Reports from Swaziland

I am becoming increasingly interested in the diagnostic capabilities of both the Baylor clinic and their outreach sites. I was able to spend the entire day yesterday at one of the rural outreach ART clinics. The one doctor and I spent 8am-7pm seeing 27 patients, 9 of which were “new ART initiations”. Five babies had their blood drawn (without a flabatamist), and one family waited, literally, the entire day only to find out that they had been directed to the wrong line. Of course, Michelle did the best she could to see treat the family. I don’t think it’s necessary to describe the condition of the outreach clinic. A description wouldn’t do it justice anyhow. Imagine a hybrid of a jail and a homeless shelter and you’ll be close enough.

The diagnostic capabilities at the clinic are astonishing. They are able to perform CD4 counts (without percentages, so the nurses must use the numbers to calculate this), LFTs (Liver Function Tests), FBC (Full Blood Count), DBS tests (to send to a PCR lab) and HB (Hepatitis B) tests. However, they do not draw blood from patients younger than 5 years of age—they refer these patients to the Baylor outreach doctor that comes once a week.

In continuation of my investigation of PCR capabilities in Swaziland, I have discovered that they have a PCR machine in Swaziland. It is barely being used—the rumor is that it is being “tested”, whatever that means. Still, sending samples to the lab in Swaziland only decreases the turn-around time by one week (from 6 weeks to 5 weeks), not decreasing the turn-around time enough to keep the patients from returning more often than their four week follow-up visits. Perhaps prioritized sampling could solve at least part of the problem—children with extremely low CD4 counts, and clinic symptoms of HIV could have their tests expedited. However, the protocol for prioritization would have to be so subjective that this might not be a possibility. They rarely do RNA PCR at Baylor—10-15 times a month—and send their samples to a private lab for results.

This morning, Yiwen and I presented our projects at the staff meeting. There were several gasps and whoa’s as I unzipped the lab-in-a-backpack. They are VERY excited about the backpack, and are eager to find a home for it. We decided that it would not be of maximal use at the Baylor clinic (most of the work is HIV-related, and they do not do outreach to clinics without lab capabilities—yet). However, I have been directed to several doctors working in the most rural parts of Swaziland. I am most interested in pursuing a husband (doctor) and wife (nurse) team from America, working in a rural community of basket-weavers (Gone Rural Bomake). As of right now, they are the most likely candidates to provide feedback on the use of the backpack.