Swaziland Day 5

Well.

I apologize for missing an entire day’s update, but I’ve been running flat out since early yesterday morning and this is the first chance that I’ve had to get myself caught up.

Ned and I left the hotel early yesterday morning (about 7:30 AM) and drove the Leyango Clinic in Malkerns. (This is the region of the Usuthu parish and the where the Rotary Club meeting that I attended on Wednesday night was as well. … Just a brief note about Rotary – it was amazing to me how similar their meeting was to the various Rotary meetings that I’ve attended around Pennsylvania. They had the same kidding with each other, the same basic meeting outline and the same quiet commitment to make their community a better place for all. This particular club – the Malkerns Club – has been instrumental in working with the club I belong to in Bethlehem to assist us with moving the containers of medical and hospice supplies that we’ve been sending to Swaziland. I had a chance to thank Glyn for all the work that he personally has done in helping us out moving the containers from Durban into the Kingdom itself.)

The Leyango Clinic is the place that Ned (Dr. Wallace when he’s there) is most excited. It’s an extraordinary example of community based health care. The region of Leyango is one of the most organized in Swaziland in responding to the HIV/AIDS situation as well as the other more traditional public health issues. The people of the region formed a clinic committee some years ago to construct a larger, more modern clinic building than the one that presently exists. The present building was designed to house a single nurse and family and it is seeing almost 200 people a day and 300 on a heavy day. The patients had been lining up early in the morning to make sure that they would have a chance to be seen and when we arrived at 8:00 AM they were just finishing up the opening ritual of the clinic. (They sang and had a moment of teaching about health issues of concern to the local community.) By the time I had a chance to meet with the Chair and the Vice-Chair of the clinic committee and take a tour the treatment areas, they were already in full use.

The patients treated at the clinic are all out-patients. They arrive by foot or by bus all through the day. They are dropped off on the side of the road that runs along the side of the clinic. (There’s no parking area for people to use when picking up or leaving patients – though one is planned after the new clinic building is completed.) While I was there a number of mothers brought their children for check-ups, immunizations, scheduled assessment visits and more acute needs. Space is at a premium. The dental area is a sheet that is pulled along beside a dentists chair in the same small room that is being used to dress wounds and counsel patients. The patients have to wait outside in an area with no shelter after their wounds are dressed before they can be given their final instructions and be discharged. In spite of the crowding, this clinic is one of, if not the most, active clinics in the Kingdom due to the fine care that is provided by the staff. Unfortunately the fine care brings patients in from a larger catchment area and makes the space issue even worse.

We walked across the narrow muddy yard to the new, more modern clinic that is being constructed. Some of you know of this clinic already. This is place that was built by the community to respond to their own community’s needs. It is built out of cement blocks, manufactured onsite by the people of the community themselves using block making machines purchased by a donation given to Dr. Wallace. The clinic is almost finished with a new rough given to the community by a grant from the previous US Ambassador. At this point the wiring was being finished, the concrete floors were being poured and the final interior work was beginning.

After a tour of the facility the clinic committee meeting was called to order in one of the soon to be finished rooms of the new clinic. We sat around the walls of the room on benches. We used an old medical exam table covered by a blanket as a board room table. The circumstances might have been a bit improvised but the level of discussion around the room and spirit of the meeting was basically the same as any Hospital Board meeting that I have attended back in the States. We had opening remarks by the chair, an introduction of Ned and me (though Ned is well known and respected by the people of the clinic) and the normal sort of business. The Committee discussed the possibility of setting an target date for the opening of the clinic. (To tell the truth though, the space in the new building is already being used, even before it is able to be painted because space is at such a premium in the old building. While we met, mothers with infants had the regular baby exams in the soon to be finished waiting area of the new clinic.)

Ned was able to announce the happy news that he had brought funds with him from the US that would enable to the clinic committee to purchase doors for the rooms of the clinic – an important need to ensure patient privacy. We talked about commitments people in the government had made to provide for the cost of paint for the walls and to pay for the final hook up of electrical service. We talked at some length about the need to find funding to purchase furniture for the new building. (The old building will be immediately put to use supporting other public health work in the area and the furniture in there will continue to be used.) There is need of couches, benches, desks, tables, examination tables, cabinets etc. The committee discussed various options for raising the funds, but was not able to take action on any of them at the meeting.

Following the meeting Ned took a few moments to consult with the head nurse and other members of the staff of the clinic. I had a chance to wander around, take pictures and just observe.

From the Clinic we traveled a bit further down the road. I was given an opportunity to meet the local Chief of the Leyango region. His English name is Peter – I’m afraid I have no hope of trying to spell out his Siswati name. He and Ned are old friends. Ned pointed out the roof on the corn mill building as we drove up the road to the Chief’s compound and mentioned that he had paid for that roof last year as part of his Christian tithe in the community. We arrived at a great spreading tree in the center of the present compound. (The Chief is building a new house and will soon move from where he is living at the moment.) While we waited under the tree to greet the chief, one of his relatives (who served as the secretary of the Clinic Committee meeting) explained the new feeding program that the Chief was putting in place in his compound for the Orphan and Vulnerable Children (OVCs) of the neighborhood. He is having a traditional big house built in a style similar to the old ways where the children of the region can gather daily to be fed and receive instruction in the Swazi culture and regular life skills (such as gardening, cooking, mending etc…) This is one of the examples of the way that the traditional Swazi government (the King and the Chiefs of the Kingdom) are working with other agencies to respond to the rising numbers of OVC’s in the area.

Ned was delighted to see that the Chief came out to great us in special dress. “He did this just for us” Ned whispered as the Chief came out of his house wearing western garb. As the Chief came closer Ned started to laugh because the Chief was wearing a necktie that Ned and Emily had given to him the previous year. The Chief greeted us, and welcomed Ned back to the region. We walked over the new construction and feeding center and the Chief showed us the plans and explained how the facility would work. We made him a gift of pens that I had brought with me and apologized for the short visit. Ned promised to return for a longer more proper visit the following week after I’ve returned to the States.

On the way back down to the main road from the Chief’s compound his cousin explained to us how she had put on a Christmas party for the OVC’s of the area. She talked about going to local merchants for donations, visiting local families to ask for gifts and working to make a small parcel for each of the children so that they would have a gift at Christmastime. It is exactly the same thing Deacon Elizabeth does back in my parish for the children who are guests of our parish Soup Kitchen.

We left the Leyango region and returned to Mbabane to pick up the staff of the Anglican HIV/AIDS program. From Mbabane we drove to Manzini to meet with some of the National leadership of the Mother’s Union. We met in one of their facilities just outside of town near where the new Swazi stadium complex is being built. The Bishop’s wife Lucy was present at the meeting and it was joy to greet her again. (We had met each other on the occasion of the Bishop’s Palm Sunday visit to us in Bethlehem a few years ago.)

We heard more details about the OVC program that Mother’s Union was starting in the Diocese. This is the same program that Bishop Meshack talked to us about at lunch on Monday afternoon at the Diocesan Conference Center. We heard about how the children, ages 8 to 12 at present, are brought to the center, fed, played with and educated by volunteers from the Mother’s Union. The director of the program talked about the need to provide psycho-social support and structure for children who had lost both parents to AIDS and about the special issues that their guests were experiencing. We talked about plans for the future and about the sort of funds that might be needed to expand the program and complete its effectiveness.

It is very impressive work that is being done, but in way similar to the experience of the Leyango Clinic, the success of the project is bringing additional challenges that need to be overcome. Children are arriving earlier and earlier on the weekend. Some children are not able to attend regularly because they don’t have the money to pay the bus fare to travel from their relatives homes to the place where the program is housed. The needs are so great across the Dioceses that it thought that this ultimately be a pilot project to be duplicated in other areas around the Kingdom.

From Manzini we returned to Mbabane and dropped of Glenda and G. from the Diocesan HIV/AIDS program. We drove back out to Usuthu parish and had a chance to meet again with Fr. Josiah, the parish Wardens and members of the parish Council as well as members of the Parish AIDS response Committee. A dear friend of Ned’s, a priest who had served his internship at Usuthu and was now assigned as Rector of Pigg’s Peak Parish, had traveled back to be with us for the meeting.

We talked about the specifics of the parish program, how it had developed over the years and where it might be headed. We heard about the challenges of the providing school fees for OVC’s – how schools were occasionally claiming that fees which had been paid were not paid, how some schools were collecting fees from two or three sources for one child and how some children were not taking the opportunity of their education seriously. We heard how important it has been for the parish committee to keep close contact with the school and the teacher, filling the role that would normally be expected of the child’s parents. We heard how often the parish committee becomes the child’s only advocate in the system. We talked about the many successes they had experienced and the failures as well.

We discussed the experience of the parish Care teams who work with people in the local region suffering at home with AIDS. The parish sets up teams of four people and assignes them to each client. The team rotates to provide regular (daily!) visits to the patient. They shared with us the difficulty in recruiting people to form new teams as the work load expected of each member of the team is very significant. We talked frankly about the real difficulties experienced by the teams. We talked about the need that each team has for more access to transportation – which is the same need experienced by the clergy of the parish. Many times it becomes impossible to provide basic Christian pastoral care to parishioners as they are dying because the clergy and volunteers can not find a transport to the client.

We ended our two hour meeting with a prayer. Ned and I drove back into Mbabane. I think I got back to my room at the Inn around 10:00 or so. It was a long but very good day. I think I see more clearly some of the hard challenges facing the Swazi people and their Church as they respond to the AIDS situation. And sadly the news is going to get worse. While the rate of infection has leveled off, the death rate, which lags about six to ten years behind, will continue to grow geometrically for roughly the same period of time into the future.