The Swaziland Experience

The past couple weeks have been great. They are highlighted by helping a very sick girl walk through the steps to get AIDS treatment. I also had another great meeting with Lwazi. I attended a couple very fun and very long certificate-giving ceremonies that really let the culture shine through. Last and least, I had a chance to visit a small game reserve.

This will be my final update email this month, so I wish you all a merry Christmas and happy New Year! I will be staying here on the farm, which should be fun. I will certainly miss my family, but I am especially looking forward to Christmas with the children here.

Much love from Swaziland. Thanks for your continued prayers and encouragement!

+++++++++++ For the curious: +++++++++++

1. Fansile
2. When Inefficiency Can Get Frustrating
3. ARV’s
4. If It’s Going to Happen…
5. Lwazi
6. Game Reserve
7. Gogo’s Health
8. Swazis Love Certificates
9. Swazis Love Calendars
10. Prayer Requests

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1. Fansile
On Thursday, December 6th, I visited several homesteads. At one homestead, we were visiting an old woman with very bad knees and legs, probably due to diabetes.
However, my attention was much more drawn to a girl at the homestead named Fansile. She had an extremely bad skin condition. She covered as much of her body as possible with clothing, but the problem could easily be seen below her ears and on her neck. She lifted up her scarf to let me see her decaying neck. I asked several questions, some with the help of an interpreter. I found out that she has had the condition for three years. In that time, she has not been able to afford a trip to the clinic (about $3.50 US including transportation). Her skin condition is painful, and the itching is extreme. I have been told that leprosy does not exist in this area, but I imagine that this situation is as close as I’ll ever get to it.
In my last update, I wrote about not always knowing when and how to help hungry or sick people. In this case, I didn’t even think twice to arrange plans to meet in town to take her to a doctor. I gave her kombi fare and told her to meet me on the following Tuesday, December 11th.
On the 11th, I took Fansile to a doctor’s office in Nhlangano rather that trying our luck with the long lines of the clinic. On the walk there, I noticed that she walked very slowly and with a limp. She said that this was due to the many sores on her skin. The doctor examined Fansile, and then she called me in to explain the situation. She told me some of Fansile’s history that I did not yet know, mostly because Fansile does not speak much English. Each of Fansile’s four children has died: one at 3 years, one at 3 months, and a pair of twins each at the age of two months. The children’s father died in July of this year. The doctor said that the skin condition is almost certainly related to HIV/AIDS. Fansile’s skin condition is extremely bad, especially, as the doctor said, around her private parts. Skin conditions like these are very common here for people suffering from AIDS. The doctor advised to take Fansile to NATICC, a local AIDS testing and counseling center, for an HIV test. If positive (and the doctor said that she was nearly sure that Fansile is HIV+ with advanced stages of AIDS progression), then we should follow up with a CD4 blood test to measure her progression of AIDS. As a general rule, if a patient’s CD4 count is below 200, then he/she is eligible for a course of medication called ARV’s (see the section below called “ARV’s”). I had been reading portions of a book on AIDS and skin disease, and none of the information that the doctor provided was a surprise.
We then walked to NATICC, where Fansile reluctantly admitted that she had tested positive for HIV in the past. I think she was previously trying to hide this, but she knew that it was going to come out soon anyway. So we talked to the NATICC people about obtaining a CD4 test. The CD4 test is required to start ARV’s, and the ARV’s are actually free in Swaziland if the CD4 count is below 200. Unfortunately, only 20 patients are accepted for CD4 tests each week in Nhlangano, the first 20 to show up at NATICC on Wednesday morning (for more info on this, see the section below called “When Inefficiency Can Get Frustrating”). People begin arriving around 5:00am, and many are turned away each week. Fansile lives 20 minutes from Nhlangano and the first kombi does not arrive early enough to guarantee her a CD4 test. So, I discussed this with the people at NATICC, and they agreed to make sure she gets the blood test as long as she arrived by 7:30am the following morning.
Fansile was able to arrive early and was the 14th person in line. She had her CD4 test, and we will soon get the results. I am confident that her CD4 count is below 200. This is sad, because it shows that she is in a bad state with AIDS, but this is exciting because the ARV’s will very probably dramatically improve her skin condition.

2. When Inefficiency Can Get Frustrating
When I set out for Swaziland, I knew that I would have to adapt to a very different setting than the demands for efficiency experienced living and working in America. Sometimes, the lack of efficiency can be amusing and I can roll with the punches, like when I experience problems at the post office. But sometimes it’s hard not to get frustrated when lives are ate stake.
Why does NATICC only accept 20 patients per week for a CD4 test? This is because the lab in Hlatikulu only runs their machine one day per week, and it serves an entire region. Why do they run it only one day per week? They say that they are short on people to run the expensive machine. However, minimal training is required because the machine does most of the work. So, this expensive machine that is desperately needed for people to begin ARV treatment sits idle for six days per week with seemingly no good reason. A day’s wages to pay someone to run it would be roughly $4 US.
Benedict, who directs NATICC in Nhlangano, says that he has asked the department of health to run the machine more often, but they refuse with no good explanation. Each Wednesday, NATICC turns away many people who do not arrive early enough to be one of the first 20 people. Some of these patients are so sick that they are being carried in by friends and family, and they must also be carried away without the test.
These are the situations in which I must consciously fight frustration to keep a sense of sanity. I prayed before coming that I would be able to deal well with these situations, and I believe that the Good Lord is honoring that. Once again, this is life in Africa. This time, however, it’s not as funny as obtaining a certificate that declares that I’m not an idiot.
This story reminds me of my conversation with my friend and cousins’ cousin Mark Knowles before I left Milwaukee. From his experience in the Peace Corps, Mark told me that culture shock is not noticing that the women carry baskets on their heads. For him, part of it was being exposed to a culture of lying. At first, it might not seem like it will be too much of an issue. However, when someone says he’ll help you and doesn’t, and then it affects or ruins the project you’ve been working on for a year and a half… then, it gets pretty frustrating. I am grateful for the conversation I had with Mark, because it helped me to think through and be prepared for situations like this.

3. ARV’s
I am not a doctor, and if you are a medical doctor, then please skip to the next section so I don’t embarrass myself.
Let me try to give a dumb man’s introduction to antiretroviral therapy (ARV’s). Patients who suffer from AIDS have a reduced CD4 count in their blood. Patients can have a blood test to measure their CD4 count, and if it falls below 200, then it indicates advanced stages of AIDS. These patients are eligible for ARV’s. In Swaziland, ARV tablets are provided by the government for free.
ARV’s have been shown to dramatically fight the HIV virus and boost the immune system through a combination of several drugs. A few weeks after starting ARV’s, a person’s condition can improve dramatically. Lifespan and quality of life are significantly improved in many cases. However, severe side effects can often occur including nausea, vomiting, diarrhea, and fat redistribution. Because the drugs are toxic, the side effects are severe, and some patients are forced to change their treatment. Similar to chemo and radiation therapy, the process is not pleasant, but the results are often life-changing. It normally takes several weeks for improvement to be evident, so some people lose hope and give up on the ARV’s. This is often worse than if they had never taken ARV’s to begin with.
In Fansile’s case, the doctor seemed confident that after 6-10 weeks on ARV’s vast improvement in her skin condition would be evident.
If you’re interested in a good explanation of ARV’s, then please check out the Wikipedia page on anti-retroviral therapy: http://en.wikipedia.org/wiki/Antiretroviral_drug

4. If It’s Going to Happen…
It’s hard for me to describe the type of joy that I have had here thus far. I don’t want people to be suffering like this, but if they are then I want to be with them.

5. Lwazi
I had another great meeting with Lwazi. We looked at Galatians 5 and the contrast between acts of the sinful nature and the fruit of the spirit. With a big smile, he said that he prefers the fruit of the spirit. We also took a look at Romans 2:7-11 to once again contrast good versus evil. I took Lwazi and his little brother to lunch at a good but cheap restaurant in town (8 rand or about $1.20 for lunch).
I have not been able to meet with Sifiso (who I incorrectly called Mifiso in my last email) again, and I don’t have a way to get in touch with him. Hopefully I’ll run into him in town again soon.

6. Game Reserve
I visited a small game reserve with everyone from the farm. This was fun. We drove around in a Land Cruiser and saw giraffes, zebras, wildebeests, warthogs, impala, and several other deer-like creatures. There were also two lions in cages, but this was not much different than seeing the lions at University of North Alabama. It was a fun trip to the game reserve, but it certainly did not satisfy my thirst for a more natural African wildlife setting.

7. Gogo’s Health
Gogo has been feeling better recently. She also told me that in September she tested negative for HIV. This makes me very happy.

8. Swazis Love Certificates
How can I describe how much Swazis they love certificates? On Thursday, Dec 13th, I attended a ceremony to give certificates to the most recent group of home-based care supporters for successful completion of ten days of training. The ceremony was fun because it was very much a celebration. There was festive singing, speeches, skits, scripture, prayer, etc. The ceremony lasted about 4 hours and 15 minutes and was followed by lunch. This topped the 4 hour preschool graduation that I attended a couple weekends ago. Both of these ceremonies were fun because the people sing with joy.

9. Swazis Love Calendars
And the Swazis love calendars, too. Each year, Arnau prints out many calendars to distribute to the home care workers and around town. These are poster-format calendars with each month of the year visible and pictures along the sides. I was given a few of these to distribute at the farm. Normally, I feel extremely safe walking around town, but not so much when I’m carrying calendars! Everybody wants a calendar! I’ve never had people hassle me like when I was carrying the calendars around town.

10. Prayer Requests
- Fansile’s health and healing for her skin condition
- Lwazi’s continued excitement about the word
- Christmas apart from the family and loved ones back home
- Praise that I’ve successfully submitted my application for Swazi residence
- Praise for joy that I have had here
- Praise for the ways that the Good Lord has protected me and kept me safe