My friends leave today

Today is a bit of a milestone. We've hit the 3 week mark and Betty and Linda are leaving me. It is an understatement to say that I will miss them enormously. This kind of experience lends itself to substantial bonding in a quite brief period of time. Yeah, I'll really miss them.
Yesterday, for their final full day here, we went to Mkhaya Game Reserve for endangered species. Because these animals are endangered, the park tries to eliminate or cut down on kills, so there are no cats in this game park. It seems I will leave Africa without having seen some. I can live with that. I've seen so much. For instance, we were able to get out of the Land Rover yesterday and get pretty close to the Rhinos. I have more wonderful images of Giraffes and Elephants. I call this one "Giraffes Two by Two". I still have an impossible time capturing Hippos. I've seen a lot of them, but everytime I'm ready to click, they dunk back under water. Cagey suckers.


The Rover we were in yesterday had no cover and the unobstructed sun beat down on us hard. I actually began to feel as if I might not be able to complete the drive. Feeling severely dehydrated even though we were drinking water constantly, during our stop for lunch my friends and I bought the only hats available. They saved us, but I'm still massively sun burnt on my shoulders, my upper chest and the back of my neck.

I kept waking up thoughout the night. Nothing new about that. But then the phone rang at 4:50am. Liam called to let me know that his call-back for Brighton Beach Memoirs (sent via dvd) had been seen by Neil Simon, who really liked it, and now he'll be headed back to NYC tomorrow to audition again for Jay Binder on Sunday and for Neil Simon himself on Monday!!!! Go Liam! Then I had to check out his auditions on YouTube and then I had to kvell and kvell and kvell because my baby is such a good guy and so ridiculously talented. Ah me.

So, I will be looking like a lobster who really needs some sleep when the new nurse arrives today. Wish me luck. I feel a bit at sixes and sevens without my two buds. I can't believe I have only one week left myself. I have such high hopes for how it will turn out.
Here's hoping.

A Schizophrenic Week

This is the longest I’ve gone without writing because I just haven’t had the heart for it until today. I’ve gone from feeling elated to blue to back again and, maybe that’s just me but, I’ve got whiplash. The first half of the week was spent working on a Procedure Manual that had nothing to do with HIV and even less to do with why we are here. All three of us were losing our minds. I thought, “Why did I come all this way to do secretarial work I could have sent via email?” It was enervating and demoralizing.
Then, a group of nurses came in from outlying clinics and the powers that be had to do something with them. Tada! I was called upon to give another presentation on ARV’s and adherence. This was great! Community Health Nurses. My bailiwick. What a great 2 hours. We really got into the nitty gritty of interventional strategies for adherence, exploring barriers and overcoming them, when to start therapy, and on and on. They even asked about how to change med administration schedules while maintaining therapeutic blood levels. I was in heaven.
The next day – back to the Procedure Manual. Blecchh.
And now today. Today. My most satisfying day yet. I actually got to go out and do home visits with the student nurses. Three weeks here and I finally got to do what I do. We drove for about 2 hours to Mpaka and Siteki. We went down roads that you could barely call paths. Very heavy brush. Normally, I work in an urban area of Swaziland such as it is. Today, the flora was truly sub-tropical and dense. The homes we visited consisted of cinder block boxes approximately 15’ X 14’ on average. Some smaller. All of the visits were conducted outside, in front of their homes. The families were very welcoming to me. Actually, everyone in Swaziland is welcoming. These may be the nicest people on the planet. I was able to do mentoring that included discussions of HIV, TB, diarrhea and Nutrition (Sorry for the specifics but it is what it is).
An interesting close to the day – On the way home we stopped at a gas station/chicken coop. Here, the clinical instructor got out, bought 2 live chickens, their feet were then bound (which kind of broke my heart), they were placed in individual bags with their heads peering out, and we rode home with them squawking all the way.

For a laugh, I’ve included a photo of me from last weekend dancing with some traditional Swazi dancers. I tried to hide but they pulled me out of the crowd. TWICE. Sheesh! I decided it would be less mortifying to just go with it.

Friday and Saturday

I had 79 final year students for the Prevention class on Friday and I had a little bit of stage fright for this one. I'm very happy about how it came out though. On a certain level it feels like if I do nothing else but that one class while I'm here, then my time will have been well spent. It was actually very good that they gave me two hours because, with this subject matter, it can take a while for a group that large to loosen up. And they did end up asking questions, though so quietly that I had to run all over the auditorium just so that I could hear each one. I doubt that they've heard sex and drugs talked about so frankly in that setting before. They seemed really grateful to finally be addressing these issues. And the beauty part was, at the end after I'd finished, a young male nursing student came up to me and wanted to talk about his girlfriend who is HIV+ while he is not. He wanted to know if what they had been doing was safe, how he could remain safe and still be loving with her and, also, how to keep her healthy. They don't start people on the cocktail here until their CD4 count hits 200. The new guidelines recommend starting by 350. His girlfriend's count was at 285. He is so frustrated and frightened for her. But it was a wonderful discussion. I'm hoping that in the final 2 weeks that I'm here, more students will come up and talk to me about prevention issues they may not have been able to discuss in an open auditorium filled with their peers.

After work, my two compatriots and I headed to Hlane, a game reserve about 1 1/2 hours away in Swaziland. We stayed over night in the camp and our cabin was actually 14 km within. We ended up driving thru the camp in the dark and every time we came up to an electrified gate, which needed opening and closing in order to get the car thru and keep the more dangerous animals away from the campers, I was the one to run out of the car while Betty and Linda kept an eye out. The next day they took this picture of me in front of one of the gates. What can I say, I'm a bit more nimble, perhaps. Or scared. You choose. Meantime, we still haven't seen any cats. They sleep in the shade of the deep brush during the heat of the day (and boy is it hot!) so they're difficult to spot in the summertime. I did see a crocodile kill an impala, drag it into the water, and flip it round and round. I know it's the circle of life and all but it was incredibly upsetting and disturbing. Yet, undeniably fascinating too. Very Mutual of Omaha.

And check out this great picture I took of trees (that have been decimated by elephants) at sunset.

Today in the Female Medical Unit

It is brutally hot here today. I'm feeling kind of oppressed by it. I spent the morning in the Female medical ward and it was an emotional experience. The women are so frail, some frankly skeletal, laying naked on their cots (because of the heat - no air conditioning). When I would come up to a woman she would look at me with pleading eyes but there was no energy to speak. I tried to make some contact, and had some success with one woman in particular who's diaper I changed (I'm not actually supposed to do that but help was needed). I helped to reposition her in the bed and she communicated with me regarding her comfort. But they were all just too weak and decompensated to speak more than just a word. The women in the section where I spent the majority of my time were all there with respiratory illnesses ranging from PCP to other pneumonias to TB. A cough would make their bodies absolutely quake. The staff were trying to treat for pain but they don't have a lot of options. They would use sort of a cocktail of diclofenac and valium. When I first walked into the ward it looked almost like a scene from a movie. But, of course, it wasn't. It was heartbreaking.
Tomorrow I teach Prevention for 2 hours to the 3rd year students, 80 of them. This is a minefield. This is a VERY Christian environment. I'm talking prayers before and after each class. This is my Sex, Drugs and Rock and Roll talk. I spoke with the Principal and asked her outright how explicit I could get. She said to go for it. I hope she knows what she's getting into. I hope I do. I'm terrified.

I taught a class in Swaziland

Well, today was my first day actually teaching a class here in Swazi. I had to present on ARV's, the viral life cycle, adherence and disease process all in a 2 hour period. It actually went really well. I got wonderful feedback and was told that it was a great class. Obviously, I feel really good about this. Now, of course, I have to figure out how to do the same thing on Tuesday, except in only one hour. That prospect is a bit daunting. But right now, I'm filled with wine and satisfaction. Hooray!

Some animals and an update

These are just a few of the many gorgeous images of animals I was able to capture on Saturday. I especially love the Giraffe at dawn and the Rhino mom and baby crossing the road. I wish more than I can say that I had the equipment and the talent to photograph the land itself. Miles and miles of wilderness. Wilderness as far as the eye can see. These pictures just don't tell the story. I plan to go out again next weekend in Hlane in Swaziland. I caught everything but the cats last Saturday. Perhaps I'll get them next Saturday.

My work week started very well. I was able to do a lot of teaching in the ART clinic this morning. Now I'm loaded down with homework because I'll be running groups on ARV's (at least one 2 hour class a week), Prevention and, next week, HIV & Nutrition (thanks, Theresa!) Busy is good. Busy is very good. I'm feeling less demoralized today and that is a real relief. I'm still hoping to get out in the community more, though. We'll see.

From Sad to Sublime

It's been a few days so there is a lot to catch up on. Friday morning I did end up in labor and delivery. It was a humbling experience to say the least. These women are not aided in their labor at all. The cots are lined up side by side with no curtain or partition of any kind. They labor naked, and if told to switch position or walk, they are to do this on their own. I went over to one woman to assist her with standing up as she was clearly in quiet agony and needed to move from the cot to a gurney as she was headed for a c-section. I was told that she must do this without any assistance. I wanted to scream but, as with the Prime Directive (hello Star Trek fans) I am not allowed to interfere with their processes. Another woman came in, gave birth, cleaned herself up, rested for 4 hours, and was sent home with her baby. I watched the c-section, which was especially exciting as the electricity kept going out. Terrifying. I was handed her beautiful and healthy baby girl and brought her to a heater to await her mom's recovery, and that was lovely, but I saw her mother and many others that morning, treated so coldly, so unkindly, that I cried afterwords.

After that, thankfully, Betty, Linda and I headed to Mtubatuba in South Africa and I honestly have no words to describe what I encountered this weekend. I've been trying to upload some photographs but I'm having some trouble. We left, with our Safari guide, at 4:30 Saturday morning and, for the next 9 hours, I was engulfed in the most devastating, the most profound beauty, that I have ever experienced. Africa is unimaginably, almost painfully, beautiful. The contrasts that exist here are dizzying. For now, it is Sunday night and I'll be up at 6:00 tomorrow morning to go back to work. I'm exhausted. I will try to get pictures up tomorrow.

Rain and more rain

It has been raining pretty much non-stop for the past 2 days completely screwing up my internet access. As a matter of fact, if this entry stops abruptly, you'll know why. Yesterday was not one of my favorites so far. I spent the bulk of it creating a powerpoint presentation regarding the college's preceptor handbook. A preceptor is a nurse who acts as a mentor to student nurses as they come into her or his area for clinical rotation. It isn't that I don't enjoy working with preceptors, I just didn't enjoy so much spending the day at a desk. People who know me well won't believe this but, of the three of us, I'm considered the most tech savvy. Today my two colleagues and I ran a full-day workshop with preceptors and faculty on developing their preceptor program. This was a great experience. We really got to become better acquainted with the people with whom we will be working.

Tomorrow morning I'll be in labor and delivery which I'm very excited about. They had 14 babies born yesterday morning alone. Jaw dropping. I should be back in the ART clinic on Monday, Peds, possibly on Tuesday, and I'll be running in-services on antiretroviral therapy and HIV prevention on Wednesday. At least that's the plan. The likelihood of this plan actually occurring is quite small. Plans are very fluid here. Oh, and I am keeping my fingers crossed - today it was suggested that they would like me to try and go with nurses on some home visits! This would be wonderful! They haven't had a community health nurse from SOAR here before. The administrator says they have a real need for mentorship in this area so they'd like to utilize me for this. I really hope it happens.

Tomorrow afternoon Betty, Linda and I will get in a car for a road trip to Mtubatuba and St. Lucia in South Africa. Our plan is to go on Safari there and return back on Sunday. I'm hoping to get some great pictures. It will, of course, be nice if the rain lets up for that but whatever happens, happens. I won't have my computer there so I'll probably post again on Monday.

Visiting the Mafutseni clinic

Today we split up. I was supposed to go the ART (antiretroviral therapy) clinic, but they thought the nurse I was to mentor was already out in the field. They considered sending me to the surgical unit, such as it is. I tried, gently, to disabuse them of that notion, when the change no longer was necessary.

The nurse for the ART clinic hadn't yet left and so I was privileged to join him in going to the Mafutseni clinic. Many of the patients are unable to get to the hospital in Manzini, so the hospital gathers up a box of meds and charts (and a number of large bags of corn meal) and takes off to rural clinics to dispense meds. In Mafutseni, the clinic consists of the container part of a large truck, taken off the truck, and placed on the ground. Two windows are cut into it, a corrugated roof is constructed on top and, voila, a clinic. There were people of all ages and in various stages of health waiting for us when we arrived. Some had walked long distances to get there. One of the patients came up to me, I think she thought I was a doctor, and started describing how proud she was of being in such good health, having been diagnosed in 2004. She, rightly, attributed that to her adherence to her meds and wanted me to know that. Anyone who knows anything about the side effects of these meds, and they don't have all the newer ones we have in the States, knows what an achievement this is. They use a lot of Zerit. We don't use that much anymore in the U.S. due to such lovely side effects as severe peripheral neuropathy and lipoatrophy, among other things. It was remarkable to see the patience and all around positive attitudes of these people, many of whom are quite ill, and almost all of whom are desperately poor.
When we returned, I had a long talk with the nurse about the educational needs of the nurses coming in to work in the ART clinic. Fleshing out the curriculum in that department may be a focus of my four weeks here.
An amazing day.

Welcome to the Kingdom of Swaziland

That's Linda, Betty and I in front of the teensy tinesy airport in Swaziland. And the other photo is actually the view outside of my window. Not too shabby. Yesterday, our first day in country, was spent just settling in and meeting with, Tony, our point person here. It was a quiet day bathed in beautiful, balmy weather.

First day at work

Today we went to the small nursing college and hospital in Manzini where we'll be working. It was very eye opening. They are really working so hard to create a top notch school given the limitations inherent here. They need so much, just in the way of books, never mind technical equipment. But they are constructing an airy and really quite roomy space and the place was filled with students. Right next to the college is the hospital. Again, It is difficult to imagine people working as hard as these providers do with so little. Patients bring their own blankets and many of the beds where patients were lying had no linens on them at all. The infrastructure is decrepit. There are lines of people standing, sitting, lying on the ground waiting for an opportunity to be seen. We walked thru all of the wards and they even have a private section for people who are willing to pay, but these sections are just as broken down as the public sections. The only difference is perhaps, a bit more privacy. It looks like Linda (pictured with me above), Betty and I will be split up according to our areas of expertise. Linda will be mentoring nurses on the medical ward, Betty will be mentoring nurses in Labor and Delivery, and I will be mentoring nurses in the antiretroviral clinic. We should be placed tomorrow. I'm excited and nervous and really ready to get started.

Saturday night update - 8:15pm

I ended up with a seatmate from Dakar to Joburg, which is actually the longer leg of the trip. He was a very nice man from Zambia and he volunteered to help steer me thru the airport when we landed, which he did. Now I’m at the airport hotel, having a glass of wine, sitting at an outdoor table by the pool on a balmy Saturday night at 8pm… Hey – I have to do my writing out here. They don’t have internet access in the rooms. But this does feel surreal. The knowledge is always there of the real reason I’m here and what my life here will be like.
I will try to get some pictures posted tomorrow night when we’re settled in Swazi. Meantime, lack of sleep and the wine is messing with my syntax.

Heading In Country

I’m writing this on the plane so the posting date is going to be a bit off.

It’s been a very full day so far and I’ve only just gotten on the plane. Last night I met the two other nurses with whom I’ll be working (They’re wonderful) and this morning we had our pre-deployment meeting.

Apparently there are 3 different categories of work we’ll be doing; Knowledge Building & Clinical Mentoring, Leadership, and, finally, Communities of Self-Care. Most of our work will fall under the first category but we will likely be delving into these other categories as well. With regard to "Communities of Self-Care, we were told an absolutely horrible statistic; 10% to 15% of nursing students in Swaziland do not live to complete their training. This is horrendous. They die before they finish nursing school! Remembering that close to 40% of the adult population is HIV+, this illustrates how every aspect of the population is affected, as well as infected. Here we'll be teaching about signs and symptoms of various opportunistic infections, and the nurses sitting in front of us will be experiencing those very same signs and symptoms. This is almost unbearable to contemplate.
And so, in a painfully tone deaf seque, and on a much lighter note…I lucked out! Nobody is sitting next to me! 17 hours in the air and I’ll have 2 seats all to myself!
As they say, I’m not worthy.
Johannesburg (or Joburg, as the people in the know call it), is supposed to be like “Escape from New York” so, since I’m traveling on my own (the 2 other nurses will meet me Saturday night in Joburg) I’m supposed to walk thru the airport as if I own the place. Thank God for New York bravado.