October Impressions

Hey everyone, we now have internet!! Here’s a copy of a newsletter I sent out at the end of October – apologies if you didn’t receive it, using the internet has been difficult until now. This version is edited to remove politically sensitive material. Thank you so much to all who have been in touch. We so appreciate your support and prayers.

Disclaimer – large amount of scene-setting… make a brew before you sit down to read…

October 2017

My calendar tells me that we’ve been living in Swaziland for nearly 6 weeks now. The fact that I have to check a calendar tells me how time has flown. We’ve settled in quickly, and want to thank you for your thoughts and prayers during this time. It’s very difficult to sumarise all that has passed since we have arrived, so you’ll forgive me if I just give you a few the highlights and lowlights. Let me begin with this:

“In approaching any new culture our first task is always to remove our shoes, recognizing that we are standing on holy ground. We are not bringing the Lord somewhere new, because he is already here. Our primary task, therefore, is to identify God’s fingerprints and to trace his footprints in the new environment. Of course, inevitably, we will also spot ugliness. All cultures are fallen, and with our foreigner’s eyes these failings may well be particularly apparent and offensive to us. But whenever we do speak out against the evil behaviours embedded in a host culture, we are expected to do so with ‘gentleness and respect’ befitting a visitor, remember that ‘love covers a multitude of sins’. We have no right to renounce all the wrong in another person, place or culture, until we have recognised all that is right, good and beautiful.”
– Pete Grieg, ‘Dirty Glory’

We arrived in early September in the middle of a heat wave, with temperatures up to 37degrees – pretty hot for the end of winter. The land was brown, dry and awaiting much-needed rain. Now in mid-October, we’re seeing things start to green a little – buds are appearing in what seemed like unlikely places. Rain is badly needed here. The summer rains over the last three years have been inadequate. The town struggles for water, resorting to pumping it in from elsewhere. The sugar industry manages to get its hands on plenty, evidenced by the luminous green sugarcane fields surrounded by an otherwise parched landscape. Fires are pretty common in these conditions – either started deliberately or resulting from candle accidents in the many houses that don’t have electricity. We recently heard of a woman who went out leaving her four children at home in candlelight. None of them survived. We initially stayed at Mabuda Farm –  unbelievably beautiful, built up on a ridge, with avenues of Jacaranda trees coming into purple blossom a few weeks ago, rocks to watch sunsets from, a beautiful lily pond perfect for afternoon braais and picnics and mile upon mile of tracks to walk/run amid fields of maize, macadamia and orange orchards. I can hardly believe how blessed we are to have such a place as a playground. It is very, very good for the soul.

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Noah relaxes on the jetty before enjoing a braai

There is a wonderful ‘immigrant’ community around the farm , who have been very welcoming to us. Most are missionaries working in various charities and enterprises doing some amazing work from healthcare to sustainable farming to child welfare and efforts to prevent trafficking. We attend a weekly bible study, there are regular braais and prayer groups. We really hope that we can in some way be a blessing to this community as we seek to look outwards together to bless this nation and its people.
Inevitably it took a bit of time to sort out the house that we had been provided with at the hospital, but after a good clean and purchase of the basics we moved to the house at the top of ‘snake hill’. So called because… well, you can guess. But we have not seen any snakes and are full of faith that we won’t! It’s a humble abode, but we like it. Apparently the hospital don’t think it’s up to much and were going to bulldoze it… We lived without hot water for a few weeks. And without drinking water for a few more. But it turns out you can get used to most things without too much bother and we quite enjoyed the challenge! It is surrounded by standard african red dirt, which provides the perfect medium for the kids to ‘play’ with ants, dig their own gardens and other such grub inducing hijinx. The tin roof provides an atmospheric soundtrack when we do have rain showers. It sounds torrential on the roof, but unfortunately there is rarely much to show
for it when we step outside. Thunderstorms have also been entertaining – fortunately we
have children who are not afraid of them. With swaziland having the highest number of
lightening strikes per square km in the world, we’re looking forward to more. We have
neighbours here at the hospital – several doctors and nurses also live in the hospital
grounds. We have found so far that people tend to keep to themselves, but we are very keen to foster community and get to know those around us. Most doctors living here are from Uganda or The Democratic Republic of Congo, most of them have left family behind to work here.

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Standard Elsie after-school scene… In this one she’s attempting to carve stones into animal shapes like the famous Malolotja stone-carvers in the North West of Swaziland.

The plan as most of you know was to homeschool the kids. We did this for a few weeks.
School largely consisted of letting them choose what they wanted to do, which was a lot of fun. Noah enjoyed working through a science textbook, got quite excited about growing plants and visiting an aquaponics farm… but was less excited about Maths and English exercises. However, he has endless ability to create tasks for himself and so keeping him occupied and learning was no challenge. Endless games of chess have been played, he’s keeping a record of all the siswati words he’s learning, started a blog, learnt to make pancakes and spaghetti bolognaise, created a timeline of the whole of history on his bedroom wall, created a mural of animals round a waterhole, invented a trap for pests out the front of the house… Elsie was less than enamoured with learning letters, so mainly started an art gallery of drawings, set up the sylvanians in a traditional swazi village complex, got extremely dirty playing outside, fed micah vegetables and listened to a lot of story tapes. Clearly it was not all idyllic quality time, there were plenty of fights, struggles and juggles… but we had fun. And I don’t ever remember hearing the phrase ‘I’m bored’.

However, led by Elsie, there came persistent requests for school. As soon as we arrived in Siteki, she started asking to go to school… watching the tiny kids with their backpacks walking back and forth from school gave her ideas. We planned to look into it for her. To our suprise, Noah also asked to go to school. I think he missed other kids. We looked at a
couple of schools that teach in English, and found one that had a great atmosphere and
seemed like a nurturing place for them to be. Prayers were answered and we were given an absolutely ridiculous discount on the fees, which has made it possible for them to attend.

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Nick hit the ground running with work almost as soon as we arrived. He has inherited a project from his predecesor focused on delivering a package of psychosocial support for people on the HIV and TB programes who are struggling with mood problems. Compliance rates with treatment are much lower than they should be (particularly challenging for the drug-resistant TB cases) and the idea is that greater support for these people will help. Though implementing this vision in a country with only one psychiatrist and limited mental health nurses (or awareness) and plenty of circumstantial reasons for people to have mood problems is challenging. Otherwise the main focus of the post involves overseeing the ongoing decentralisation of clinical services from the hospital to a network of 40 community clinics across the Lubombo region. Many of these are hours away from the hospital and transport is a major barrier to people accessing appropriate care – previously people had to travel to hospital for any chronic conditions. Clinic nurses have been trained to deliver HIV and TB care. We are now training them to take over care of diabetes and hypertension (high blood pressure) -both of which are growing problems in the country. Nick is planning to design a package of training and other resources to also decentralise asthma care – currently most people cannot access regular inhalers and serious asthma attacks are far too common. Children and adults with asthma die in the community for lack of access to inhalers, nebulisers and a way to get to hospital to reach these life-saving drugs. More work needs doing to improve contact tracing of TB patients (finding close contacts who are also at risk of TB) plus looking at rolling out a preventative drug to reduce the risk of people with HIV developing TB. The challenge is that the needs are so great, and the resources so few. But people are resourceful and he has the benefit of being able to build on a legacy of 15 years worth of public health work at the hospital.

It has been interesting to get to grips with how the hospital runs, and there are certainly
challenges. We are trying to learn how things work. The hospital was original a Catholic
mission hospital. The church still owns the buildings and lands, but provides no funding for the running of the hospital. The hospital receives funding from the government, but is not strictly speaking a government hospital. It is the biggest and best-equipped hospital in this region of Swaziland, but unlike the government clinics, it charges user fees. Whether or not user fees are prohibitive to those seeking care is a matter for debate. Most doctors feel they are necessary to the running of the hospital, providing about 10% of its income. The initial clinic fee is around 20 rand (about two pounds) and further charges depend on what treatment is required. One family recently told me that it cost a total of 1,800 rand (about 100 pounds) for a caesarean birth. This cost is unaffordable for most people living in Lubombo, the poorest region in Swaziland. There is one other hospital in Siteki (run by the government),but it is really a large clinic which provides only daytime services at the moment and transfers cases that require more intervention to The Good Shepherd.

As we’ve mentioned before, HIV and TB rates here are the highest on earth. 1 in 3 adults
have HIV. 1 in 2 pregnant women. Infection rates are fairly stable, despite prevention programmes being fairly well funded and deployed in schools and communities across the countries. Asking around about this, we have been given several explanations. One
outreach nurse explained that Swazi society is promiscuous, nothing seems to be able to
change that. It’s normal for guys to have upwards of 20 partners, there’s no shame or taboo in that – in fact, quite the opposite. I asked about programmes to educate and empower women. He didn’t feel these were working. Polygamy is common and acceptable, even within most churches. It seems most people take their lead from traditional societal patterns despite all the money going into safe sex and relationship campaigns.

Like prevention, most HIV and TB treatment initiatives seem well-funded, both from within Swaziland and by international donors. We wonder if this will be affected by Swaziland’s recent ‘upgrade’ to become a middle income country. We can’t believe this is the case as we look around at life in Lubombo. It’s true that there is a massive income gap between the richest and the poorest in Swaziland, but the poor are undoubtedly the massive majority. We go to Manzini and Mbabane, and it seems like a different country.

I am gradually becoming involved in work at the hospital too. Last week I spent some time in the maternity unit. Things are certainly different there. I am aware that i am new to the way of working here, and I need to observe further and build trust before drawing conclusions. However, I have noticed that hypertensive diseases (Pre eclampsia and gestaional hypertension) in pregnancy are rife and poorly controlled. Anecdotally, I feel that more than 50% of the women I have come into contact with have an HIV diagnosis. However, the hospital is unable to obtain an estimation of their viral load to help plan their care. I did my first Caesarean section without diathermy and with catgut sutures (!). The staff apologised when I seemed surprised at being handed catgut… they explained that they are reliant on donations of sutures and this was all they had. Anecdotally, maternal mortality in the region is horrendous, so I am starting to try and gather what data there is on this and identify gaps in our knowledge of why this is the case in order that interventions might be planned.  The challenge as always, is building relationships sensitively… and also juggling school runs, school holidays and a non-sleeping baby.

I have also begun to visit a local carepoint for vulnerable children and orphans, and found some local women producing the most gorgeous embroidery designs that I am attempting to export for sale in the UK in order that they may gain a small income. More on that in an upcoming blog post.

‘Church’ is an interesting one… As many of you who have spent time in Africa will know, churches are ten-a-penny here… false teaching abounds from ancestor worship, to  prosperity gospel… it’s difficult to know how to choose one to attend on a Sunday morning. We are finding that a lot of the locals are turned off by the double standards
they see in their churches… We pray that God would guide us as to where to be on these mornings and as we ponder what ‘church’ really is. If Sunday morning church is what God calls us to then in an ideal world, we’d find a Swazi church that preaches truth, where we can partner with local people in reaching those around them, where our kids play and learn with Swazi kids. Meanwhile, Jenny has started spending some time doing DBS bible study with some Swazi friends so prayers for that appreciated.

—-

So that was October’s update!

Hopefully next week I’ll post November’s and I’m aware Noah is currently working on his next draft too.

Lots of love and many thanks.

 

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