1 week left in Swaziland

Only 1 week left in Swaziland. To say the time has flown by is a true understatement. No only do I not know where the time has gone, I’m not sure what I’ve done in that time.

I just found out yesterday, there are 3 CT scanners in all of Swaziland ( pop. 1.1million)... two of the 3 are in private clinics, but they're both broken... the third is at the Mbabane Central Hospital ( in the capital city), but they don't have the money to pay the x-ray guy to operate it, so it just sits idle...
Oh, and the x-ray unit at Mbabane is now broken ( 1 x-ray unit in the capital city hospital? ) so they are sending all of their x-ray requests to the hospital we are at, which is only an hour and a half away...

One of my patients made the front cover of the local newspaper. “Woman Bitten By Rabid Pig”. And yes, she was really bitten by a rabid pig. There is a serious outbreak of rabies in the cities right now, with quite a lot of people brought into E.R. with dog bites. But the “Rabid Pig Woman” takes the cake, by far. I’ve kept the newspaper article, because it is so outrageous, it’s worth reading again and again.

While I was purchasing the local rag for rabid-pig woman’s story (the Swazi Times is akin to a hybrid between the Vancouver Province and the National Enquirer… they purport it to be news, but how fact-laden is a story about a priest who prays for dead people and brings them back to life – something tells me the reports are not checking the facts quite as much as they should.)
Anyway, one of the other ‘semi-reputable’ papers featured a story about research recently carried out by the Swaziland government. Their new projections for life expectancy will drop to 30years old by 2010 – the vast majority of those dying being between the ages of 19-45 (the entire working populous)
Current forecasts are an estimated 110,000 orphans by 2015.
That’s 10% of the entire population of Swaziland.

On a brighter note, we were at an in-service on Friday, and changes are being made to the approach to counseling and testing of HIV ( aka. “The Virus”). Currently, all testing is done at a VCT ( voluntary counseling / testing ) centre. This seriously limits the number of people who can access the testing services, as the centres are primarily in large cities. The proposed changes will have many more testing centres throughout the country. The current set-up also means that people with opportunistic infections ( ie: TB or Kaposi’s Sarcoma) will come to the doctor / hospital with their complains, and when the physicians asks if they know their status, they indicate that they do not know whether or not they have HIV, nor do they wish to be tested – meaning the root cause of their ailments goes untreated, leaving the physicians to deal with the infections without treating the cause. The amendments will also mean that physicians can order an HIV test without the pre-counseling ( but still with consent), and counseling will follow only in the event of a positive result.
This will hopefully result in more people knowing their status.

Currently, only 18% of Swazi’s know their HIV status…. 82% have no idea if they’re carriers or not. Ironically, I was in the ART ( antiretroviral) clinic yesterday, and there was not a since patient all morning. Apparently, the CD4 count machine at RFM hospital is broken. This is the machine that tests for the viral-load in the blood. I was told it will be up and running by early next week… I’m keeping my fingers crossed.


And since it is winter here, the number of burn victims has increases substantially. Some are drunk and roll into the fire, others are very young and left at home by themselves…. The only reason I mention this is I was in surgery today helping with the debridement of a 6 years old girl’s severe burn. She has no parents and lives with her older brother, who was not home at the time. I will not elaborate any more, but writing about what I saw helps me deal with what I saw ( think of it as digital grief counseling )

One of our crew ( Dr. Karen from California ) went home yesterday to start her surgery residency in Cali.
The rest of us plod along, bouncing back and forth between Emergency, the O.R. theater, and the outpatients departments.

This weekend will involve the last major big-game park in Swaziland.

Next week is our final week here – then we will go our separate ways for a few weeks before heading back to Canada. Andrea is of to Tanzania to do a tour of one of the major parks in Africa. Ryan is heading back to South Africa to spend some time with family there. Jenn and I will be driving down the east coast to the tip of Africa, and flying out of Cape Town.

I’ve still got 3hr and 32 min of time here at the internet café – so I will try and update once more before we leave ( no promises )

Cheers
Andrea, Ryan, Jenn and Chris