settling in swazi

hello

I have now settled into my own house in Mbabane, Swaziland which is quite nice. It is part way up a hill with great views of a valley. I am now finally settled where i hope to stay for a while! I have been taking local transport to the clinic. I walk about 10 min to the main road and hop on a coombie (sp?...a van) and for two emalangani (7 e per 1 US dollar roughly) I get to the clinic. The clinic is an amazing space with fantastic patients. It is exciting to be part of a new clinic with lots of upcoming projects. I have found it nice to be a Family Practicioner b/c often i will see several family members and having experience with procedures has been helpful. Next week I will be involved in a training for health care providers from the east of the country. I am lecturing on diagnosis of HIV/ WHO staging and also on Prevention of Mother to Child Transmission. Looking forward to it.

There are apparently some great parks here in swazi. The hiking and camping seems to be fantastic. Soon i am planning on making some trips - when things get settled with our house in california. Mozambique is only about a 2 hour drive from here and supposed to be quite beautiful. Great scuba diving on that coast too. I would also like to make some trips to South Afica - Durban is not too far. Kruger national park is not a far drive either and supposed to be one of the best parks in S. Africa. So many places to go, so little time. The visuals here are quite pleasing.

Bill - I think the high prevalence is difficult question and obviously multifactorial. First off, people have not had access to ARVs until recently and the virus is spread more rapidly/readily when viral loads are high. Secondly, the whole condom issue is huge. It is not often culturally very accepted in many countries plus it is a stigma indicating that you have HIV if you use one so people are reluctant. There are many more issues with that. Other huge factors are that PMTCT is just getting started but has been fully implemented in the US for a while so new infections are taking place all the time when pregnant women aren't treated. Lastly, there are big genetic differences that contribute to suceptibility and the virus also is a different sub-type than found in the US. It is usually HIV 1 subtype B in the US but HIV 1 subtypes A and C among others in Africa....so, this discussion could go on for a while but those are some of the reasons why the epidemic is out of control here. Not to mention lack of health care providers....it is an amazingly complex issue the more you look into it.

Good to hear from Kate and Justin in the comments! Kate - would love to get connected with your friend in Durban. Justin - send me an e-mail. Would love to hear how things are going.

Later,
Dan