Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Cresent Societies - 22 July 2003
John Sparrow and Selma Bernardi in Silele, Swaziland
Tuesday
10.30am
In Silele, a small rural community which doesn't appear on most maps, chief nurse Joyce Zwane bustles down the corridor of the Red Cross clinic from which the home care emanates. She mutters about traditional healers interfering. She has a man in her office with a serious case of herpes zoster, or shingles. He had come to the clinic some time ago, with sores around his waist, but stopped treatment abruptly and switched to a local healer. The traditional remedy has failed and he has returned to Joyce in great pain.
She doesn't doubt that healers have answers for some things. Elsewhere in Africa cooperation between clinical and traditional practice contributes immensely to the care of patients with AIDS-related problems. But hopping from one to the other without any consultation only interrupts treatment. Joyce complains, "People can choose but I get them coming back when their disease is advanced and serious. Something has to be done about it."
The patient rolls back his head and grimaces. The skin condition is improving but herpes is a viral infection which also affects the nerves. Italians call it Fuoco di Sant Antonio (Saint Anthony's fire) and the man feels burning inside. If this is AIDS-related it could last a long time. Herpes is opportunistic and recurrent. When immunity is low it can return.
10.45am
Silele clinic serves ten districts and people travel up to 40 kilometres to reach it. Once there were more in the region but the government and churches that ran them closed their doors. Security was reportedly one of the problems but the consequence was that access to health care deteriorated, as it continues to do across southern Africa.
Ill people sometimes arrive at Silele in wheelbarrows. There is an ambulance, the only one serving the district, but the terrain is tough and it isn't an all-terrain vehicle. In any event, it is always busy. With the accelerated spread of tuberculosis, malaria and common disease the outlook is grim, and the clinic reports that the hospitals it refers people to are themselves overwhelmed.
Joyce and her nurses get on with business; ante-natal services for the line of waiting women, immunisations, cases of sexually transmitted infection, abdominal pains, diarrhoea and chest infections. Spiro, 15, is a paraplegic and has come to collect a wheelchair. The one he has is almost unusable and Joyce persuaded a politician to donate a newer one.
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