Hard to believe it's already been 6 days since we touched down! It has definitely been a whirlwind as we've gotten settled in, explored some of Manzini and Swaziland, and had our first peek at Raleigh Fitkin Memorial Hospital.

Friday was spent mostly taking care of business after our 24 hour trip. Trip went off mostly without any problems, except for a few stumbles at JFK when we ended up at the parking lot on the shuttle train (the furthest stop from the terminal). We blame poor signs throughout, and all agree it is the worst airport on the planet. Rest of the trip was a breeze, walking through customs with no issues (almost too easy) before taking off with Echo VanderWal into Manzini (we've ditched the rental car for now). Our first stop was Raleigh Fitkin Memorial (RFM) where we are staying. Our room is pretty nice, with two bathrooms (one currently has water), 4 beds in each room (most have sheets), and a kitchen/washing machine. In all seriousness, pretty comfortable, and we've certainly made ourselves at home.

Saturday we went with the VanderWals to an orphanage near Hawane, NW of Manzini. Again, the trip was beautiful; the landscape here is really gorgeous, with rolling, rocky peaks, and green trees and brush scattered on the brown (it's winter here) veld. The orphanage "fun day" was a blast... our team ("Green Land") won, thanks in part to some sack race heroics by Brad Scherer, who managed to recover from his stumbles into a graceful somersault across the finish line. Most of the participants (outside of the residents) were members of the VanderWals' church; interestingly, the church was founded as an extension of the orphanage, and is dedicated heavily to mission work in Swaziland. We attended church with the Vanderwals on Sunday, a much different experience than the Catholic masses I am used to attending. Afterwards, we had lunch outside, overlooking a ffield holding about a dozen Crowned Lapwings (bird... google it!). This country is awesome.

Monday was our first day in RFM; we've since spent the rest of week thus far in several different departments, following behind many different doctors. Monday morning we met with Dr. Costa, the student coordinator at RFM. He took us on rounds in the male medical ward; starting from the entrance, working towards the back of the ward, the patients become progressively more ill (the back two rooms sealed off, holding patients with tuberculosis). The first few patients weren't unlike anything you'd expect back in the US; a man with a seizure disorder in one bed, gastroenteritis in the next.

Pushing deeper into the ward, the patient population became much more representative of the HIV crisis crushing the country and continent. As we neared the furthest reaches the patients became thinner, weaker, and less responsive. Their infections seemed to come right out of our POD coursework: oral thrush, pneumocystis, histoplasmosis, and with just about every patient, Tb... almost all having wasted down to skin and bones. The last patient we saw, we'd later find out, had a CD4 count of 2 (for those not in medicine, this is the cell HIV destroys, and a count of 2 is extremely, extremely low).

Tuesday and Wednesday we have spent exploring more of the hospital, meeting new doctors and figuring out which of the physicians are better teachers. I've spent time in the outpatient department, which functions more like a walk in clinic; we've met a few pediatricians here who have been great, walking us through each patient, explaining disease and treatments, from HIV/AIDS, through skin and respiratory infections. In addition, I've had a chance to follow rounds through the malnutrition unit, learning about the two classifications they use and the treatments each require (fortunately, while on rounds today, many of these children were a day from discharge). I've also spent a good amount of time in the Emergency Department. Not unlike the two years I spent working there in the US, it's a lot of organized chaos, but the doctors have been pretty good about grabbing us to watch procedures or quizzing us on X-rays. I saw an abscess with a drainage that puts just about any I've seen before to shame, along with quite a few thoracentesis (mostly draining pleural effusions resulting from Tb). All 6 of us have had some pretty neat experiences, and seen a lot of diseases we otherwise won't back in the US (measles!).

This afternoon, Echo tracked us down in town to bring us to their home for a few interesting cases (when not running clinics, they treat patients there). One particularly intersting case was an HIV patient with what we thought was a lipoma, a benign adipose tissue tumor (skip to the enxt paragraph if you've got a weak stomach). After it was punctured, Echo forced our globs of grayish, color-flecked, proteinous tissue (I thought it resembled wet pocket lint); the best guess the VanderWals had (they'd seen one more like this) was that some sort of insect/worm had laid eggs, around which this tissue had developed (it wasn't vascularized like a lipoma would be). Fascinating.

As a unit of 6, we the majority of each day together. While each of us claims to have no cooking ability, we've pulled together some pretty decent meals. Picture to the left (mostly to let my mom know I'm eating well) is our first hack at it, with all 6 of us contributing to make a pretty tasty pasta dish. We definitely have settled into a pretty good group dynamic (not that that was ever in doubt); I'm really glad I'm traveling with these 5 people! We had our first adventure walking out of the hospital today to grab lunch and some groceries (most of the area is not too safe to walk in); had my first Stoney Tangawzi (ginger beer) of the trip.

That brings me to an end to this update; I'm going to follow shortly with another based on some of what I saw today. Tomorrow, we venture back into RFM, with our first rural clinic to follow on Friday (we're all really pumped), and Hlane Game Preseve over the weekend.