Back in Swaziland

We returned to Swaziland after a whirlwind tour in the US. I passed through 7 different airports in the US alone during the course of 3 weeks. It was a bit hectic but great. We did back to back weddings, Saturday night in Duluth, MN until 1:30 am then to the airport by 4 am and off to San Fransisco in order to make it to northern California for a wedding on Sunday afternoon. Both were great and it was wonderful to be there with most our closest friends in both states. Yeeeebo! Congrats to Barry & Amy, Kevin and Jolaine.

We were able to see our families in MN and fortunately be there for the arrival of the first Dewey girl in over 80 yrs! Isabel Rose Dewey had to come out and meet her aunt and uncle before they returned to Swaziland (just a couple days before)! We were very happy about that.

I also made a side trip to Tennessee of all places to interview for a couple of fellowships in Emergency Medicine. More to come on that in upcoming blogs. Mom and dad made the trip with me and enjoyed some music, some Colorado Bulldogs (Mary Ellen) and some BBQ. We had a fun trip, saw some music and got my parents to try sushi!

All in all it was a great and exhausting trip. Arriving back in Swaziland to our quiet lifestyle was almost a relief. It has been raining a lot in Swaziland these days but we are still loving our house by the rock.

I missed the children of Swaziland when we were gone. It continues to be an emotional experience in a good and difficult way at the same time. My first day back I saw many sick kids and was doing a spinal tap within hours of going back to work, shocking me back into the realty of what childhood means to an HIV positive child in Swaziland. The suffering continues and the healing happens.

I traveled to my usual outreach sites twice in my first week back. At one site I see mostly pediatric HIV patients and a few adult HIV pos patients. I saw 16 children and one adult. I recommended starting Tuberculosis treatment on three children whom I thought had active TB, 3 children were on anti-TB meds and 2 had been recently treated for TB. That makes 8 out of 16 children that had TB! Some were extremely sick and near death. One child who had already been treated for TB came in respiratory distress and clearly had a bad pulmonary illness. I listened then sent him for a chest x-ray finding that his entire right lung was infiltrated with an infection. His left lung also had a smaller infiltrate.

On the Thursday, I went to Emkhuzweni, as usual. I arrived there to a mother and baby in my exam room waiting for me. I was unpacking my things when my translator tapped me on the shoulder to look at the 16 mo old, 10 lb girl seizing on the exam table. She had a temperature of around 104, seizing, breathing fast and generally not looking well. I brought her to the hospital and we put an IV in her scalp vein, gave her valium to stop the seizure and antibiotics. Likely she has meningitis but possibly a febrile seizure from another illness. I think she aspirated b/c of the seizure and was breathing fast later in the day. I have seen that girl about 7 times in the last year, treated her for TB, Pneumonia, infectious diarrhea and now meningitis. It has been difficult to get her well enough to start anti-retroviral treatment. I have wanted to start but you cannot start them when someone is acutely ill. She has had a fever 5 of the 7 times I am seen her. She has suffered and I can only continue to hope and try to get her on ARVs before it is too late. She is a beautiful girl who has had a tough go at life thus far and I just hope I can have the opportunity to set her on the healthy path. The next two patients had severe edematous malnutrition of which the prognosis is very poor – Kwashiorkor. Neither had any form of milk since breast feeding was stopped, mostly due to poverty. A daily liter of milk is about a dollar a day and most families live on about $25 dollars a month for the whole family. Once breast feeding is stopped, many rural families cannot afford replacement milk. Formula is ridiculously expensive and simply out of the question for most of them Water sources are unsafe – most use river water, often not treated/boiled leading to infectious diarrhea. Not to mention with a fair frequency people get mauled by crocodiles when trying to fetch water in the river. Life aint easy, life aint easy.

So, given these experiences, it is difficult for me to flip between the two worlds. One of privilege, comfort and excess vs one of disadvantage, discomfort and minimalism. Both worlds have happy and unhappy people, which makes me ponder where real happiness comes from. Not from a big mac but not from a crocodile mauling which fetching dirty river water. I continue to feel lucky for what the card I drew in life. I hate to should people….but in this moment I will. We all should remember to be thankful for the good things in our lives, appreciate them and celebrate our clean water, food on our table, shelter over our heads, comfort in our lives, love of family and friends, people who we can lean on. Not everyone has these things. So, the next time life in the fast lane pisses you off, lean back in your easy chair and re-evaluate. I won’t should again but these are the thoughts I have when shifting between worlds. Go for a walk, shut off the TV, call your loved ones, plan fun trips, listen to music, appreciate the night sky, eat in moderation and relax.