St. Theresa's

This will be a short blog post as I am quite tired tonight. I just got back from a dinner party hosted by the visiting medical students. There are five students here, working at Good Shepherd Hospital for six weeks. Three from the UK, one from New Zealand, and one from France. I guess it is quite common for there to be medical students living here at Mabuda Farm. They are a really lovely group, and it was so much fun to have a dinner party (and a home-cooked meal!)

They hosted the party at Jono (Dr. Pons) and Helen's house. Two of the students have been house-sitting for them while the Pons' were in the U.S. Which means there house was available to them for hosting dinner. I think it was also a thank you/goodbye to Dr. Fetherston and his wife Viv.

From front, heading clockwise around table: Dr. Tim Fetherston (retina specialist from the UK), Ashley (UK), my empty seat, Ciaran (NZ), Viv Fetherston (UK), Charlotte (UK), Emily (UK), Angela (South Africa), Camille (France). We are sitting in the Pons' lovely dining room :)

Today Dr. Tim and I went to St. Theresa's Clinic in Manzini. It was a fun day, with a lot of patients. Dr. Tim was really happy to have my help, as last week he did the clinic solo...and it is a lot of patients, the majority of whom have very complicated eye disease.

The trip to Manzini was long. It really isn't very far distance wise, maybe 45km or so, but it takes nearly an hour and a half to get there because there is only one road between the two cities and it is in poor repair. In addition, it is only two lanes and there were a variety of road hazards: slow drivers, crazy drivers, cows and other wildlife wandering up on the side of the road, many children/people walking along the roadside, etc. Hitchhiking seems to be the favorite mode of transport, as we passed literally over a hundred people motioning for a lift.

St. Theresa's Clinic in Manzini Swaziland

The pathology in clinic was again, amazing. I had the cutest little girl who was 8 (but appeared to be about 5), who clearly had a genetic eye disease. The family history was hard to obtain, but her mother and her only brother also had "very poor vision" since birth. The most likely diagnosis is anirida. There isn't much to do from an ophthalmic standpoint, but we counseled her family on the condition. Although legally blind in one eye with pretty poor vision in the other, she has good enough vision to get around in day to day life, so she will be okay.

Aniridia in an 8 year-old girl. This was taken with my iPhone through the slit-lamp! There is no iris whatsoever, and the lens is misshapen with the inferior half "missing" (never developed). This patient was referred for "pupil abnormality". I find that funny because she has no pupil...

For those ophthalmology minds, I also saw:

-  Florid panuveitis, likely from active tuberculosis

-  Symblepharon from Stevens-Johnson Syndrome from the antiretroviral drugs he takes for his HIV

-  An old choroidal rupture/macular scarring from head trauma

-  A child with an 8-ball hyphema from blunt trauma

-  The most cupped out optic nerves I have ever seen (from end-stage glaucoma)

-  Gonococccal conjunctivitis in a man who was immunosuppressed (HIV +)

-  Vernal keratoconjunctivitis with Horner-Tranta's dots/limbal follicles

-  And today, there were NO normal eye exams :-/

We finished eye clinic at about 3:30 pm and still had the long and arduous drive back to Siteki. We did stop for some quick grocery shopping (there is more selection in the "big city") and Dr. Tim treated me and the French medical student Camille to a "fancy" coffee at the local coffee shop. That was huge, because coffee shops (by American standards) are very rare. So it was a nice treat after a hard day's work!

One final thought: there is an incredible amount of HIV in Swaziland. The population is 1.3 million, and it is estimated that 25% are HIV positive. In addition, it is estimated that 70-80% of patients seen in the hospital setting are HIV positive. It is so sad. And we see all the awful sequelae of the disease.  I will write more at a later date about HIV, how it is handled, and how we test/screen for it here in Swaziland.

That's all folks. Time for bed.

And some photos of the farm:

On a walk with the dog Inghazi ("Danger" in SiSwati) on my first afternoon in Swaziland



On a walk around the farm with the dogs

Mabuda Farm. The shed to the left is where Dr. Pons keeps his airplane. The grassy area is the landing strip. He will fly in from Johannesburg tomorrow, after arriving via commercial airline from the U.S. Viv had to make sure all the cattle and horses were out of this area today so he has a clean landing tomorrow :)