Swaziland

Hello again

All is quite well in Swaziland. It is an amazingly lovely country with beautiful mountains and a nice capital city - Mbabane. I am settling in and will be moving into my rented house next week. It is a newly remodeled 3 bd/ 2 bathroom house on a hill with a very nice view. It has a nice yard where I hope to start a garden. The weather here is fantastic - similar to Sonoma county. Mid-day it is in the 80s now and at night cool and comfortable. I am not sure how hot it gets but around december to jan is the summer season. I don't think temps get much more than in the 80s. The city has a lot of modern things with a great variety of groceries available and is quite walkable. It is much smaller than Kampala but has almost everything I could want.

I have started working in the clinic here seeing patients all of last week. It is quite exciting to be part of a new project bringing much needed care to HIV pos children and their families where previously very little has been available. The orphan situation here is alarming and growing very rapidly. Looking at the math, women in the child rearing age group have a prevalence of close to 50%. Up until very recently there has been very few of these HIV positive women receiving antiretrovirals to prevent mother to child transmission. Many of the parents are dying young and leaving behind so many HIV positive orphans. It really is a humanitarian crises. I saw a pair of orphans in the clinic the other day and really fell in love with them. They were so sweet, well behaved, cute and unbelievably happy with the excessive amount of attention i was giving them. After the visit three 4 year old boy orphans and one 6 year old girl orphan sat on the bench waiting for their ARVs i prescribed with their feet dangling a long way from the floor. I couldn't resist but to sit with them tickling them and laughing with them for about a half hour while they waited patiently. I am seeing mostly children but also a fair bit of young adults. I am pushing to be involved in outreach projects that treat pregnant women and follow their newborns. I will also be lecturing in the rural areas on HIV care and treatment with the other doctors in the program. I think the changes we will see over time is going to be phenomenal.

I will include photos as soon as i get more organized. I hope everyone is well. Still awaiting Angela.....=-( Seems like I end each entry with that. Here's to hoping I won't have to enter that much longer!

Peace,
Dan

Times a changin'

The times, they are a changin'. A lot has happened since my last blog post and I will attempt a re-cap. Not to worry all is safe, no coups or anything like that. The big news is that I am moving to Swaziland today. It all happened very fast and has been a bit of a challenging time. Last week we took a trip to the west side of Uganda to evaluate the feasibility of beginning a project in that area on national scale up of pediatric HIV treatment. It has been an emotional time. The hospital, the ugandan people and the children have been wonderful beyond words. I fall for every child I meet and my heart goes out to them. I want to help all of them and it is difficult to know that I cannot. Ugandan people are a happy, friendly, open, warm, accomodating, intelligent and sweet. It will be hard to leave them. The location in the west was far, about 6 hours drive from Kampala and near to the Congolese border. It seemed quite safe there but would have been very remote and somewhat isolating. After the business we took a trip to Queen Elizabeth National Park which is quite lovely - we saw plenty of animals and I have included just a couple of the 200 plus photos I took on the trip.

Without going into too much detail, the decision by Baylor leadership was to transfer all five of us doctors to other countries where they are operating successfully and need more doctors. I chose Swaziland for many reasons but didn't have much time to choose. It is a mountainous, landlocked country in South Africa, close to Mozambique. It is much cooler and now is winter, with lows in the 30s at night. It is a small country with a population of 1 million and about 50,000 in the capital Mbabane, where I will be. The HIV prevalence there is one of the highest, if not the highest in the world at approximately 40%. In turn, the life expectancy is the lowest in the world - 32 years. There were apparently only two pediatricians in the entire country before our program arrived. There are currently 10 PAC doctors there now and three of us from here will be going to make a total of 13. I am hoping to get involved in a new project there of starting anti-retroviral therapy on pregnant women and then treating their children after their birth. I will be the only Family Physician for PAC there so it seems like a good role for me, not to mention my love for obstetrical care. The current PAC doctors there are some of my favorites that I met in the Houston training. All in all, I think it will be a good move.

Changing jobs, moving countries, still not having the house sold, not having Angela here, having my first GI illness and financial strains have made for challenging times but I am always hopeful. Its difficult to keep me from being always hopeful. I am confident that I can make a big difference in some peoples lives in swaziland and am doing what I have dreamed of for the last 11 years when the idea of being a doctor came to me. Just looking into the eyes of these beautiful, innocent children, seeing them suffer and knowing I can help keeps me positive and hopeful. The other details, although stressful, will all work out.

Internet in Swaziland is hit or miss - so blogging may be a little more basic and more intermittent. I will probably get a new phone number soon and will forward that as soon as I have it. I hope everyone is doing well. I think of life, friends and family back home often and miss everyone. Congrats to Barry and Amy and their engagement! I am sad to miss the celebration! Please send some positive thoughts for the sale of our house and the re-uniting Angela and I. Take care. Peace.

dd

The Market

We went to one of the local markets today called Nakasero Market. There were very few Muzungus (foreigners) there. We were having trouble finding any meat to eat that looked good in the grocery store so we asked the locals where they get their meat. We were instructed to go to Nakasero Market and pick a "broiler" (hen i think) not a "cock" because the meat is more tender. So, the process is that you pick out which live chicken you want, they grab it, carry it to the back and butcher it. The pictures show the back area where they cut the head off, dip it in boiling water, pluck the fleathers, clean it out and return it to you in a plastic bag. The smells were intriguing. Now, that is a fresh chicken. The market is full of fruits, veggies and other meats as well. It is crowded and a bit hectic. You've got to shift into relaxation mode and soak it in or you will have a difficult time. I am pictured with Ivan, one of the chicken guys. Fortunately, there is no bird flu in Uganda but the chicken guys said that chicken availability is down b/c of the fear of bird flu.

Next week we will be seeing patients all week in the clinic. Looking forward to taking care of these adorable and unfortunate children. About 50% of them are at least partial orphans (lost one parent) and usually due to AIDS. They are in need of lots of love and caring. In about a week we will be traveling to kassese and soroti to visit some clinics and hospitals there. Should be an interesting field trip. I hope everyone is doing well. I miss home/family/friends and my lovely angelina but am having a good experience here thus far. I know a few words in Lugandan (local language) but don't know how to spell them so wont type them. Until next time.....

Dan