Monday, October 29, 2007

Training trainers in Swaziland

This week, we are training a group of fourteen excellent nurses. We are teaching them teach others about pediatric HIV. The curriculum is based loosely on the South African advanced training from earlier this month. The group was recruited because they demonstrated advanced knowledge and leadership during our basic trainings, and so trainers-in-training are teaching us trainers-of-trainers plenty.

Here are a couple of photos. I will try to post more later in the week.

Bongile giving a talk on how to teach children about HIV.
A map of Swaziland. Post-it notes represent where trainers are currently working.

Sunday, October 28, 2007

Yesterday's jog past the graveyard - Cultural encounter series (3 of 10)

We had biked past the graveyard before. The first time I pedaled by the place, just less than a year ago, I did not know that dead bodies were buried there. It looked more like a quarry of some sort, or an unlikely rock garden. I say “unlikely” because I have yet to see a rock garden in Swaziland, and if there was a lonely gardener of stones, he or she would be unlikely to choose this exposed, treeless, featureless, eroding square of land.

Not the best place to bury something either, I suppose.

I did not point this out to the three men with shovels. On my next pass, a week later, they were methodically lunging toward an enlarging hole in the ground, moving earth and aerosolizing dust. Their shovels made the sound that cats make when frightened. Sometimes, when the tool’s metal hit rock, it made a different sound. A short-lived, lifeless one.

In the foreground, there was a prone, human-shaped shadow in the back of a carelessly-parked pickup truck. The able-bodied figure was awkwardly positioned and perfectly still. I did not stare, for the scene was already rife with indecency.


Yesterday, I jogged past the same cemetery. There were no grave-diggers there, or anybody for that matter. On the surrounding hillside, however, it was a busy Friday afternoon.

A few paces from the piles of dirt and rock, there was a child carrying a child. They were the same child, it seemed, but one was smaller. I believe they were sisters. They were at the base of the hill, walking up. Others followed, many of them students returning from the school in the valley below.

Further along, two men peered into the rusty bowels of an old tractor. One was crouched down looking up, while the other was perched on a tire, peering down. They both looked perplexed, as if there was no good reason for the ancient machine to be giving them so much trouble.

Ahead, two sheppard boys began waving their whips at a small herd of cattle that were slowly crossing the road ahead of me. Under the threat of the leather lash, the cows’ pace quickened. A calf, trapped between me and a hillside drainage ditch, leaped away from me in desperation. Despite the well-known nursery rhyme, cows are not able jumpers, especially on concrete. Shortly after a frantic extension of the front legs, there was slip, a buckling, and an awkward tumble. The calf regained its footing, seemingly satisfied with itself for having avoided both the runner and the whip.

As I began the two-kilometer climb to the top of the hill where I was to turn around, a child began to run alongside me. He was punching the air in front of him, like a shadow boxer, or, for those familiar, one of those miniature boxing nun novelty toys. I had no idea why he was doing this, nor did I understand why he was nudging me to the right side of the road. After a few seconds of fist-pumping and nudging, a four-wheeled cart sped by in the other direction. The child driving was holding a horizontal stick, like a water-skiing tow-rope. He was steering the vehicle with the same back-and-forth hand motions as my new running escort.

After the cart had passed, my gesturing protector smiled and asked me, “Want to ride it?” I answered “no thank you”, for it looked a lot like one of those old wood-and-red-metal Citizen Kane “Rosebud” sleds, and I crashed too many times as a child. (We rarely got more than an inch of snow in Texas, and this provides little cushion.)

I ran up the hill and turned back. I passed the graveyard. This time it was on the left. I crossed a bridge where a woman was washing her clothes in a shallow, smoky river. The water smelled of algae and sulfur. Five children shouted and waved from outside a shack built from corrugated tin and weathered wood. Their bubbly excitement when I waved back and said “hhheeeellllooo” made me feel happy but small, maybe even a little bit old.

I looked back at the hill I had just climbed. The rains have recently arrived to Swaziland, and the grass was rich and green, the color of a plastic turtle.

The graveyard was not green. It was brown and ruddy, the color of a place where too many young people are buried.

The children were still waving, so I shouted “Bye byeeee!”

Recognizing another of the few English words they knew, they were delighted, and each of them squealed the same word back several times.


Thursday, October 25, 2007

Swazi HIV Awareness Poster Series - (19 of 20)

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Tuesday, October 23, 2007

Swazi HIV Awareness Poster Series (17-18 of 20)

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Friday, October 19, 2007

Swazi HIV Awareness Poster Series (14-16 of 20)


Where I used to fish for bass - Today's travel digest (4 of 10)

Phelps Lake.

This small lake (some might call it a large pond, but they would be wrong) is across the street from my childhood home. It is called "Phelps Lake", and is being guarded in the above picture by one of the household's new puppies.

Wednesday, October 17, 2007

Why pleasantries are so named - Today's travel digest (3 of 10)

Prologue: For those new to the site, I am currently in Texas to take my pediatric credentialing exam and visit family. Therefore, the following dialogue occurred a few clicks west of Swaziland, in a north Texas coffee house.

“Good morning!”

The eyes of the greeted met mine, wearing what is most accurately described as a blank stare.

“Good morning,” I repeated, beginning to wonder if it was actually a good morning...maybe it wasn’t. It seemed like one, but I have told that I do err on occasion.

“Uh, good morning?” countered the young lady behind the coffee counter.

She didn’t know either.

“How are you?

The stare was replaced by that forehead wrinkle and flickering twitch of the eyelids that means “I do not understand you and I am suspicious that you might want to harm me.”

I gave up.

“A medium coffee, please.”

“You mean a grande?”

“Is a grande a medium?” (Everyone knows darn well that “grande”, literally translated, means “large.”)


“Then, yes, I would love a grande,” I said in clarification, wondering if a “medio” was a small.

“That’ll be two dollars thirty-six.”


When it comes to greetings, Swazis have it right. In Swaziland, money does not exchange hands until the payer and payee greet one another. Favors are not asked until the there is a mutual well-wish. With very rare exception, niceties precede necessities.

Take this common Swazi exchange, for example: “Good morning. Good morning. How are you? I am fine. How are you? I am also fine, thank you. Good. May I have a medium coffee, please?”...and so on.

Only takes a few seconds, and I must point out that a cup of coffee, while nice in and of itself, tastes even better after some humanizing behavior.

Size inflation is no substitute for a smile.


(“Size inflation,” however, is worth its own blog entry. Stay tuned.)

Friday, October 12, 2007

The selfish [and possibly a wee bit lazy] gene - Today's travel digest (2 of 10)


Not too long ago, “people movers” were called “feet”. Though many other mammals scurry about on four, Darwin, Dawkins, Mendel, the double helix and the gang voted unanimously that a pair is enough, provided it is accompanied by some modicum of wit.

Well, several witty bipeds apparently got together and decided that the few hundred meters from the Atlanta airport’s international arrival gate to customs was too far for two feet, and they created a moving sidewalk. It transports those standing on it at ~3mph, about the speed of a Sunday stroll.

A moving sidewalk. (

At the end of the airport's moving sidewalk there they engineered an escalator, a device that preceded "moving sidewalks" and “people movers” by several years. (Climbing stairs, after all, requires more exertion than walking.) The interesting thing about these particular pre-airport-customs escalators was this: There were no accompanying stairs.

My only option for getting from level one to level two was to plant my two feet on the motorized metal platform and wait. (Strange that escalator actually means "one that increases intensity.")

Near the top of the escalator, I ensured that my shoe laces were free so that I would not get sucked into the metallic bowels of the device. After my safe dismount, I noted that there was no nearby moving sidewalk, so I walked to the adjacent men’s room on my own. With alternating feet, I approached the sink to wash my face. When I arrived, I found a faucet without a handle, a soap squirter without a button, and paper towel dispenser without a lever. To my astonishment, thanks to motion detectors, I was able to wash my hands with zero twisting, pushing or pulling.

Like my legs, my arms and opposing thumbs suddenly seemed obsolete.

I never once had that feeling in Swaziland.

Here in the USA, automated effortlessness abounds. Even the security personnel monitoring the passport verification process were riding the thing pictured below. I don't even know what the machine is called...but the riders were not wearing helmets.

If we are no longer going to use our legs and arms, we can at least protect North America's brains until they too are eclipsed by supercomputers.

Only kidding, of course.


Next in this series: why saying hello is a unprofitable waste of time.

Thursday, October 11, 2007

One hundred and one Swaziland destinations - #19: "The Swazi Cultural Village"

I recently accompanied two friends to the Swazi cultural village to watch traditional dancing. I had been once before, shortly after arriving to Swaziland over a year ago. I felt less like a tourist the second time around. The cultural village is near Mantenga Falls, discussed in a previous post.

Here is a short video clip.

Wednesday, October 10, 2007

If "banana-ness" was a Platonic form... - Today's travel digest (1 of 10)

I was last in the USA ten months ago. Until today, that is.

I am just off the plane from Africa, in the Atlanta airport. Though only back for a few minutes, I already find myself with a growing list of, um, transatlantic observations.

After clearing US customs (an interesting experience in and of itself), I proceeded directly to buy some coffee.

Despite forgetting that 'small' is now 'tall' and 'medium' is now 'grande' or something like that, I managed to convey that I wanted some coffee in a cup.

As I stepped up to the cash register and transacted with green money for the first time in a long time, I was struck by a a basket of yellow fruit on the counter. The contents looked a lot like bananas, but were much bigger and much much better.

I am not sure what Del Monte (the red, oval sticker on the mega-fruit read "Del Monte") does to coax flawless, foot-long bananas from the same earth that yields the brown, shriveled ones I have become familiar with, but they need to export the technology (produce life coaches?) to Southern Africa. Very impressive. I mean, I am very very impressed with those bananas.

Take the picture above, for example. Imagine banana #2 was perfectly yellow and 50% bigger. Now, extrapolate from banana #7 and imagine that there is an eighth. I have been eating #8s for a long time.


Stay tuned for my next travel digest entry on the universal automation/automatization of the American airport bathroom.

Tuesday, October 09, 2007

Your 5-day blog forecast

The Spice Master's bounty.

I am getting on a plane in a few hours to fly to Texas for my pediatric board exam and some family time. Below are some of the upcoming blog entries that I plan to post. Maybe I will write them while airborne or while in the throes of jetlag-induced insomnia.

- Why AIDS is a disaster in the most literal sense

- The Spice Master: a Durban phenomenon

- The little devil of Zululand, and how to avoid its wrath

- A debriefing on last week’s training of trainers

- The high-kickers of the Swazi cultural village

Friday, October 05, 2007

Training trainers in Kwa-Zulu Natal, South Africa - Part 2

I just arrived back in Swaziland from South Africa. The training went well. I will fill you in on the highlights "just now". (This phrase, as many of you know, is local slang for "soon, loosely defined".)

Seven highway hours require me to spend "now now" (meaning "now, literally defined") doing something besides sitting and typing.

Blogging is too much like driving.

I will, however, post the remainder of the cartoons (see below) that we use for counseling children with HIV. See Oct 3 entry for the original batch.

The reminder.

The HIV virus says, "Oh no!"

Giving the medicines.

Life on ARVs.

Thursday, October 04, 2007

Stories about Sipho, Part 2 - A guest-blog patient encounter

Please check out the (BLOG) RED link below for the second half of my recent patient encounter narrative about a child named Sipho. Click here for the first half.

(BLOG) RED: Stories about Sipho, Part 2


Wednesday, October 03, 2007

Training trainers in Kwa-Zulu Natal, South Africa - Part 1

I have been in Pietermaritzburg, South Africa (near Durban) helping to give an advanced training on pediatric HIV care and treatment, and have had some difficulty finding time to write and post.

I will write and post soon, but in the mean time, have a look at the drawings below, which were taken from today's pediatric HIV counseling talk. (I have discussed the "soldier cell" analogy in several previous posts, including patient encounters with Siyabusa (July 2007) and Alshande (May 2007).)
The CD4 (or "soldier") cell.

Soldier cells protecting the body.
Soldier cell being attacked by the HIV virus.

The body's defenses being challenged.

The body's defenses weaken and the patient gets sicker.

The timeline for the HIV-infected body.

The revenge of ARV-armoured the CD4.
(Cartoons to be continued soon...)

Swazi HIV Awareness Poster Series - (12-13 of 20)