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