"This is Africa."

Took off early today for the first of several rural clinics we'll be doing with the VanderWals and the Luke Commission. While today's clinic was smaller than most of their others (meaning we only worked about an hour past dark, instead of past midnight), it was a good introduction to how they run their rural clinics; the more relaxed atmosphere also provided us an opportunity to visit two homesteads near the clinic site to peek in to a more typical rural Swazi household.

"Make" (pronounced mah-gay- SiSwati for "mother" and a nickname for any woman of appropriate age), at the center of the picture (the rest is the complete Boonshoft crew), led us around her homestead, where she lives with her husband, three of her children, and the three children of her husband's other wife (polygamy is a part of Swazi culture), who had abandoned her children. The family survived on the maize they managed to coax out of the tough red clay and grass mats she weaved (60E a piece, <10 US $) which took about two weeks to complete (her loom is in the picture on the left); her income is further compromised as she had to take public transport into Manzini (it took us 2 hours to drive), and could only sell what she could carry. The homestead itself was made of 3 or 4, with walls made of branches weaved around rocks, later solidified with mud, covered with a thatched (and often leaky) roof; a couple huts were designated for the 8 to sleep in, and another was used for cooking. Her homestead was fairly typical for the area (some better, some worse), and fortunately, her family was relatively physically healthy. We visited a second homestead nearby, which was empty except for one "gogo" (grandmother), sitting on the floor of her home, unable to walk to the clinic because of her asthma (audibly wheezing when we arrived); some of her family members were in Johannesburg working as well. She showed us around her hut, and even pulled out her Swaziland ID card, showing us she was 86 years old. As our car was too far for her to reach, we sent medicine back to her homestead with the local pastor.

After these visits, we climbed back up to the clinic; typically, they are run at a school, which provides several buildings for the operating of different stations. At this clinic, clothes and bandaids were given out to children, largely aiming to develop stronger relationships with the community. The real focus, however, is the medical clinic, which is run entirely by the VanderWal's staff in an amazingly efficient, organized manner. First, patients register, and the TLC staff fill out brief patient histories. From this station, they proceed to triage (where we spent much of our time); based on patient age, blood pressures and blood sugars are collected, as well as a rapid ELISA HIV test if requested. Next, they see Dr. VanderWal, where they are given an interview and prescriptions. Some patients may require an extra, private physical screening. Addtionally, patients are given HIV counseling, and HIV positive patients have their blood drawn for a CBC (cell count), chemistry, and CD4 count (again, measuring the "progress" of HIV in that patient). Once they have been treated and counseled, they proceed to the "pharmacy", and are given medications.

The clinic was truly impressive to witness; the number of patients served (even at this small clinic), is amazing; according to Echo, they screen more patients for HIV than any other operation or institution in the country (upwards of 120-150). Additionally, because of the remote locations, every piece of equipment (including lighting for after dark and the generators required to run them) has the be carried in by trailer over many kilometers of rough, narrow, dirt roads. The clinics serve an important role, covering a gap in care that would otherwise go unserved. In Africa, the most pressing problem (what am I going to eat today, where am I going to shelter my family tonight, etc.) continually takes precedence over more chronic issues (even if they are more dangerous); slowly developing health problems often take a back seat. For example, we saw a man with very large, bilateral, inguinal hernias; he had not made an effort to have the problem corrected because he had been able to survive with it to this point, while giving attention to other issues. Through the intervention of TLC, he was set up with an appointment at RFM Hospital with a general surgeon, as well as an account at the hospital (a huge bureaucratic hinderance in Swaziland), all on the dime of TLC. Furthermore, his travel expenses would be reimbursed. If he follows through (Echo estimated about 80% of the patients given this setup do), he would be saved from a potentially deadly emergency.

It's been a long weekend (our first great African adventure as an independent group... another entry on that soon), and another clinic awaits tomorrow. I've got many more stories to share about these clinics and their impact, and I look forward to writing more over the next few weeks!