MGH part 2
Unless a person has personally visited a government hospital or one of the rural clinics, the HIV statistics about Swaziland do no justice to cycle of destructive impacts the disease has rack to the people. Official HIV prevalence of Swaziland is reported to be around 40% but most suspect that actual percentage is around 50%. 80% of inpatients to government hospitals have HIV.
Driving up to the Mbabane Government Hospital (MGH), located in the central government district, I saw an imposing muti-story, red-brick building next to the hospital’s parking lot and thought to myself this must be the hospital. When we walked the other way, into a dimly light hallway of what I can only describe as a delipataded jailhouse, I was stunned that this was the government’s hospital, the premier public hospital in this kingdom. I can’t believe it of myself now, but at that moment, I asked out loud “Is this the government hospital?”
Big chunks of paint were peeling everywhere the eyes can see. What much could be seen was mostly though natural light passing through often web-cracked windows. Doors leading to wards or conference rooms were reinforced with bar gates. In the pediatric ward, bugs, roaches were easy to spot as they moved without fear. It is not as worse as a hospital can get, especially after reading the Lesotho interns’ experiences, but for Swaziland, a country considered to be one of the richer nations in Africa, where there are no outright beggars, where people dressed so well, where the MGH is located in the center of a rich government district, I expected more. I expected that the Swazi citizens would demand more from their government. It was really shocking to see the contrast between the condition of the hospital and the government building across the street. It was an overt sign that the government’s focus is not where it should be.
The facilities inside the hospital didn’t get much better than the hospital’s appearance. I am glad that it is equipped with basic diagnostics such as ultrasound, CT and x-ray machines and with a decent lab. The hospital might more or less meet the demands of a HIV-free population in a developing country, but the high prevalence rate of HIV opens so many doors to common and unusual—all serious—diseases ranging from cancer to simple opportunistic infections that it becomes very hard for doctors to diagnose and treat, especially in a resource-limited sitting. I won’t detail all the cases, but to state simply, I saw doctors who could not diagnose children because of the lack of laboratory capacity and patients with serious forms of cancers like osteosarcoma who cannot get treatment here because there is no oncology center in the country. Almost all the cases we toured—nine out of eleven—were HIV-related. We weren’t specifically shown HIV cases; we followed doctors on their morning rounds and discovered that almost all cases were linked to HIV. The prevalence rate, when you see it in face after face, on bed after bed, is shocking.
What was perhaps most heart-wrenching to see was that the kids just seemed to be hit from all sides as soon as they are born: malnutrition, HIV, respiratory infections. Almost every kid we saw had all three of these: three inseparable sisters that pull the children into cycles of unrelenting illness. The infants get HIV either from their mother or through breastfeeding. They almost immediately become malnourished due to the socioeconomic conditions in the country. Both then make them easy victims of ubiquitous respiratory infections like TB and pneumonia. If a baby is lucky enough to avoid TB or pneumonia but is admitted to the hospital, he will get either one during his stay because all the children are kept in the same room. Life is unbelievably harsh to a baby here.
On top of everything, I learned that there is no medical school in the country. None. A person has to go to South Africa to receive training and if Swaziland is lucky, he might come back. Of the four pediatricians I meet (the only four in the hospital), three came from another country. The hospital is attempting to try task-shifting. When the pediatricians make their rounds, a group of nursing students follow each doctor much like medical students or first-year residents. However, no matter how the people try to compensate for a government’s inattention, it is clear that the government needs a firmer commitment to the health of its people, especially when it is in such a dire situation. At times, I feel that the people must demand it, must want it from their leaders. More Swazi citizens must show their own commitment to health and more men voluntarily need to be tested and treated.