The broken road

Siteki, Swaziland06/05/09MiddayAs the mist settles over the emerald mountains of Swaziland, the Good shepherd hospital stirs into movement.The first few hours of my work day are spent in clinic. There I see patients afflicted with every imaginable ailment. From tropical infections like schistosomiasis to the complications of terminal HIV like toxoplasmosis, cryptococcal meningitis and multi drug resistant tuberculosis. These severe conditions are interspersed with the more benign aches and pains and dripping noses which can still malign the days of a Swazi man or woman.After clinic I assemble with the homebased care team and we drive out to the the neigbourhoods surrounding the little hamlet of Siteki.The yellow grass grows wild and taller than a basketballer. And we drive through it each day.Sometimes we go around it. But usually it is 'through'.The nurses say "Left here!" - and we turn.... making roads where I'm sure no road was ever meant to be...The homebased care truck is small but sturdy. The windshield cracked by years of being battered by pebbles and flying debris as the team travels the dusty roads of Siteki. It navigates the most inhospitable terrain, roads covered in mud and potholes and ditches. Grass quite literally as high as an 'elephants eye'.Each day we visit a series of homesteads. A homestead is a group of huts where one or more families reside.We are a medical service, and as such the primary purpose of our work is to provide compassionate medical care to those afflicted with severe HIV, Tuberculosis and those who are simply too sick or too poor to get to hospital.In addition to medical care each family recieves a bag of corn soya, milli meal (which can be made into a porridge), beans, and on good days a bag of oranges or a bottle of milk.Many of the homesteads we visit consist entirely of orphan children fending for themselves. In a country where 10% of the population are orphan children under the age of 15, orphan headed households are sadly very common.A doctors or nurses office is where you find it in Swaziland. Sometimes in a field of corn....Sometimes under a tree. (This is what we might look like if you were inside a hut)The aim of homebased care is to treat not only the patient but their family. To assess issues within the home like access to water, sanitation, poverty, malnutrition and sick family members. It is to look broadly and see a patient within the context of their every day lives as opposed to merely an afflicted body part or disease process.In addition to assessing and treating patients, the reason I was asked to work with homebased care this year was to empower the team, teaching further clinical skills and knowledge about disease and its management. But in truth I am the one who is learning.This team are expert in areas where every physician can refine their skills. They know how to see deeply and listen intently, how to treat the ostracised, unloved and dying with dignity and gentle reverence. They believe that the soul of medicine is not simply about handing out pills to patients but about helping an equal in need.In more ways than my little words can describe, this team of beautiful men and women and the other human angels whom I encounter each day are my teachers.We walk the broken road together, delving into our own woundedness to find a seed of hope to plant in the heart of another to whom the winter has come.From Siteki with love,Maithri