Visit to RFM
We have officially been in the country for one week and have spent most of our time observing the clinic and working on finding a licensed translator for the dosing clip study. While this may seem like a common enough request, it has been quite an ordeal here. The only one we were able to locate was through UNICEF and lives in Matsapha, the city where we first landed.
Yesterday, Dr. Eric, one of the Baylor doctors, took us to a Baylor satellite clinic in Manzini. The clinic was much smaller than the one in Mbabane, seeing only about 50 patients a day. It was located right next to the government hospital, thus allowing it to serve only pediatric HIV patient, unlike the Mbabane COE which also saw adults and non-HIV-related illnesses.
One thing I noticed at this site was the much higher number of Gogo’s (grandmothers) who brought their children to the clinic. In Mbabane, there were many mother mothers and fathers coming in with their children. Manzini also had a disproportionate number of very young babies coming in. Most were right around one year old and HIV positive – for me, it was really difficult to watch. The Gogo’s tied the babies onto their backs with large towels or small sheets. Gogo’s are much more dedicated to keeping kids strictly on their regimens than parents because they are part of the older generation who remembers what Swaziland was like before HIV took the country with devastating force. Many have lost their own children and seen the change in the country that the epidemic has brought and thus want to do all they can to protect their grandchildren from it.
One of the patients was a little boy who came in with both of his grandparents – he, too, had lost both parents to HIV. Around nine years old, he had already failed the first line ARVs. His virus had thus gotten stronger, causing him to have to stroke and leaving him unable to even walk from the waiting room to the exam room – his grandfather had to pick him up to bring him into the room. He had to be prescribed second line ARVs. As HIV becomes an older disease in Swaziland, many more people will end up failing first line and even second line ARVs.
At the end of the day, we went to see the government hospital right next door, and afterwards observed a patient visit for a pregnant woman. During this visit, Dr. Eric told us that women here have very little power in their relationships. Often, the man of the house decides unilaterally how many children they will have, even if her health is being affected. Thus, family planning is a big issue here. We may end up pursuing a project related to that area.
For now, our mission is clear: find that translator!