Good Shepherd Hospital
Bulembu panarama
Borrowed Jonos Landrover to get there

Kids on the Mabuda farm who play with tim and RObyn

Town scene
Typical Africa
Cultural centre
Dancing

Good Shepherd OPD

Sorry I still havn't worked out how to order the pictures...

Blog update:

Well here we are still in Swaziland. We have once again delayed our trip to Kenya. This time we are scheduled to go on the 21 April, God willing.
We are finally feeling more settled and in a routine here in Swaziland- school work is more consistent etc. which is the main reason we decided to stay longer. It appears to have been a good decision from the political stability aspect as well as we believe Kenya is again unfortunately feeling unsettled….
Life is proving interesting: yesterday David was up at 5am to go for a bike ride, Lynne and the kids were up at 6am to go bird watching. Lynne and the kids then went over to the primary school to help out- I think she helps with getting the supplies for lunch. I believe they have one classroom and 170 children, 2 teachers and 2 cooks, so they all take turns using the class! Many of the children are orphaned, only have one parent or live with their gogo (grandmother, who may not be related in any way).
At lunch time Jono brought over a chameleon for the kids to see which amused them to no end.
Today the kids have horse riding lessons over lunch break which is the highlight of their week.
Work for David is proving quite challenging: so much pathology and so little resources. He is working with the visiting internist from the USA to try to develop rational empiric treatment algorithms- his first task is the management of an HIV patient with neurological symptoms (unfortunately a common presentation here). There is practically no CT scanning available and doing a lumbar puncture is mostly unrewarding (for one thing they can’t do a culture). So all the decision making has to be on “gut feel” and the problem is that the medications are expensive and in short supply so one has to use them rationally or else when someone else needs them they will be unavailable.
The sad reality is that at that stage, death is a frequent end result, but how can one choose to withhold treatment? Tough decisions.

Last weekend we went to Bulembu, a deserted mining town that is now being revitalized into a Christian community. Jono is involved in the process and that is how we heard about it. There are multiple organizations working out of Bulembu : one to provide shelter for the many AIDS orphans, another to provide shelter for abused children. Teen Challenge is also there to provide drug withdrawl services.
It is quite the project and I believe about 2000 inhabitants now with a projection to 10 000 over the next years. The startup funding has come mainly from Canada I think with an aim to make the project self sustainable- there is a forestry program working right now proving needed jobs for the adults. Sunday we attended Church and it was really wonderful to see such a different way of worship. There is the beautiful harmonizing as the choir sings (was excited to know some of the songs), and everyone sways or dances along. On Saturday Lynne and Robyn were joined by the pastor and his wife for a hike to a waterfall. They had a wonderful time of sharing and she ended up parting with her Trusting in God Bible Study so please pray for this young Church and for a strong foundation to be built. Ps; I really miss our Bible studies but have been blessed with a group of ladies who get together regularly here on the farm and by no co incidence are studing along the same topic. Happy Birthday to Pat and any others . Our prayers are with you all. To Jane you would absolutely love the hiking out here. Take Care.

With us spending more time in Swaziland we will have more opportunity to see the family- we are hoping for Lynne’s sister to join us over the Easter break and at some time for Mom and Dad to meet us half way for a long week end. We will also try to get to see Lynne’s Mom and other sister again.
If there is anyone out there that wants to venture to Swaziland over the next 2 months we have place for visitors……

Just a funny story that we need to share: we have been impressed with the apparent safety here as compared with South Africa- Lynne and the kids are walking through the taxi stands and market place, something one would be very afraid of doing in SA. Our bubble was burst when one of the craft shops owner described how she was robbed at gun point, she went on to say that the thieves were very concerned about her as she was elderly so they brought a pillow for her head as she lay on the floor!!!
So danger is everywhere, it is just that there are different experiences that one can have…

Swazi update

Hi all
We have arrived safely in Swaziland- it took us about 7 hrs from Pretoria.
As we crossed the border we all noticed a change in atmosphere- less busy and more relaxed.
Swaziland is a small landlocked country adjacent to South Africa and Mozambique with a population of about 1 million. It is a “monarchy”and in general is politically stable. There is only one tribe here which likely contributes to its stability.
We are staying at Mabuda Farm (which belongs to our friends) and have been put into lovely accommodation. The first thing we noticed was the lack of “burglar bars”- an essential feature of any house in South Africa. In fact we don’t lock our door when we leave the house (there’s no point if the windows are open!).
The children have had lots of excitement on the farm already- they are both involved in twice weekly horse riding lessons, there are about 6 dogs to play with, Robyn loves to wait at the chicken hutch for the hens to lay eggs so she can collect them “warm”. Jono and Helen have 4 children, 2 at boarding school and Ruth (9) and Daniel (11) here on the farm, so Tim and Robyn have teamed up with them.

As for the medical work, it has been quite the “baptism by fire”. Swaziland appears to have the highest incidence of HIV anywhere in the world- 42% of prenatal patients are positive. Unfortunately this is likely a result of some cultural issues. The present King has I think 12 wives, and the report was that the King prior to him had 100 wives and 600 children!
My first day in OPD I think close to100% of the patients were HIV positive (and this is not the HIV clinic- that is separate)!!
The medical pathology is extreme and overwhelming- the average life expectancy is now reported to be 31yrs (understanding that this is an “epidemiological” number and if there is a high perinatal/neonatal mortality rate, this obviously skews the number).
The commonest combination that I am seeing is AIDS (endstage) and TB(advanced). The facilities are primitive although there is a HAART (Highly effective antiretroviral therapy) clinic so the patients are able to access the medications for free, there is still a cost to them for transport which can be a barrier for some.
One difficult issue is that for regular medical care including admission, the patient is responsible to pay for everything- it is not much by American standards, but these people are very poor. A visit to OPD costs E15 (at E7 to $1 = $2).
Xray costs E10, CBC E10, etc.
This makes one very aware of what one orders- not that there are many options anyway!
There is a CT machine about 1.5 hrs away, but the cost to the patient is E3000!

The hospital is quite run down, and the “oasis” in the middle of this is my friend Jono’s eyecenter. He is a classmate from medical school and although he has not specialized in Opthalmology, God has placed him as the only Eye Surgeon in Swaziland.
I will be spending 1-2 days per week in his clinic and have already seen the devastation of adult gonococcal conjunctivitis and reactive uveitis in AIDS patients on HAART leading to irreversible blindness. I will also be assisting him by doing the anaesthesia on his patients requiring GA (mainly the children).
Through prayer and lots of fund raising he has built up an eyecenter with fairly modern (by African standards) equipment including several slitlamps, 2 lasers, OR equipment for eye surgery etc. He has an amazing (Canada take note) policy of “Zero waitlist” for his surgical slate.
If a patient is seen in his clinic and requires eye surgery, the operation is performed the following day- this is in part because patients have often had to travel long distances to get to see him (they come from all over including neighboring countries like Mozambique).
The majority of his operations appear to be cataracts (generally in people who are legally blind) but he covers the whole spectrum. I think his biggest operation slate was 34 patients!!

As for our future here, we are not sure what is happening in Kenya at this time as we have limited media access. We have heard that the mediation talks seem to be ongoing and that things are more settled. We are waiting on God for His direction in this.
Our flight to Nairobi has been rescheduled for 3 March so we will be reaching a decision within the next two weeks.

There are lots of needs for prayer out here- the most dramatic is the devastation of AIDS on this population. Medically one feels helpless with the extent of the disease burden.
One sees the desperate need for these people to know God.
There is nothing any person can do in this situation!

Was meant to take some photos today but got caught up with other things. Will post this now and then the photos next week.

David, Lynne, Robyn and Tim

An interesting sign...


"Free Range Children" taking it easy.

Another picture of the beach at "Happy Wonderers" caravan park.

Update

Well things are progressing.
We leave tomorrow for Howick, see Lynne's Mom, then head up to Pretoria on Thurs to Lynne's sister Judy.
There we sort through all our luggage and then Sunday head off to Swaziland.
The rest is unknown and will be the substance of further updates!!
We unfortunately will miss our easy internet access that we have enjoyed here in Hibberdene- for those technical people out there, we have been using the WiFi on our laptop to connect to a "hotspot" about 800m away!!! This is virtually impossible so has been one of the miracles that we have appreciated, as for a time there we were needing to send and receive multiple emails to get things organised.
We will keep you informed as we are able. We appreciate your ongoing prayers.

David, Lynne, Robyn and Tim