Wednesday, June 21, 2006
Swaziland Discovery Trip March 2006
March 14 – 19, 2006
Four in every 10 people in Swaziland are HIV positive. The life expectancy is 33 years old (2005 estimate) and is expected to drop to 30 years old by 2010. A third of all children are without parents. Half of the patients in the hospitals have AIDS, and an estimated 50,000 people are dying each year from AIDS. Most AIDS victims never see the hospital and die at home most of the time alone. The orphaned children are who we are concerned about, and it is with that in mind, that I went to Swaziland to look at the medical care available for the “Forgotten Children” cared for by Children’s Cup and Mission of Mercy. The result is both encouraging and overwhelming.
Swaziland is a country slightly smaller than the state of New Jersey and has a population of around 1,173,900 people. The figure is inaccurate because of the AIDS pandemic, the lack of current census data and the lack of documentation of those who die or who have HIV/AIDS. Swaziland is a land locked country in the north eastern portion of South Africa and is a monarchy. Agriculture occupies more than 80% of the population and the country is heavily dependent on South Africa from which it receives about nine-tenths of its imports and to which it sends nearly three-quarters of its exports.
MEDICAL FACILITIES AND PROFESSIONALS
Medical care is far from adequate. The hospitals are antiquated, the equipment is non working and the facilities are dirty, crowded and poorly staffed. Nursing staff are obtained from local training programs which in themselves do not have enough teachers to educate the students. There is no medical school and those who wish to become doctors travel to other countries to receive their medical training and do not return. The doctors who are practicing in Swaziland are from Cuba, Zambia, Egypt, Ethiopia, and other outside countries. I was not able to determine their quality of education, nor their clinical competency, although I met 3 doctors, 1 of whom seemed average in his knowledge base, 1 Cuban doctor who I could not evaluate, and an Ethiopian pediatrician who had a personal bias towards palliative care for children with HIV, citing the futility of trying to treat children with HIV/AIDS only to have them die anyway.
The 2 hospitals we visited were as described above. The first, Raleigh Fitkin Hospital, is a Nazarene associated hospital, with some confusion as to who actually owns and runs it. The second was the government run hospital, Mbabane Government Hospital. The wards and the outpatient clinic were both below standards even for a comparable under-developed country (Ethiopia for example). Physician availability was marginal if non existent and nursing care was absent. The Matron of nursing shared that the nurse to patient ratio during the day was 1:25-35 and at night was 1:45. This would eliminate any care what so ever for a patient from that nurse. The wards were crowded, and babies were lined up on a table side by side, with their mothers standing at their feet with no place for them to sit. The babies we saw ranged from 1 month to 1 year, all with IV fluids running, and all clearly critical. We saw 8 babies one afternoon, and when we returned the next day, 2 of them had died during the night. I had asked the pediatrician about aggressive care for the babies, as it was clear to me that several of the babies needed additional care and intervention. He remarked that they are “heroic” and described their intervention, but it was hard to believe that it was done. There is no equipment available to do what he described.
The out-patient clinics were crowded and always full. There is a VCT clinic (Voluntary Counseling and Therapy) where patients would go on their own to be tested for HIV and counseled and started on anti-retroviral (ARV) therapy. The follow up on these patients was admitted lacking as stated by the counselors. Many patients never returned and therefore the number of people with HIV/AIDS and the mortality rate is inaccurate.
An exciting project exists on the other hand. Baylor University in association with Bristol-Meyer has a brand new outpatient pediatric clinic for children with HIV/AIDS. We visited it and met 2 American pediatricians who work there. The facilities are modern and clean. It has just opened and serves only children with HIV/AIDS and their families. We established a relationship with them for referrals.
We met with SwaziPharm, a wholesaler of medications and equipment in order to establish a relationship for the purchase of both medications and equipment. We toured the facility and were impressed with the inventory and feel that it will serve as a resource for our medication and equipment needs.
A mobile clinic was seen that was bought to Swaziland by a volunteer organization and has a fully functional dental chair with equipment run by a generator. It is a converted horse trailer and fairly large, but will serve well for the dental part of medical missions.
CHILDREN’S CUP, CARE POINTS, and MISSION OF MERCY, MERCY CENTERS
Care Points serve a resource for holistic care for orphaned children. The medical component is what I looked at, and Children’s Cup has done a wonderful job of providing healthcare to those orphans. Teresa Rehmeyer who is a missionary and a nurse, cares for all the children served by the Care Points, giving basic medications and healthcare as needed and referring those who need advanced care to local hospitals and clinics. Each Care Point has a small room that is designated as a medical room and is stocked with basic medications.
Mission of Mercy will be building 3 Mercy Centers, physically the same in structure as the care Points, and similar in holistic approach as Children’s Cup.
There will a total of 12 centers serving approximately 3250 orphaned children. That number alone dictates the need for a comprehensive medical system solely for those children.
With 12 centers and approximately 3250 orphaned children, the establishment of a dedicated medical system is recommended. This can be accomplished using a 3 tier system, all of which is either in place or obtainable. Meeting the healthcare needs of these children early will help prevent long term effects of chronic illness and perhaps prevent devastating terminal illnesses.
Posted by David H. Beyda, M.D. at 9:20 AM