another day...

Looking back and reflecting on my day yesterday made me note what a shocking world this is. Here’s what my day entailed yesterday:

I arrived at the clinic at 7:30, well actually we were on Dangela time and arrived at 7:45. Some things don’t change….I was greeted by a room full of beautiful children and their families. Always a pleasure to see such appreciative families but also sad to see such a room full of needy patients. I was scheduled to go to a romote clinic in Emkhuzweni yesterday leaving at 7:30. The delays were in motion. I had to see a follow up patient – a sexual abuse case. Being paternal in these cases, I didn’t want anyone else to see this child. I finished prescribing this child’s ARVs for post-exposure prophylaxis, counseled the family and rushed out the door for the 1 ½ hour trip to the outreach site.

After avoiding cows on the road, picking up a dentist and a nurse on the way, stopping at a government lab, a Kentucky Fried Chicken stop for the driver and meeting a parliament representative we arrived part way. We stopped at a clinic in Dvokolwako (or something like that) where I was asked to see a mother and her new born to give advice on what medications to give for PMTCT (prevention of mother to child transmission). The mother came to the clinic once for HIV testing during her pregnancy but could not afford the transport to return for her CD4 results. While in labor, she tried to come to the hospital to deliver her baby but had to walk. She collapsed half way there and was brought back home and delivered her baby at home, not getting the ARVs she should have had during her labor. A few hours later she found her way to the clinic and saw the nurse who had questions about what to do. No meds during pregnancy, no meds during delivery, now what? Fortunately I was able to give advice and a prescription. How can you rush on in our nice clinic car when a mother like that needs your help?

Finally, we arrived at Emkhuzweni to a room packed with expecting mothers or mothers and their newborns. They had been waiting all morning for the doctor (me) but I arrived finally at 11:30 am. These poor rural Swazi women were nothing but appreciative to see a doctor. I was happy to give advice, prescriptions and ponder very difficult decisions in order to try and prevent yet another HIV positive child. I had to draw my own blood which I have very little experience with. The nurses always did that for me in my residency. Adults were easy but the 7 week old patients were difficult considering I had never done it before. Those are some small veins! I did have some good success and it was great to learn a new skill. Don’t worry, I was very careful. Many of the women walked a long way to see the doctor and get care. They are trying but fighting difficult foes – poor food security, no transport, no money, little male support, HIV stigma, opportunistic infections, doing manual labor daily while pregnant, walking long distances etc. It makes me want to give them my best. Finally, I finished – making many people wait and work overtime before making our journey home in the rain. A typical day. I will be going there every Thursday and some Tuesdays.