here on earth is limited. They have no immune systems and they are covered in skin infections and tumours. They are just lying there, unable to even roll over to change positions because they are so weak. I felt overwhelming hopelessness.
This feeling was compounded by the fact that things here at Good Shepherd are deteriorating. We have no reagents to do a complete blood count. We have no India Ink to look for Cryptococcus on cerebral spinal fluid (In patients with AIDS, it is incredibly important as many patients get meningitis and it’s important to be able to tell the difference between a bacterial meningitis and a fungal meningitis called cryptococcal). We don’t have the reagents to test for syphilis (again, very common here). We are starting to run out of a powerful antibiotic called ceftriaxone which I use effectively for many of my patients. Yesterday we ran out of sputum cups so I was unable to test for tuberculosis which is in epidemic proportions here. I am so incredibly frustrated and upset that I actually feel I would be better off just getting on a plane and coming home. This is all so difficult and no hope of improvement is in sight.
Today, for the first time in my career so far, I let my hostility out on a patient and I feel incredibly guilty about it. I was seeing one of my patients who was diagnosed with HIV on admission. I had spoken to her about the diagnosis and its implications yesterday. Today she asked to be discharged and when I asked her about how she would follow up on her CD4 count, she told me (through an interpreter) that she thought I was lying by telling her she had HIV, she thought she had malaria and I had got the diagnosis wrong . First of all I was a little insulted that any patient would think I would lie to them and secondly I was just filled with enormous frustration that despite the fact that Swaziland has the highest incidence of HIV in the world, people still will not accept it as a problem here. I went up close to the woman and pointed to a patient in the bed opposite to her. The woman in the other bed has AIDS with a CD4 count of 1. She is incredibly emaciated and semi-comatose with shallow end-of-life respirations. I pointed to the patient in the other bed and said “If you do not accept you have HIV and you do not follow up on the recommended treatment, you will end up looking like her!” Perhaps my voice was raised a little because in the ensuing silence, you could have heard a pin drop. I think I shocked the nurses with my outburst. I am not proud of my performance. I was just so frustrated that I allowed by emotions to overcome my professionalism. The patient with newly diagnosed HIV was very upset with me and I know that I behaved very badly and inappropriately as far as Swazi culture is concerned. I apologised and moved on. I could not continue to argue with this patient. Her non-acceptance of the situation is reflective of most of the attitudes here. People present here at a very late stage of their illness and I am often left with hopeless situation of applying a “band aid” to give them some quality of life for their last months on earth. Because people present so late, we are often unable to effectively give anti-retroviral treatment. Many people who commence ARVs die within the first 6 months of their commencement.
So whilst the US may have gained some much needed renewed hope, I am afraid that this is not the situation here in Swaziland. My joy was short lived. Tonight I am going to Chris’s for her infamous Cincinnatti chilli, perhaps this will cheer me up.

Sunday, November 2, 2008

Melanie in Manzini

I have no idea whether I will ever be able to publish this blog entry. It is sweltering hot and the winds are cyclonic and this means one thing: the electricity goes off for a few seconds every couple of minutes and I lose everything I have done on the computer. I’m typing in a word document and saving as I go, but who knows if I will ever make it onto the internet….

Yesterday started well. Susan woke me at 8am and asked if I wanted to go into Manzini- did she really need to ask?! I haven’t been out of Siteki for over a month, so I was desperate for some time away. I called Chris and like me- she started squealing with delight. We were really hoping that this would be the weekend where we would be able to “escape”. Susan will be working here for a year and she actually gets paid to do her project here, so we thought all our Christmas’s had come at once when she purchased her own vehicle last week.

I spent my morning preparing for my big trip into the “metropolis”. I shaved my legs, wore my $50 pink lace French knickers and applied mascara. I felt a hundred times better than what I had during the week. For my male readers, the significance of all this will probably elude you, but hopefully my female readers will be able to appreciate just how uplifting a little bit of primping can be.
There were four of us that ended up going on the “big trip” Susan, Chris, Kristin and myself. (If any of you are wondering why I haven’t mentioned Julia in a while, it’s because she is holidaying in Uganda with Farrah and Emerald. She returns on Friday).
The first place we visited was our usual “haunt” at Swazi Candles. We enjoyed a beautiful lunch and the girls kept remarking just how contented I looked. My joys in life are simple- beautiful scenery, good coffee and the company of friends.
We then went in search of gifts for Christmas presents and I was delighted to find some Christmas cards that I will have to send off soon. We finished our day by going to our favourite supermarket- “Pick n Pay” where I was able to buy some of my luxury items that I am unable to buy in Siteki. The day was fabulous but a little overwhelming. On the drive back home, I developed a migraine and by the time I got home, I was a mess. Nevertheless, a few drugs and a good night sleep later, I woke up this morning feeling much better. I have spent the day reading some gossip magazines that my best friend Courtney sent me from the States. It reminded me of just how far away I am from the reality of the Western world. I feel very torn between the “two worlds” I have been living in. I’m working in remote Africa and at the same time, I’m reading about Britney, Jennifer and Angelina. I really have no idea how I’m going to adapt once I return to Australia.

Speaking of which, today marks exactly 6 weeks until Mum, Graeme (my step-dad) and my sister Rachel arrive. I cannot wait to show them Swaziland. We have planned a holiday in South Africa, but before that, we are going to do some volunteer work in Swaziland. We are going to volunteer our services at the orphanage in Bulembu for a few days and then we are coming back to Siteki and organising a day camp for a group of orphans. We hope to spread a bit of Christmas cheer amongst those who are not as fortunate as us.

Speaking of Christmas cheer, I would like to make a special request to you all. From reading of my adventures in Swaziland, it would be obvious that I am a passionate supporter of the orphanage in Bulembu. From all the places of need that I have visited, I am convinced that this is the place that offers the most hope for the vulnerable children of Swaziland. I have witnessed first hand the amazing work these people are doing. I have seen with my own eyes just how well nourished, loved and nurtured these orphans are. Just last week, the orphanage received 3 more orphans. They now have 14 babies, 19 toddlers and 5 children aged 3-4 years. The workers there are committed to the children, their health, their spiritual growth and encouraging their Swazi culture. I truly believe that this place has the potential to offer hope to future generations of Swaziland. I would like to help them by asking you for a monetary donation. They are struggling financially to cope with the increasing demands of looking after 38 young children. For example, they go through 8kg of washing powder each week. (all babies wear cloth nappies and in addition to all the clothing and bed linen, this makes for endless loads of washing!). They need money to buy bread, peanut butter, formula, cereal, nappy rash cream etc, etc. They also need money to employ the Swazi women who are there to feed, burp and change all the babies. They rely solely on donations- they do not receive any government support. Sending items is too expensive and difficult to actually get to this location, but all the above items can be purchased in Manzini and my family and I will purchase these and take the items to Bulembu.
After a discussion with my family we have decided that the best way to co-ordinate this is the following:
Send a cheque to:
Sally Woodings
7 Stowe Court
Forest Lake 4078
+61 7 3879 7662

If you would like to donate cash, then you can contact my parents and they will organise to collect the money from you.
As soon as my Mum receives the cash/cheque, she will issue you with a receipt. (please send put your address on the back of the envelope)
Mum will cash the cheques and transfer them into South African rand (this is the most economical way of handling money in Swaziland)
Once we reach Bulembu, we will have Robyn, who runs the orphanage, write an individual receipt to each of you on behalf of ABC ministries.
I can promise you that every cent that is donated will go to those orphans. I know with Christmas approaching there are any demands on the family budget, but believe me, here in Africa, even the smallest amount of money can go a long way. I ask you to please consider giving to this amazing charity.
Anyway, another week is about to start at Good Shepherd and who knows what I will be challenged with. Stay tuned.