Alexandria the Second Capital of Egypt

Our third full day in Egypt (Wednesdy March 25, 2009) was spent traveling to Alexandria about three hours away from Cairo. It is the city that of course Alexanda the Great made the capital of Egypt when the Romans ruled in Egypt.

Today Alexandria is known as the second capital of Egypt. It sits on the shores of the Mediterranean Sea and is a common vacation spot for Egyptians. It is very much a coastal city of about only 12 million people. My initial impression was that it is much nicer, less hectic, less crowded and more relaxed.

We left our hotel at 6:15AM for what was a full day of touring. Once in Alexandria we first stopped and visited the water front area and sat by the Mediterranean Sea (those are the pictures of us by the water). We then went to visit the "Kom El-Shuqafa Monuments" which is a underground Roman tomb with egyptian details. Next was a stop at the Roman Theatre or the remains of what was once the theatre. We spent about two hours touring the new "Bibliotheca Alexandrina" or simply the Library at Alexandria. This is a new structure dedicated in 2002. The ancient library of Alexandria is mentioned several times in historical text and was the depository of a great deal of knowledge. Sadly it was destroyed twice and now the original site sites under water. This new library was built to honor that historic past and is a beautifully contructed building. It has the largest reading room in the world and has seven levels to it (Three of which are below sea level). It is a modern day technologically advanced library with several really cool projects going on like the digital library, web page project, and a project to record Egyptian history. You can check out the library for yourself on line at wwww.bibalex.org
The last site we visited was "Montazah" which has one of the summer palaces used by the Egyptian President. That is the palace we are standing in front of in the pic.

We took this opportunity to sample some local Egyptian food. We had a dish called "Koshary" which consist of rice, Black lentils, tomato sauce, macroni, and onions. Yes a rather strange combination of food but it was actually very tasty. That is the dish in the pic above on the table. It was also cheap only 5LE (about 1 U.S.D). You know what they say when in Rome and we took the opportunity to sample some local flare.

Cairo Day Two

ok, mark Cairo as another city I will most likely never come back to visit in my life time. I found myself today realizing that at this point in my life I have very little tolerance for very large busy, noisy, dirty, chaotic, pushy, manic, fast-paced, crowded cities like Cairo. This is probably the reason why even though I grew up in NYC I will most likely never live there again in my life time either. I had the same reaction last summer when I was in Mexico City, Mexico attending the International AIDS Conference. Cairo is a city of 22 million people, and Mexico City about 20+ million. Its just to many people in a small space all clamoring like crabs in a basket for the same scarce resources. I much prefer Swaziland, which I would go back to in a heart beat. It was much quieter and had a totally different feel to it.

So what did we do today? This was our second full day in Cairo and we started out with a trip to the 100+ year old Egyptian Museum. The museum is old and is showing its age for sure on the inside (I think they need to tear it down and basically start over) with cracked plaster all over the place and the artifacts in old casings with cards that were not always clear to read. Our tour guide attempted to rush us through at times and I of course being who I am slowed her right down. She wanted to only show us the major pieces in the museum and I wanted to take time to browse a bit more. The most famous King Tut artifacts are all here (minus his actual mummy which was left in his tomb in Luxor in the Valley of the Kings) and they were nice to see. They do not allow any photography of any kind in the museum and in fact you have to check your camera at a booth outside the museum before you go in. While I understand why I still think it sucks that I could not take any pictures (especially since again I will most likely never come back here). We are all familiar with the story of the child King Tut who died at age 19 and only ruled Egypt for 8 years. He is only famous because unlike most of the other tombs of the ancient Pharoah’s, his tomb was not robbed. When his tomb was unearthed in 1922 all of its contents were still inside including his solid gold burial mask that was found on his actual mummy incased in three coffins which was enclosed in three outer gold gilded sarcophagus’s. These items are all in the museum and we were able to see them. The jewelry he was buried with is amazing to see. I did enjoy going to this part of the museum, to bad I could not take a picture. We also saw one of the famous statues of King Rames II who ruled Egypt as pharaoh for 76 years. There are rooms and rooms of stone tablets and monuments dating back thousands of years and with out a few days it is impossible to stop and take in each and every one of them. By the time we were ready to leave the line to get into the museum was very long as the museum tends to get busier in the afternoon.

Our Second stop today was the Citadel. This is a castle that was built by Salah Al-Din who was Syrian. He came to power in Egypt after pushing the French out. It is built on a hill top overlooking the entire city and become the governmental home of many Egyptian rulers to follow. Inside the Citadel is the Alabaster Mosque. This mosque is one of the most famous in the world and is still used for prayer once a week on Fridays. Fridays is their major holly day here and most businesses and banks are closed on Friday. You had to take your shoes off before you walked into the mosque. The mosque took 15 years to build and five of those years was just the ceiling in the inside which is extremely ornate. The panoramic city view from the top of the hilltop was a nice surprise. It was a clear afternoon so you could actually see the pyramids of Giza in the distance as well.

Cairo is an ancient city struggling to assume its place in the modern world. Large parts of the city are simply in disrepair and a lot of building are under construction or were left half built. The main down town areas with the nice hotels and what not is of course much better but you do not have to go far to see what being poor in Cairo will do for you. While yes our economy in the United States is having its own issues (I have been watching CNN/BBC while over here and I will not talk about what I think of AIG or our current president and his economic team) people her still think of all Americans as rich. They all know the exchange rate of our money to theirs and can quote it to you. The current rate is 1 USD = 5.6 LE. Even in the market today I got into a debate with a merchant while attempting to buy some silk carves over paying him in U.S. dollars versus LE (Egyptian Pounds) and he quoted the exchange rate. Needless to say we each stood our ground and I walked away as he was being unreasonable and I would not be taken advantage of, American or not. Even my tour guide today let it slip that a certain amount of money is not expensive for me when I told her to find another place for lunch today that was less then where she wanted to take us. As much as so much of the world does not like America lord knows they all still do want our money and business.

That brings me to my final thoughts today about Cairo. It is such a money hungry driven place and that just irritates me. Yes I understand what my status as an American conveys but as a Black American who was raised poor in America and fought to get an education and worked hard to achieve what I have I find it all a bit irritating to be thought of as just an American when I know they are referring to a White American Ideal that is not my background. On that note they all hate President Bush here and love Obama, go figure. I also think my general irritation has to do with now being away from home for a month and I think its time to come home. So its off to Alexandria tomorrow which is about 3 hours away to the sites there. I was going to cancel this part of the trip but since I know I will most likely not come back I might as well go and see it now. My journey home will also start early on Thursday morning and I will be back home in Rochester on Friday morning.

The pics are of us in front of the Egyptian museum and at the citadel for the most part.

Sheldon

Cairo and the Pyramids

Cairo is a very old, noisy, crowded, dirty, polluted city. That being said I am glad to be here experiencing it for myself. Me and DeWayne got her at different times yesterday with my flight from South Africa (Johanessburg) took 8-hours and in all from Rochester to Cairo (via NYC-JFK and Istanbul, Turkey) took DeWayne and total of 18-hours. Needless to say we were both exhausted from the traveling and after dinner crashed for the evening. We are staying at a local hotel called the Golden Tulip Flamenco on the little island of Zalemek on the Nile River. It is a hotel that one of DeWayne’s colleagues at HWS recommended as they stayed here several times and found it to be a good place. Its not the Hilton but its is nice. It is filled with a lot of tourist from all over the world. It is a pretty good deal at only $74.50/night for both of us that included a full breakfast buffet each morning. Breakfast was actually very good this morning.

Today we spent a day out touring the pyramids at Sakarra and Giza where the Sphynx is as well. On the recommendation of everything we read on line and of colleagues who have been here before we have hired a local licensed tour guide. Her name is Naglaa Samir and she and her husband work as a team. She is the guide and he is the driver. We also wanted our own personal tour guide and did not want to book a tour with an over crowded large tour company that would rush you through the sites and keep you on a tight schedule. This way we will get to also personalize our trip and do what we want to do. There is so much to see here so we have set a three day itinerary that will allow us two days in Cairo and one full day in Alexandria.

OMG they drive like maniacs here. There are no rules on the roads and most streets do not have stop signs so you just go when you can. Most of the cars on the roads are dented and banged up from what has to be a series of fender benders over the years like the ones we saw at several times throughout the day today. I am from NYC and I would not dear risk driving in this city. The roads are beyond congested and chaotic. The roads in a lot of places are not paved and are in disrepair. Pot holes are every where and you are also sharing the road with all sorts of other cars, trucks, and donkey pulled wagons (especially outside the city on the way to Sakarra). That being said our tour guide and driver got us around the city to our various destinations safely and back to our hotel. My closest reference point to this type of congested traffic was when I went to Bangkok, Thailand in 2004 for the International AIDS Conference. The congestion, pollution, and chaos there is exactly the same.

Our first stop today was at the Step Pyramid in Sakarra. The pyramid of course is famous for being the oldest in the world. It like most of the monuments here in Cairo are so old that most of them are under some form of restoration as is evidenced by the scaffolding around most of them. Tourism is of course a major industry here and boy have they figured out how to capitalize on it. You pay an entrance fee for each pyramid site (60LE, about 12 USD) and another fee to actually go down into the second large pyramid at Giza.

We had lunch today in Giza at nice restaurant from which we could see the pyramids. It was a set menu of humus, egg plant, and pita bread as an appetizer followed by a mixed grill dish (I just had chicken) with rice and frence fries. Dessert was a orange that was actually very good.

After lunch we then went to the pyramids at Giza. This is actually a complex of 9 pyramids (3 large ones and 6 smaller ones) and the Sphynx. The great pyramid is a site to behold as is the second pyramid of Pharoah Kufu. This is of course the last of the Seven World wonders to remain on that list of the originals. You have to walk out in the sand and of course today of all days while we were are at the site it was a bit windy and the sand was blowing all around. So we got to experience a bit of a sand storm as well today. I think I have managed to get all of the sand out of my hair finally but most likes not out of my sneakers. The Sphynx is actually not as big as it looks in pictures. It is still an amazing site to behold as well. Especially when you think about how long it has been.

The pictures speak for themselves. Tomorrow were set to visit the famous market area (shopping), the world famous Egyptian museum, and old Cairo where the Citadel is. Bye for now and thanks for reading my ramblings.

Sheldon

Egypt Bound

So today I am actually leaving Swaziland my assignment is over. I am on my way to Cairo, Egypt for a 4 day holiday before returning home on the 27th of March. I figured since I had already came all this way that I would take a side trip over to see the pyramids myself. I am looking forward to touring Cairo and Alexandria as well.

It was foggy in the valley when I woke up this morning and this was the picturs right outside my hotel window and the other pic is me sitting on the bed in the hotel room here which has been my home a way from home for 3 weeks now. Hit you all back when I get to the land of the Pharohs.

RFM People

I have meet some incredible people since I have been here in Swaziland. The gentle in the top pic with me is Sandile Malza, RGN/M, He is the infection control coordinator for the entire hospital. He is a registered general nurse (RN) and midwife. He is new to his job in infectin control so I have been working with him to get organized and prioritize his work. We take so many things for granted such as being able to work a computer but Sandile did not have much experience with computers so we spent on afternoon just going over the various Micro-soft WORD applications on the computer in his office that he shares with the hospital's inservice coordinator. He was very happy when I showed him hom to insert a page header and page numbers into a WORD document. Then we created a schedule for him on line that he can update daily and I showed him how to create a few simple tables as he is setting up a hospital nosocomial reporting system. Such a small things that I know I take for granted made him smile.

The gentlemen in the second pic with me is Dr. C.I. Vitalis. He is one of the doctors who is posted to the ART clinic (Anti-retroviral Treatment) here at RFM hospital. It is basically the outpatient HIV/AIDS clinic. He also admits and rounds on his patients who are mostly in the male and female medical wards. I spent two day working with Dr. vitalis and the wonderful nurses in the ART clinic here. Again this clinic is full each day and the patients come early and wait to be seen. Dr. Vitalis will on average see 50+ patients aday in the clinic. While the patients sit in the waiting room they have "Expert Patients" teach them about HIV/AIDS, taking their medications and why that is important, and why they need to use condoms when having sex. These expert patients are just that current patients who are also living with HIV/AIDS on treatment for the most part doing well. They serve as role models for the new patiets and advocates as well. They are also natives (Swazi) and will serve as interpretors as well for the patients who do not speak english for the doctors and nurses who do not speak SisWati (The Swazi native language). They really are integral to how this clinic functions and are just wonderful with the patients.

Dr. Vitalis like most of the physicians here is foreign. He is Nigerian and is a wonderful doctor. His clinical skills are sharp and he picks up on things just by looking and taking very detailed histories very quickly. He allowed me to observe him while he saw his patients and expalined a great deal to me. I must admit I learned a great deal from him. Even though I have been working in the HIV/AIDS clinical arena for some time now I have ever seen certain opportunisitc infections or drug reactions that HIV/AIDS get. In the course of two days I saw them all in this clinic, steven johnson syndrome, advanced kaposi's sarcoma, lipodystrophy of all forms, tinea, CMV retinitis, PCP pneumonia, molluscum, and many more. It was an eye opening experience but a very valuable clinical lesson for me. I can to teach and mentor but I have also learned a great deal which I hoped would happen when I came here.

To the wonderful people at the RFM hospital and the Nazarene College of Nursing thank you for allowing me to be a part of your world and for doing what you all do on a daily basis.

RFM Clinic

Above is a picture of the out patient medical clinic at the RFM hospital here. People come early in the morning and wait for hours on these benches to be seen. It is very much first come first served so you are not givne an appointment time. They also do not do triage so people have died while waiting in the "que" (as they refer to it) to be seen. The outpatient maternal-child clinic is the most full every day with women and children waiting to be seen.

the patients are seen in the exam rooms off this open court yard area (The greenish doors)and even when it is raining this is where they wait. Not the most ideal of situations but it is what they have here. I go to my doctor at home and if he keeps me waiting more than 15 mintues I get inpatient imagine waiting all day and then being told sorry the doctor has left or that we are close you have to come back tomorrow.

Physical Assessment Master Course

Ok so yesterday in one 8 hour day I had to teach the basics of how to do a comprehensive head-to-toe physical examination to 30 midwifery students. These students are all Professional Qualified Nurses already who are doing an additional one-year of training as a midwife. The dean of the school here asked me to conduct a special master assessment course specifically for these students since they will for the most part at times be alone out in the community attending to deliveries. She was concerned that many of them lack the general assessment skills they need to function independently.

So my challenge was to take a semesters worth of work that I teach at the University of Rochester and condense it down to a 8-hour super course and relate it all to the issue of HIV/AIDS which is the primary reason I am here in Swaziland. Yeah no small task but I was able to do it and the students responded really well. We had a rocky start in the morning as my teaching style is something they are simply not use to. They are use to just sitting quietly and being lectured to or at and that is not the way to teach comprehensive physical assessment. They also do not speak up, they tend to talk very softly and you have to lean in to hear them. Oh and one other thing they do in class is answer their cell phones and text on them as well. So the first thing I did that shocked them was that I requested that they turn their cell phones off and that they do not text at all as I need their full attention. I demonstrated by turning mines off and placing it in front of me on the table. I also made them each introduce themselves to me after I did so and tell me why they wanted to study midwifery. In doing so they had to talk up loud enough for the entire class to hear. Lastly I informed them that they would need to talk to me as I will being posing a lot of questions and that we will not only talk about Physical assessment but we will practicing it throughout the day. After all it is skill so application is important.

I was able to give them the broad overstrokes and did a head to toe demonstration for them in the lab as well. The entire last hour of the day was also spent in their lab practicing. I will tell you that by the end of the day I was exhausted, my voice was gone, my feet hurt, my back hurt, and I had a headache but boy what an awesome challenge to have tackled. They warmed up as the day went on, asked really good questions and began to pick up the skills. I made them all promise to continue to practice and the dean informed me that the instructors here will be following up with them to make sure as well. So another mission accomplished here.

The pic are of me and the students in their learning lab.

Running in Africa

On sunday afternoon the sun came out after a morning rain and I decided I would go for a run from my hotel into downtown Mbabane (The capital city of Swaziland). It is approximately 3 miles away. This is the first time I have gotten the opportunity to go running since I have been here. I felt very connected to this place, the land, while running through the clean crisp air of mother Africa. I had images of the many great long distance runners from Kenya and thought to myself I am half way around the world going for a little sunday afternoon run in Africa. Wow life is one interesting journey for sure.

Skies over my Africa

Since I have been here I have witnessed some of the most breath taking sunsets, sun rises, rainbows, storm clouds I have ever seen. Its like the sky is dancing all around me. Since the wheather changes so quickly and can go from cloudy, to sunny, to rainy all in one day, you just never know what the sky will look like. So I have been paying attention and as you can see I have taken a few pics of it as well. I have really been enjoying just gazing at the sky here. The other night it was a full moon and clear so it lite up the night.

A bit of Swazi Culture

Me and Kevin went to the cultural village yesterday afternoon. This a area where you can see a traditional swazi village community and watch a performance of traditional dancing and singing. After we took a tour of the village and walked down the water fall in this area. It was very nice to see something traditional and see how it is some of the people in the country side are still living. Our guide informed us about the traditional swazi culture. Here are some points I remember.
1. The oldest son stays with the family in the village and he inherits the fathers land and property.
2. The youngest son also stays with the family in the village and he will inherit the mothers land and property.
3. In traditional swazi culture a man can have an many wives as he can afford. Each time he marries he has to pay "Eee-bowl-la (a dowry) to the women's family which is in the form of 12 cows (Each cow is about $800 dollars here). So it is expensive to get married here.
4. Swaziland is ruled by a King who has ultimate authority but he does appoint a prime mister who reports directly to him. The government is run by a cabinet of ministers (Finance, health, education, etc). The current King has 15 wives and is 40 years old. The King is always from the same family line which is the "Dlamini" family. He has to be the only child and the only son born to a wife of the King at the time of the current Kings death. So there is never an apparent aire to the thrown while a current king is reigning. The Dlamini's also do not inter-marry so the mother of the King is never a Dlamini.
5. The women are usually not allowed to eat the brains of the cow cause she would become as smart as a man.

Now those are some traditional pointers but there is a very modern christian based society here as well. A great deal of the population is very religious (Christian) and that from what I can see has lead to a few problems here. The clash/tension between the traditional swazi culture and the White-Christian value system is very evident, at least it is to me. Take for instance the issue of polygamy, not really a christian value. I can go one but you get my point and one would think that in a country with such a high HIV rate that there hyper religiousity would be to there benefit but so far not so much again on that front. Those with HIV/AIDS are highly stigmatized here (which with 4 in 10 being infected is a lot of peopel to stigmatize)and all the men are expected to get married and have children. That means that a lot of gay men (because gays and lesbinas exist in all cultures) are not allowed to live there live as gay men here at all. I can go on about how this is affecting the epidemic here (homophobia, shame, self-hatred are never good things).

So I have been here long enough to begin to pick up some language as well and I know hoe to say good morning, good night, hello in Siswati their native language, although for the most part they all speak engish. I have one week left here, then I am off to Cairo, Egypt for a vacation before coming back home.

The RFM Hospital

I spent most of last week doing clinical teaching, mentoring, guiding, role modeling and what not on several of the wards of the RFM hospital. This hospital dates back to the early 1950's and is very outdated and in need of major renovation. It is also unlike any hospital that we would have back home in the United States, but it is functional and I am amazed at some of the working conditions the nurses have to contend with. I have been working with the level-2 (second year) nursing students who are diong there clinical rotations in the hospital. They slight the groups in two so half on the wards in morning and half in the afternoon. I am also working with the staff nurses on the wards who are assigned to be the students preceptor when they are on the wards. The staff nurses who act as preceptors get no incentive to do so but they do it anyway. RFM is considered a teaching hospital after all. Although it is not officially a "government" hospital because the buildings are all sitll owned by the Nazarence Church so it is a private-public partnership. The government does provide some 90% of the funds that come into the hospital which mainly goes to pay the staff. These wards are separated by gender (Male Medica, Female medical, Male surgical, Female surgical, Pediatrics, Labour and Delivery, Post-partum, ED, and then all of the clinics). They are very open and there is very little privacy in them at all. Few of the wards have curtains but most do not and nurse use portable screens to give some privacy when doing a procedure or when a patient is using a bed pan.

In any event the nurses on these wards are working hard and in unsafe conditions as times. Some of them however are not so well trained if truth be told. I have found that the foreign nurses that are here from places like Zimbabwe, Nigeria, and Zambia are better trained and more knowledgeable about issues such as infection control and clean technique, than the swazi nurses. Case in point I spent one morning observing a young male swazi nurse only one year out of nursing school administering IV medications to patients with the assistance of three male nursing students. He did a few IV pushes and some directly into heplocks with a flush after. The problem is he did wipe any port with alcohol before inserting the needle or connecting the IV tubing and worse yet he re-capped every needle he used after using them and had the students do the same thing. It was all I could do to not ask him if he was insane to re-capping needles on a ward where the majority of the patients have HIV given the risk of a needle stick injury. So what I did in this case was wait until after they were done and we were away from the patients and I asked the students first what they told about re-capping needles and all three of them said at the same time, "We are taught to never re-cap a needle". So I asked why did they and what they thougt would happen if they just happen to stick themselves with a used needle. They were all aware of the risk here and knew they were not doing the right thing. At that moment the young male staff nurse walked up and I said to him I am glad you are here were just discussing the dangers of re-capping needles, "what do you think about that". He said as well you should never do it. I then said so explain to me what happened this morning and how you think we can keep you and the students safe while administering IV medications which you will have to do again at 2PM this afternoon. We agreed that he would not re-cap any more needles and would discard them directly into the big plastic bottle that they were using for a sharps container.

I tell you this scenario above so that you can get a sense of the basic nursing skills that some of the nurses here need assistance with. It was not that he did not know that re-capping was not good practice but I do not think he understood the connection to the real danger a needle stick injury poised. Also I helped him to appreciate that even thouh he is a new nurse that in this case he is a teacher for these students now and he has to show them the correct way of doing things so that they are safe and learn good practice. I went back to this ward the next day to check up on the nurse and students and asked if he had re-capped any needles today he immediatley told me no and pointed to the sharps container. I will go back this again and observe one last time just to make sure. These are the small changes in practice that we attempting to do here with the Nurses SOAR project.

Up above is a picture of the "Medicine Trolley" that is used on the wards. The nurse push the chart around the ward stopping to administer medications to each patient. This is how they do it here.

The second pic is of Dr. Kevin Mallison (the Nurses SOAR PI) cheering up a infant burn patient on the pediatrics ward with a simple ballon. This boy burned his feet and he just lite up when we came in and blew ballons up and played for a few minutes. Such a small thing could have a huge impact.

Death and Life

I spent a large part of today on the female medical ward of the hospital working with the second year nursing students who are in clincal now. The hospital wards of RFM hospital are again like nothing I have ever witnessed before in my life. There were 22 patients on the ward in the morning and 20 when I returned in the afternoon from lunch to work with the second group of students that come at 1PM. Just that quick two patients had died. One I knew from the moment I saw her this morning was very near death. No matter what it is still a humbled experience to watch it all play out. The bodies are removed quickly from the wards as they do not like them to lie around. It is also an infection control issue for them.

Nearly ever female patient in this ward ranging from old to young has HIV and it is a devating site to behold. Many have waited so long to come for help that there is just not much that can be done besides making them comfortable which the nurses try their best to do. The nurses here are a bit over worked and most likely traumatized by all of the death they have had to deal with. At one point nurses were leaving Swazi to go to other countries (some recruited away) but Swazi is considered stable now and more are staying in country and some are coming here from places like Zimbabwee and Zambia that are currently having problems.

Rather than show you a picture of death I thought I would share a pic taken while on safari that speaks more to life. its a Wharthog and her two children.

The Indian Ocean

On sunday we got up had breakfast at Wendy's, packed up, paid our bill and headed out to drive about an hour out to an area called Cape Vidal. This is a pennisula island that is a game reserve park and beach that goes out to the Indian Ocean. It is a major vacation area for people in South Africa. It was once again an amazingly awesome site to behold. We saw a Rhino, and Hippo in the park and I got to step into the Indian Ocean for the first time. Yes there were crocodiles around but I managed to avoid them.

What appears to be mountians in the pic of me on the beach are really Forested sand-duns and this is one of only a very few places in the world were such a thing is found. The water was very warm and the scenary just incredible. I sat on the jetti and wondered how such a beautiful continent in some areas could be home to such pain and suffering as well. The contrast is mind boggling at times. It was nice to get away for the weekend as the work I am here doing really does start to take a toll on you.

Safari Outing

Its been a few days since my last post but I was away in South Africa over the past weekend and got back late on sunday and up early on monday so I am just now getting back to this. Me and my colleague Dr. Kevin Mallison drove about 3.5 hours from Swazi to Mtubatuba in South Africa on Friday Afternoon. We went to go on a safari drive in Umfolozi National game reserve. We stayed in a very lovely B&B called "Wendy's". It was like taking a step back into a colonial period but it was really comfortable and included dinner and breakfast for only $47.50/night. We got up at 5AM on saturday to go out on the safari game drive with our guide "Jenny". She is the daughter-in-law of Wendy the owner of the B&B and was very knowledgable about the animals.

My first safari: Umfolozi is 220,000 acres and once were the royal hunting grounds of the Zulu people. It is amazing to stand in such a vast land mass with life all around you. I felt insignificant for sure and completely in awe. To be able to come so close to some of the animals is incredible. We witnessed a entire herd of elephants, a herd of Giraffe, and we spotted a White Rhino as well (they are extremely rare). Jenny takes you out in this huge 4x4 vehicle (There were a total of 9 on this trip, including two couples from England who were a hoot). We start out early in the morning as it is cooler and more animals are out then. We also stop in the park at resting area and Jenny got out and made us coffee and then again later we stopped and she cooked us breakfast in the park as well. We spent 8 hours in total in the park.

The beauty of this park unlike anything I have ever seen. The picutres do not capture it all but I hope they give you some idea. I hope I am blessed to be able to come back again in this life time. That was our trip on saturday.

Chief Medical Officer

This is a picture of me and the Chief Medical Officer of the RFM Hospital that I meet today. He is very encouraging of the work we are trying to do with the nurses in the hospital.

The Students

I spent most of my day today on the male surgical ward of the hospital working with the second year nursing students one of the staff nurses who is acting as their "preceptor". The students are doing their "clinical block" and the since there is such a severe shortage of nursing faculty (worse than our faculty shortage at home)they have to rely on the staff nurses to teach and watch the students while they are on the wards. These staff nurses are already overworked and they get no incentive to work with these students. Pet Kunaka the preceptor (women in red in the above picture)is originally from Zimbabwe and she is an excellent preceptor who really challenges the students. I was very impressed with her today. She was trained however very differently than the nurses here in Swazi and she is frustrated with what they students are not learning, but she is doing her very best to teach the students that come to her unit.

The students (there were 19 in this group all together)are young, and want to learn but they are also not properly supervised in the clincal setting. I worked with the students today teaching them how to do a complete cardiac and respiratory system assessment. They all need to study their anatomy and physiology a lot more and practice their assessment skills. For second year students their skill set is at a very low level, but this is part of the reason why I am here with Nurses SOAR. I will be making my rounds to all of the units by the time I leave and will interact with all of the 80+ students in the second year, 30 midwifery students, 13 faculty members, and 17 preceptors. I will be reviewing and teaching physical assessment skill to them all.

My up coming weekend: Tomorrow is Friday and I and my colleagues have have been invited to attend the "Capping and Striping" Ceremoney for the first year students in the morning. In this ceremoney the first year students who have now been in school here for six months will take the Florence Nightengale nursing pledge, the women will recieve their white caps with one strip and the men will get on strip on their uniforms as well. They are all excited about this ceremoney and have been preparing for it all week. I am told it will take about 4 hours and will include a singing and dancing as well. After the ceremoney I am headed back to South Africa with Dr. Mallison (The Nurese SOAR Pricipal Investigator)to go on a Safari all day on Saturday. I plan on taking a lot of pictures and will post again when I get back on sunday some time.

The Future

These are the two 1-week old babies that we did the home visit on with the HIV task force. They are so cute, how could you not want to do all you can to help. Because the mother took her HIV medications while pregnant there is a good chance that the babies are HIV negative.

More Community

The picture is of me and my colleague Stacey (she is a HIV/AIDS homecare nurse from NYC). We are standing in the middle of the community garden that the HIV+ support group planted and tends to.

The second picutre is simply a face of HIV here in Africa.

Community Visit

Yesterday we went on a community outreach visit with the HIV Task Force. It is a community outreach program coordinated by a nurse. Me and Stacey got to ride along as they were already taking a another group from the Nazarene Church out to see a community HIV support group, a community garden that they funded for the group to develop, and a home visit on a young HIV+ women who recently had twins (They are one week old and very cute). We went only about 30 minutes outside of Manzini to the Western Manzini district. Swaziland is a country of contrast for sure. Only minutes outside the city and you step back 100 years it seems to a totally different time. It is rural and you can see the devastating symdemic effects of poverty and HIV. Where as in Manzini and Mbabane (the capital) there is obvious wealth (modern shopping malls, large grocery stores, a KFC, and a very lavish Casino and Spa). It feels like half of the country progressed and left the other half totally behind.

We got to bear witness to a community HIV+ support group that was conducted in a open field on a government owned agriculutural station. There were 13 women, and 4 men in the group and they were happy to see the HIV Task Force team. We all sat in this field under a tree and the group started with singing and a prayer. Those in the group talked about the stigma of living with HIV/AIDS in their community. They also talked about the challenges of getting their medications (ARV's)to treat their HIV from the hospital that was so far away. Many also talked about not having enough food to eat at times. One women talked about the death of 4 of her children from HIV which she now has as well. At the end of the group they sang again, prayed thanked us for coming and then the task force team handed out clothing and food to them. They were happy to get a new t-shirt as you can see in the picture and yes they are American Cancer Society t-shirts that they just loved.

After the group was over we took a short ride up the hill to their community garden. Its more like a farm (10 acres)where they are growing potatoes. The Nazarene church group that was with us today donated the money for them to set up this garden (It only cost about $5,000 dollars)and all the members of the HIV+ support group work and tend to the garden.

The home visit: After the garden we then went up a rahter rocky dirt road and hill to a homestead where we encountered a young HIV+ women who was caring for her one week old twins (1 boy and 1 girl). The mother had been positive since 2004 and was on medication for her HIV so it is a big chance the babies are HIV negative not positive, althhough she is breast feeding one of them and breast feeding can pass the HIV virus to the child. The conditions they live in are humbling. She had the babies wrapped up lying on a mat in the front room of this very small house. Again this mother talked about not having enough food to produce milk for both babies.

As you can imagine all of that took some time and I was exhausted by the end of day and very reflective. There is so much need here and I am so glad I am here doing a small bit to impact this pandemic.

Morning bliss

This is the view from my hotel room widow. It is amazingly beautiful.

My first Day on Assignment

I woke up this morning and began my day with a workout session at 6AM in my room (I brought my workout DVD's with me and play them on my laptop)and watched the sunrise over the mountains. The country is very mountainess and the hotel we are staying at is high up looking down on the valley. I took a picture of the view from my room but I am not yet able to upload them here (I will figure this out). After breakfast we were driven to the Nazarene College of Nursing and the Raleigh Fitkin Memorial Hospital (RFM)which are both on the same campus along with several other primary schools and of course the church.

The College of nursing was first established in 1928 by Rev. Dr. David Hynd and the missionaries of the Church of Nazarene. They only admitted women students unil the early 1970's when men where admitted as well. It is the major school of nursing here in Swazi and has two nursing program. The General nursing program which is a 3-year diploma program and the Midwifery post qualification program which is one year after your general studies.
The current students:
1st years: 94 (about 30 are men)
2nd years: 88 (about 40 are men)
3rd years: 83 (about 39 are men)
The students come from all over swazi and some from other countries as well. Most have taken a test to be admitted and the government pays their fees which are about
E30,000/year in total ($3,000 in U.S funds). This amount includes all fees for instruction, books, uniforms, and board. The average nurse here that is dual qualified makes about E8,000/month which is $800 U.S. dollars. It is estimated that on that amount each nurse is supporting about 5 people since many of them have the only stable job in their families.

The school Administration and Faculty: The principal (the equivalent of the dean) of the college is one of only 3 PhD prepared nurses in the entire country. Her name is Whinney. The Deputy director position is currently vacant and has been so for almost two years. There are then three coordinators in the General Nursing Program. A first year coordinator, second year, and third year. These thress women all have Master's degrees and are Senior Lecturers (also called Sister's). On the same level is the coordinator of the Midwifry program who is also Master's prepared and a Senior Lecturer. In total the college has 13 faculty members and only three of them are men (Adam, Simon, and Sownyboy). One of the male faculty members is currenlty pursuing a PhD at the University of South Africa. All of the men are "Mister's and Lecturers".

RFM Hospital: We took a tour of the RFM hospital as well today and wow are things drastically different here. The hospital is a series of interconnected single level buildings (the wards) and one connected two story building (with administrative offices on the 2nd floor). You have to walk outside to get to each building as well. The following wards and department at RFM include:
1. The lab
2. X-ray dept
3. Pharmacy (with outpatient and inpatient sides)
4. Labour and Delivery: The women deliver (about 19 -25/day)rest for 4 hours and leave with the bady.
5. Post-partum: This where they rest. In this ward is a Pre-mature baby room, Isolation room for mothers and babies who may have communicable diseases, and a resuscitation room.
6. Female surgical ward, with the Gynae ward
7. Female medical ward
8. Male medical ward
9. Supply area
10. Laundry area
11. Mortuary
12. Childrens ward (very full today)
13. Male surgical ward
14. Out patient clinic area (Open court yard with designated exam rooms (Medical follow-up, Eye room, cast room, etc).
15. Private Ward (Patients with money and who can pay are treated better)
16. Private Out-patient dept: Again if you can pay for it (nicer waiting area).
17. Emergency Dept: Very busy with an observation area
18. Maternal-Child Oupatient clinic: by fare the busiest and most crowded area. Women line up and sit on benches and wait for hours to be seen. It is first come first serve and some are sent away at the end of the day. They do not triage the patients so people have died while waiting in line to be seen.

I can not fully describe the conditions, and I do not mean this a bad way but the conditions are not anything that we would tolerate in the United States for a hospital. The smells in some the wards just took my breath away. There is so much need and so much to do I can see how one can easily become overwhelmed as to where to start.

So where will I start and what will be doing:
1. I will be doing some work on teaching physical assessment to the the student nurses, the staff nurses in RFM, and the faculty at the college of nursing. It will be general physical assessment with an added emphasis on what to assess for related to HIV/AIDS. The nurses do not do much actual hands on physical assessments and most do not use a stethoscope at all. So I will helping to build there capacity in this way.

2. Research concept paper: I will be assisting the principal (dean) of the college of nursing to complete a paper on how the college can integrate research concepts into their curriculum. They hope to get funding to do this so the concept paper will help them write a proposal for funding.

3. Staff nurse preceptors: I will be role modeling in the wards for the staff nurses how to be preceptors to the student nurses. The students are currently left on the wards unsupervised for a great deal of time in groups of up to twenty sometimes and this is of course not working. The groups have been cut to ten but with out enough faculty (remember there are only 13 faculty members)they can not supervise them all them time. They have to rely on the nurses already on the wards whom for the most part have never been taught how to precept a student.

4. Student leadership: I will be assisting with helping the SRC (Student Representative Council) with some leadership development skills. The students need to learn to help each other and they are not organized to do it effectively. The male students will also be brought together for a special session of just the men.

5. New bachelors program: The principal (Dean) has also asked if I would take a look at their proposal to establish a new BNMS degree program. The BNMS (Bachelors of Nursing and Midwifery Science) will be a 4-year university degree program. They are attempting to become a university themselves but until then will partner with the University of Swaziland to offer this new degree once it is approved. I will review the proposal and give her back any comments I may have about it.

Ok that is a lot in only 3-weeks but I did come here to work so here I go. I am so excited about the possibility of being able to make even a small difference is how nursing is done here at this college and hospital. It will be small steps but a bunch of small steps over time add up to great distances.

More, Later

I am finally here

The Picture: Me and my two travel mates: Dennis and Gerry. Taken as we were waiting to pass customs at the Johannesburg airport.

Ok so after a 14 1/2 hour direct flight from Washington's Dulles airport to Johannesburg, South Africa where I spent the night last night at hotel near the JohBurg airport, and a 50 minute commuter flight from Johnannesburg to Manzani, Swaziland followed by a 30 minute cab ride I have finally arrived at the Mountain Inn Hotel. I will be staying here for my entire time in Swaziland. I left home originally on Thursday from the Rochester airport and three days later I am here.

My flight over: The flight over from Washington to South Africa was not bad at all. I had an aisle seat which of course is my preference when flying. I sat next to a student from Georgetown University who was going over to take part in a business competition of some sort. South African Airlines did a nice job with their service overall. It did not feel like over 14 hours to me although I know it was. I had a book to read, my mp3 player and the plane had a very nice interactive tounch screen video service (individual monitors at each seat)that offered, movies, TV shows, radio stations, and video games. I can not really sleep on planes so I passed my time watching movies mostly (Hair spray, The Devil's Wears Prada, Anna and the King, The Dutchess, The Emblem City, and Batman Begins). Airline food is what it is but I have learned from traveling to do one things when it comes to the food on these flights: Order a specialty meal if you can because they usually serve the specialty trays first (so know matter where you are sitting on the plane you get served first) and the drinks with no ice works fine. I ordered a "Kosher" meal I find they take better care of those trays and of course I was served first. Just a little tid bit for those of you doing traveling of your own. I also of course brought on board my own granola bars, protein bars and almonds. You should always brings a few of your favorite snacks when traveling long distances.

First Ipressions Well I am a bit tired but overall OK. It is raining here in Swaziland and the sky is very grey. The Kingdom of Swaziland is one of the smallest countries in Africa with just 1.1 million. The city of Manzini where I am at has about 80,000 people. The hotel I am in is definitely in the mountains and it is very green. The countries main natural resource is "Water". Flying into the local airport the scenary was beautiful from the little commuter flight I on. It is cool here about 58 - 60 degrees. The hotel is fairly modern with wireless internet so I will be able to post more frequently then I thought. I will attempt to upload my first pics later.

Whats next: At some point today I have to meet with the lead researcher and figure out exactly what I am going to be doing tomorrow. I am told for the first week here I will be doing a lot of observing and meeting people, which is fine. There is some paper work related to the project I have to become familiar with, which they gave to use on a jump drive. I will be working with the faculty at the Nazarene College of Nursing and in the clinical wards at the teaching hospital attached to the school. I will tell you all more about them later. OK I need a nap, followed by a work out session, so bye for now.