Overseas Adventures: 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.