Saturday, June 30, 2007

Sand and time - A ode (of sorts) to the family with whom I cannot currently reunite

My family, 2006.

I am not sure how many years there has been a family beach trip, but, for around a quarter of a century, each and every year, my mother's side of the family has spent a long weekend in Port Aransas, Texas.

It is an occasion laced with intricate tradition, kindred fellowship, and, every so often, crude, fringe behavior.

Until this weekend, I had only missed one of these gatherings.

The first time, I was studying in Brazil during college and the flight was too expensive. This time, I am working in Swaziland and the flight is too expensive. It is now my firmly held belief that sacred, time-tested family reunions should qualify one for discounted airfare.


As I post this, my father and my mother's father are probably waking up to ensure that their lures are in the water before the sun spoils the fish's appetite. (Time difference ~7hrs.)

After all, Saturday morning precedes Saturday night by much less than a day, and Saturday night is the night of the traditional “fish fry extravaganza”. (Given it’s extravagance and import, I probably should have capitalized the name.)

The betwixt hours leading up to the deep-fried seafood dinner will be spent as they have been for two point five decades: throwing horseshoes, frisbees, washers and bocce balls, playing volleyball and football, bodysurfing and, of course, sitting and talking.

As tradition dictates, an amateur home video will be made. It will star as many cousins and family mascots as possible. We have several such mascots. I would list them but, without an explanation of each, the list would lead you, the reader, to question my family’s sanity.

While I often do this, I will not force you to read the mascot roster.

After tonight’s battered feast, there will be a talent show, usually showcasing very good music and very bad poetry, both apparently woven into the collective genetic fibers of the participants.

Sunday will bring more fishing, swimming, sporting, visiting, videotaping.

More smiling, laughing, joking, playing.

All of the "–ings" that summertime family reunions are for.


While there is plenty to do here in Swaziland, there is little angling and zero beach. No family. There is a swimming pool or two...but it is currently mid-winter.

Still, as a gesture of solidarity, I recently took a very brief swim in some very cold, wintery water. The dip was ~25 seconds...seemed longer.

The first beach trip seems not so long ago.

It's funny how time expands and contracts.

The photos below, which I offer as proof of my frigid submersion, are my tribute to the 2007 Port Aransas Family Beach Trip and all gathered there.

Just before.

Just after. (In case you are wondering, the wetsuit did not help much. I have recovered sensation in most of my toes.)

Friday, June 29, 2007

Swazi HIV Awareness Poster Series (7 of 10)


Thursday, June 28, 2007

One hundred and one Swaziland destinations- #10: Shewula, continued

Shewula is a health centre disguised as a cluster of farm houses. There is a ten kilometer dust road leading to the place.

Normally I would call a road of this sort a dirt road, but this one was definitely a dust road. Our vehicle left a wake of airborne powder which pedestrians (many of them patients) avoided by sticking to the upwind side of the dust road. On arrival, in the place of a sign identifying the place as a health facility, there was a rusty tractor surrounded by strutting, cackling chickens.

If there ever was a farm-like medical complex, this was it.

Shewula is but a few hops and skips from Mozambique and over a hundred kilometers from a region where people outnumber livestock.

Shewula is also where hundreds of adults and dozens of children receive their ARVs.

This past Tuesday, Dr. Carrie Golitko and I traveled there and mentored Sister Sonnie, a sharp, vivacious nurse who is essentially qualified to begin seeing pediatric patients on her own. (Baylor docs have been working with her for several months.)

After consulting the day’s pediatric patients, we gave Shewula’s six nurses a lecture on the prevention of maternal to child transmission of HIV. I found that they knew as much as I did about the medication regimens for the various clinical scenarios.

With the exception of our monthly visits, there are no doctors at Shewula.

In a country with so few physicians, this rural health centre is a heartening reminder that motivated nurses can get the job done.


Wednesday, June 27, 2007

Very happy - A patient encounter

Today had all of the harbingers of being a bad one. I have some sort of food poisoning, which I blame on the “enchiladas” I had last night at a local restaurant that I will describe as an African Chili’s (or Applebee's, Bennigan's, Cheddar's, etc.). It was my first (and last) foray into Tex-Mex on the continent.

On top of that, my plate (figuratively speaking this time) looks like I just passed through a buffet line with an empty stomach. A feast of activities, it is.

To top it off, I received bad news about a patient. (See below.)

Around 8am, doing my best to feign enthusiasm, I called the first client of the day.

Zamekile was severely wasted when he fist visited our clinic in January of this year. Her weight placed her at the bottom thousandth of her age group.

That was then.

Now, she is on ARVs and weighs in at the 50th percentile.

She likes to give high-fives.

I have never met a more avid high-fiver. Nor have I met a more eloquent reminder of why my job is a dream job, even an a day shadowed by death and diarrhea.

As the gogo shook my hand and Zamekile raised her palm in the air for one more, the gradmother said, “I am very happy, doctor. When I first came here, she is too too small. Too small. Now she is big.”

At that moment, so was my smile.


Rebecca (1997-2007) – A belated patient encounter

I took this photo hoping that it would be the 'before' in an uplifting 'before and after' pair. This photo was also posted on June 4, 2007 along with some of Rebecca's story.
I was hopeful that she would survive.
Well, after being admitted two weeks ago for severe malnutrition and spending several days too weak to eat but strong enough to pull out several nasogastric feeding tubes, Rebecca died.

She arrived to us too thin, too weak, too sick.

Her CD4 count was near nothing and her viral load was in the stratosphere.

May she rest peacefully alongside the countless others that have succumbed to this preventable, treatable disease.

May those of us still living strive to reach the children sooner than we reached Rebecca.


Tuesday, June 26, 2007

One hundred and one Swaziland destinations- #10: Shewula

This is the table where they perform rapid tests in Shewula, the health centre where I worked today (2hrs from Mbabane, a few miles from Mozamique).

More on today tomorrow. It is dinner time.


Swazi HIV Awareness Poster Series (6 of 10)


Monday, June 25, 2007

Upcoming blog entries will include but will not be limited to...

- Last week’s pediatric HIV training in Vryheid, South Africa
- The Swazi Cowboys (as promised)
- My recent, severely malnourished patient (Intro #10 below)
- Food distribution and the World Food Program
- ARV adherence

Swazi HIV Awareness Poster Series (5 of 10)

"Teach us about HIV and AIDS so that we can survive the virus."


Today's family photos - The Draks

We spent this past weekend in the Drakensberg Mountains (roughly translated="Dragons Mountains"). They form highest peaks in Southern Africa.
This is the last batch of family photos, as my sister and brother-in-law left from Johannesburg last night.


It is indeed true what they say about good things.
The Drakensberg's "Champagne Castle," brother Alan and me.

Drakensberg mountains, sister Sarah and me.

A rock formation called "The Sphinx", Alan, me.

Friday, June 22, 2007

Swazi HIV Awareness Poster Series (4 of 10)


Today's family photo - Ultimate frisbee

Sarah running. (Me standing still, likely winded.)

Me running, likely winded.

Sarah and me, sweaty and winded.

Last weekend, Swaziland's only ultimate frisbee team challenged Mozambique's only known ultimate frisbee team to a friendly match.

Thanks to my sister Sarah (the hands-down rookie of the year for Swaz ultimate), we prevailed 8-15.

Thursday, June 21, 2007

Swazi HIV Awareness Poster Series (3 of 10)


Today's family photo - Jump

Alan and Sarah in air last Saturday at dusk, with downtown Maputo 's silhouette behind them.

Tuesday, June 19, 2007

Swazi HIV Awareness Poster Series (2 of 10)


Recent Media - Rosier futures

"I hate having Aids because I get very sick and I get very sad when I think of all the other children and babies that are sick with Aids." -11-year-old Nkosi Johnson

This is an excerpt from an uplifting story about pediatric HIV in South Africa, where I am helping to give a training this week. It was written by a friend of mine, Fran Blandy. (Thanks for the link, Fran.)

"Rosier future for SA children living with AIDS"

Sunday, June 17, 2007

Happy Father's Day!

Me and father Chuck Phelps...and several fish.
A thank you to all you papas, daddies, fathers, grandfathers, Grandaddies, Opas, etc. out there, especially mine.
Dear "mine": Please click here for a Father's Day message.

Saturday, June 16, 2007

Today is the Day of the African Child

Just to review the numbers one more time…

2.3 million children are living with HIV worldwide, ~90% in subSaharan Africa. Every day, 1400 children die of AIDS related illnesses. Another 1500 become infected with HIV.

Thirteen million children have been orphaned by HIV/AIDS in subSaharan Africa, projected to reach 18-20 million by the year 2010. In subSaharan Africa, an estimated 9% of children have lost at least one parent to AIDS, and one in six households with children is caring for at least one orphan. (Stats compliments of the Stephen Lewis Foundation.)

If you are interested in helping, please see the post titled “birthday wish” below.

Today's family photos - The Maputo fish market


Clams and Sarah.

Calamari and Alan.


Steamed clams, Sarah, and me.

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Friday, June 15, 2007

My 32nd birthday day

Well, I am a year older...

Today's sunrise jog with the sibs. (Photo taken by Dave, my loyal running partner.)

....and I am ostensibly a year wiser.

My sister made me promise to post this. She was proud of the balloon hat...which she and Alan made. At least the image gives the impression of youth.


When I returned from outreach in St. Phillips yesterday (see post below), I was welcomed with a miniature surprise party in the clinic kitchen, thanks to my sister and bro-in-law.

Having my cake and eating it too.

A clean bill of health.

My Swazi colleagues.

Please do not forget 'my birthday wish' below...

Thursday, June 14, 2007

Swazi HIV Awareness Poster Series (1 of 10)

On a totally unrelated note, don’t forget to read about "my birthday wish" below…


One hundred and one Swaziland destinations- #9: St. Phillips

St. Phillips is a small village where I went for "outreach" today.
St. Phillips is about two hours from Mbabane. You will probably never find yourself there, but if you do, ask for Sister Sweetness. Her name is apt and easy to remember, and if you are lucky she will be able to show you around.

Here are a few pics…my best attempt at a virtual tour. Bear in mind that I am no Sister Sweetness.

The girls dorm on laundry day.

Leaving class.

Baby cows on laundry day

Five adolescents in after-school tutoring.

Five kids hanging out after school.


Well, hope you enjoyed the tour.

We (Dr. Carrie Golitko and I) spent the day seeing patients alongside Nurse Simon, helping him become more comfortable with pediatric HIV care and treatment. The photo below was taken by a 9yo patient.

Dr. Ryan and Dr. Carrie.

Simon is an excellent clinician and avid learner. He will be a pediatric HIV expert soon.

Nurse Simon reviews the adherence calendar.


Wednesday, June 13, 2007

Ryan's birthday wish

My 32nd birthday is on June 15th. June 16th is the International Day of the African Child.

Both of these days come and go every year with little to-do, little fanfare.

Just as the anniversary of my birth brings with it an excuse for celebration sprinkled with introspection, so should the day after.

The Int'l Day of the African Child might seem like one of many designated “special” days that show up only in almanacs and obscure blogs.

Well, it is one of those days.

However, unlike “Wrong Trousers Day” (June 29, 2007) or “World Turtle Day” (May 26, 2007), this day is set aside to call attention to one of the catastrophes of our time, that is the plight of kids living amongst the most challenging circumstances the modern world has to offer.

This blog, though occasionally flippant, is meant to help illustrate this.

The day after my birthday is an opportunity to celebrate the progress made toward health, education, equality and protection for Africa’s children and also reflect on our failures and, most importantly, the future.

I will be posting more about this as Saturday approaches, but I wanted to take this opportunity to call your attention to these two upcoming days and, for those interested, share my birthday wish.

Here it is: Please make a donation to Young Heroes.

Your money (all of it) will go directly to a family caring for an orphan here in Swaziland.

See the Young Heroes website for more information.

Tuesday, June 12, 2007

Today's family photo - Country line dancing? Yebo.

Last Saturday night in Swaziland

This photo speaks for itself, but I really do look forward to telling you the story.

My guests are at home waiting for me, so it is a story for another time.

(I went to the hospital today to check on the two girls discussed below. Both of them are receiving intensive inpatient nutrition. Rebecca remains in especially critical condition.)

Monday, June 11, 2007

Blown away – Two patient encounters, in brief

I saw Rebecca for follow up today (See Introduction 10 of 10 below).

She has lost another 1.5 kg and is even further off the chart.

My grandmother used to tell me that if I did not eat well, I might “dry up and blow away.”

Well, I have never seen a child so dried up.

Within her skin, there are merely bones and some semblance of a child trying to hold on.

Because her mom has to carry her wherever they go, I dropped her off at the hospital during my lunch break.


I just finished seeing my last patient. Her name is Lindiwe, and today was her first visit to the Baylor Clinic.

She and her mother are waiting outside for me. You see, Lindiwe has several things in common with Rebecca.

They are the same age.

They are both HIV+.

Like Rebecca, Lindiwe can barely walk.

Like Rebecca, she weighs just over 13kg.

They will both be spending several weeks in the hospital…if they can afford it.

If they can survive it.

I will let you know if they do.


Sunday, June 10, 2007

Upcoming posts

I have recently promised blogs on:
-- my recent, severely malnourished patient (Intro #10 below)
-- food distribution and the WFP
-- ARV adherence

I also met some Swazi cowboys last night, and it is a story that begs telling.

Stay tuned, y'all.

Today's family photo(s) - Beauty and beasts

Yesterday, Sarah, Alan and I biked the first 22km of the 68km route of last weekend's exquisitely painful Imvelo MTN bike race.

Cool logo, though.

Yesterday's sightings included kudu, impala, warthogs, wildebeests, zebra, a [baby] crocodile, and several other varieties of something-boks. (Left my game guide at home.)

Sister Sarah and brother Ryan.

Alan after a death-defying end-over into the briar patch. (Bike initially atop him, but my camera was not readily available for more embarrassing photo-documentation.)

Sarah, Alan, and zebra family.

Friday, June 08, 2007

Today's family photo(s) - Powdered foods and flippant moods

Alan, Sipho, and Dave.

Corn soy blend (CSB) is aptly named. It is powdered soy and powdered corn, and it can keep a malnourished child alive. Thanks to a donation by the World Food Program (WFP), we began distributing the food yesterday at the Baylor clinic. We moved a few hundred kilograms of the one day.

The photo above depicts Alan preparing some CSB packets for next week. After an hour or so of this, he was covered with a thin film of nutritious dust. More about CSB and the World Food Program soon.

Click here and here and here and here for 4 previous blog posts on food insecurity and malnutrition in Swaziland.


After returning from prepackaging CSB, both Alan and Sarah began helping me write up a couple of articles. Sarah found herself a bit giddy after editing a recent draft of an article discussing a staff adherence exercise conducted here at the clinic. More to come on this as well.

They are both working hard. I am trying to get them to write a guest blog entry, but they are already averaging 11 hour days.

At least they are getting some exercise.

CSB bags...and more CSB bags.

Thursday, June 07, 2007

Today's family photo - No time to blog

Today, Sarah (my sister, left) went with me to assess a health centre a couple hours away. Alan (my bro-in-law, right) traveled in the opposite direction to participate in a PMTCT/peds ART clinic. Total hours traveled = 9.
Conclusion = it is dinner time, and therefore too late to post much more than this.