Pre-Departure:
Swaziland, one of the smallest countries in Africa, is situated in Sub Saharan Africa bordered by South Africa and Mozambique. It is landlocked and is ruled by King Mswati III under absolute monarchy. The country is mainly divided into four regions namely Lubombo, Shiseleweni, Hohho and Manzini. The capital of Swaziland is Mbabane however the most densely populated city is Manzini which was once the capital before 1968 when Swaziland gained independence from the United Kingdom. The total population of Swaziland is roughly just above 1.3 million. Swaziland is classified as a lower to middle income country and its economy is pegged to the South African Rand.
Swaziland has a quadruple burden of disease namely HIV/AIDS, TB, NCD (Sugar diabetes) and mental illnesses. It has one of the highest rates of HIV infected people on the continent with a study conducted in 2002 citing almost 28% and the WHO stating approximately 64% of deaths in Swaziland are HIV/AIDS related. 38.8% of woman in pregnancy tested positive to HIV/AIDS. In 2005 the country declared to be in a humanitarian crisis due to the number of people infected with HIV/AIDS and a major shortage of healthcare workers with approximately 16 doctors per 100 000 people and most facilities located in central Swaziland reducing healthcare coverage by almost 80%.
Raleigh Fiktin Memorial Hospital (Is partially owned and run by the Nazarene Church, a Christian mission group that settled in the country and also opened a nursing college) is situated in one of Swaziland’s most populated cities, Manzini in Central Swaziland. Due to the health structure in the country one cannot clearly distinguish at what level of care it provides but from working there for four weeks officially and one week unofficially one can gather that it’s mostly functioning as a level two hospital with a lot of services missing which are then transferred to Mbabane Government Hospital which is the National Hospital and should be able to provide almost all the essential needs however that is not always the case.
It has approximately 80 in-patient beds, 5 in trauma and 4 private rooms. There is an X-ray department, a lab that can do basic tests and 2 basic theatres which are normally reserved for emergencies. There is also a Gastroscopy/ Endoscopy lab. There is no CT scan, MRI, or any other imaging modalities.
Experience at Raleigh Fiktin Memorial:
Nestled in between two countries, Mozambique and South Africa, land locked Swaziland has been dubbed the friendly country. With a very modest population and an economy heavily reliant on its neighbours Swaziland shares so many problems with its much bigger neighbours but unfortunately lacks so much when it comes to combating those problems unlike some of its neighbours. Like most under developed countries the state of healthcare is nowhere near a standard fit enough to aid and alleviate most of the burdens of diseases its stifled with. For most doing an elective here would not necessarily be their first pick but with me, it was challenge accepted.
The only way to really effect any amount of change in Africa is to go to the places that need it most. The abandoned places where basic healthcare has become a luxury no one can afford. It’s at the war stricken deserts of Sudan, the many refugee camps scattered in East Africa, the heavily burdened Sub Saharan Africa with HIV and the many parts of Africa that are struggling as a result of climate change. It’s there where real change can be effected and I personally want to do my bit to equip myself with the fundamental skills like language, cultural sensitivities, empathy and zeal to work in such hostile places. It’s not romanticising poverty and playing the super hero role, no its just being human and understanding that there’s more to this degree than what meets the eye.
Professor Dempers words still resonate deep within me. It’s making the tough choices that earn us the big bugs and put those letters at the end of our surnames on the wall. The decision to leave the comfort of your bubble and put yourself where you not even bound to get the highest of accolades but deep down you have offered so much to so little. It’s the decision to sincerely play your part wherever you may be and doing your utmost best not for the article in Time magazine but for the person sitting across your consultation table or lying on that stretcher en-route to ICU.
Return to Stellenbosch:
It is with that spirit that I did my elective in Swaziland. Yes, I am well acquainted with the country. Half my ancestry is from those shores but it became much bigger than that when whilst working there that the bigger picture dawned upon me. Africa needs to help itself and it starts with every one of us. I am privileged to be in an institution that is equipping me with skills such as Quality Improvement and being a change agent. An institution that is making sure that at the heart of my training the country I am in and continent will benefit the most. The only other thing left was for me to expose myself to these places and further my learning and taking responsibility in equipping myself with the necessary skills.
That is why I chose to do my elective in Swaziland and it has not only been an eye opener but I sternly believe has contributed immensely, in a psychological manner, the grit and guts necessary to expose yourself to these harsh realities and still offer the best that you possibly can with very little to so many.
Rural medicine, I believe, is still the most powerful tool we have to offer to our communities. Urbanization is taking place drastically and as a result I personally feel like we are now abandoning these communities to deal with the influx into the cities. It’s all upstream- downstream. Get a hold of the stream at the top and you won’t have much to do with the downstream. Africa has real African problems and unfortunately, we still heavily reliant on solutions very far from out continent. Sharing knowledge and getting advice from others is very important and paramount in our quest to achieve the healthcare goals on our continent but we also need to be innovative as we are the ones experiencing these problems and ultimately, we are the responsible ones.
I am very privileged to be in an institution that is very focused on creating doctors for South Africa and equipping us with skills for South Africa. I feel this is important to really aid in combating that which is continuously crippling us. African doctors for Africa!