Sunday, October 17, 2010
You might have noticed that these posts are written without benefit of a dictionary or a thesaurus, (or sometimes, sleep). We purposely left those things at home, considering our weight restrictions, thinking that we would have any information we wanted at the stroke of a key. Our first mistake. I tried getting pictures out to you again, but after 20 minutes of “your pictures are being transferred” and the power going down twice, I gave up. I think a good part of the problem is trying to push the pictures into the 21st century from here in the 1940s.
We still marvel at reading your e-mails as a text message on our ‘phones a minute after you send them from 20,000 km away. Meanwhile, we are issued hand-written receipts by the post office and electric company.
My school has a computer lab, but the computers are vintage 1980 (donations) and there is no connection to the internet.
I’ve written about our life style in the Posh Corps and this weekend we’ll be hosting a couple from the Hard Corps who have neither electricity nor running water. We are considered peri-urban but as you get more rural, it’s not at all unusual to lack those utilities.
But the Swazis have good humor, smile easily and have a ready laugh. (There is no siSwati word for ‘friendly’; they’ll use ‘kindly’.) Meanwhile, 69% are classified as ‘poor’ and about 30% are unemployed. Signs of poverty are all over.
Swazis like to dress well and somehow have shiny shoes (in this dust). But there is trash and plastic litter everywhere. (Lady Bird Johnson apparently didn’t make it here.)
We were told to not hang our sox or underwear out to dry in public in this conservative culture. We soon learned that nudity is from the waist down. I attended a small, local pageant of school kids. A class of high school girls was costumed in native reed dance costume (which is to say a few beads and feathers above the waist and a very short ‘skirt’ which only covers the front) and performed with a total lack of self-consciousness before an audience including classmates. Can you imagine if…ah, I digress: We live in a contrasting culture.
William Kamkwamba wrote in “The Boy…The Wind”, in 2009, “Only 2% of Malalwians have electricity….Once the sun goes down, and if there’s no moon, everyone stops what they’re doing, brushes their teeth, and goes to sleep. Not at 10:00 p.m., or even nine o’clock—but seven in the evening! Who goes to bed at seven in the evening? Well, I can tell you, most of Africa.” By contrast, we are so posh, we have revived a stateside routine of watching a movie on a weekend night and stay up way past seven. A fellow PCV has many movies on disc which we borrow and watch on our laptop 12” screen. Contrasts, indeed.
Sunday, October 10, 2010
Some of you know, by now, that I (yes, Debbie is actually writing a blog) am working at Good Shepherd Hospital three days a week. Currently I am visiting each department in the hospital so that I can get an understanding of their operations. The goal is for me to work with Quality Assurance to help them improve their policies and general quality of care. It has been an eye opener for sure and the challenge will be to build relationships and be able to help them within the context of a different culture and a severe lack of infrastructure and supplies. It will probably be the biggest challenge of my “working life” and will take me the two years I am here to, hopefully, make a small contribution. GSH was evaluated about 3 years ago by an accreditation body from South Africa and failed in many areas including nursing and administrative policies. Currently, GSH ranks second best hospital in the nation. Swaziland is setting up their own accreditation body and the Senior Matron (Director of Nursing) wants to get this work started now. I have the previous volunteer that worked at GSH to thank for paving the way for me and providing me this opportunity.
GSH is a 250 bed regional hospital that serves about 300,000 people and an area roughly a quarter of the country. It is about a 25 minute walk from our home and is truly an uphill walk both ways as I walk down into the valley before coming back up the other side. GSH has a huge outpatient department which serves as access to physicians. Physicians do not have their own offices except those that cater to the rich (mostly whites serving with development organizations). They have 8 docs and 2 small operating rooms. They have an active ED, mostly for trauma. The illnesses they see are mostly chronic opportunistic diseases from AIDS. TB is HUGE here. The inpatient area is really one long corridor and you can tell that you have gone from one nursing unit to the other by the color of the tile floor (e.g., Maternity has pink floor tile, and the next unit, male medical-surgical, is blue). The male TB ward is on the other side of the open doors to maternity. The wards are on one side of the long corridor with the bathrooms, utilities rooms etc. on the other side. The latest structure was built in 1980 for peds and the eye clinic but the main hospital is 1960 vintage with 1940 equipment throughout. . Rooms are 4-8 pts. with communal bathrooms and no sinks in the rooms. No air-conditioning of course so windows are wide open. Losing electricity is not unusual and sometimes they run out of water. They are trying very hard not to have patients on the floor for infection control reasons. They are proud of this achievement and only rarely have floor pts in maternity.
My first experience was in maternity. All deliveries except c-sections are natural with no medication. Privacy doesn’t exist and I never saw a dad in the maternity ward. All moms go home the day after delivery. All moms have pink cards that they bring with them that contain all their medical history. They do have a preemie room and moms stay in the hospital to breast feed the preemies. Breast feeding is strongly encouraged here particularly with HIV positive babies. I saw four babies born and all were to HIV positive moms. All the nurses are midwives and do the vast majority of the deliveries. Of note, a nurse must be a midwife to advance to being in charge of any unit in the hospital.
I just spent two days on the female ward. It has been a long time since I gave a bed bath or made hospital beds and I learned a lot by just doing things. I constantly had to remind staff that I was not licensed in Swaziland so couldn’t put in IV lines, give meds etc. They are quite understaffed and the student nurses give a great deal of the care. GSH has a “LPN” program. The biggest problem I can see is infection control with TB and HIV being the problem in this country. The TB wards doors are open as there is no ventilation if they are closed. There are not enough masks so nurses write their names on them and use them for who knows how long. There are not enough gowns to use in isolation so pt. gowns are used which leaves no pt. gowns for the patients. Most of the time nurses are double gloved. For the whole ward, that holds a general census of 40 pts., there are three places to wash your hands; the dirty and clean utility rooms and the nurses’ station. So how do you creatively write Infection control policies taking into account the current realities? I expect I will be learning more from these nurses who must be creative to function in this environment then I will ever teach them.
I worked with two nurses from Zimbabwe that told me they liked working at GSH as the hospital pays more and is much better equipped than in their country. Speaking English will not be a problem for me as most of the physicians and some of the nurses are foreign. All professional staff speak English and all records are written in English. I have been very pleasantly surprised at how easily I am accepted here. I think they have been conditioned to think that people coming from developing countries are smarter than they and have all the answers. In reality, they have the answers and perhaps with some guidance can be confident enough to find them within the context of an infrastructure that is not going to change any time soon.
Friday, October 8, 2010
I’m not sure when word went out or what was said, but I find myself with a good supply of coffee. It wasn’t that long ago that the British pulled out of here, leaving behind their language, a kingdom of tea drinkers, and a few blue-eyed children. The problem with the coffee that we can get locally is that it is all contaminated with chicory and tastes dreadful. The Southerners did that during the Civil War to make the precious coffee go further, but I don’t know what the reasoning is here. When we last went through Manzini, we were able to find unadulterated coffee, so I have some backup in reserve. We also got a French press, so now I have the option of ground or instant coffee and, either way, I use the French press as a convenient measure/carafe. It is one step up from ‘cowboy coffee’. (Don’t forget we need to purify our water here, so some extra steps are required.) Thanks to my contributors (you know who you are). The care packages are much appreciated.
We’ll be making a trip to Manzini tomorrow (Oct 9) for a little shopping and a good meal—back the same day. We have a meeting in Mbabane later in the month and intend to use our ‘overnight’ then. I’m heading for the internet café now, and if all the planets are aligned just right, I’ll try to get some photos posted—again.
Some of you have heard these before, some of you more than once, but indulge me.
Story number one: A new PCV finds something floating in his drink so he rejects it and calls for a new one. Some time later that PCV, finding something in his drink, will simply pick out the flotsam and enjoy the drink. Much later, a veteran PCV will see the contaminant, down the drink anyway, and give thanks for the added protein. I only mention this because I picked something from my mouth after breakfast today, identified the probable source, and continued with my schedule. Guess I’m there.
Story number two: Some people see the glass as half full; some people see the glass as half empty. A PCV sees half the glass and says, “Wow, I could take a bath with that”. Although we’ve had our share of bucket baths (in training), we’ve been fortunate to have indoor plumbing since moving to permanent site. But you might have forgotten the hot water heater (the ‘geyser’) was not functioning. My counterpart was instrumental in moving the bureaucracy and we finally have hot water! (A three-man crew came to install a new element. One of them was a hunchback barely four feet tall. He introduced himself as ‘King Size’.) We feel we are definitely part of the Posh Corps now. Most of our acquaintances don’t have running water—merely Peace Corps; and some have neither running water nor electricity—which makes them Hard Corps. We’ve been honored to have overnight guests from the younger crowd in the Peace Corps on a couple of occasions—even before the enticement of a hot shower.
Story number three: We saw signs of rain today—a gentle, Seattle type of rain, but enough to make the ground wet, and we’ve had a couple of warmer days which seems to indicate that summer is coming. The equinox was a couple of weeks ago when our night was the same length as yours, but our days will now begin growing longer than yours. Here in SD that means the approach of Mamba season, and that is one of the reasons we aren’t supposed to be out at night. (You don’t want to come upon a mamba that you can’t see.) So if you’re not part of the elite Posh Corps and you have overnight guests of mixed gender, you will experience a strong bonding among PCVs who will be sharing a common pee-bucket. Posh Corps—Peace Corps—Hard Corps. We’re thankful for what we have.
Sunday, October 3, 2010
We said we wouldn’t use this forum for complaints, so consider the following simply vignettes of daily life in Swaziland.
Banking: The bank Peace Corps uses does not have an office in Siteki, so to get money, we walk to the other side of town where an ATM is located in the gas station. Emalangeni are tied, at par, with the RSA rand, and when we want cash, out pops rand. Turns out to be okay because rand are readily acceptable here, but when we go into South Africa (or Mozambique), the lilangeni is not accepted. The rate of exchange seems pretty constant but it has recently fallen to 7.0 rand to the dollar. When shopping, I usually do a quick conversion into dollars and prices seem to be pretty reasonable; that is, until you factor in quality.
Shopping: Back in eMboshini, we had our OneStop grocer, an occasional ‘general dealer’ along the tar road, and several ‘markets’ (produce sold from a plank under an umbrella). Now that we are near a town, the Make (‘maw-gay’) markets are consolidated in a building behind the bus ranks, with overflow along curbside, and ShopRite is THE grocery store. Walking into ShopRite is like walking into a Safeway in the early 1940s. (If you can’t picture that, ask your mother.) There is no brand selection even when you find what you’re looking for. We can’t find mustard or pickles or olives here so we’ll try to find them when we go into the big cities of Mbabane or Manzini. The stock is dusty and we’ve learned to look for rusty and dented cans. There is a very limited selection of spices and those available are impotent. Eggs are a popular item, packaged in various numbers, but with only a bottom ‘egg-crate’. The top is shrink wrapped. They are not refrigerated. We’ve just found butter so we won’t be buying margarine anymore because it resembled some kind of heavy petroleum product. Another popular item is a bag of chicken from the butchery which is labeled ‘7 heads, 14 feet’. We’ve passed. The cuts of meat are not recognizable to us; the chicken seems to be quartered; the ground beef is white with fat. We do indulge ourselves with a good ol’ American comfort food: Various flavored potato chips (from Lays of South Africa), but they only come in 125 gram bags. Checking out means queuing in a line leaving no space between bodies. Leaving ShopRite, Build-It is where we get our hardware. Paints and large materials are on the shelves for the public, but to find tools, brushes, hooks, etc, etc, you need to ask for assistance from someone behind the counter. Finally, we have the Indali stores. This is where you find everything that you weren’t able to find elsewhere—especially if it’s made of plastic. And this is where we need to talk about quality. You won’t find it here.
After all that shopping, there is yet another consideration. All our purchases need to find a way home and that means loaded into our shopping bags and carried back. (I’m still doing weight & balance.) The day we did groceries and bought paint, we got a taxi which only came to E20, so we expect we might do that once a month or so (our ‘Costco’ run.) Meanwhile, we only buy what we can carry which, in turn, means more walks into town, which means more time spent in just the activities of daily living.
Bureaucracy: I mentioned earlier the need of passport photos to get our electricity, to get our library cards (still waiting), and the need to identify yourself for any transaction. When you complete a transaction, the clerk will reach for a dusty ledger and begin entering various entries—using carbon paper; not even NCR paper. (Kids, if you don’t understand these terms, go ask your mother.) Last of all, you know the deal is done when the official stamp is used a couple of times with a decided thump.
Superstition: William Kamkambwa writes only two or three years ago in “The Boy Who Harnessed the Wind” that he feared for his life because he was accused of witchcraft when there was a drought after he built his windmill. Witchcraft remains one of two reasons for divorce in Sd. Eighty percent of Swazis admit to consulting a traditional medicine man (who consults with ancient ancestors). I’ll have more contradictions next time.