Primitive.
That was the word Sister Diane used to describe the mud huts, dirt roads, and general culture in the Lubombo region. She stated it matter-of-factly and without any hints of condescension. At first, you would imagine that such a word would be too harsh to describe any community in the modern world. After all, technology and society has progressed enormously during the past century. But all of these advancements have occurred in developed countries and the wave of progress seems to have skipped over areas such as southern Swaziland.
In addition to living in mud huts ( a picture of one of the nicer homesteads we visited is below), most people there are also living without running water, electricity, or a steady source of income. The only local industry in the region comes from harvesting sugar cane, but until the dam was constructed recently, farmers were only able to grow sugar cane during the summer months. These challenges, though, have not kept farmers in other areas from progressing. For the past 15 years, however, the Lebombo region has also been crippled by the a massive drought as well as the HIV-epidemic. The epidemic devastated the region, wiping away an entire generation and crippling a society that depends on the productivity of its young adults.
Last week, Lauren and I visited the Cabrini clinic in St. Phillips (the rural community). Unlike the clinics in Mbabane and Manzini, the Cabrini clinic actually goes out in to the rural community to provide outreach care. The nurses who go to each homestead are tasked with distributing medications (mainly anti-retroviral treatments), distributing food, providing counseling, and providing immunizations. Expert clients who go on outreach missions are given a trickier task; they are asked to track down patients who have stopped coming to the clinic or have defaulted and encourage these patients to continue their medications. These expert clients also perform phlebotomy (blood draws) to check CD4 counts and liver function. I was fortunate enough to join both the nurse and the expert client. Considering how comfortable I have been living in Mbabane, it was certainly an eye opening experience to go out into the community and see the widespread travesty.
The St. Phillips clinic, like most other African clinics, is mostly staffed by nurses and expert clients (specially trained civilians). Though they have recently received funding and equipment from international organizations, they are not as well-resourced as other clinics we have visited. We were therefore able to use our adherence charts and, for the first time, demonstrate how to use the salad spinner centrifuge. We also left our transilluminators with the clinic to use, and I was able to draw a rough sketch of a phlebotomy kit for our transport system. We were definitely encouraged by how receptive the clinic staff was to our technologies. I feel that it is in clinics like St. Phillips that our technologies can have the most immediate impact.
In addition to the feedback that we received for our technologies, I felt that being able to see the impoverished conditions in which some Swazis are living was an invaluable experience. Until last week, mud huts were only a piece of my mother’s fictitious impression of where I was staying rather than an actual part of my African experience. It also made me realize that there are so many other barriers to delivering healthcare than simply having access. Even though there is a well-stocked clinic that has become integrated into the community and that has programs to make receiving healthcare as seamless as possible, there are still major cultural and societal stigmas that prevent people in St. Phillips from accepting treatment.
But that is a discussion for another entry. For now, happy Independence Day and I hope that you are able to enjoy the fireworks back home.
