Preliminary Results

After a long time gathering data in the basement of Mbabane Government Hospital, a Baylor doctor named Fiona and I ran the statistics on a total of 205 patients admitted to Pedatric Ward 8 from March-May of this year. Because of the political sensitivity of our results, I have been advised not to release our specific mortality rates over the internet. Much of this is caused by the fact that hospitals are being decried as deathtraps around Africa, and there have been articles in the Swazi Times lately stating that there is no real confidentiality of peoples' HIV results. Additionally, our clinic is partnered with the government, and so a great deal of discression is called for until the hospital staff has formulated their own stance on our findings.

Without being too specific, I can give a few of the broader details of our work. Let me start with the fact that our most well represented primary diagnosis for the Swazi children was severe acute malnutrition (over 1/3 of all admits) followed next by Gastroenteritis with dehydration and then pneumonia. Since HIV destroys the immune system, those infected are even more likely to be admitted with the aforementioned conditions, and that is exactly what we found. While we were surprised to find that roughly 3/4 of the patients knew their HIV status when they came in to the hospital, those numbers improved little if at all by the time a child was discharged, and the most common test for HIV had been given only about half of the time that it was indicated.

Because HIV is the most common cause of malnutrition here, we found the majority of the children we admitted to the hospital from our clinic were severely malnourished, and they comprised over 1/3 of all of the admitted malnutrition cases on the entire hospital ward at any given time. Since our patients accounted for such a large number of all of the kids at the hospital, we have a legitimate stake in what is going on there. While undoubtedly we see some of the sickest kids in the country, the typical mortality rate for a malnourished child with HIV in a developing country is right around 30%, but ours was significantly higher, with more than half of these dying within the first three days.

While the numbers we generated are clearly disturbing, they serve as a powerful tool to facilitate change and partnership from outside organizations. Among those currently collaborating with us are Action Against Hunger, the national Nutrition Council, and UNICEF. Our main goals to pursue in order to make a difference are twfold: to improve HIV testing on the ward and to improve the quality of care for malnourished children. The next question becomes, "How?" For one, we can promote accountability and leadership among the current staff by delegating tasks more efficiently and bringing in more trained HIV counselors and testers. Secondly, we can try to write our own malnutrition protocol and provide training for those who work at the hospital. Thirdly, we could try to mirror our sister program in Lesotho which staffs its own group of malnutrition experts and funds them through an outside non-profit organization, but this brings issues of sustainability into question.

One of the most difficult lessons for me here has been the eagerness to DO when I must learn to have faith that things will happen according to a greater design. There is a formidably fine line to tread when it comes to intervention in government health policy from an outside source, and any change we seek to implement will have to occur first with the Ministry of Health which translates into a long time after I leave this country. I suppose this is rightly so when the delicate balance of so many vulnerable lives is in question, but it's hard to tolerate when the faces of the little ones we follow on a regular basis disappear before they are made whole again. In the meantime, I will start searching for models and budgets that can give our ideas the feasbility to at least initiate the discussions that must take place among the various players involved. Always in the background are the children, and I ask you please keep them in your thoughts and prayers.

Lion King

I found this lion and these rhinos in Hlane, a park about an hour and a half drive from our clinic.