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Went to the Mbabane Catholic Church today. I love how no matter where you go in the world, Catholic Mass is always what you would expect. There is a comfort in that consistency. Today we sang “And he will raise you up” and other familiar songs. The church was very pretty, although humble, and the people were all friendly. We walked home today an hour, uphill, in the rain… The minibus transportation system is scary and so we are trying to walk as much as possible. They shove as many people as possible into a 14 passenger van (sometimes about 25 people!!) and then drive as crazy/fast as possible the whole way home. It’s only 40cents US each way but I don’t think they guarantee that you will make it to your destination still alive.

This afternoon we went for a walk and met a bunch of neighborhood kids. (attached pictures) They were absolutely enjoyable to be around! Felicia and RoseMary (the two closest to me) spoke very good English. We took them all back to our place and gave them jump-ropes, puzzles, stickers, play-dough, and lip gloss. They are coming back tomorrow afternoon to play soccer with us. The youngest boy, only about 1 year old, (who I’m holding) was running around town with the 10 year olds without shoes on and no adult in sight. It always amazes me that mothers here are not more vigilant of their children. Even in church this morning there was a 10 year old with a baby on his back and no parents in sight. HIV is killing all of the mothers. Felicia said she has 7 brothers and sisters at home and they live in a 3 room house. None of the kids were wearing shoes. We gave them toothbrushes and toothpaste and they didn’t even know what they were… their teeth were already rotting at 10. It is heart-wrenching every time you put food in your mouth knowing that there are kids just down the street with nothing. I am feeling so small.

“Everything will be all right. The heart is stronger than you think… even when you think you can’t, it finds a way to still push on. I’m tellin’ you, things get better, through whatever, if you fall, dust it off. Don’t you know, you can be your own miracle?? If your mind keeps thinking you’ve had enough, don’t give up!! Through it all just stand up.” – Leona Lewis, Mariah Carey, Miley Cyrus

Today Anne and I made dinner for the Swazi University students. They invited all of their friends so it turned into a little party. It was nice to have people over since Anne and I have been alone quite a bit. Nuvhilla brought her son who is only 7 months! We played cars and with a ball, he was quite the cutie.

After dinner, Alex took one of the girls home and asked if we wanted to come along for the ride. She lived out in the bush and we had to take many unnamed dirt roads to get there. It is sad enough in the city with all of the poverty and hunger staring you in the face… but when you get into the rural areas it is unbearable. It looks like a wasteland. Trash everywhere… stray dogs that look like skin and bones just longing for something to eat. I lost it on the way home when we saw a little dog that appeared to have starved to death on the side of the road.

The problem is that they are not putting their resources where they could best tackle the problem. They are looking for a vaccine for HIV or a cure… what they need to do is focus on prevention. The poverty, illiteracy and unemployment are the true proponents of the HIV epidemic. Without tackling those issues, the HIV epidemic will continue to sky-rocket. And with the current prevalence rates of over 50% in 14-24 year old girls, hopefully there is not much more sky-rocketing in the future!!

Busiest. Day. Ever. This morning we woke up at the butt-crack and rode two different mini-buses (always an ordeal) to Elangeni Village (the village we first worked with). Once at Elangeni we met Nelly, an RHM (rural health motivator) who is HIV-positive, to assist on her door-to-door HIV counseling visits. She lives her life persuading people to volunteer to get tested to know their HIV status. She also escorts them to the clinic to start ART (anti-retroviral treatment) if they are found to be HIV positive. She motivates them to continue to excel in life and not give up. The picture of the 3 kids sitting around a pot is at one of the homesteads we visited with Nelly. They are eating sour porridge which looks gross but everyone here likes it. The little baby in my hands is a “colored” baby at the same homestead. They call mixed babies colored here and apparently it is a luxury to be colored (but not as much of a luxury as being white). We later met a crazy old lady who smelled like permanent markers only to find out that she was a glue sniffer, but that is a different story for another day…

Anne and I are Visiting Scholars at Baylor College of Medicine Swaziland!!:

1. In newborns and infants up to 18 months old it is difficult to test for the antibodies for HIV because the kids will test positive for the antibodies from their mothers even if they themselves are not HIV+. Therefore, to test for HIV, they have to perform a DBS test (Dry Blood Spot test) which is a PCR (polymer chain reaction) that tests for the actual virus. Unfortunately this test takes 6 weeks for the results to come back (rather than the 3 minutes it now takes for the antibody test) and some mothers fail to return for the test results due to the lack of money to travel to the clinic or some other reason. However, in children, the virus spreads very quickly and the children need to start ARTs immediately because kids tend to die soon after the HIV+ results are back at the clinic. Dr. Michelle recently received grant funding to set up a “retrieval” procedure for tracking lost patients and bringing them back to start treatment. Unfortunately here in Swaziland there are no addresses due to the lack of street names/house numbers so tracking anyone (even myself) is quite challenging. Dr. M plans to incorporate village Chiefs, Rural Health Motivators, and other key community informants into the tracking process. She wanted our help with the logging system to track the use of the funding and to set up a sustainable plan to implement over the course of a year.

2. They were interested in my nutrition background for a study they have pertaining to the high rates of malnutrition in infants suffering from HIV. They asked Anne and me to develop a protocol and educational material for counseling new moms of HIV victims on proper nutritional care. The latest WHO and UNAIDS reports are encouraging mothers worldwide to continue exclusively breastfeeding even if they have HIV due to the greater risk of death caused by malnutrition. However, mothers who are HIV+ are afraid to breast-feed for fear of infecting their babies; but, the chance is quite small and does not compare with the alarming rate of deaths due to malnutrition – especially in Swaziland! The mothers cannot afford formula so they typically dilute cow’s milk with river water which is wrong on many counts. First, there is not enough protein to support the growing child resulting in malnutrition and inevitably death. Second, the water is not clean and the babies tend to get parasites and worms also leading to malnutrition and death. Even for those who can afford formula, clean water is still an issue.

The fastest and most efficient way to get a program or idea accepted in a local context is to get local people involved in the development and implementation. Therefore, the materials Anne and I create will be given to “Expert Clients” who are identified by Baylor as trustworthy adults who are HIV+ and are taking all necessary precautions to live a long life, such as taking their ARTs, eating healthy, etc. These Expert Clients will then educate the patients and their families using the nutrition protocol we develop. If all goes well, Drs. Fiona and Stephanie are going to take our program to the Ministry of Health to get it accepted as the nation-wide pediatric HIV nutrition protocol!! We are very excited to get started!!

“I woke up, and wished that I was dead… with an aching in my head. I lay emotionless in bed. But the world spins madly on. I watch from my windowsill. The whole world is moving, but I’m standing still” – The Weepies

The lyrics of the Weepies song remind me of how an orphan must feel here in Swaziland. Their whole world stops. They have to drop out of school and stop having steady meals – but the rest of the world keeps going. I went to Elangeni today to meet with the Secretary of Elangeni Secondary School and Bheki (the Elangeni Village Facilitator).There are 68 orphans in need of help paying school fees in Elangeni Secondary School and probably an equal number in the primary school. These orphans could not even pay for a portion of last year’s bill as well so their grades are being held and they are no longer allowed to come to class until the remainder of last year’s bill and this upcoming year’s bill is paid. These children receive 1950Rand from the government (orphan schooling grant) but still owe another 1950Rand for Highschool and 900Rand for primary school.

We decided to choose the following children to support.
High School:
• Noncedo Simelane…………………………..2189.00 Rand
• Nkosingiphile Tsabedze…………………….2223.05 Rand
• Siphesihle Mabeleza………………………..1986.75 Rand
• Njabuliso Mabaso…………………………..2050.00 Rand
• Nomfundo Msibi……………………………2296.90 Rand
Primary School:
• Celimphile Maziya………………………….900 Rand
• Sizolwetho Msibi……………………………900 Rand
• Sibusiso Kunene…………………………….900 Rand
The conversion factor changes everyday and you get slammed at the banks here – but typically the conversion is about 7 or 8 Rand per $1. So, it is about $2033USD.

We are going to the village on Tuesday to pick up all of the children and take them to their first day of school ourselves. Once there, Anne and I will be able to assess who needs what in terms of textbooks, paper, pencils, book-bags, etc. The highschool students are all top of the class and the headmaster really believes they will all be college bound if they can just find the funds to finish school. I am super excited to see their faces in the classrooms with the rest of the children who still have parents to support them. Their parent’s deaths should not translate into a lifetime of struggle and poverty.

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