Catch up...

It's been a pretty busy week and a half stretch over here, and I haven't really had a chance to catch up the blog. We geared up with TLC for two more clinics in the three days after Hlane, and on the third I followed Dr. Costa for rounds at RFM Hospital. Dr. Costa has been a fantastic teacher, pushing us with questions, and always keeping us involved with his thought processes and patient diagnosis, outlining both disease conditions as well as the methods used in Swaziland to treat these problems (many methods much different than American norms).

The two clinics we participated in were much larger than the first "warmup" clinic; in the picture to the left, only a fraction of the crowd Dr. VanderWal and Sipho are speaking to can be seen. The clinics start with talks about HIV and directions regarding the day's clinic from Pumi and Sipho, two of the veteran Swazi team members/translators, and Dr. VanderWal, as the rest of the team sets up the series of stations the patients will pass through. It is really a spectacle to witness as multiple trailers are unloaded, including all of the supplies for registration, triage/screening, and counseling, as well as the pharmacy; I have been particularly impressed by the way that Harry and Echo's team performs on the clinic days ("gameday"); on a given day hundreds of patients will be seen, and according to Echo, the TLC clinics screen more patients daily than any other operation in the country.

The first of these two clinics involved a large number of children; four different schools were brought together. Every child is screened for a number of problems, especially ringworm, scabies, and/or bilharzia (bladder worms aka schistosomiasis, the same worms that cause swimmer's itch, present in Elk Lake!), for which they then receive medication. We had the opportunity to learn on the fly and help Dr. VanderWal with the screening process; between about 8 of us, we picked through the scalps and scanned the skin of a few hundred children in about half an hour. After being screened, we helped distribute wrapped baskets to the children, donations from an organization called "Operation Christmas Child". Each is a shoebox, filled with gifts for the children, generally including toys, clothing, and toiletries; in addition, each gift is handed out individually, allowing for a lot of interaction with the Swazi children. We've learned that in this culture, children generally are not valued, and often used by adults as means to ends; the gift-giving gave us a chance to make the Swazi children feel cared for, and furthermore serves as a means for TLC to strengthen relationships with the communities they visit. After the gifts were distributed, we filtered into the crowd to show the (many) confused children how to unwrap their presents and try out their new gifts. It was definitely one of the most enjoyable experiences I've had thus far in Swaziland.

The first part of the clinic is devoted to screening children; as the morning, afternoon, and nights carry on, the team's focus shifts to the adults. We spend most of our time in triage, screening blood pressures, blood sugars, and HIV status. Our patient population is variable, as we test any ages, from infants to the elderly ("gogo"- grandmother & "mkhulu"- grandfather) in any willing patient of unknown status. Tests (to the right) require a drop of blood placed onto the test strip, which then filters up the strip and gives a result in a matter of minutes (two lines indicated a positive result, while one line a negative- the 3rd from the left and 2nd from the right above are positive). It is hard to gauge exactly how many Swazis test positive, but our group seems to agree that anywhere from 20-35% of our tests come back positive. Every test is encoded, with a test number corresponding to the patient's name and a + or - result indicated by otherwise unrelated letters to protect patient privacy. Working in triage allows us to contact a large portion of the clinic population; furthermore, it allows us freedom and time to interact; the typical triage can be performed in a minute or two, depending on the patient, and so often we are able to stay well ahead of the flow from registration. The last clinic, we all split time between work and playing with the local children, including the group of 4 to the left, who would pose for pictures, then immediately scurry over to see what they looked like on camera; every time, they would burst forth with squeals of laughter before quickly striking another pose.
Each clinic has carried into the night; in rural Swaziland, this provides additional challenges. Many of the school's we've visited lack electricity, so TLC carts in several generators to run their equipment. Much of this power goes to lighting, as the rural Swazi locations become pitch black by about 6 PM; in the picture to the right you can see a floodlamp behind Graham and Chris as they triage a "gogo". At times, the generators have been unreliable, providing additional challenges; I've even had the chance to draw blood using a headlamp flashlight.

The clinics have been without a doubt three of my favorite days so far on this trip. The well-oiled TLC machine is truly impressive to see in action and an honor to be a part of, even if small and temporary. While the striking number of positive HIV results is frustrating, especially when I can start matching test numbers to faces in my head, it is encouraging to know how many Swazi's are being made aware of their status, and being provided with the guidance and direction needed to start their treatments. As a medical student, I've had the opportunity to see some amazing pathology, many HIV related, and many of it not (most recently, caput medusae- distention of abdominal veins from liver failure that feels like a ball of snakes). Finally, the days provide plenty of chances to interact with the Swazis. Even while on the 7 day South African adventure we just ended, I've been looking forward to our next clinic on Friday.