Outreach Clinic in Sithobela

Last Thursday I went with one of the BIPAI (Baylor International Pediatric AIDS Initiative) docs to one of their outreach sites in Sithobela, a very rural town out in the bush about 1.5-2 hours drive from the main Baylor clinic in Mbabane. Kate has been there as well, and we will both likely go back at least once during the next 2 weeks. Sithobela Health Center is comprised of a small clinic building and adjacent hospital, which has somewhat limited services. They have some great doctors and nurses, but very few antibiotics, spotty lab services and only intermittent power. The power went out 4 times on the morning I was there. On the dirt road to Sithobela I saw something very interesting...a cow on a leash! It is certainly not uncommon for cows to be in the road in Swaziland, but this one cow was been lead by a young man on a leash, much like you'd walk a dog. I guess, why not?

When we got to the clinic there were roughly 40-50 people in the hallway outside our little clinic room and spilling out of the building. We saw about 20 patients and their parents with siblings in tow over the course of probably 3 hours. I saw a new diagnosis too -- cutaneous larva migrans in a toddler. The kid has worms that intermittently crawl out of the skin on his left hand. The mama worm is likely laying her eggs underneath his skin, delightful. Luckily it's treatable (with Albendazole)!

Here is a picture of cutaneous larva migrans on the hand of a light-skinned person:

We also saw some very sick patients in the hospital. The first was a teenage girl who just looked very despondent and weak. Apart from being very dehydrated she was suspected to have possible cryptococcal infection...that or a viral meningitis -- neither of which would be good. Then we saw a young mother and her son, who were both admitted with weakness and fevers. After the little tater tot coughed in my face I learned that they both have active TB. Fantastic. N95 masks and true isolation don't really happen in most places that we've been here. I do bring my own mask with me to the hospital, but even then preventing TB exposure here is almost impossible. It is thought that 80% of HIV patients in Swaziland will have concomitant TB in their lifetime. In addition, people are often really close together, making the spread of the mycobacterium very easy. Van taxis (called "kombis") are packed with people and many Swazis have a tendency to stand really close together in public places...especially in queues or waiting rooms. Not to mention that many homes are small with several people sleeping in the same room (while they have fever, nightsweats and cough).

That's all for now! We have many pictures and stories from our long Easter weekend, but it will take some time to put those up. Hope everyone is doing well!