home again

this note is somewhat delayed, but wanted to close the swazi section with the safe arrival notice. the trip back was a lot less painful than the trip there, and my bags even managed to make it back when i did:) i spent a week with the fam mired in the zombie-like trance of jet lag. i don't know how much fun i was to be around, but no one seemed to mind. now back to work where the reverse culture shock continues. hoping i can hang onto the revitalized super-charged gratitude i have for the love that is to know and be known, a comfortable bed, a variety of clothing options, and a car that vrooms when i want it to. it's a good life, people:)

parting words

baylor clinic has been home base during my stay in swaziland. yesterday, i caught the kumbi (spelling?) for the first time. it's small van public transportation that conveniently stops right across the street from the clinic. only costs 4e which is about 40 cents. guess i didn't close the door hard enough since it started to slide open before the next stop. the other passengers didn't seem to be too disturbed by it, maybe hypnotized by the blaring disco music.

roommate and i met up with some folks over at cafe lingo which had some pretty yummy pizza and buffalo wings. they also happened to have some live acoustic guitar/singing performances going which were actually quite good. then we caught up with the rest of the gang at yet another braiie (sp?). swazis love bbq and i do, too:) i've been nauseous and sick to my stomach most of this week, but it hasn't stopped me from eating my fill. food was good, but it was rainy and cold and itchy since i seem to be a mosquito magnet. we left after a bit and watched a dvd. i think it was shark vs evil, very likely the single most ridiculous film i've ever seen in my life. yes, even worse than the spirit. oh my...

then back to the charming cottage i've called home for the past week and a half. the fact that it is next door to the clinic is wunnerful, but i won't miss the bathroom door that sticks, the slow shower drain, or the non-existent dryer. it's nice that there's a washer. we didn't have one of those in gabon, but i'm gonna smell like eau de bbq smoke on the very long flight home because i don't have enough time for my sweater to hang dry.

we went to the mediterranean, an indian restaurant with a big screen, for inauguration day. the time difference worked out perfectly for us to watch it live on cnn. swazis love obama, too. i thought it was funny when the swiss nursing students in gabon would say, “bonjour, les states” when addressing rachel and me. then last week i told this swazi guy i was from the states and his immediate response was “oh, the obamas!” the cover of the swazi times the day after inauguration actually said obama wants democracy for swaziland. i knew there were a lot of high expectations for our new president at home, but i hadn’t thought of all that the rest of the world is expecting him to do especially for them.

thursday i had my first outreach trip to st. philips, and it was great. after a long ride on a bumpy road, we landed at the compound that includes a church, elementary school, high school, two clinic sites, and orphanage/hostel. the sisters are doing excellent work out there. that’s me in the picture with sisters barbara and diane, left to right. sister diane is wearing two memory sticks around her neck alongside the cross. not exactly the way i’d expect a nun to look, but she’s got to be one of the funniest, quirkiest, hardest working people i’ve ever met. if i were staying longer, i would have tried to return monday to do health screens on the orphans returning from their homesteads. they call it a hostel because the kids live in the community during the summertime. they try hard to keep the ties in place. that means they ensure there’s enough food, and they get their medicines on time even when they’re out in the boonies.

we only saw two patients on the trip, so there’s still room for improvement in the country wikipedia says has the highest prevalence of hiv in the world. i hear numbers that range from 26-42% with the higher end likely representing the prenatal visits. the pregnant women tend toward 39-42% while all comers end up on the 26% side of the spectrum. the data we cite most often are from who 2006 with a prevalence of 38.8% in adults with hiv as a cause of 64% recorded deaths. for kids under five, hiv causes 47% of recorded deaths. those numbers are ugly, but i've been fortunate to see some kids helped by antiretroviral medications during my short stay. i have been asked about other ways to help, and one i know of is at www.goneruralswazi.com. this program supports swazi women and children. in the end, it always seems to me that empowering women and children economically and educationally is the first right step out of oppression.

swazi in a nutshell

during my three weeks in swaziland, i’ve learned a little basic information that i thought i’d share. first things first. the kingdom of swaziland is a small land-locked nation between south africa and mozambique. it is the only absolute monarchy in africa (and i’ve heard it’s also the only one in the world?). it is divided into four regions: hhohho (mbabane is here – that’s where i live), manzini (that’s where the airport is), lubombo, and shiselweni. swazis, originally known as the nkosi (king) dlamini (surname of royal family), first settled in shiselweni. during the reign of mswati II, the nation became known as swaziland (land of the people of mswati). alongside the continued rule by kings, swaziland has been a protectorate of the boers, brits, south africa, and then the british again until independence in 1968.

the process of king selection is quite interesting. the king is always a dlamini and never intermarries, so the king has lots of wives who are not dlaminis. the swazis are one ethnic group with multiple clans, so the king is supposed to choose wives from different clans to foster unity. after he dies, the royal council chooses among his surviving wives looking for high rank and status. the chosen woman, now called the queen mother, must have only one son who is unmarried. he will be heir to the throne. so it’s not that situation we’re used to seeing in fairy tales where the king and queen are husband and wife. the king and queen mother in swaziland are son and mother. those are the people who have power. all those other wives fade into the background. if the heir is still a child, the queen mother will serve as the regent until her son is old enough to govern. the current king is mswati III. his mother, queen dzeliwe, was regent 1982-1986 while he studied in england. he was only eighteen when he became king.

speaking of school, you have to pay fees to go to any level of school here. there is no free public education. i’m pretty sure you have to have uniforms too. not all parents can afford these expenses, so every kid doesn’t get to go to school. all the kids just took a big test, and the highest scoring of the country were featured on the front page of the swazi times. education is valued. it’s just not available to everyone.

the first fruits are celebrated in the incwala ceremony where the king and his warriors do a traditional dance. there’s also some water collecting and bull slaughtering in there. the umhlanga or reed dance is a ritual where mostly teenaged girls (topless – this is considered normal, and lots of girls like > 20,000) present reeds to queen mother as a show of respect. i’m told king uses this venue to choose his wife. i’ve never seen the sibhaca dance, but it makes me think of my little brother since it’s popular with young boys who perform in teams for special events. that’s your shout out, classicboyadams;)

beyond goodness

dark chocolate and obedient internet. mmm mmm good. “it’s perfect. it’s more than perfect,” i hear myself think. all that’s left is to count ten fingers and ten toes, but i’ll settle for three of five bars. it works and i’m plugged into the rest of the world again. i may be cold and the heater is slow to warm and i somehow didn’t bring very many warm clothes, but i feel like i’m me again in some way that is as disturbing as it is comforting. the rain is raining cold rain. no one else seems to be cold, but i’m cold as always. maybe i’m getting sick, but i don’t feel so bad. i ache all over, i mean all over from frisbee. i have no idea how left shoulder got in the mix; i’m a rightee, and paraspinal muscles are squawking. i feel like i can’t drink enough water to quench my thirst. surrounded by water, but dry oh so dry. i’ll either dilute my blood chemistries or allay my ungrounded fears of kidney damage from muscle breakdown. neither is remotely likely. these are just the musings of a medical mind left to play. i’m winded and blaming it on anemia and over-exertion and high altitude. my marrow can only crank out so many red cells so fast. i think i’m compensating by taking huge breaths, kinda kussmaul breathing, but it’s not a diabetes thing. yes, it’s good and bad to be able to diagnose yourself. my second dresser drawer is a mini pharmacy of over-the-counter meds smuggled, i mean carried, over from the us. i will probably never need these things, especially since i remembered them this time, but maybe they will be helpful for my roommate who seems to have come down with a case of the runs. been there, done that. determined to get out of here without gastrointestinal disease. which is another reason i’ll never drink myself into dilution. i’m discriminating against tap water and i refuse to spend millions on bottled water. but no worries, i will calculate my fluid requirement and it will be okay. yup, i’m kinda digging my new digs. the heater is sputtering out a 3-foot radius of warmth and the clinic wireless reaches just far enough to satisfy my inauguration curiosity. i’m crying because this election thing, it’s so good, and for me, goodness is high praise. my favorite fruit of the spirit. who needs heat and water and normal tidal volume anyway? my watch has stopped working and it kinda doesn’t matter. it’s all good, people. it’s more than good. it’s perfect.

this week in pics

swazi landscape with a modicum of humidity. this is the transition pic bewteen the big fog and the clear-headed gorgeosity of friday. quite lovely.

monday was michelle's (seated on left) birthday celebration at the lugogo sun hotel restaurant complete with all-you-can-eat buffet. chefs were at the ready to whip up stir fry and crepes. yum yum:)

that's where i used to live. i moved on wednesday to a humbler abode, but right next to work (e.g. right next to internet:)) now i have a roommate and share the bathroom which is a definite demotion, but the old tv came with me, so i won't have to miss oprah...

went to satellite clinic at rfm hospital thursday. this child is 3 years old even though he looks closer to a one-year-old. they call this "stunting" because his weight-for-height is well matched, but 9.8 kg and 80 cm is not normal for his age. he's not just making a grumpy face. he has vision problems and is often looking out at nothing with right eye esotropia (inturning) that is not easily seen in this pic. each pic is taking 15 mins to download so we're gonna skip the one with the really good esotropia. his speech is limited to mama and baba which is clearly developmentally delayed. he's a good example of the havoc wrought by malnutrition and limited resources.

saturday played ultimate frisbee for the second time in life under the scorching african sun with my out-of-shape anemic body at high altitude. so exhausting, but so much fun. motivated to work out for real now....we'll see how long this lasts. and my arms and legs appear to be two different colors. lol. something to work on later.

after frisbee saturday, we took off for the game park at malolotja. very beautiful. pictures do it no justice. had bbq and more bday cake and the best flan on earth in massive quantities. that's a different kind of malnutrition. planned to go birdwatching and hiking sunday, but the dense fog descended once again and thwarted those missions. did get to see a bit of wildlife up close from the cabin as pictured.

tea breaks and handshakes

i am so exhausted i can hardly type. today was actually a fairly efficient clinic day. charts are grouped by family, one to three patients per chart, and we called about 100 chart numbers in six hours. if i don’t sit down and write now, i may never catch up. as it stands, i have quite a few observations that could easily be expanded, but there’s not enough time for all that. that said, today’s entry will be a hodge podge of sorts.

i’m told mrs. reynaud’s class (my sister’s class) is following my misadventures in swaziland:) so this entry is dedicated to you guys. might make for some entertaining discussion points. and i know everyone is waiting for pictures, but i’ve only recently come into repossession of my camera, right when the fog of eternity and showers of infinity descended. in addition, it’s kinda against the law to take pictures of government buildings unless you have some special permission. but i’ll see what i can do.

that brings us to rule number one: try not to get arrested in a foreign country. it’s sad to be cuffed for a kodak moment. also try not to say things against the king within earshot of his top ministers which i did. lol. i didn’t know the minister of foreign affairs was sitting at the next table. there’s just a lack of this little thing we take for granted called freedom of speech. this guy who writes political opinion articles in the times of swaziland (national paper) was dragged before the king for his views. then he “decided” to write this apology article in the paper basically explaining why it’s good for everyone when the king is not angry. a little too old testament for me, but no more rants on that until i plant my little feet back on american soil.

i was talking to one of the baylor drivers, and it seems that some swazi people are ready for a president with political parties, but his majesty is not so ready. this is hearsay, but i’m told one king had 100 wives and 600 children! i don’t know how he could keep up with all those people. the current king is only up to about 14 wives. (there is a lot to be said about the position of women relative to men here, but for now i’ll just mention how it makes controlling hiv that much more difficult). now i understand why there are so many dlamini’s. he must have been one of those fruitful kings.

rule number two is try not to die in a foreign country. some people ask me about the dangers working with hiv-infected patients, but i think the real threat is bad drivers. sadly, two of the cuban doctors died this week in a car accident. i think they were sitting in the flatbed of a truck that suddenly got a flat tire. yesterday my taxi driver was in a near accident. our little corolla almost got smushed. gotta buckle up, people!

rule number three is try to learn about the local culture when you’re in a foreign country. it’s sometimes kinda hard to do when america has a way of popping up all over the globe. i still watch oprah at 5:45pm (although i’m about to move to a tv-less place), but it’s followed by isidingo (which i think is a south african soap). there’s also joel osteen and the apprentice on tv and anita baker and mariah carey on the radio. there’s a shell gas station and a kfc next to the nando’s which is local fast food offering both french fries and spinach as sides. i tried these greek cheese/avocado oil pringles that taste just like regular pringles. i’ve tried fresh lychee, but i’m not excited about chicken intestines. we’ll see. i usually try most things. people eat porridge and the support staff seem to take tea break all at the same time. no coffee breaks around here. i suppose that’s a leftover of british rule. i’ve got a long way to go to dig into swazi culture. for now, i’ll work on my handshake, a three maneuver interaction not unlike all those european kisses.

they have faces

it’s hard to believe a whole week has passed. the weekend has been quiet and stormy, brooding, as if nursing some old wound. the lights have gone out several more times since that first blackout. i’m fine enough living alone in the middle of so many unknowns, but being plunged into darkness holding a metal pot under running water and showers of lightening makes me feel like a sitting duck. i tell myself death by electrocution is a low probability event. comfort in statistics. i feel my way upstairs to my stash of candles and matches and am amazed by the amount of light one little candle emits. i sing “this little light of mine” in french because french is home to me and faith is home to me, and it makes me feel better.

i finish washing my pot. i hate dirty dishes. they multiply like gremlins. and besides, i need the pot to soak my beans. i am pleasantly surprised this morning that my boiling sugar beans (white with red spots) smell like red beans (which is what i was looking for in the first place). for a person who does not claim homesickness or loneliness, for the moment, i bring a lot of home to me. few things are more new orleans than red beans and rice. the weather is nasty, but i thrive on the scent of water in the air. it makes me feel alive, like the air is living. it probably is alive, filled with mold and fungus and bacteria, but i’m okay with that.

it makes me think of the branches on the wall in the computer room. it was completely unexpected, but one day last week i said to myself, probably out loud, “they have faces.” suddenly some forgotten, dead, driftwood was alive with eyes and arms and legs, man’s art on top of god’s art. i thought of our clinic babies, how each one is unique, but in essence not so different from babies everywhere. it’s in the eyes. barack obama talks about it in dreams from my father, “the curiosity they displayed toward every new face, seemed the equal of children anywhere.” he’s watching kindergarteners at carver elementary in chicago (actually same name as segregated school some of my family members attended). the principal remarks, “the change comes later. in about five years…when their eyes stop laughing. their throats can still make the sound, but if you look at their eyes, you can see they’ve shut off something inside.”

i guess that here, we’d like to keep that something on, but we’re more preoccupied with simply keeping them alive. the eyes shine alright, despite ophthalmic herpes, despite cutaneous hpv. some thirty to forty percent of screened pregnant mothers here are hiv positive which makes for plenty positive babies. despite our best efforts, so many die. from far away, they may look like something unrecognizeable, but i assure you, they have faces and names and mothers and fathers who want only the best for them.

to generalize further, halfway through residency, i remain appalled by the way some parts of society treat children. i’m sickened by the number of abused children, neglected children, and abandoned children. i don’t understand how our government did not support s-chip when the entire budget for children’s health care comprises the slightest of slivers in the grand scheme of american health care. come to ben taub (county hospital in houston) and look at the faces riddled with eczema gone too long, nostrils flaring with asthma out of control, and runny noses that are honestly best seen in the doctor’s office, a less expensive venue. then tell me that all you see is a system you didn’t create pinning people you don’t know to the wall of indifference.