Monday, September 17, 2007

Why the chicken crossed... Swaziland destination #16 addendum

This narrative below is a follow-up from the previous two entries regarding Swazi destination #16, Lomahasha (red arrow on above map).

The four chickens’ heads bobbed slightly with each step the ladies took. The women were almost to the kitchen, two chicken legs (and one down-side-up chicken) in each hand. The doomed necks of the chickens were contorted maximally in an effort to correct the inverted horizon, giving all four animals a proud, distinguished appearance in their final minutes. The birds looked remarkably calm as they disappeared into a hut of clanging pots and women’s voices. Smoke rose slowly into the hot, dry air from a chimney-pole above.

The scene, as witnessed through the Lomahasha ART exam room window, made me question the appropriateness of the oft-used adjective “chicken”.

It is not easy to be a domesticable, tasty forager in a hungry, unjust world.

It is also difficult to be a patient in Swaziland. Human beings packed the hallway outside the exam room like a rush-hour subway car. Nikiwe and I could not actually open the door to leave. We would literally have to work our way to freedom.

Until the vehicle with our chart and medicines arrived, however, we could do nothing except chat and wait. Despite copious schooling, I am useless without patient records and ARVs.

As Nikiwe and I discussed some of the differences between Baylor clinic and the rural government health clinics (there are several), three bleating goats and three languid donkeys passed by the window. As I reviewed our plan to slowly transition out of Lomahasha and begin mentoring at other rural clinics, six right-side-up, naïve chickens strutted past. Eventually, we heard the louder, mechanical cackling of a diesel engine. The welcome sound preceded the Ministry of Health vehicle itself by sixty seconds and a large plume of dust by sixty-one seconds.

We saw twenty-five patients in the following four hours. Nikiwe did all of the real work, consulting me occasionally.

While the Baylor doctors will miss the farm life surrounding the Lomahasha clinic and the people within, we will be shifting our attention to another site soon. The queue of sites awaiting mentoring is long.

After we saw the last patient, I told Nikiwe, “That was not so bad.”

"No, it wasn’t" was her reply.

Nikiwe (pictured below) is the last of the three nurses to receive one-on-one teaching in pediatric HIV care, and is prepared to provide pediatric ARV care independently. When children need ARV initiation or when complicated cases arise, she will refer them to Baylor or nearby Good Sheppard Hospital.



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