Reports from Swaziland

Since we’ve been in Swaziland, we have been on a constant lookout for projects that we won’t have the time to pursue, but that might be viable for future interns. I noticed that, often times, bloody needles, gauze, syringes, and even body parts, are thrown out in the common trash can. Even when sharps boxes were available, they were often left unused. This dangerous waste was then thrown out with other common waste, to be rummaged through and handled without care. A low-cost incinerator, a waste treatment technology involving the combustion of organic materials and substances, would be very useful in these situations.

Again, I wish I had more time to spend with nurses and expert clients in the field, working on adherence monitoring skills, or even developing a simpler adherence monitoring system. Of course, it would be wonderful to be able to provide hospitals with a low-cost, easy-to-use DNA PCR machine. However, this is likely wishful thinking, and an endeavor more suitable for a graduate or Ph.D. student. I noticed that Swaziland, like Malawi, has a network of “Community Health Workers”, called “Lay Workers”, who work in their communities to provide health care in the most remote regions of the country. These workers are provided with only a few tools, and would benefit greatly from a Community Health Worker backpack. This possibility is, of course, dependent upon how the pilot of the CHW screening kit rolls out in Malawi, and what modifications are made accordingly.

During our time at the Baylor clinic, we saw more than one pleural effusion drained with just a syringe and a needle. It was a painful process to watch. The doctor would poke the patient several times, unable to determine where the pleural effusion was located, making their best guess. Without the aid of either a pleural effusion kit, with butterfly clips for when the patient moves unexpectedly, or an ultrasound machine to track the location of the pleural effusion, the process was very painful for both the patient and the doctor. Perhaps, this is a problem that could be solved by some of Rice’s finest engineers.

One of the PAC doctors, Michelle, works closely with Swaziland’s ONE OBGYN. We discussed some of their barriers to treatment and diagnostics. They are able to do pap smears, but often have trouble both funding the routine examinations, and working with the pathologist to confirm a diagnosis. So, they are shifting towards the VIA screening method. While this method only requires vinegar and dye, the biopsies that are being done on detected lesions are atrocious. There must be a better way.

Of course, a resource that could be utilized at every Baylor Clinic is a curriculum for the Teen Clubs. Botswana has set the precedent with a well-organized, well-attended, well-funded teen club. But, even the director of the Botswana Teen Club is searching for a year-long curriculum. I wish we had more time to focus on these projects. Although, I’m sure we would have discovered more projects to be done along the way. One thing is for sure, there’s always work to be done in Africa.

Our last few days in Swaziland were filled with excitement, as the US made it to the FINALS of the Confederation Cup in South Africa. They would play Brazil (the GREAT Brazil) in their first FIFA Cup final, ever. They went on to lose (3-2, after a halftime score of 0-2) on Sunday night. Yiwen and I blame it on the fact that we left Swaziland. Perhaps, we should have stayed one more day. Still, our last few days were filled with warm goodbyes.

We managed to finish all of the projects assigned by our mentor. We reorganized their resource library, in an attempt to make the resources usable and accessible. We created a check-out system for their x-rays, in order to track the location of all x-rays that leave the data room. We planned and taught the teen club, and provided the clinic with resources and activities for the next few months. We created a brochure for the teen club to use in order to raise money for a nutritious meal once a month. We read to kids as they waited patiently to see a doctor. Finally, we worked on a couple of data systems – one, to help the PAC doctors develop quarterly reports for their outreach work, and another to track the progress of patients on nutritional supplements.

Both Yiwen and I were able to complete our primary projects – the implementation of our design projects from back home. I left the Lab-in-a-Backpack with “The Luke Commission”, with a promise by two eager American doctors to provide tons of feedback, and Yiwen delivered an incubator and a phototherapy light to one of the government hospitals, RFM.

On top of my primary project, and the projects assigned by our mentor, I identified several secondary projects during my five weeks in Swaziland. I worked with ICAP (International Care for AIDS Care and Treatment Program) to set up FrontlineSMS, a text-message based communication system between a central hub (ICAP), and outlying communities. ICAP then put me in touch with several Peace Corps volunteers who were hoping to use FrontlineSMS in their community development programs. We worked together to get the system up and running, and to brainstorm several ways that the system could be used in their communities.

I also worked with one of the expert clients at the Baylor Clinic to develop a data collection system for a program that is using cell phones to connect mothers of children who have received DBS tests with their health care providers, in an attempt to increase the number of patients linked to care. Finally, I worked with nurses in several outreach clinics, discussing and practicing adherence monitoring. I wish I could have spent more time with this project – perhaps, this would be a worth-while project for future interns. The Baylor clinic is focusing intently on “task shifting”, the transfer of responsibility from doctors to nurses, from nurses to expert clients, and from expert clients to communities. Adherence monitoring is one of the tasks that is being shifted, from doctors to nurses, and sometimes from nurses to expert clients.