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.