Happy Easter!

So finally updating after over a week. I have been really struggling in Swaziland. I have been all over the world, worked in many different cultures, and somehow connected with most, but I feel like I am struggling with Swaziland. I have made some incredible friends, dont get me wrong, but I feel that I am lacking a connection to the people as a whole and to the culture. Stef, Lauren and I were trying to pinpoint what it is and it may be the blatant degrading of women, or the violence we see working in the emergency room, but the cultural just seems more difficult to understand than other travels. I hope that I can work through these feelings over my last 2 weeks and really see the beauty of Swaziland that I know is there.

Throughout the last week, I have been working in the emergency room on evenings. I am getting experience working with very sick patients and with procedures. All 3 of us are feeling very homesick and took the afternoon off on Thursday to head down to the mall for ice cream. Nothing a little fat and sugar cant help with!

I had a hard week when it comes to difficult patients. I had multiple women come in from domestic violence. One woman was about 20 weeks pregnant and she said her boyfriend tried to kill her, he strangled her and repeatedly kicked her stomach. She was then having abdominal pains. I told her I would find her a place to stay and give her food for the night so that she could have an ultrasound in the morning (they dont do ultrasounds at night) and she said no. She begged me to call her boyfriend to ask him to come get her. She said that he promised her he wouldnt hurt her again. I told her that she was beautiful and deserved to be loved by someone. I told her that she needed to know she was worth being loved and didnt have to live a life with a man like that. I told her that he was going to hit her again guaranteed. She still begged me to call. I couldnt get a hold of him so she just left. I just hate being in a situation where I cant help someone. She has no resources, there are no non profits that help abused woman, there is no one that will take care of her baby. She has no options and I could do nothing for her.

We also had a man come in with anaphylatic shock from some allergic reaction. We immediately started to rescusitate him. After about 40 minutes of CPR, epinephrine, and multiple failed attempts at intubation, he was pronounced dead. The ER is one open room with about 10 beds all around with curtains in between, but clearly all of the patients were able to see the patient die. At least 3 patients were within 5 feet of us while we attempted rescusitation. It seems like everyone is so accustomed to death and loss that it is no big deal.

Warning- bloody details! Dont read if queasy!

Last, I saw a women be carried into the far cubicle on the end. She was yelling and rolling around on the bed. She was having a miscarriage at 2 months and I walked in to see her covered in blood. I will spare the details, but I ended up having to help her finish the miscarriage. I have never done that before, never seen that before, but it was really difficult. I dont think I will ever forget that.

In Kenya, the atmosphere of Jesus loving people was incredible. It brought love to any situation and comfort during the difficult cases. Swaziland doesnt necessarily have that other than Stefanie and Lauren around me. There isnt comfort and prayer during difficult cases. Death is so normal and so inevitable to these people that nothing seems to faze them. I would love to see God's love spread to this country and lift their spirits.



Stefanie and I in the ER during a fairly calm moment.

On some happy notes, we were able to visit a vacation area in Swaziland to shop and look around on Friday. It was awesome! The area was beautiful. We went shopping at a woven basket store (which we bought an incredible amount from) and had the most amazing lunch, literally the best food we have had in Swaziland by far.

On Saturday, we drove to Hlane Game Park near Mozambique for a safari. Four of our friends that we met in Swaziland went with us. Zakhele works in statistics at the hospital, Sandile is in charge of infection control at the hospital, Ceby is friends with Sandile, and she brought a friend from South Africa, Lindelo. While the Americans went on a safari, the Africans cooked up some amazing food on the grill. We came back and had an awesome picnic with delicious food.



Group photo before the picnic!

 

The 3 of us before the safari!



 Zahkele and Sandile sporting their Kentucky shirts that were a gift from Emily!

The internet is being ridiculously slow right now so I cant add anymore pictures, but we spent our Easter back at Malandelas, the touristy area. We originally walked to a large Easter Church service that was in all Siswati so we decided to leave since there was no English. We decided to go back to Malandelas and lie on a sheet while Stefanie played her ukulele and we sang worship songs, read some passages from the Bible and prayed, just the 3 of us having a church service on our own. It was exactly what we needed. We have been able to get around Swaziland on our own now. We are efficient at taking Kombis which are basically vans that drive around and pick people up on the side of the road and take them along a predetermined route. They stuff as many people as possible into them, usually around 20. People are sitting on laps, and several stand in the aisle way. We learn to get really close to each other. We are really starting to feel self sufficient in Swaziland.

First Week in Swaziland

So I have been incredibly unmotivated since I have arrived to update my blog, but I am attempting to finally do it! I have finished my first week and Swaziland and it has definitely been interesting. I have met some incredible friends, seen incredible medical cases, and seen some incredibly large cockroaches.

Lauren has been working in Pediatrics and loves it. She was seeing patients on her own by the 2nd day. It's great to come home at night and hear her stories. Stefanie and I have been splitting day and night shift at the ER. The mornings are slowing but pick up in the afternoons, by night time it is pure chaos. RFM Hospital is the only hospital in Manzini. Throughout my blog, I will be stealing tidbits of info from Stefanie's blog because I am lazy and she is an awesome writer. If you want to read hers also, feel free! srbrock-africa.blogspot.com

Here is a little excerpt from Stefanie's blog

Monday we were given a full tour of the Raleigh Fitkin Memorial Hospital! It is a Nazarene hospital with a history of missionaries, but was taken over by the government and has only remnants of a mission hospital. It is actually quite large and handles ¼ of the country’s childbirths! The country as a whole is on the radar for HIV/AIDS- over 65% of the patient population at the hospital has RVD (RetroViral Disease, or HIV); over 25% of the general population is infected, and over 50% of all 20-30 year olds in the country is seroreactive. There are tons of social campaigns, signs and education opportunities promoting protection from the disease, but it seems as if it is deeply ingrained in their culture (and the king is not doing much to set an example of monogamy!). The average life expectancy is 48. It seems to be a contradiction, when the literacy rate is 92%, and most of the 1 million Swazis live in urban areas and have wonderful access to healthcare!

Here is the entrance to the hospital and our home! We sleep on the second floor in a room that is connected to another room by a small kitchen. Our roommates on the other side are 2 girls from Finland that are nursing students. This hospital is actually huge going back behind this building.

Here is one of the sidewalk advertisements to help with the incredibly high HIV rate in this country. Someone out there is trying public health strategies, but it is difficult to encourage monogamy in a society where the king of Swaziland has well over 10 wives. 

The ER has been a good experience so far. I have been able to suture daily and even practice some new procedures. The types of patients we see vary incredibly. The main ones include meningtist, tuberculosis in all varieties including TB of the spine, AIDS, PCP, stabbings, assault injuries, pedestrians being hit by cars, and asthma attacks. I have has to pronouce 2 people dead, a father and a daughter who were hit by a car on the sidewalk. The police bring dead bodies to the ER so that a doctor can pronounce them dead. The HIV population is astronomical and most of the patients in the ER are positive. I have truly seen the sickest people of my life here, barely hanging on my a thread. The extent of damage at AIDS inflicts to people who are 16, 19 years old is heartbreaking. 

I have been able to practice lumbar punctures, which almost every patient with a fever gets. I feel like the doctors trust me and are willing to let me try anything as long as I watch one first. Caution to anyone who gets queasy from medical stuff like MY SISTER. I am going to put a picture of a case and I dont want to hear any complaints that I didnt warn you!

A patient came in complaining of shortness of breath. The patient has HIV positive and was on treatment for pulmonary TB. 3 months ago he had a small left pleural effusion (fluid gathering in the left lung) when he was diagnosed with TB and was put on medication. The medication caused a drug induced hepatitis and he was changed to a different medication that was only supposed to be for a short period of time and then to be switched back to the original medication. Well that never happened and the TB became worse.

Monday we were given a full tour of the Raleigh Fitkin Memorial Hospital! It is a Nazarene hospital with a history of missionaries, but was taken over by the government and has only remnants of a mission hospital. It is actually quite large and handles ¼ of the country’s childbirths! The country as a whole is on the radar for HIV/AIDS- over 65% of the patient population at the hospital has RVD (RetroViral Disease, or HIV); over 25% of the general population is infected, and over 50% of all 20-30 year olds in the country is seroreactive. There are tons of social campaigns, signs and education opportunities promoting protection from the disease, but it seems as if it is deeply ingrained in their culture (and the king is not doing much to set an example of monogamy!). The average life expectancy is 48. It seems to be a contradiction, when the literacy rate is 92%, and most of the 1 million Swazis live in urban areas and have wonderful access to healthcare!

The x ray on the left is from 3 months ago when the patient was first diagnosed with TB with a small left pleural effusion. The x ray on the right was from last week in the ER. The entire left lung is full of fluid and is pushing is heart to the right side of his chest, the trachea is fully deviated to the right side.

So, we tapped him! This was my first pleural paracentesis (where you insert a needle between the ribs in the lung cavity and drain the pleural effusion). Thick, purulent green fluid was expelled. We decided that the fluid was too thick for that small of tubing so a chest tube was needed.

The ER doctor placed a chest tube and around 3 liters of thick green fluid was drained from this man's chest. I definitely believe his complaint of shortness of breath after seeing what came out!

This is Sanna, one of our Finnish roommates. We visited a pool the first weekend and relaxed in the amazing Swazi weather!

We were feeling homesick so we decided to order pizza. It was delicious but very difficult. Laurent tried to call and order, but the woman could not understand her accent after several attempts. I finally walked down the hall in the hospital and found the IT man still there. I asked him to call and order for us. Much easier that way!

Zahkele and Stef in the background while we right in a Kombi around town. It is basically a big van that people jump in and out of as a taxi to get around. We have had 22 people in one at one time before. No such thing as personal space in Africa!

We visited a cultural village where we were able to take a tour of how traditional Swazi's live. There were monkeys everywhere! The grandmother of the village said she had to swat at them to keep them from stealing things inside the hut.

This is my favorite man in Swaziland! He is the medicine man of the village or traditional healer. He had his own hut in the middle of the village with a ton of plants around the opening that he uses to treat people. He was showing us some roots. He was absolutely hysterical. I kept telling him to smile for the pictures and he said, "I cant! I have no teeth". We told him we practiced medicine so he wanted to show us everything. He kept giving us roots of his plants so we could grow our own herbal garden.

He loovved pictures! Lauren even got his phone number!! ( I cant believe he even had a phone)

The village put on a dance. It was awesome! They kick their legs really high. Of course we were pulled to the center to dance with them. We really looked like bad white girl dancers out there!

The little boy in the front was my favorite! He was crazy on the dancefloor!

Eating fresh guavas for the first time! Ceby (a friend of Zahkele) invited us to her families home. They were so hospitable and welcoming. They made us a delicious dinner all from things around their family home including chicken, guavas, bananas, spinich, maize, corn, and pap!