Thursday, December 25, 2008

A very Swazi Christmas

It's Christmas morning here in Swaziland. This morning, I did a ward round with my mum and we got to see all the patients for whom Christmas is a just a remote, far-away concept.
It's been a week of highs and lows coming back to Good Shepherd. Because it's Christmas, I'll talk about all the depressing things first and then I will try to finish on a more happier note.

We got into Mabuda Farm on Sunday night. It was an incredibly long drive from Motswari back to Siteki, but it was a safe, uneventful journey and we all just had tea and toast before we fell into our beds.
The next morning, I got up early to start my ward rounds. I took my mother in with me. Although she does not have a medical background, she feels as though she went through medical school with me and there are times when I think her medical knowledge rivals that of a medical student. She found the ward round to be one of the most fascinating experiences of her life. I have got so used to everything that I often have to take myself back to my very first days at Good Shepherd so that I can empathise with the "shock and awe" that people experience when they first arrive. It wasn't too long before I realised the devastation I had left behind was still pervasive throughout the ward. Most of my patients were languishing in the terminal stages of their HIV. One lady, in her 30s had a massive abdominal tumour that now has formed an enterocutaneous fistula. This is where there is a connection between the bowel and the skin so that faecal material just oozes from her abdominal wall. She was incredibly emaciated and you could see every bone in her fragile body. She was vomiting everywhere and too weak to even roll over to vomit on the floor.
Another patient, this time in her 20s had HIV with a CD4 count of 5. She also had severe TB and was 30 weeks pregnant. She went into labour yesterday (her temperature was above 40 degrees celcius and this often precipitates premature labour). She delivered a tiny little girl who is surprisingly still alive today. The baby isn't exactly thriving and I wonder who will die first- the baby or her mother.
Another lady had this massive fungating tumour on her (R) leg and it had spread to her lungs. I had nothing to offer her and she died yesterday by asphixiation
We have run out of blood here in Swaziland and most of my patients have severe anaemia secondary to the HIV suppressing their bone marrow. The normal value for a haemogloblin is about 11-18g/dL. Most of my patients have a haemoglobin count between 1-4g/dL. They are so pale and weak and can barely walk. To the ones that could walk, I offered to discharge them. I did not see any point keeping them in hospital (where they have to pay for every day as an inpatient and where they are susceptible to catching germs from other patients). I sent them home and told them to return in the next couple of weeks to see if any blood was available. I'm afraid some will be dead in this time.
This morning, Mum and I saw a 21 year old girl with AIDS. She had what is called "wasting syndrome" where she was completly emaciated and not able to move a single limb. Unfortunately, as is regularly the case, she died whilst we were with her. My mother, with her intuitive compassion, just sat and stroked the patients forehead, so at least she had some human contact during her final moments. My mum has obviously not witnessed anyone die before, particularly in such deplorable conditions, but she was incredibly strong and only shed silent tears. I feel that through this experience, she now has a more intimate understanding of what I have seen here. Rachel, my sister who is a lingerie designer, also came on ward rounds with me yesterday and was confronted with desperately ill, AIDS ravaged patients. I think the experience was a little overwhelming for her although she seems to have bounced back today. I think both my mother and sister recognise they are extremely privileged to pay witness to what is happening here in Swaziland.

The highlight of our week here in Siteki has been our time spent with Kristin and Andrew (Peace Corp). On Monday afternoon, My family and I made the arduous trek to their place in the blistering heat. Graeme complained bitterly with every step we took and I think it will be a long time before he lets me forget the exercise I made him endure. However, Kristin and Andrew were thrilled that we made the effort to walk out to see where they live. It also gave us the opportunity to walk through the local villages and see how Swazi's truly live. As usual, the children all ran out to greet us and it reminded me of the photos I have recently seen in the "Australian Woman's Weekly" where Princess Mary was greeting children from Uganda. The experience here in Swaziland is not too different as children here just seem to thrive on us waving at them and greeting them in english. We walked back to Mabuda in much cooler weather and then had Susan over for a lovely dinner. Susan and I spoke of all the local gossip and some of the projects we have been involved in. I became acutely aware that during our conversation my family didn't really have a good understanding of what we were talking about and I realised that even though they are seeing a lot of Siteki during their week here, they will never truly understand what I have seen here in the past 5 months. At times it seems a little lonely when I think of all I have seen and done here.
Kristin and Andrew decided to spend a couple of nights at Mabuda so they could spend extra time with us and I was absolutely thrilled to have them around. After my ward round on Tuesday, the six of us went to the local game reserve called Hlane. It was there we had lunch and got up close to rhino, hippo and elephant as well as antelope and wart hogs. It was Kristin and Andrew's first experience in a game park and they were incredibly excited. It meant a lot to me that we got to share this special time with them. We then spent the next two days together and it was like we were one big family. They got on extremely well with my family and they even commented that it meant a lot to them that they got to be part of a family in the lead up to Christmas. Last night we had a big roast dinner with Susan as well. Much to the horror of my vegetarian mother and sister, we had a big, fresh turkey that had been sacrificed the day before and it was delicious!
It was with many tears that I said goodbye to Kristin and Andrew this morning. They are going to spend two days in Mozambique with some fellow Peace Corp volunteers. We have created such an incredibly special bond during my time here and I love them as though they are my family. Their acceptance of me and all my little quirks, their unconditional love and understanding and their gentle kindness and compassion have sustained me during the difficult times here in Swaziland and I know that they will be my friends for life.
Today we are hosting Christmas lunch at Mabuda Farm. We are hosting Elsie (my housekeeper) and her 5 children as well Susan and various other volunteers around the hospital. It should be fun although I have to admit, after my sad ward round this morning, it will be hard for me to feel overly festive.
I will miss Siteki and the Good Shepherd enormously. For all the heartache and tears that I have shed, I have also been enormously enriched in a way that I have never experienced in Australia. I feel like a part of this place and I suspect I will be returning some day (although it won't be for a while- I need to earn some money. I checked my bank account the other day and I have the grand total of $1 left in it....)
Tomorrow we say goodbye to Swaziland and head for Cape Town. I have already started carrying tissues around with me because I randomly break down into tears- who knows what I'll be like tomorrow..