Friday, December 01, 2006

Today is World AIDS Day, 2006


Swazi child. (www.ifrc.org)

Stay tuned for photos from Swaziland on this important day. Will post soon.

Please visit www.worldaidsday.org for more information.

Please visit www.youngheroes.org.sz to donate directly to support families with orphaned children here in Swaziland. This organization spends its money very carefully.
If a Bono fan, check out http://www.joinred.com/news.asp for a video blog from the man himself.
Thank you for visiting...

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Monday, November 27, 2006

Parentless children with nothing to lose



There are around 1,000,000 people living in Swaziland. 500,000 are adults. Up to 200,000 of those adults are infected. Most of those infected are caring for children. 20,000 of those infected need ARVs immediately, or they will soon die of AIDS. The remaining 180,000 adults have an average of around 10 years before they will meet the same fate.

Today, there are 70,000 orphans in Swaziland. In 2010, there will be around 120,000.
120,000 children without adult caregivers.


This is not complicated math, and the dangers of allowing 120,000 parentless, unschooled, unemployed, undernourished, helpless, hopeless children wander a small country are not difficult to calculate either.


In the words of Derek Von Wissel, the Director of Swaziland's National Emergency Response Council on HIV/AIDS (NERCHA), “They will have nothing to lose. They will be rampant. It is a nightmare.”


This is a nightmare we will most certainly want to wake up from. Should we not wake up sooner than 2010?


To do your part, see the following link, or email me for other ideas as to how you might contribute.


www.youngheroes.org.sz/index_home.asp



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Saturday, November 25, 2006

Doctor’s Meeting Minutes (DRAFT), 24 Nov 2006

Suppose you were a fly on the wall...

Doctor’s Meeting Minutes (DRAFT), 24 November, 2006
(Respectfully submitted by Ryan. Actionable items in red. Contact me with additions/corrections.)

1) Patient flow log (Delouis)
· Reviewed purpose of log, which we will use for 2-3 days to gather info on pt flow and complexity of visits. Translators to fill out with MD help as needed.
· Also logging lab entry time to measure how many MD-hours being used.
· We are doing both of these logs to improve efficiency and to build argument to hire digitizing staff to protect MD time. Discussion ensued.

2) Outreach updates (Dewey et al.)
· What is going on, in brief? Are folks happy or wanting to rotate?
· Piggs Peak
- Dave and Dan D. in PP, getting to know folks and doing bit of everything.
- There are 5 docs there, but PMTCT strategies are high yield investment opps for our docs (little VCT, with 50% or more HIV+ but poor f/u).
· Shumwula/Lomahasha/Good Shepard (Gretchen and Helga)
- Gretchen and Helga happy to have other docs come with them.
- The perspective from being “out in the field” very valuable.
- Gretchen recommends grant-writing over holidays to try to ensure some inflow, esp. for transport. (UNICEF a “maybe” at this point.)
· Matsangeni Govt Hlth Center (Sach)
- Many challenges, esp. in peds and PMTCT. (Eg: Cotrim/MVTs often not available.)
- Still, have made great strides in short time, building inroads and demonstrating partnership and support.
· Mbabane Govt. Hosp (Nanda)
- This has been Nanda’s site for 3 months, and she sees positive changes with her persistent presence. (Eg: Malnutrition protocol starting to work.)
· COE (Amy, Julia, Eric, Ryan, Johanna, and others):
- All generally happy at COE, but little protected time for other projects.
- Working on pt flow.

3) Protocol committee
· Diarrhea (Helga)
- Reviewed “Diarrhea SOP” draft, derived from Uganda SOP.
- Reviewed zinc, vit A, antimicrobials, and antidiarrheal data, in brief.
- Plan to look over diarrhea SOP and discuss/edit next week.
- Need for water hygiene handout and rehydration SOP.
· Adult ARVs (Eileen)
- AZT vs D4T for adult is a question that freq comes up
- Proposes we shift from D4T to AZT for new ARV pts unless good reason not to
- Also cited 2 recent studies from Uganda and SA (see Eileen for refs)
- Cut-off for anemia in adults <>

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Saturday, November 18, 2006

A brief encounter with a weaver bird



The weaver bird. What a fascinating animal. Yesterday, while reading an article in the Economist magazine (which I recently discovered has some distribution in these parts), I noticed that one of these birds had landed on my patio chair. The chair is one of those nylon camping chairs, and is dark (or Duke) blue. The bird was similar to the one pictured, quite pretty to look at.

Weaver birds seem to spend essentially every waking moment tirelessly building and remodeling their nest. This one, it seemed, was foraging for building supplies.

I marveled at how many bones he must have in his neck, or rather how accommodating those bones must be, for his head could achieve impossible angles as he looked around.

Now to the fascinating part. After scanning the totality of my back porch and lawn, the bird darted directly toward the sliding glass door with such swiftness that I thought he would disembowel himself on it (for I have seen this happen). At the last instant, he threw back his ultra-limber neck and did a midair about-face. All I heard was a tiny click on the glass, and suddenly the bird was back on the chair.

Faintly in his beak, I saw what looked like a 2cm thread, a small, thin blade of grass. With that tiny piece of vegetation, he darted off. Curious, I stepped toward the glass door. To my surprise, I had been observing the bird through a delicate spider web, and in the web were a few tiny bugs and some debris, with a small interruption in the web where the bird had extracted his small discovery.

That small filament, as I type, is no doubt woven into the wall of one of the nests I see high in the pine trees outside of the dining room window from which I type.

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Monday, November 13, 2006

My Swazi family


Meet my youthful housemates.

Well, actually, Busi (the tall, grown-up one) lives in the adjoining guest house, while Phephisa, Thando, Neliswa, Philile (left to right in bottom row) and Ntshiki (in Busi’s arms) come and go between Busi’s home village of Siteki a few hours east.

The two little ones are deathly afraid of me (as pictured), and I have no idea why.

Phephisa and Ntshiki are Busi’s children (she has a third child of fifteen years). Thando and Neliswa belong to Busi’s sister, Sphephile, and, finally, Philile is the child of Busi’s other sister, Futhi.

Such names make “Ryan” seem a bit of a yawn, no? Posted by Picasa

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Standing on shoulders – A brief tribute


Liquid antiretrovirals, formulated for children too young to swallow pills.


I am not a laboratory scientist. I did not painstakingly develop AZT, 3TC, d4T, nevaripine, and the other antiretrovirals that keep HIV-positive children alive.

I am not a clinical researcher. I did not keenly design costly, intricate clinical trials to ensure the safety and efficacy of these drugs.

I am not a visionary. I did not partner with a multimillion dollar pharmaceutical company to ensure that these drugs would be available at or below cost in Africa, where they could save tens of thousands of young lives.

I am but a pediatrician and amateur blogger. I examine sick kids, give them medicines, and when able share a bit about my experiences.

This past week alone, thanks to the people above, our clinic here in Swaziland was able to offer hundreds of children life-saving HIV treatment at no cost. Around Africa, other clinics like ours are doing the same.

Without these individuals, these children would die.

For this reason, this pediatrician/amateur blogger would like to say, “Thank you. For what it is worth, thank you very much.” Posted by Picasa

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Sunday, November 12, 2006

Where to plant a yellow rose


A yellow rose outside our clinic. Mbabane, Swaziland


Late one afternoon last month, I stood outside the Baylor COE clinic and watched two landscapers discussing where to plant some recently-delivered flower bushes. Though I did not understand what they were saying, both seemed to be making a careful argument regarding aesthetics, light, shade, etc. They eventually agreed on a bare spot in a nearby bed and began picking up the flowers.

As they passed, I noticed they were yellow roses.

They were not quite like the oft-cited yellow roses that grow in east Texas, the kind that cost 60 bucks a dozen (an average Swazi’s monthly salary).

The stems were pragmatic and wiry, the thorns few. The petals were smaller and less compact, almost indelicate.

The flower was not slender and romantic like the ones we used to distribute to unsuspecting coeds on Texas Independence Day back at UT-Austin.

I remember those afternoons fondly, riding the campus shuttle around the university’s 40 acres, giving away roses, asking nothing in return.

An all-too-rare gesture.

As the gardeners carried the pots across the lawn, the yellow roses of Swaziland bounced with each step. They nodded at the mid-afternoon sun, as if reminding me that home was still out there.

Reminding me that I too was changing. Posted by Picasa

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Thursday, November 09, 2006

Lake Malawi’s #1 Boy Band

“Look, the moon is full,” said one of the silhouettes as we wandered down the shore of Lake Malawi.

“I believe it is actually a waxing gibbous,” one of my other traveling companions objected.

Regardless, we did not need a flashlight as we sought out the pizzeria down the beach from our thatch-roofed cabin.

Nor did “Lake Malawi’s #1 Boy Band”.

They use the name “Boy Band” for short.

One instant, we were discussing the moon, pizza toppings, and how hungry we were. The next instant we were being entertained by a four-piece-two-dancer band, average age 6.5 years.

Boy Band someday hopes to buy trousers to go with their matching shirts.

These children are an affirmation of hope, a reminder of what we must strive to protect.

Have a look…


Boy Band's bass guitarrist.


Boy Band's backup drummer.


Boy Band's lead guitarrist.


Boy Band's dancers, demonstrating the ever-popular "old man dance".

To be continued... Posted by Picasa

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Lake Malawi's #1 Boy Band, continued.


Boy Band's lead percussionist, lead singer, and leader.


The Boy Band drum set. (Note the bottle caps.)


What I hope is Boy Band's smallest audience for years to come, for they deserve no less than fame and furtune.


Behold the future of Malawi... Posted by Picasa

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Sunday, November 05, 2006

Looking for a good cause for holiday giving?



Swaziland has the world's highest rate of HIV infection, and the disease is creating a generation of orphans. The country has nearly 70,000 orphans, and over 15,000 Swazi households are headed by children who are raising little brothers and sisters by themselves.

Please check out the following link as you make plans for holiday giving.

http://www.youngheroes.org.sz

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Malawi photos


Lilongwe's "Black Stars" soccer team (managed by David Jones, a BIPAI colleague) take on presidential guards' team on field near presidential palace. Final score: Stars 1, guards 6.



Roadside shop selling toys and baskets.



Malawi is Africa's most densely populated country. Houses (such as these) dot the landscape.



Malawi baobab at dusk. Posted by Picasa

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Lake Malawi photos (4 November)


Canoe carpenter, Cape Maclear, Lake Malawi


Children, Lake Malawi.


Children with fresh catch, Lake Malawi


Children fishing, Lake Malawi Posted by Picasa

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Sunday, October 29, 2006

Fish-N-Chips


One million calories. Two dollars. Quite tasty. Travel at least a thousand miles to visit me, and I'll buy. -Ryan Posted by Picasa

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Monday, October 16, 2006

Weekend in Mozambique




 Posted by Picasa

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Sunday, October 01, 2006

Sunday brunch




 Posted by Picasa

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Thursday, September 28, 2006

Swazi sunset

 Posted by Picasa

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Saturday, September 23, 2006

Hiking and biking


Me with other Baylor AIDS Corps folks on a hike near Mbabane.


Typical Swazi landscape.


Saturday morning in Mbabane. Elevation approximately 4000 feet.


Typical Swazi landscape with colleague Eric Raabe pedaling in the distance. Posted by Picasa

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