Biking in Mbabane

While I may have been called a "diva" because of the amount of stuff I brought back with me to Mbabane on my latest trip, I'm more than a little bit excited about having my bike here.  So far I've only logged about 35km (21 miles) over three rides of the same loop, but it feels like a great start.

Hopefully it means I won't collapse on Kilimanjaro next month.  Hopefully.

Here's the loop:


Most notably, there are a lot of hills here.

Male Circumcision in Swaziland -- A Shameless (but interesting) Plug for a Friend

Hi Everyone!

I have heard your (incessant) requests that I post to this blog more, and while I'm in the US for one more day, I thought I'd pass along this Atlantic* article written by a friend of mine about the massive male-circumcision campaign underway in Swaziland.  Male circumcision strikes me as a pretty big social experiment -- some results suggest that circumcised men engage in more risky activity because they are less at risk of contracting HIV -- but one worth watching both in Swaziland and across Africa if only because of the scale of the effort.

http://www.theatlantic.com/magazine/archive/2011/01/the-kindest-cut/8338/

Happy 2011!

Garrett

*Interesting side note: The Atlantic is the only magazine that arrives for me in Swaziland, though I usually get an issue that is 2-months old.  I've tried without success to get the New Yorker to come, but no luck so far.  Will have to switch that subscription to the Kindle, I guess.

P.S. I've heard the call to write more, and now have dozens of ideas.  Upcoming posts to include (with no timeline attached, and in no particular order):
- 2010 Year in Review
- Southern Africa's weird use of urinal cookies
- Thoughts on international development
- Pictures
- Pictures
- Pictures
- Videos (Thanks to Lani and Val's Christmas gift, I have a "Flip" cam that I'm hopeful will prevent user error behind the camera)
- Etc.

For now, back to Swaziland via JFK and Johannesburg airports.

The Impact of HIV Drugs

A pretty incredible video demonstrating the impact of HIV drugs.  People talk about the "Lazerus Lazarus Effect" of ARVs, which you can see pretty clearly from this video.

What do you want to know?

I guess this is a little bit shameless, but I'm sure that I'm not doing as well writing this thing as I could be, and that's in part because I am terrible at coming up with ideas for things to write about.

So a request: what do you want to know about?  If you propose an idea, I'll write about it, at least in some way. The more ideas, the more posts, maybe?

-G

What I Do, Vol. II

This story from today's New York Times talks about how hard it is to identify patients in need of HIV/AIDS treatment, and how much harder it is to keep them on treatment once they've started: http://www.nytimes.com/2010/10/26/health/26cases.html 

It's a good opportunity to talk a bit about what I do in the context of what the article lays out.  We face all the same problems here in Swaziland, though admittedly it's easier to get from one end of the country to the other than it is in Kenya.

What I do -- what a large number of people at the Ministry of Health and other NGO partners do -- is try to make it easier in different ways for patients to begin and remain on treatment.  For me specifically that means helping more patients get onto medicine regimens that are as close to one-pill, once-per-day as possible instead of that (mostly antiquated) handful of pills you see in the picture from the Times at left.  This means helping doctors and nurses understand and order the new medicines for all their facilities, quantifying the number of patients expected on each regimen so that medicines are available centrally, making sure the government is aware of future changes, etc.  The hope is that changes like these will ultimately make it cheaper and easier for all patients to be on treatment.  

Other things we're trying, (both at my office and in other parts of the Swaziland health community) to add more color to the Times article :

• Decentralization: Move treatment closer to patients to reduce travel time and cost and make seeking help more convenient.  Of course, with a limited number of doctors in the country this means empowering nurses to initiation HIV treatment (the drugs are toxic if used incorrectly, remember), ensuring monitoring and evaluation, etc.  No easy feat but one that the country is pursuing with some vigor.
• Patient Tracking: Collecting better information about patients at treatment facilities to allow for better follow up if they miss an appointment.  Details include the usual, cell phone number, cell phone of family or friend, address (including nearest bend in the river/other landmark since postal addresses don't exist for homesteads) and better counseling 
• Advertising and media and other outreach to minimize the stigma of HIV and HIV treatment, and teach people that if one regmien isn't working for them another might be better.
• Develop community support structures to identify patients that have missed appointments to encourage them to return.
• etc., etc.  

If you have an idea, this country would try it.  Facing a "lost-to-follow-up" rate approaching 20% per year, clearly what we have isn't working well yet.

-G

Silverback

Hiked in the north of Rwanda yesterday to see the Mountain Gorillas.  More to come soon:

The "king" Silverback Gorilla from the Sibyinyo Group

A King Sighting

I got my first glimpse of King Mswati III over the weekend at the annual Umhlanga ceremony.  He's the one in the middle with the red something-or-other on his shoulder.  Check out the fancy watch.

The Umhlanga (reed dance) ceremony is one where thousands of Swazi "maidens" celebrate the Queen Mother in a week-long event that culminates in two days of  traditional dancing.  The King has been known to pick a new wife at or near the event, but doesn't seem to have done so this time.