ER

The first week in the emergency department has been already an eye opening experience not only to the healthcare issues that I have been focusing on throughout my time at RFM, but also to many of the social problems that the Swazi people are facing. Big amount of the cases that come into the ER are assault. Assault from a domestic partner, assault from a mentally ill family member (mental health is not accepted as a true medical illness here, and is generally ignored), or assault from a member of the homestead. Other common cases are diarrhea, vomiting and other abdominal problems, due to HIV, not access to clean water, proper sanitation and poor nutrition. Another common visit to the ER is meningitis, which mean lots of lumbar punctures and people from mainly working age population terrific severily ill. Big number of people have also got hit by cars from the side of the road. It’s easy to see how this happens after seeing the number of people walking on the roads not minding the traffic, and likewise, the drivers not minding the people on the side of the road. 

There is an “asthma” room at the ER, as many patients come in needing a nubulizer treatment. Asthma is actually a big problem in Swaziland, mainly because the patients can not afford to proper treatment with short acting inhalers to use at home when they feel an attack coming on, so they have to come to the hospital for treatment, or just by not knowing very well how to take care of ownself when having asthma. One of the pediatricians is working on a project to make inhalers available to patients to prevent all these emergency room visits.

Can not wait for another week to start!

Cabrini Ministry

Because of receiving so tempting invitation of joining the Cabrini Ministry outreaches, which I could not have imagined being honored with, I could not refuse and ended up spending in total 5 days learning the insight of this amazing organization. It was fantastic priviledge to join the visits to homesteads with ill patients, track patients all around the bush who had missed their appointments and do ARV refills in sites deep in the nearly unreachable. I am impressed how committed Cabrini sisters Diane and Barbara are to improve the wellbeing and welfare of the place where "is nothing", working for the kingdom of God, helping with so little resources and medical services. The main target is to leave the homestead with ensuring they can survive until the next visit or next contact with health care facilities. Cabrini distributes for instance World Food Program pags of rice, beans, oil and maize flour, in order to help people far away from water, public transport, health facilities, schools and other essential things of everyday life. Sometimes the food of these people are roots, aloe vera, sugar cain, insects, fish or whatever nature can offer. Precious water can not be used for having a garden and often there is not enough water for domestic animals even. And yet there are people living. Happy of owning own peace of land, or actually it is only king who can own land, but let us not go to too deep in details...

Glass factory

 Amongst the mountains that encircle the tiny African Kingdom of Swaziland is the world's most ancient iron ore mine, dating back 43 000 years and at its foot is the remote village - NGWENYA- (Siswati name for "crocodile"). Here a small group of Swazi craftsmen and women - with age old artistry - breath life into enchanting interpretations of the animals and birds of Africa, imbuing each with its own irresistible personality. Each item is handmade from 100 % recycled glass. 

Since its rebirth in 1987, Ngwenya Glass has been more than an inspiring success story. It is an environmentalist's dream. The products, which include a range of tableware, drinking glasses, vases, jugs and ornamental African animals, are all handmade from recycled glass. Most of this is from soft drink bottles, gathered from all over Swaziland . Not only are the people of Swaziland encouraged to collect the bottles, but Ngwenya Glass works with the local schools to instil in the children a sense of environmental awareness. In exchange for building materials and the sponsorship of the soccer team, the students must participate in roadside clean-up campaigns.

Lutheran church immunization

Today I went to help government immunization program to immunize tens of pre-school children from 2-6 years old in Manzini Lutheran church. Today was the first time seeing children in line opening their mouth to catch Vitamin K and polio vaccination drops. Today was the first time seeing children injected Measles vaccination to elbow with the speed of factory, where I had my hands full of dressing the children back to their clothes and giving all of them a lollipop to take concentration away from unpleasing feeling in the hand. The group was in such a hurry that no vaccination cards were fulfilled and no name checking was done. How about making sure some children do not remain without or that some of them do not get too much vaccination? And how about making sure all children cover immunization program properly? Sincerely hope it is not waste of money, when country is full of children with unproperly followed vaccination programs.

Mothers2Mothers

Today I had a privilege to participate Wellness Center facilitating one Mothers2Mothers group session in Nhlangano rural clinic in Southern Swaziland. Since 2008 Mothers2Mothers has preventewd mothers to child transmission, provided access to medical care for mothers, educated, supported, and empowered mothers living with HIV to keep themselves and their children healthy and overcome social stigma to live positive and productive life. Today the project has more than 80 Mentor Mothers around the country providing one-on-one and group sessions for pregnant women living with HIV advising them about how to keep themselves healthy and what steps they can take to have a healthy HIV-free baby. Since 2001 M2M has expanded to 7 Sub-Saharan African countries with a total of 405 sites and 712 Mentor Mothers. In Swaziland only there are 57 sites and 82 Mentor Mothers at work reaching approximately 75% of HIV+ mothers . http://www.m2m.org/what-we-do/where-we-work/swaziland.html

Mentor Mothers live with HIV themselves and are trained to provide life-saving health education and psychosocial support and network to their peers. Mentor Mothers are role models in their communities, putting a face to empowered, strong, and healthy HIV-positive women. Mentor Mothers are powerful agents against the stigma of HIV that causes women to live in fear and prevents them from seeking care. This month Wellness Center travels around the country talking about disclosure of HIV status to loved ones. Joining the group session and discussion of Mentor Mothers helped to get a picture of the main challenges in terms of disclosure, stigma and culture around the disease, since many mothers are ashamed and frightened to tell their status to their families and friends.

Good results are gained: Women who visited a mothers2mothers site multiple times for education and support were more likely to receive anti-retroviral drugs (ARVs) than women not coming to mothers2mothers. M2M mothers are also more likely to have disclosed their HIV status to others. Disclosure of status makes women more likely to take ARVs. Women who take ARVs are less likely to infect their babies. Mothers who attend m2m are more likely to deliver their babies in health care facilities than mothers who do not attend m2m. Mothers who attend m2m have high rates of getting CD4 counts, a measure of immunity and an indicator of AIDS. Mothers with AIDS who attend m2m are highly likely to get life-sustaining ARVs. The Mentor Mothers themselves were very optimistic big amount of HIV positive mothers can be covered through their work. Mothers are followed by Mentors for 2 years and Mentors do their best to improve the quality of life of their peers.

Day and night in orphanage

Cabrini Ministries is a faith-based / community-based non-profit organization, situated in the Lubombo lowveld region of Swaziland, the most dry area, where only few days a year they have rain. Since 1971, their vision has been to ''Restore Life'' and mission to provide comprehensive care for those infected and affected by HIV, AIDS and TB in the rural chiefdoms of Ngcamphalala, Mamba and Gamedze. In 2002 all resources were refocused towards Health care and care of Orphans and Vulnerable Children (OVCs), and today they are providing care to over 3000 children, education to over 700 children and housing for 140 orphans. Cabrini serves surrounding communities also by agricultural development and mobile nursing services in homesteads which cover 40 kilometers to all directions from St.Philips. Cabrini provides testing, counseling and treatment of HIV as well as prevention in terms of male circumcision.

I was surprised and honored for receiving an invitation to stay over night and join today the catholic feast of the Sacred Heart of Jesus, which is main celebration for the Cabrini sisters, Diane and Barbara, two hard-working aged sisters, who have devoted already more than 10 years to help Cabrini Ministries in Swaziland to bear fruit. The whole afternoon and evening was a big festivity consisting of church service, dinner, children dancing and singing, short speeches and thanksgiving. These sisters have warm diaconal heart, for going where nobody else is and helping most needy. The staff consists of few American part-time and full-time workers, about 40 swazis, and volunteers and peace corps, from who many are also having background of experiencing what it is to be orphan. From this video you can get a better picture of their work:

Operational theater

Welcome to theater. Hopefully they told you before arrival what you are doing here, because we are just going to do the procedure. Hopefully you signed a paper that we are allowed to open and close you. Hopefully you are not too scared of microbes, because even if we dress according to the hygiene criteria and have many surfaces and equipment cleaned, desinfected and sterilized according to their purpose, we might not be able to guarantee 100 % safety. We follow goals and objectives that we have agreed upon on our department, which include trying to provide good quality care, safe intervention, equipment and anaesthesia, aseptic techniques and proper management. Here, in RFM, we work 24/7, but from Thursday afternoon to Monday morning we have only acute operations.

4 täyttä kuukautta ja talvi saapui

Kolmasosa ajasta jäljellä ja kaksi kolmasosaa takana. Paljon olen ehtinyt näkemään ja kokemaan, mutta vielä on paljon tavoitteita matkan varrella tarttunut matkaan, jotka ovat saavuttamatta. Olen tullut uusien ystävieni kanssa läheisemmäksi ja alkanut saamaan satunnaisia vierailijoita pistäytymään lähes päivittäin enemmän tai vähemmän yllättäen. Olen iloinen, että ystävien saaminen kulttuurien ja elinolosuhteiden erilaisuudesta huolimatta ei ole kovin hankalaa, Swazimaassa rasismia ei oikeastaan ole, mutta ainut kuilu joka usein on paikallisten kanssa on heidän haasteensa yrittää ajatella meidät samanarvoisina, tasavertaisina, taloudellisten lähtökohtien erilaisuuden lisäksi.

Olen jo loppuraportit vaihto-ajasta Diakiin palauttanut ja loppuarvioinnit pitänyt, sillä lukukausi Suomessa päättyi toukokuun lopussa ja pisteet piti saada ennen opettajien kesälomia merkityiksi, vaikka ehdolliset ovatkin, sillä runsaan kurssimäärän vuoksi kerään vielä harjoittelun tuntimäärää kasaan. Tällä hetkellä odottelen siis pisteiden ilmestymistä elektroniseen opintotietokantaan ja Swazimaan yliopistossa kirjoittamieni lopputenttien tuloksia, joiden pitäisi saapua muutaman viikon päästä. On ihan mukavaa, kun ei tarvitse joka toinen päivä enää matkustaa Mbabaneen, vaikka tuleehan sitä vähän väliä sinne tänne reissailtua, ja olen löytänyt enemmän aikaa urheilullekin eli olen nyt enemmän ehtinyt käymään yliopiston koripallojoukkueen treeneissä.

On tervetullutta kun on taas kämppiksiä eli kaksi amerikkalaista farmaseuttiopiskelijaa, usean viikon tauon jälkeen, eli vähän enemmän eloa illoiksi ja viikonlopuiksi hiljentyvässä sairaalassa, vaikka ovatkin vain lyhyen aikaa ja lähtevät jo ensi viikolla. Usein ruokailemme yhdessä lounaita ja päivällisiä, ja on mielenkiintoista oppia farmaseuttinäkökulmaa kehitysmaaolosuhteista.

Sateet ovat oikeastaan loppuneet vaikka vielä onkin ollut yksittäisiä pieniä kuuroja, jotka ovat kummallisia tähän vuodenaikaan. Luonto alkaa kuivumaan ja pölyä on ilmassa joka kulkeutuu kaikkialle. Tällä hetkellä on kova ikävä Suomen valoisia iltoja tai paremmin sanottuna yöttömiä öitä. Pimeä tulee jo puoli kuudelta ja kylmimmät yölämpötilat laskevat tällä hetkellä 7 asteeseen ja vaikka aurinko lämmittääkin päivällä aina 23 asteeseen ovat aamut koleita. Lisäpeitot, lämpöpatteri, lämpimämpi takki, sukkahousut ja sormikkaat on otettu käyttöön. Olen kiitollinen, että asunnossa suihkussa saa lämmintä vettä vedenlämmittimen ansiosta, mutta tiedän, että suurimmalla osalla maan asukkaista ei ole näitä ylellisyyksiä. Sandaaleissa sukitta tai kokonaan kengittä kulkevat vaatimattomissa oloissa elävät vähäpukeiset swazimaalaiset, jotka ovat herkkiä tälle pienelle viileydelle ja sairastumiselle. Sanomalehdessä olikin aukeaman kokoinen kehoitus hyvään käsihygieniaan ja influenssan ehkäisyyn. Lisäksi on alkanut myös rekisteröityminen syyskuussa oleviin eduskuntavaaleihin ja siihen liittyen lehtijuttuja:

 

What is history behind the name of Africa?

According to the United Nations Educational, Scientific, and Cultural Organisation (UNESCO) during the time of the Roman empire, the term became accepted as a replacement for the word "Libya" which meant the land of the Lebu or Lubins in Genesis.

Geographically, Libya meant only the north coast of the continent and at first, so did Africa. By the end of the first century A.D., Africa came to mean the entire continent. The etymology, the origin of the term Africa is not so precisely agreed upon and, according to UNESCO, its origin is credited to one of seven theories:

The Afarak, also known as the Aourigha, were a Berber people who lived south of Carthage. The terms "Afarik" or "Africa" were used to denote the land of the Afarak.

Some believe that the word comes from the Latin adjective "aprica" which means "sunny" or the Greek aprike, which means "free from cold".

The Phoenician root "faraqua", which suggests a separation or in other words, diaspora. The same root is found in some African languages, like Bambara.

In Sanskrit and Hindu, the root Apara or Africa denotes that which, in geographical terms comes "after," or in other words the west. From the geographical position of India, the Asian country from which the Hindus originated, Africa is the western continent.

Another school of thought states that the word "Africa" comes from two Phoenician terms, one of which means an ear of corn, which was a symbol of fertility in that region, and the other Pharikia, which means land of the fruit.

A historical tradition states that a Yeminiter chief named Africus invaded north Africa in the second millennium before our era and founded a town called Afrikyah. Some say it is more likely that the Arabic term "Ifriqiya" is the Arabic translation of the word "Africa."

Another theory states that Afer was a grandson of Abraham and a companion of Hercules."

Another General Assembly

This time RFM, the trendsetter hospital of Swaziland, had priviledge of having visitors as far as from TB hospital and Governmental hospitals, added to official governmental quality experts. Conversation was fertile and versatile. Topics covered fluids policy and guideline development to private ward, pharmacy cooperation with the wards and medication ordering, maintenance injury management and waste management in emergency room. Especially pharmacy project caught my attention, since I have new new roomies, pharmacy doctorate students Jessica and Jackie who have arrived for 2 weeks short-term medical mission as a conjuction with their Advanced Pharmacy Practice Experience rotation included to their 6th year at the St. Louis College of Pharmacy. You can find their blog from http://pharmacymissiontoswaziland.blogspot.com/

The Luke Commission

Swaziland has 2 main cities, Manzini and Mbabane. The rest of the country is mainly rural. Imagine living in the homesteads on the hills of the mountains, far from cities, with the only means of transportation being your calloused feet. This is why community health facilities have a crucial role in the lives of swazis, especially among vulnerable groups, such as children and elderly.

The Luke Commission, the only mobile hospital of Swaziland, has operated since 2005 under the direction of Dr. Harry and Echo (PAC) VanderWal, taking free health care and the good news of Jesus Christ to the most isolated and underserved populations, in partnership with the Swazi people and the Ministry of Health.

At 6 am several times a week, big kombis and trailers, in total of almost 20 Americans and 15 Swazi translator-assistants leave base camp in Manzini, head to remote areas and start up a 9 room hospital normally at schools. Communities with hundreds of patients are welcomed and team explains how the clinic will operate and that everything is free. Blood pressure and sugar level are determinated for each patient. Each patient is treated by a doctor or a physician assistant. Patient are given medications, purchased in Swaziland, verbally instructed how to use medication and written directions in SiSwati printed on each medication packet. Each patient receives a one-month supply of vitamins, extra pain-relief medicine, and intestinal worm medication for every member of the family. Voluntary HIV testing and counseling is offered to everyone at the mobile clinics. During 1 day up to around 40 male circumcisions are also operated along with sexual education and counceling. The Luke Commission even has x-ray and laboratorio. The day is in the end only when the last patient is checked and treated, which is around the midnight.

Those with eye problems are tested with a portable auto refractor and computer program specifically designed for these bush clinics, appropriate eyeglasses dispensed from the database of 3500 donated eyeglasses and, if necessary, scheduled for free cataract surgery.  PET bush wheelchair are provided for those with mobility limitations. Often, new clothes or shoes are given to AIDS orphans and the children. Activities are conducted for the children since it is a long day to spend waiting.

Bibles and Scripture booklets were distributed with the goal of putting one Bible into every Swazi homestead. Only since 1996, has the Bible been translated in SiSwati and often Zulu translation is used. Prayer is provided for every patient. If patients so choose, they can watch a movie depicting the life of Jesus while the clinic activities continue.

The Luke Commission is a highly-trained and hard working team, treating more than 25 000 patients a year. To learn more please visit their website http://www.lukecommission.org/ and watch their video:

Bring your fire

Backlit by fiery mountain sunsets across acres of pristine farmland, MTN Bushfire is Swaziland’s internationally acclaimed 3 day music & arts festival that celebrates creative expression whilst promoting social responsibility, and drawing talent and tourists from across Africa and around the world.

This year again, a multi-generational global community of up to 20,000 “brought their fire” to the scenic Malkerns Valley to experience an eclectic Pan-African and international line-up of live music, theatre, poetry, film, circus, dance, food and visual arts.

Founded in 2006, MTN Bushfire has a well-deserved reputation for its visionary approach, integrity and “Call to Action” mandate which defines its commitment to nurturing the Swazi arts and cultural scene, whilst raising awareness and funds to tackle the nation’s most pressing social needs. Donating 100% of its profits to Aids orphans through the Swazi NGO, Young Heroes (www.youngheroes.org.sz), and 100% of merchandise proceeds to the non-profit rural community development project - Gone Rural BoMake (www.goneruralbomake.org), MTN Bushfire serves, in the words of one journalist, “as a living, breathing, creative ecosystem.”