What am I up to? (26 November - 10 December)

The clinic has been increasingly busy, and I have started to get the hang of outpatient HIV care. Our electronic medical record system and clinic flow keep getting better and better, and hopefully will stay a step ahead of our growing patient volume.

I do not yet have the recent numbers from our data people, but I can say that recently I have been seeing many more new patients coming for first-time screening. We do very little advertising, and so word of mouth seems to be a very effective PR tool in this small kingdom.

We are facing some challenges on that front, however. Because of the quality of our facilities and services, it is clear that many patients are coming to us from long distances despite the availability of nearby HIV clinics. This is a reflection to our dedication to excellent patient HIV care, but reinforces the need for continued outreach. Efforts to this end are vigorous, but early progress is always gradual. (The somewhat dense meeting minutes I posted a while ago list some of our early-stage outreach activities.)

I am still spending most of my time at the main clinic (the “COE”), which has allowed me to gain much needed experience in the approach to the HIV positive child (as well as adult). The clinical experience is incredibly diverse, from scabies to myiasis, eczema to zoster, asthma to TB (pulmonary and extrapulmonary), foreign bodies in the ear to esophageal candidiasis.

I see basically a little bit of everything—tropical, general, infectious, chronic, bizarre, hum-drum. My patients and their illnesses run the gamut.

In my nonclinical work time, I am helping to develop pocket-sized abridged references for the COE health care workers, especially for those students and residents that will soon be passing through, as the learning curve here is by necessity quite steep for those unfamiliar with HIV care. (It certainly was for me.) These condensed reference cards will also be potentially useful for Swazi health care workers at other sites, and can be distributed at future trainings.

Leisure in Swaziland remains easy, as leisure should. I do plenty of running and biking, and conditions in this temperate, mountainous region are ideal for both. This past weekend traveled to Maputo (3 hours away), where the sunshine, seafood, and Brazilian music are plentiful.

In other news, I recently bought a cheap, second-hand station wagon, fuel-efficient but also good for hauling things (many Texan’s pre-requisite for any auto purchase). I drove it off the lot with no warranty (which is why it was so imminently affordable), and realized shortly thereafter that the wipers did not work (a novice auto purchaser’s oversight). When the rain inevitably started to fall two minutes later, I was forced to drive the 20 kilometers home with my head hanging out the window.

Lesson learned = when buying used cars, seeing the road ahead is more important than a few extra cubic feet behind.

In any case, if you find yourself carless/truckless on a rainless day in Swaziland and you have somethin’ for haulin’, and you can limit the “soccer mom” jokes, call me and I will bring the station wagon over. Wait a week, and I can come by rain or shine, as I will have replaced to wiper motor.