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.