Holes

After just a few days in Swaziland, I noticed that many of the women and men from about 50 years old and up had holes in their ears, often in both earlobes. These aren't the small holes that one has when they get their ears "pierced" as we think of in America. Nor are these the large holes held open by "spacers" as some of the kids have in America. I was curious.

As I was reading a book about Swaziland (that I ordered from Amazon before I left for Swaziland) called "The Kingdom of Roses and Thorns", I soon learned about this cultural mark.  The book follows the lives of five Swazi women, and was written by Debra Liebenow Daly. The book outlines that in 1968, when Swaziland gained its independence from Great Britain, King Sobhuza (the current King's father) issued a royal decree that Swazi children should "open their ears" to the king. He was to be recognized as the ruler of Swaziland. The chiefs (there is a chief of every little township in Swaziland) took this decree of the king literally, and ordered the Swazi soldiers to slash large holes in all of the Swazi children's earlobes. An excerpt from the book:

"One soldier held a child down while another soldier took a long rusty knife and carved a hole into each of the child's earlobes. Then that soldier pushed a dirty stick through the earlobe to keep open the piercing."

This seemed slightly barbaric to me, but I confirmed the story with a gogo "granny" (how we refer to older women here) and with one of my co-workers at St. Theresa's. They both recall the day vividly and stated they were scared but were told not to cry or they would be cursed. They went to the chief's area of rule, and a hole was cut in each ear. Afterwards, a "small piece of wood" was placed into each earlobe. My co-worker Martin said it hurt quite a bit (no anesthesia was given), but they realized this was a matter of Swazi culture. I asked him why he didn't pull out the stick and he said he would have gotten in big trouble! (The sticks were eventually removed once the holes had healed open). 

I am not quite sure when this tradition fell by the wayside, but it is no longer practiced.  There is just the ever-present reminder of the practice when you look at the ears of any middle-aged or elderly Swazi.

 

 

Lobola Ceremony

On Friday, I asked one of my friends and co-workers, Setha, what she was doing this weekend. She told me she was going to spend the entire weekend at a lobola ceremony. This is a very traditional Swazi ceremony where a man's family gives a woman's family cows (or equivalent in money) prior to their marriage. Between 8-15 cows is a typical "lobloa" (or dowry).

Setha asked if I wanted to join her at the festivities. I thought she was joking, as I hadn't received a formal invite, but she was serious. I had plans on Saturday, so I told her I would meet up with her on Sunday.

We met today in Manzini and then I accompanied her and her husband to the bride's homestead. I had decided to wear traditional Swazi dress (I purchased it, I might as well wear it more than once!) and Setha wore Western attire :-)



Setha and me

Cooking the meat

Guests looking at the lobola (cows) that were given by the groom's family to the bride's family yesterday.

My friend Setha and her husband.

 

The kids attacking the mealie-meal (ground maize) and the meat broth. They were like little vultures!

The bride's family cooking.

Yesterday was the day when the cows were given to the bride's family. Two of them were then slaughtered and butchered for today's meal. When I arrived today, they were still in the process of butchering the meat. It was rainy and cold, so we sat around the fire where the meat was cooking. A goat was also slaughtered today (Setha and I went on a walk during this ordeal).

The men butchering the goat.

At one point, I was invited into the room with one of the uncles. They wanted me to join them in eating all the meat delicacies, which consisted of liver, spleen, kidney, etc. I was very polite, but didn't eat much. Unfortunately, in this same room was where a few men were butchering the remainder of the cow... It really didn't do much for my appetite...

The grilled meat (foreground) that we were to enjoy in the slaughterhouse... The portions of meat in the background will be sent home with different relatives, as an appreciation for their participation in this important weekend.

Setha was so wonderful! She explained everything to me. Both families were so gracious and kind to me. The kids kept staring at me, and the men kept asking to take a photo with me in my traditional Swazi maiden attire.

 

Setha serving up a traditional Swazi lunch.

 

After lunch was finished (traditional Swazi food: samp, beans, salad, meat, etc), the gallbladder of the recently slaughtered goat was used in a game between the bride and groom's families. It was placed in a cup and the children (some from bride's side, some from groom's) chased each other back and forth between the bride's hut and the groom's hut. The crowd was really into it!

 The gallbladder is located in a tan cup that is always in the hands of one of the runners.

 

It was really neat to experience some traditional Swazi culture. This was just the giving of the dowry--the wedding will be in the coming months.

Robben Island (Tuesday, Sept 9, 2014)





More on my Cape Town trip...

 



This was Angie’s and my final full day in Cape Town. We decided to do some shopping in the morning and then go to Robben Island, where Nelson Mandela was imprisoned for 18 of his 27 years.

We headed down toward the Waterfront and found a little area teeming with vendors selling African souvenirs. Angie had the foresight to do most of her Christmas shopping in Africa, so she had a little list of people for whom she needed to purchase gifts.

Market in Cape Town.

We had purchased our tickets for Robben Island online. Our boat time was 1:00 PM. After passing through the metal detectors, we boarded our boat. It took 45 minutes to get to Robben Island, but there were beautiful views of Cape Town and Table Mountain. We also saw dolphins, seals, and whales!

 

Table Mountain/Cape Town. Notice there are no clouds around the mountain at 1pm (compare with later photo).

Dock at Robben Island.

 

Upon arrival, we went on a bus tour around the island. The island is not very big—8 miles in circumference. We saw the leper graveyard (prior to being used as a prison, lepers were banished to the island), the leper church, and the limestone quarry where the political prisoners (such as Mandela) were forced to do hard labor on a daily basis, mining the limestone.

 

Leper Graveyard on Robben Island.

Limestone quarry where the prisoners where required to do hard labor on a daily basis. The hole in the limestone was where they could eat lunch. The guard tower can be seen in the background.

 

Pile of stones placed by ex-political prisoners during a reunion on the island on the 5th anniversary of Mandela's release from prison. (Stones placed in 1995).

From shore of Robben Island looking toward Cape Town. You can see why not many people attempted escape from the island!



 

 

Afterwards, we went on a tour of the prison, lead by a former prisoner. Our guide had served ten years for a political crime. He told us of the prison conditions. The prisoners were divided into “Couloreds (Asians, Indians, etc)” and “Africans”. There were no white prisoners housed on Robben Island. Everything in the prison was done according to race. For example, Couloreds received more food than the Africans. They also got a bit of sugar with breakfast and bread with dinner (when the Africans received none). In addition, the Africans had to wear shorts and were not given socks, while the Couloreds were allowed to wear long pants and socks. It was really eye-opening. We saw Nelson Mandela’s tiny cell and the bush in the courtyard where he hid the initial draft of his book “The Long Walk to Freedom”, which I am currently reading.

 

Our tour guide, a former political prisoner at Robben Island.
 

Diets for Couloreds (left side) and Africans (right side).

Prison

Garden/courtyard. Mandela hid a copy of his autobiography (initial (and partial) draft of The Long Walk to Freedom) in the corner of the courtyard. It was later discovered by the authorities, but a copy of it had already been smuggled out by another prisoner.

Mandela (left) and his friend Walter Sisulu. This is the only photo ever taken of Mandela while he was imprisoned on Robben Island.

Mandela's cell on Robben Island. He slept on the thin mats (pictured).

 

The final prisoners being released from Robben Island.

 

We headed back to land around 4PM, and the waters were definitely choppy by this point. Angie and I stomached it, but just barely!

 

Table mountain (L side of photo) and Robben Island (R side of photo).

The "tablecloth" (clouds) moving in over Table Mountain.

Whale jumping off the coast of Cape Town!

That evening we had a sushi appetizer at the local mall, and then headed back to our B & B so we could walk to The Codfather one more time for dinner!

All in all a great day. We had heard many mixed reviews about the Robben Island tour, mostly people said it wasn’t that great. However, we both felt it important from a historical point of view to tour the prison.

Horseback riding on Mabuda Farm!

One of the farmhands took me riding today. It was really fun, although my horse (Charlie) decided to get a bit rowdy at the end...

Nkosim with Charlie

 

Tops!

I agreed to help Sharon (optometrist at MGH) with eye exams at a “local” school in Siteki. She and Sikalela (our previous cataract case-finder turned chauffeur because funding ran out) drove to the school from Mbabane (about 2 hours), and I met them at the school. When she said the school was in Siteki (where I live), what she really meant was the address was Siteki. It was actually a good 40 minute drive into the countryside.

I could tell right away I was in a very poor area of Swaziland. The school was on a dry and dusty plot. I am not sure if they had electricity. The kids appeared much younger than their actual ages.

 

 

Holy Ghost Primary School

We examined the children, many of whom had failed the school screening (done by a Peace Corps volunteer in the community), but actually had very good vision. (Apparently some kids really want glasses, so sometimes they purposely fail the eye test. This often occurs in the U.S. as well!)

 

 

I had asked the administrator if I could hand out a top to each of the children we examined, as I didn’t have enough for the whole school. The tops were made by a woodcarver’s association in Oklahoma, and donated to Dean McGee. They are amazing works of art, and the kids love them here. The administrator agreed, and stated she didn’t think it would cause a problem.

 

 

 

Beautiful toy tops made by a woodcarver's group in Oklahoma. They donated over 500 tops to our group!

 

Well, of course good news travels fast. We were finishing up our final few exams, when a little boy came in and stated that he was worried he had bad vision and wanted to be tested. We all realized what was going on: he knew if he had an eye exam he would get a toy top. We were kind to him, and I played along. His vision was better than okay (20/15 in each eye), but in the end he got his top. Kids are smart little buggers!

At the end of the time, a CROWD had arrived at the door. It was clear that the tops had caused commotion after all!

 

 

The Luke Commission

I knew this week was going to be very busy! After Monday in Mbabane, I returned to Mabuda Farm (2 hour drive). The next day (Tuesday), I headed back to Manzini (1 hr 10 minute drive) for clinic at St. Theresa’s. I had my bags packed. After work, I drove to Sidvokodvo, where The Luke Commission headquarters are located. I was to spend all day Wednesday with them. They were kind enough to house me on both Tuesday and Wednesday night, since they leave early and get home late.

 

The Luke Commission was started by Harry and Echo VanderWal. They are Americans who have dedicated their lives to helping the people of Swaziland. Harry is a doctor and Echo is a Physician Assistant.

 

They have developed a very well-thought-out system where they set up clinics in schools and provide free medical care to the local community. The schools are often in very remote locations. TLC does a wonderful job off figuring out the needs of the particular community prior to setting up the clinic. They will send out members of their team to visit the area, meet with the Chief of the community, and explain the system to the citizens. They get an idea of how many people in the community have mobility problems and are in need of a wheelchair. They also counsel them on services provided, such as circumcision for the males. The children under 18 must obtain consent from a guardian.

 

TLC returns to the community at a later date, once the needs are known and the visit to the community has been well publicized (word of mouth, flyers, etc).

 

They leave early in the morning (clinics are on Mondays, Wednesdays, and Fridays). Vans of volunteers (often visiting from America) and full-time staff (a mixture of Americans and Swazis) drive to the location. There is also a large truck and several smaller trailers that head to the site. They are filled with wheelchairs, medications, shoes, surgical supplies, etc.

 

We departed at 5 a.m. for a rural area in northern Swaziland. We arrived by 7 a.m., and immediately started set-up. We turned the school into a full clinic. The capabilities are amazing: they can test for HIV, diabetes, can do chest x-rays on those suspected of having tuberculosis, perform circumcisions, and  obtain CD4 counts on those that are found to be HIV positive. This system has evolved and expanded over the last decade.

 

Again, the system is very organized. For example, the boys who want circumcision have to have a consent signed by a guardian. These consents are handed out at the preliminary visit that occurs weeks before our arrival. On the day of the clinic, these signed paper consents are followed up with a phone call (most all Swazis, no matter how poor have cell phones). After the phone call, the Chief of the community attests that they he knows the guardian and signs the paper as well. They want everything to be done with prior consent and full disclosure.

 

There are nine different rooms that are set-up, each room serving a distinct purpose. Upon the arrival of TLC to the site, the patients are given a card with a number on a first-come, first-serve basis. (By the time we showed up, there were over 1500 people milling around the school). They do not push or shove, because the policy is that TLC will see every patient who desires to be seen. Thus, they know we will not leave the site until the work is done, and they, in turn, are very patient.

 

The patients are first seen in Room 1 where an intake form is done by Swazi staff  member. All staff have been carefully trained. Demographic information is recorded. Questions are asked, such as “number of children born”, “number of children still living”, “water source” (most common is lake water). HIV status is included on the intake form. If the patient doesn’t know his or her status, they are offered a test.

 

They then move to Room 2 where blood pressure is tested on everyone, HIV tests for those who desire, and blood sugar tests on all those over age 50. This room is often staffed with volunteer staff (visiting from abroad) as well as a clinic staff to oversee that everything is done properly.

 

Room 3 is where they are able to have a staff member pray with them if they wish, while they wait to see Dr. Harry VanderWal. He will see every patient. Based on their needs, he will prescribe medications, etc. The patient then goes to Room 4, and mediations are not given until after the patient has been to Room 4. This ensures that the patient does not just go get his/her pills and leave the premises without proper counselling.

 

Room 4 is where counselling is done for those that have tested positive for HIV. Condoms are offered (TLC is Christian based, but they believe first in “saving a life” (by offering condoms)). There is also a portable digital x-ray machine that was developed by a radiologist who volunteered several years ago. Everyone who underwent an HIV test is counselled, whether they tested positive or negative. That way, there is no stigma associated with walking into Room 4 and the patient can be given the results in a controlled and confidential manner. If the test was positive in Room 2, the test is now repeated in direct view of the patient so he or she can “own” the diagnosis and know that there is no chance there was a mistake.

 

After Room 4, the patient can go to Room 5, where the medications prescribed by Dr. VanderWal are filled at a walk-up window. Every patient receives a de-worming medication, some vitamins, and acetaminophen. The other prescriptions are filled based on the recommendation of Dr. VanderWal. If a patient is newly diagnosed with HIV, they do NOT receive their ARVs from this clinic, but rather are referred to a clinic nearby to get their pills. TLC has an excellent way of following up with patients to ensure that they indeed did get started on ARVs. If they didn’t, TLC will help facilitate getting the patient medications.

 

Room 6 is where circumcision is performed. The entire room is set up into a surgical suite. The room is well-scrubbed by TLC prior to setting up the operating tables. They are absolutely meticulous about maintaining sterile conditions. Echo and one other person do all the circumcisions. After the circumcision is done and the first suture placed, nurses will finish the suturing and do all the bandaging. Each patient is provided with a bag that includes a clean towel, a bar of soap, extra bandages, pain relievers, a clean pair of underwear, a paper on how to take care of their wounds. TLC is very good about follow-up. Several nurses from TLC will do a follow-up at 2 days and 1 week. They make the long journey back to check on all post-op patients. There is also a phone number that any Swazi can call (even if they have no credit remaining on their phone) to reach TLC. They cannot talk to TLC, but their number will show up on the TLC cell phone (which is manned by a Swazi 24-7), and the TLC staff will immediately call the number back to talk to the patients.

 

Rooms 7 and 8 are the pre and post-op rooms. And room 9 is the eye room. TLC is currently trying to expand their eye services, and I am trying to help organize this. Currently, they are able to check vision and pass out reading glasses. We are hoping these services will expand greatly in the next 1-2 years.

 

The circumcision patients are watched for quite awhile, in a room where they can watch movies and relax. After about two hours, they see the nurse again, where their bandages are loosened and they have to prove that they are able to urinate.

 

Of note, TLC is also able to hand out free shoes to kids 12 and under. These were donated by a very generous American shoe company. Last year alone they gave out 100,000 pairs of shoes. The day I visited, we gave out 1900 pairs of shoes!  The kids were SO excited, and you should have seen their existing footwear (if they even had any). Some of these kids have never had a new pair of shoes. You can refer to the TLC website for more information on the shoes. (www.lukecommission.org)

 

It was a wonderful day. We made it back to the headquarters at 11pm! It was a long and exhausting day, but also exhilarating.  I am really excited to help them advance their eye care services. Myself and Dr. Hildebrand (my boss in Oklahoma) will offer the technical advice, and Echo will make it happen (obtain the resources, etc).

 

I was very impressed by the whole system. TLC can reach nearly 1/5 of the Swazi population (total population is about 1.3 million) annually. They have the highest ARV compliance rate of any group of patients in the country.

 

Again, for more information, please visit their website. (www.lukecommission.org)

 

I hope to return to several more clinics prior to my departure!

 

Photo diary of the day:

 

 

TLC Miracle Campus

Prayer and singing in the early morning hours, prior to setting off on our trip. The people in red are full-time TLC staff. Those in other clothes are visitors or volunteers.

TLC truck pulling into the clinic site.

Kids everywhere! These were only the female students. There were just as many male students and many adults and babies too.

Unloading the truck. The wheelchairs were to be presented later in the day to those we determined needed them.

The intake questionnaire in Room 1. There were about 8 Swazi staff in this room conducting the intakes.

Room 2: Blood pressure testing, blood sugar testing, and HIV testing for those who desired to be tested.

Rapid HIV tests. They are marked with a number corresponding to a patient. One line is "non-reactive" (negative), two lines is "reactive" (positive). The first two tests from the left are negative. The next two are positive. And the final test is still in progress. The test takes about ten minutes from start to finish.

 

Setting up the circumcision room.

 

HIV testing the children (on whom guardians had given prior consent). The consent form is the piece of white paper on the right side of the photo. They take this very seriously at TLC.

Dr. VanderWal and his translator (both in red shirts) in Room 3.




The counselor in Room 4. All counsellors are Swazis because they understand the culture and speak the native language of siSwati. The white boxes below the window are boxes of condoms for the taking. The literature on the windowsill is in regards to HIV and safe sex practices.

The portable and digital x-ray machine specifically designed for TLC by an American radiologist. Chest x-rays (to assess for tuberculosis) can be done on-site!

Viewing a digital chest x-ray.



A puppet show designed and performed by the missionary children, out of the back of the truck.



Two machines for determining baseline CD4 counts in patients newly diagnosed with HIV.



Children waiting in line for their new shoes!
 

A kiddo in need of new shoes...his toes were poking out!



There is a method to the madness. Each child's foot is measured before he/she gets in line. The number (in millimeters) is written on the child's forearm with permanent marker. After the child gets his shoes, the number is crossed off. This is to ensure that they don't try to get a second pair!



Child with ringworm on his head. This is very common, especially in the rural areas. These children are given treatment by TLC.
 

Ceremony in which the wheelchairs and PET carts (personal energy transportation carts) are given to their new owners. They are told to take good care of them and give them back to their communities in the event they should no longer need the device or if they should die.



Two school boys who wanted a photo!



I was trying to teach the boys to make fish faces, which they thought was very funny.



The line outside Room 9, the eye room.



Echo (in green) performing a circumcision.



Ladies getting reading glasses.



Many of the patients are illiterate and thus are asked to thread a needle in order to determine the correct strength of reading glasses.

Helping out in the eye room.