The journey to Nhlangano

Photo taken on my journey back from Nhlangano.

I travelled 2.5 hours from Mbabane to the Nhlangano health centre in Swaziland for field work. Today’s field work involved interviewing HIV infected individuals for job position known as ‘expert client’. An Expert client is a HIV positive person that offers counselling, support and advice to other HIV positive people. This initiative came about because research found that it is better when HIV positive individuals get involved in HIV prevention, advice and counselling of other infected individuals.  As you can imagine it’s always easier to open up to someone that is in the same situation and probably knows the difficulties you may face.

When i got there i immediately noticed the long waiting queue just to see a doctor. There weren’t very many doctors and so people had waiting time of over two hours.  This ranged from newly born babies to older citizens. I walked around the health centre really itching to take photos but it would have been a very uncomfortable situation for these people, especially as i didn’t have their consent. Not very ethical i thought, so i put my camera away and instead went on to actually meet these people and have conversations with them.

I spoke to the HIV positive women waiting to be interviewed. They had lost so much weight and all seemed very nervous about the interview. After i shook them and introduced myself, they went on to ask me how many expert clients were going to be chosen. Unfortunately i had no clue as i was not in charge of this. I reassured them all was well and tried to make the nervousness disappear. I sincerely doubt i was successful. Majority of these women were infected through their cheating husbands. What immediately struck me was these women seemed very repressed. The Swazi society is such that women have no say or can’t make decisions.  Perhaps their HIV status also added to their suppressed nature as stigma and discrimination makes this health burden worse. They all needed this job as this was the only form of income they had a chance of getting. One of the women i spoke to was fired from her job due to her HIV status so she expressed how important getting the expert client job was to her. I wished all of them good luck and continued on to exploring the health centre.

I went to the Tuberculosis (TB) wing and immediately i was asked to wear a mask at the entrance. I introduced myself to every one i came across and i was allowed to get into the laboratory...only briefly though!  I spoke with nurses and had the privilege of filming one of the nurses. I asked her TB related questions of which she answered so well. One thing she said that got to me was the fact that most patients are not able to handle the toxic nature of the drugs so most of them end up dying. Bear in mind that those that get admitted into the TB wing are HIV positive. So taking both TB and HIV medication can’t be so easy for people whose immune system is already suppressed.

After speaking to the nurse i noticed a man sitting alone getting some sunlight. I went and sat down with him. He told me he had TB and HIV and that was the first time in weeks he could come out in the sun. My heart sank. He said he had only been on Antiretrovirals (ARVs) just a week ago, and he had no clue he was HIV positive until he started losing so much weight and falling ill. Looking at him, it was clear he had a very low CD4 count and so was very late to get on ARVs. He couldn’t breathe properly and struggled with sentences. He told me to come back in 2 weeks to take a photo of him, that hopefully he would look much better for a picture. I felt so sad. All he wanted was to recover and go back home to his two sons.  I will be going back in 3 weeks to visit him and i hope he will be much better.

This journey opened my eyes to the reality around me. One recurring them was poverty. The HIV positive women and the HIV+TB man had that in common. When i asked, it was confirmed that majority of the patients were poor...very poor.  Some didn’t even have food to eat so how were they supposed to stand the harsh effect of the drugs? I really feel all these programs that focus on uptake of drugs should also consider if people have food because without proper nutrition, the immune system (which is already compromised), will not be able to fight off infections properly.  If organisations really want to help, then they should help properly. Just three days ago a woman in Swaziland ate cow dung because she had no food to eat before taking her ARV’s.  This is the reality over here and it’s so sad. I keep saying, if international organisations are not ready to immerse themselves into communities they do research in and carry out proper needs assessment, then there is no point! I say this because at this rate, they seem to be gaining more from these poor communities than these poor communities are gaining from them.  Organisations should direct funds and energy into poverty alleviation. For example, if funds were directed to education, a whole lot will change ranging from increased job opportunities to gender empowerment.  Only when organisations start doing so will i feel people don’t have vested interest.