3rd World Medical

Working within the government medical system in a third world country is quite challenging, I must say. The chemotherapy program still isn’t up and running. For a while I kind of lost hope that it would be. We recently had a meeting with a private oncologist in Jo’burg, thanks to my friend who works with a pharmaceutical company in South Africa. This meeting was very encouraging. This doctor has worked in the government system before and is well aware of budget constraints and other limitations that we are facing. He is willing to assist us with fund raising, and training our nurses in mixing and administering chemotherapy. We are now working on getting approval from the Ministry of Health here in Swaziland to partner with this oncologist for the chemotherapy and breast cancer program.
Last week at the breast cancer clinic at the government hospital, we saw a lady that literally crawled into the clinic, because she was too weak to walk any further. This lady has advanced breast cancer. The cancer has actually caused the breast to turn inside out and is now growing into the chest wall. She had been admitted to the hospital just the week before and had fluid drained off of her lungs and sent to the lab. The report came back that it was metastatic breast cancer. She was now at the point that she had so much fluid on her lungs that she could hardly breathe. We sent her to x-ray via wheelchair with her family to have another chest x-ray done. We received word that she had collapsed in x-ray and was brought back up to the outpatient department. The doctor and I went over to check on her and we found her lying on a exam table with an oxygen mask blowing 02 in her face. No one had noticed that she was already dead. No respirations, and no pulse. We took the oxygen off. Her daughter was sitting in a chair in the next room and she asked me if she would be OK? I had to tell her that we had lost her. The young girl (probably early 20’s) dropped her phone and everything in her lap and screamed and cried! I took her in to see her mother. She just kept saying “Make, Make” (which means mother in SiSwati). She asked, “How could God let this happen?”I was able to talk with her and comfort her and pray with her. I helped her call her family members on my phone. She had no airtime on her phone. Her brother and her uncle came, and I was also able to talk with them. Later that afternoon I received a call from the uncle thanking me for being with them and helping them. Praise the Lord for the opportunity to minister to the broken hearted!

Swaziland Update

Greetings in the precious name of Jesus!

The past 12 months have been most eventful: defining our place within a new organization and our own ministry goals, computer crashes, forced eviction (by none other than our own embassy), vehicle challenges, ……

But, we are thankful that our God is faithful and that everything we go through works to our good. And while we can attest that we don’t see the good immediately, looking back, we can see His hand in everything:

· Working with African Leadership Partners (ALP) has enabled us to focus on the programs and ministry that God has uniquely given us.

· Being forced to move actually has worked to our benefit. The rent on the house we moved to is significantly cheaper than the house we’ve been in. The house we’ve moved to feels more like a home, more so than the other one ever did. There are enough rooms in this house for all the kids to have their own bedrooms and for Daran to have an office as well.

Ministry Projects

CHIPS: we are finishing up the first year of the Children’s HIV Intervention Programme in Swaziland. Over 400 children and caregivers have tested for HIV through the program this year. 7.3% of the children we’ve facilitated testing have tested HIV+. 49.5% of the caregivers have tested HIV+. CHIPS has allowed us to facilitate life giving care for these children and caregivers. Without it, these children would have faced debilitating disease and certain death. Without it, these caregivers would have succumbed to the disease and left even more orphans. We have had painful experiences during this year as well. Several participants have died, having been brought into the program too late to be able to help medically. But through that, there have been many opportunities to minister to the ailing children and caregivers and to their families and relatives. As we start year 2 of CHIPS, we ask you to continue to pray for wisdom for us to manage and expand the program to new areas and to effectively and personally share the hope found only in Jesus. Regardless of the outcome of any disease or circumstance in any of our lives, the only thing that really matters is that Hope.

Kudvumisa Glass: The youth “skills training” program has continued to develop this year. We have taken the Money Matters course developed and taught by Peter Kopp of ALP and taught it at both full day seminars and weekly classes. We have developed a Money Matters II course as well. Both of these courses have become the core of the skills program. The goal of our skills program was never to ONLY teach a hard skill, but to help effect life changing attitudes relating to personal responsibility, creativity, and recognizing the unique mix of talents, abilities, and dreams God has placed into every one of us. We have teamed with Hawane Lighthouse to implement the Kudvumisa Glass program. Young adults enter the facility through Teen Challenge at Emafini, older orphans from the Lighthouse Care Centres, and referrals from churches around Swaziland. They live at Hawane attending Bible training classes and learning basic life skills (gardening and small livestock). We began teaching the Money Matters courses this term at Hawane and to teach and train on the glass art skills (glass etching, blowing, slumping, beadwork, etc). We hope to move all of the equipment on site over the next few months. This is a huge step forward as we now have a “captive audience” to implement the program, real classroom and real computer lab space to teach the glass skills, and space to set up the equipment on site. We can’t express how excited we are to be able to work with Hawane Lighthouse to offer this program and to further develop what we can offer.

Swaziland Breast Cancer Network: Teresa continues to work with SBCN to help develop a breast cancer care program here. There is no point in trying to develop a first world program in a third world country. Besides impractical, based on standard of care, it would be impossible due to budget at all levels. So SBCN is trying to develop a basic program that will begin the process of developing first class care. Working in a system that often is dysfunctional and even more often doesn’t seem to really care at all about the outcome for a patient can be extremely frustrating. But even in this Teresa has had many opportunities to minister to hurting women and their families. That is a blessing.

The Rehmeyer Family

All of the kids continue to work hard at school. We have Gabby here with us for one more year as she completes the International Baccalaureate program at Waterford. We would ask you to keep our children in your prayers: that they can do their best in school and also develop a heart for ministry. They are learning to play various instruments which is allowing them to help play for worship at church. This is a tremendous opportunity and responsibility for them.

Support & Help

We want to thank everyone who has helped support us here. There have been many donations of one time support and many monthly contributors. We are reliant on everyone who prays for us here. You are all a part of this work. Please continue to lift us up in prayer and prayerful support.

We are asking for a different kind of donation at this point. Teresa and the kids would like to return to the States for Christmas this year. Financially we don’t think it is feasible based on our current support levels. We are asking for donations of frequent flyer miles so that they can afford to return for a few weeks. If you have been able to accumulate points from travel or possibly from a credit card, we would ask that you see what you could donate to us. It would be a tremendous blessing to Teresa, the kids, and family in the States.

Blessings in Christ!

Daran & Teresa

Gabrielle, Danielle, Nathanael, & Joelle

Kaposi’s Sarcoma

We have two patients on the CHIPS program who have Kaposi’s Sarcoma. This is an opportunistic cancer that is common among HIV positive people. It causes big dark ugly skin lesions to form on parts of their bodies. One of the ladies has it all over her face as well as her body. It can become painful and infected. If a person has this, they are considered stage 4 HIV disease. The only treatment is chemotherapy. The government hospital in Mbabane tries to treat these patients, but frequently run out of drugs and are unable to complete their treatments. There is a list that the patients are placed on to wait until they receive drug in order to get treatment. The last I checked about 2 months ago, the list was over 100 people. In the mean time these people die, without treatment. The only way to get the drug right now is to pay for it yourself. Many people are not able to do this, as is the case with our patients. We are not able to pay this for them, as we are not set up financially to be able to take care of this.
Along the same lines of the government hospital not having drugs; I was on the surgical ward yesterday seeing one of our breast cancer patients who had just had a mastectomy (removal of the breast), the day before. She was in severe pain, and I asked what they were giving her and was told, Panadol or Tylenol. When we looked at what the doctor had ordered, we saw an anti-inflammatory drug called Voltarin. I asked if she was receiving this and was told that it was OS (out of stock). So I asked, “What about Ibuprofen?” The nurse called the pharmacy and they said that is out of stock as well. They don’t have any idea when they will receive it. I went to the doctor and asked him to please order something stronger for her. These are such simple drugs, so easy to get, if you can pay for them. It is such a shame that people have to suffer unnecessarily!

CHIPS – Mbabane Chapel 13.Sept.2009

1. HIV in Swaziland. Everyone knows the extent of the problem here through a constant barrage of advertisement and news articles. There is no need to belabor the issue of HIV in Swaziland.
2. And there are many groups and organizations here doing exceptional work in the areas they have budget and mandate to work.
3. But, because of the size of the problem, it has completely overwhelmed all coping mechanisms and service delivery in the country; whether these are cultural, social or governmental.
4. So there are still many gaps and holes in care and service delivery.
5. Our original work here was focused primarily on children and youth in the urban and peri-urban areas.
6. What we found was that even in these areas, excellent HIV care, while readily available, was not necessarily easily accessible. Especially for children.
7. As we moved to work in more remote and rural areas, we found the problem of accessibility exacerbated.
8. Last year, about this time, we approached Pastor Ken with a proposal to Claypotts Trust to fund a pilot program to address the issue of accessibility for isolated groups of children. In “isolated” we mean isolated from available heath care.
9. We chose to begin the project in the Maphiveni area which is at the junction of the road past Simunye to Lomahasha and the road coming past Mhlume from Tchaneni. This may not sound like an “isolated” community. Until you look at the economic make up of the community and the distance and therefore cost of transport to the available HIV care, which in this case is in Siteki.
10. From an economic standpoint, the community in general is impoverished, made up of displaced sugar cane worker’s families and refugees from Mozambique. They are typically assigned plots that are nowhere near the size required for subsistence farming.
11. Good Shepherd Hospital has several community outreach initiatives. They are limited to an area of roughly 30 km around Siteki. Maphiveni is closer to 45km away. There are clinics at Simunye and Mhlume. However, these tend to be more of a dispensary than true clinics.
12. To give you an idea of cost to access the care at Siteki, consider the following scenario:
 A caregiver has a sickly child and wants to have the child tested for HIV
 The trip from Maphiveni to Good Shepherd for both the caregiver and child is around 50 Emalangeni if the child is under eleven, over 100 otherwise.
 Let’s assume the child tests positive. There are typically at least 5 trips required before the child will start on ARV’s. And then a monthly trip for drug refill and adherence checking.
 That is a huge burden on a family that may not have the means to put a regular meal on the table.
 So given the scenario, will the child be tested or treated? Probably not.
 And if not, what is the outcome for the child?
13. So our program, dubbed, CHIPS for Children’s HIV Intervention Program in Swaziland was started to address this issue.
14. The program serves two primary purposes: to manage the HIV care of children and to bring awareness of HIV treatment for children to the community.
15. The program includes training for community workers: teachers, health motivators, and caregivers, providing transportation to Good Shepherd, managing appointments, continuous counseling for strict adherence to drug schedules, an advocate for the patients at the Hospital.
16. What have we found?
 PMTCT has seemed to help reduce the number of children being infected at birth! Older infected children are followed by younger siblings who are HIV free! (Good news!)
 The “C” in CHIPS has moved from children only to children AND caregivers. Leaving a caregiver to cope with the disease will invariably lead to disablement and death and ultimately more orphans and uncared for children. So we’ve expanded the nature of the program to manage the care of caregivers as well even if the children in their care are HIV free. 5% child infection rate, 50% caregiver infection rate. (Bad news!)
17. Our three year goal is to move out into squatter and informal settlements in Vuvulane and Lomahasha. Ultimately to have a model that can be replicated in other regions of the country
18. We appreciate the confidence placed in us by Pastor Ken and would covet your prayers for wisdom to see CHIPS grow and provide care on a larger scale!

Zodwa!

Praise God for success stories! Let me give you an update on Zodwa, the lady with cervical cancer that was in the hospital earlier this year. She was so sick, she could barely walk, sit, or urinate, without extreme pain. She was sent to Jo’berg where she received chemotherapy and radiation treatments. I ran into her in the grocery store the other day and I couldn’t believe my eyes! She looked great, no more pain, and she is back to work! We have asked her to speak for us at the end of this month at our cervical cancer program launch.