Rehmeyer Ministry Vision Statement for Swaziland - Short Term Relief / Long Term Change

Short Term Ministry Vision

We will be working in communities that have no access to HIV testing/treatment. The goal is to educate the caregivers as to the importance of testing and early treatment for HIV/AIDS for the children under their care. The community that we will be working in to start is Maphiveni, outside the Tambankulu sugar estate. There are about 1500 people in this community. It is a squatter community of ex-sugar cane company workers or families of the workers who have passed away. These people do not have the means to get to clinics or hospitals for testing or treatment. Two or three babies under the age of 5 die in this community each month from HIV related causes. Our goal is to be a facilitator for a project to provide them with education, and access to nearby clinics and the Good Sheppard Hospital to get the care and treatment they so desperately need.

During the past 3 years, working with Children’s Cup, we were able to roll out a program where we provided these services to the children at the care points. We will be trying to replicate this program in areas where it is needed. There are two additional areas of health education we will be focusing on: teaching pregnant women what they must do to prevent mother-to-child transmission of HIV and education regarding water purification and how important it is. Their water source, the Mbuluzi River, is contaminated by run off from nearby farms, industry, human and animal excrement.

The rate of chronic diarrheas in this community is extremely high. In a clinic done for the children in this community recently, 33% of the children were identified as needing to be tested for HIV and almost half were victims of chronic diarrheas. When you add chronic diarrhea on top of already being HIV+, especially in children, you increase the risk of health issues such as dehydration, weakness, and weight loss. These people need to be taught how to treat the water source to make it clean before they drink it.

We will be working with the Home Based Care outreach team at Good Sheppard Hospital to provide HIV testing and treatment services to the Maphiveni community. They provide mobile services in the general area, approximately 30 km radius of the hospital. The area that we will be working in is 48km from the hospital; therefore, they do not have access to these services, unless transport is provided for them. This will be a program that we plan to replicate in other poor squatter communities in the Lobombo region.

The other opportunity that has been presented to Teresa is that of helping to provide guidelines for chemotherapy and breast cancer care in Swaziland. The Swaziland Breast Cancer Network wants Teresa to assist in developing this program for Swaziland. If diagnosed, cancer patients are presently being transported to South Africa for chemotherapy treatment, which is very difficult for them, as well as expensive for the government. Many times they are not able to complete their treatment due to cost constraints.

Long Term Ministry Vision

Ministry Mission

And the Lord said to him (Moses), what is that in your hand? (Exodus 4:2) God has given us everything we need to begin this earthly journey.

Ministry Vision

We see a long term investment into the lives of young people in Swaziland. Training these young men and women up and giving them Godly skills in life and in business. Affording them the opportunity to break the cycle of poverty, and excel.

Background

Beginning in 2005, we made the commitment to work with Children’s Cup to help develop the compassionate care and ministry outreaches to the children in the urban and peri-urban areas of Swaziland. Over the course of the three years, I oversaw the effective doubling of the number of NCP’s that ‘Cup managed and the doubling of the number of children attending. A concern from the beginning was the apparent loss or non-participation of the teenagers at the NCP’s. We have seen teenage boys and girls engaged in stealing, gangs, and prostitution in order to make money. For the NCP’s to have their intended impact on the community, they would need to provide a greater engagement of these older youth. Paradoxically, and of primary concern, is that these youth , as they fall back to their community, with no leadership and a crumbling (or nonexistent) social structure, are the ones to either make or break the fight against the HIV pandemic in southern Africa.

Key Ministry Objectives

The primary challenges in this sub-region are:

• A culture that stifles innovation and creative thinking
• Rampant under and unemployment
• An education system that does not have the infrastructure or capital to educate the children through primary or secondary schools
• A university system that struggles to find government bursaries for the majority of students that do attend

In answer to this, a program whose goal is to help break the cycle of poverty and HIV is essential.

At the age of 16, many young people in Swaziland are the head-of-household for their homes and providing for younger siblings. As the AIDS epidemic sweeps through this country, this age will become younger and younger. The ministry we have been involved in has been a great short term support to young, undernourished children affected by AIDS through loss of responsible relatives. Over the past two years we have seen these children grow. We have asked ourselves

• What will happen when they are no longer eligible to be fed or choose not to participate at the NCP’s?”
• What are we accomplishing – are we establishing lasting Godly principles in these children, that will change their lives or are we just a stop gap to the inevitable decline in health and values when they move on?

As God has spoken to us we have seen that it is Jesus that these children need. Our hearts yearn for a chance to feed these children more than food. They need the unending supply of God’s grace and the sustainable supply of meaning through self worth.

Grappling with these two ministerial objectives we feel we can be life changers here in Swaziland. By providing a ministry opportunity from where the NCP initiative ends, we can and will make a difference. This will be through two primary areas of focus:

1. Business Opportunity
The actual skills being taught are not what are important. Many skills based programs in Swaziland concentrate on specific skills with no concept of market saturation and effective wage earning capability. They do teach a specific skill, but they do nothing to prepare the student for effectively implementing the skill in a successful business.

The primary goal of the program will be to teach the participants to effect life changing attitudes about their potential and responsibilities. Secondary will be the specific skills. Even so, the skills that will be taught will be unique and provide opportunities in and of themselves as well as significant crossover into other areas of work.

• Personal financial responsibility
• Personal moral responsibility
• Mastering basic business fundamentals
• Entrepreneurial skills and training
• Learning technical skills in glass blowing, etching, beadwork, torch work, slumping, etc.
• Confidence to seek, and pursue, the dreams and ideas that God gives to each person

2. Camps
During the school year, schools are closed for several weeks between each term. We would use this time and the venue of the vacant schools to provide day camps. Impacting child-headed households will be the primary focus of these camps. Local and international groups will be engaged to assist in the running of life and business skill camps; teaching in areas they have specific expertise.

Skills for household management, health management and self reliance will be the primary focus:

• Nutrition
• Budgeting
• Sustainable household vegetable plots
• Disease management (HIV and TB being the primary focus)
• Child rights
• Homestead micro economic projects

Thobile Update - 17 Years Old

Thobile is a little girl who is 17 years old, but only looks ten. We first met her about 2 years ago as we were planning a CarePoint at Madonsa, and decided that we (the Rehmeyers) would sponsor her, since she was too old to be sponsored thru Mission of Mercy. In the past two years, she has been going to Baylor Clinic and taking ARV’s, and has been able to go back to school. She has not been able to walk the long distance to get to school, so we have provided her with money for transport to get back and forth to school each day. This year in March, she was diagnosed with TB, and had to have daily injections for a while. She is still on oral TB meds, she has been hospitalized several times this year for various respiratory problems. After one of her hospitalizations she asked if we could get her a book sack with wheels because the one on her back was too heavy for her to carry.

She has been getting weaker and weaker. She was just discharged from the hospital in Manzini last week, on Thursday and readmitted to the hospital in Mbabane on Monday. They said that the hospital in Manzini said that she was too critical for them so they sent her to Mbabane. One of the nurses told me that when the Manzini hospital weren’t getting anywhere with a case and thought they might loose her, they sent her to Mbabane. I’m not sure if her TB is becoming resistant, or if she has another infection. Her mother seems to be very caring, but I don’t think that she is very responsible in keeping up with her medications.

When we arrived to see her on Monday, we found her lying on a mattress on the floor underneath another bed. There were empty beds in the front of the ward, so I asked why they couldn’t put her there. The answer was that the ward was divided into chronic and non-chronic cases, so she couldn’t go in that part of the ward. I think that they are trying to keep the TB cases separate, which is good, but there is nothing really protecting others from them. The next day she was in a bed, and asking for us to bring her something nice to eat!

I’m not sure what we are facing with this one. One of the Baylor doctors promised to go and see her. As of the second day, she had seen no doctor and nothing had been done except a chest x-ray. She is complaining that her legs are painful and weak and she is unable to walk. Please help us pray that the doctors have wisdom and that she gets the treatment that she needs!

update on Lomansontfu

The beautiful little girl from Maphiveni with the large cyst on her cheek returned from Pretoria. Unfortunately the cyst is still there. She called me on my cell phone from the hospital several times, until I was able to make it to the hospital to get her. When I walked into the room, she smiled, grabbed her little bag and ran to hug me. We were going to have her family come get her the next day, but when the nurses told me how anxious she had been to have me come to get her, I couldn’t bring myself to leave her. We had her family come up and meet us in Manzini at one of the care points. When we drove up to the care point, she slumped down in the seat so the other kids couldn’t see her. She was afraid that they would stare and make fun of her. I quickly took her into the clinic so the kids couldn’t see her.
The doctor from Pretoria found that it is a very vascular cyst, which means that it is full of blood vessels. It can’t be removed until it is clotted off and the hope is that it will shrink. He did try to clot it by going in at her femoral vein in her groin and going up to the veins that feed the cyst. He wants to see her again in the 1st of October. So far, the cyst hasn’t shrunk, but we are praying that this will work. Once it is clotted, she will need surgery to remove it. Depending on how extensive it is, she may need reconstructive surgery as well. Please continue to pray for this situation and for this precious little girl!

New Beginnings

Dear Friends

Thank you for all your support over the last three years. God has done wonderful things for us here in Swaziland and has opened so many doors we never knew existed!

We know that God has called us to Swaziland and the people here who are in need. Children’s Cup is doing a wonderful work in this country and we are proud to be associated with this organization. The focus of Children’s Cup is clear and well executed. As our time with Children’s Cup has shown us, there are many needs that are outside of the scope of work we are currently doing.

The vision of Children’s Cup is, and will always remain, our vision. After being in Swaziland for some time, our original calling has grown. A clearer picture of the overall need in Swaziland and our place in God, in fulfilling that need, has been solidifying in us for the past six months or more. We feel that the time has come to respond to this larger vision. Children’s Cups’ vision and the confines of the organization cannot facilitate this divergent direction. Prayerfully and with the consent and support of the Children’s Cup leadership here in Swaziland it has been decided that we shall continue working out our calling beyond their structures and leadership.

The number of children with HIV/AIDS and directly affected by HIV/AIDS continues to rise here in Swaziland. We seek ways to help those children who are still not being reached with diagnoses, treatment and coping strategies.

In parallel, there is a large and growing population of older teenagers and young adults who have had little or no training or encouragement/mentorship for growing up to be productive in their communities. There is no provision for being responsible for themselves, their families or even younger siblings that they may find themselves responsible for. We see a great need for developing progressive training in fields that would promise economic growth and self reliance as well as the moral and ethical foundations found in the Christian world view.

Coming alongside the leadership of Children’s Cup, training and assisting new leadership to take our place in Children’s Cup as well as helping with the transition of new leadership in Children’s Cup is our next goal. After three years of experience and commitment we shall be taking as long as needed to ensure a smooth hand over is done. During this hand over period our financial and other personal detailing will be sought out and communicated to you. We are preparing clear visionary goals and we will be sharing them with you as the Lord continues to direct and lead us.

As the Lord led us here as a family, He is continuing to lead and grow us as a family. Thank you again for all your prayer, support and generosity. We hope that you will be as excited as we are for the awesome work we expect to be doing here in Swaziland. Taking the last three years with Children’s Cup, and our lives, to the next level, we trust that God is refining our faith and growing us in Him.

Growing both in God and for God, in vision, action and impact for Swaziland.

God Bless

Daran, Teresa, Gabrielle, Danielle, Nathanael, & Joelle

Lomansontfu June 26

Good News!!!! Praise the Lord!!!!! At long last, after 3 or 4 weeks, we finally have all of the documents necessary to send Lomansontfu to for her surgery to have the tumor removed. I saw the letter from the senior medical officer today, and it states that she will go to South Africa on Monday the 30 of June. Abraham came up from Maphiveni today and took the sister and the child to get the travel documents. He said that it was just God, because when he got here, he realized that one of the certificates he was bringing was not correct. So he prayed and asked the Lord to make a way where there is no way, and He did!! He said that they took them into an office and corrected the document and they were able to get the travel documents without even waiting in the line! We were rejoicing and praising God right there in the corridor of the children’s ward at the government hospital! Prayer works!

When I visited her earlier in the week, I felt led to just pray and agree with the child, and the sister that this paperwork would be gotten quickly and that the doors would be open to get her to I could hear the other care givers in the room agreeing with me in prayer, and God did hear us, and answer! The tumor is getting bigger every day and causing her more and more pain. One of the care givers in the room told me today that it causes her much pain and she cries at night.

Now we must get her older sister to Mbabane to travel with her on Monday.Please help us pray that this goes smoothly, they travel safely, and that the surgery goes well.God is a good God!!

Lomansontfu - June 22

This is a little girl named Lomansontfu (name means Sunday), which probably means she was born on a Sunday. She is from our Maphiveni CarePoint. She is about 10 years old, and she is an orphan. She lives with her older brother and sisters. She is not treated very nicely by them, because she is just an extra mouth to feed. She has a large tumor growing on the side of her face. The doctors think that it is a myeloblastoma. She needs a major surgery to remove the tumor and probably plastic surgery because the tumor is eating into her jaw bone. This surgery can’t be done here is Swaziland. She has been in the Mbabane Government Hospital for 3 weeks waiting for the Senior Medical Officer to approve her case and provide the money through a government fund to send her to South Africa to have the surgery done. We are also waiting for her family to get her certificate of birth from the chief so they can get travel documents for her trip to South Africa.

Each time I see her, the tumor is bigger and bigger. Sometimes, she drools because she can’t keep her mouth closed. She is having a lot of pain, especially at night, and her gums are beginning to bleed. In spite of all of this, she manages to still have a beautiful smile that lights up her whole face! I pray that we can get the help that is needed for this little girl. Please pray that the funding, the paperwork and the approval will all come quickly so that she can get the medical care that she needs and deserves!

10 Year Old Caregiver - June 15

There are so many children that are raising themselves. It is very common that the mom and dad die, and the younger ones are raised by the older siblings. Then the older sibling has children of their own and they are being taken care of by the younger siblings. In many cases, the older sibling is working and the younger sibling is raising their children. So, you have an 11 year old taking care of a 5 year old, a 3 year old, and a 1 year old. This 11 year old girl brought these little ones in to see me at one of the clinics. They all had scabies from poor hygiene. They also had infected sores from where they had been scratching. I can’t imagine my 10 ½ year old being capable of taking care of 3 little ones 24 hours a day 7 days a week. I’m sure that this little girl doesn’t get to go to school since she is the care giver for these little ones while their real mother works, or does nothing, whatever the case may be. She doesn’t have much choice in the matter, if she wants to eat; she has to take care of them. I’m sure that she needs to be tested for HIV herself, but she really has no caretaker to be responsible for her. I sent our counselor out to talk to this family about testing. I have not heard how it went yet. This is one of the many difficult situations that we deal with here in Swaziland, only God has the answers to them all!

Nothando - June 8

This little girl’s name is Notando. She has TB, but not in her lungs. Her TB is in her lymph node on her neck. She is also HIV positive and eligible for ARV’s based on the fact that she has TB. She was hospitalized for about 2 weeks to begin her TB treatment. Both her mother and father are mentally challenged. She was discharged on TB meds, which she is supposed to take 3 tablets daily. When we tried to find out from the mother about the meds, she said that there were no meds. When I checked with the nurses at the hospital, they said that the dad had been trained about the meds and the meds were given to him. I had the teacher at the CarePoint investigate and we found the meds. It looks like none of the meds had been given since the child was discharged from the hospital, which had been about a week. So I had the teacher (Lindiwe) keep the meds and start giving them to Notando when she came to the CarePoint each day.

Now this little one needs to be started on ARVs also. This will be a big problem, because they have to be given 2 times daily, exactly 12 hours apart every day, without missing a dose. This will be next to impossible with mentally challenged parents. Lindiwe can give one dose a day, but the 2^nd dose will be difficult to ensure.

Notando has a younger brother. The mom brought him to me at the clinic this week. He was very sick, probably pneumonia. I knew that I could give her an antibiotic to give him, but it has to be given 3 times daily. This mom really does love her children and care about them, but she is just not capable of taking proper care of them. There is no way that she can handle this, so I told her to bring him to the government hospital the next morning, hoping that they would admit him to get him well. I sent them home with Tylenol for fever and nothing else. I didn’t feel good about my decision, but really had no other choice.

Please pray for me for wisdom. Sometimes I just don’t have the answers, but I know that I serve a big God that does have all of the answers!

Update for April MoM Medical Team

I heard from one of our teachers that a lady from the Logoba CarePoint who was helped by the Mission of Mercy medical team wanted to say thank you for giving her the money to go to the hospital. This lady is pregnant, and was having problems with her pregnancy. The medical team collected money and gave it to her to go to the hospital to have proper tests and medical treatment. She was able to do that and had some left over for food. She has not had the baby yet, but everything seems to be OK with her pregnancy now. She just wanted to let the team know how much she appreciates their kindness!

Belated Mother's Day Update

Again, when the medical team visited Maphiveni, they saw a baby who was dying from malnutrition. The mother is HIV positive and had no more breast milk, and the baby was starving to death. The team gathered money and sent for formula and bottles for this baby. We were able to work with the mom and baby, teaching her how to mix the formula and feed the baby with formula to save her life. We also counseled the mom about getting on ARV’s herself. Pastor LaSalette and her staff also counseled and prayed with her and she accepted the Lord and is now coming to the church regularly! I saw the baby on Mother’s day. She and mom both look good! Mom says that she is now laughing, and she was not doing that before. The baby is about 11 months old, still can’t sit up, but is making progress. Praise the Lord! What a great Mother’s Day Blessing!

MoM Clinic Outcomes

George is a 16 year old boy who lives in Maphiveni. When the doctors visited in April, he had just gotten out of the hospital. He had recently been diagnosed with diabetes. He had collapsed the week before at school and been rushed to the hospital, unconscious. He was living with his old grandma (gogo), who has difficulty caring for him. Some of the members of the medical team from the States gave Pastor LaSalette some money to take him back to the hospital to get his blood sugar under control. When we checked it at the clinic, it was still very high, even though he was on insulin.

I went back to Maphiveni and checked on George a couple of weeks after the medical clinics. He is now living in a room at Pastor LaSalette’s church. He is being taken care of by Abraham, who also lives and works there at the church. He is trying to cook healthy meals for George and make sure he checks his blood sugar twice a day and takes his insulin. Pastor bought a blood glucose machine for him to check his blood sugar. George looks and feels so much better these days.

HIV Testing Results

	Positive		Negative
Age	Females	Males	Females	Males
^14	2	2	5	4
15-19	1	0	2	0
20-29	7	1	1	3
30-39	7	0	0	0
40-49	4	0	4	2
50-59	0	0	1	1
^60	1	0	4	1
Total	22	3	17	11

These are additional results from the clinics held in April with Dr. Beyda's MoM medical team.

Pepe Update

PePe finally went home from the hospital on the 8^th of May! Praise the Lord! She no longer has an NG tube for feeding. She is now drinking the nutritional formula by mouth. She has to have four 500ml bottles of the formula daily and then she can have other food. She celebrated her 12^th birthday on the 10^th of May! She is doing well at the home that her and her brother, Banele are in. Banele is also doing well! He is going to school this term! Hopefully, soon, PePe will also be strong enough to go to school!

Clinics with Mission of Mercy

The clinics with the Mission of Mercy medical team went very well. The team consisted of 2 doctors, 3 nurses, a paramedic, and 3 other non-medical people, who ran the pharmacy. We saw over 1500 people in 5 days. Everyone had an opportunity to pray with someone before they left. There were many testimonies of salvation, and spiritual encouragement over the 5 days. Many people also went for HIV testing and counseling.

We saw many difficult situations, and were able to help with most of them. One lady that we saw was 11 months pregnant, and could not be induced, because she didn’t have R250 ($32), for the medication for induction. The team gave her the money to go to the hospital to be induced.

There was an 11 year old girl at one of the clinics that had been raped. Her father brought her to be seen by the doctors. She had been living with her mother up until about a month ago, when she was taken to live with her father. He said that she won’t talk to him about what happened, all she does is cry. When we asked her what happened and when, she said that the last time it happened was about a month ago. She said that she feels safe now that she is living with her father. She wouldn’t tell us who raped her, only that it happened while she was living with her mother. She didn’t want to be examined by a man, but when we told her that the teacher and I would be with her, she finally agreed. Dr. Beyda was so kind to her and explained exactly what he was going to do, and that he was so sorry that this terrible thing happened to her. When we tried to examine her, we could only get her legs a few inches apart. We had to do the best we could not to traumatize her anymore than she already was. On examination, we discovered that she had a discharge and a large wart growing between her labia, which is very painful. Dr. Beyda decided to treat her for all STD’s (sexually transmitted diseases), which included an intramuscular injection, along with several oral antibiotics.

After the exam, we called in one of our missionaries, who was doing spiritual counseling to help us talk to her and pray with her. Jacci was definitely led by the Lord, and talked and prayed with her for a long time. The little girl was crying, I was crying, Jacci was crying and our interpreter (one of our teachers) was crying. The girl accepted Christ into her heart, and when we were finished, she was hugging us. In the beginning, she would stiffened when we tried to hug her. Her facial expression changed and you could see that she was different than she was before.

We saw her a week later, and she looked like a different child. The withdrawn, unhappy countenance was replaced by a smile and she was hugging us willingly. I’m sure that she still has a long way to go both emotionally and physically, but praise the Lord, she is on the right path!

Thanks Sabine for the pictures!

PePe Update

PePe is still at Mbabane Clinic. She is now receiving tube feedings via an NG tube to increase her calories and improve her nutritional status. She has lost so much weight because of TB. This terrible disease has caused her to waste away to a mere 12kg (26lb), at 12 years old. This was her weight upon entering the hospital 3 weeks ago. She is now up to just under 15kg. She has difficulty keeping anything down that she takes by mouth. We have had to give her medications by NG tube as well. She had to have a blood transfusion, which helped to strengthen her. She is finally tolerating the tube feedings now. At first, she had vomiting and diarrhea when she got her feedings.

We are waiting to find out if the latest sputum specimen is negative so that she may be able to go back to the home and get her tube feedings there until she can tolerate the feedings by mouth. Our first challenge is to get her to take her medications by mouth again, without vomiting. She is getting really bored with staying in one room, so Sandra and I try to get her out as much as possible between feedings.

We took her to the park on Saturday. She was only able to play for a short while, before her strength was gone. We got one smile out of her, when she was turning the steering wheel of the pretend train! I went yesterday and gave her addition and subtraction problems to work on. When she got to the higher sums, she started using her toes to count! I was on the phone with Sandra, when I noticed her playing with her toes, then I realized she was counting them when she ran out of fingers!

PePe doesn’t talk much, but she is very smart, and she has a very strong will. That is probably why she has lived so long, as sick as she has been. She will not take her medications by mouth for the nurses. Sandra and I have to remind her that if she wants to go home, she must take her medications by mouth, not the tube.

Tonight, we went to visit, and she had made notes for Sandra, Joelle and I, each written personally with our names on it, spelled correctly, saying that she loves us. I will cherish these forever! I know God has something special for this little girl and I am anxious to see what He does in her life and what she will become in Him! She is certainly a blessing to my life!

Mission of Mercy - Medical Mercy

We had the privilege to host a Medical Mercy team this past week. There was well over 1000 children and adults seen at the five Mission of Mercy CarePoints. The patient flow started with registration, then the medical team, HIV testing/counseling, then spiritual counseling, and then the pharmacy. Tremendous testimonies came out of the spiritual counseling where each patient was prayed for individually. Tremendous testimonies from tremendous hardships and pain. I watched as one crestfallen young woman (17?) came out of the HIV testing bewildered and in shock. Not having to say a thing, I knew what the results had told her. What answers do cold dead religion or an uncaring culture have for her? There is no hope there.
We received the results from PSI from testing during the clinics. PSI and TASC are two agencies here that offer free HIV testing and counseling. TASC will test children. Below are the statistics from PSI. (I know column 1 doesn't add up, I'll correct it when I get updated info from PSI)

CHILDREN’S CUP REPORT - FROM 7 TO 11 APRIL 2008

AGE	15-19		20-24		25-29		30-34		35-39
SEX	F	M	F	M	F	M	F	M	F	M
NEGATIVE	1		2	1	2	1		3	1
POSITIVE	2		6		1	1	3	1	4
Pos %	66%		75%	0%	33%	50%	100%	33%	80%
TOTAL	5		8	1	3	2	3	4	5

40-44		45-49		50+
F	M	F	M	F	M
1		11		8	2
1		2			3
50%		15%		0%	60%
2		13		8	5

Some people walked in to be tested on their own. Most were referred by the medical team. Many people did not test even after the referral. The numbers don't look encouraging.

The tremendous testimonies came from people who recognized that in their hardship and pain, there is One who offers hope above and beyond our present circumstances.