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.

Tema ca. 1964 - 5 July 2009

Tema passed away late Sunday afternoon. A victim of a slow silent disease, poverty, and an overloaded, broke medical system. We did what we could through CHIPS and getting her into the medical system. But in the end, even that did not prove enough to overcome the hurdles of disease and medical non-practice.
Teresa had the opportunity to pray with her a number of times and she came from Christian Family Church in Tambankulu, so we trust she knew Jesus. But it was still very hard as Teresa was by her bedside as she took her last breaths Sunday. Alone. Abandoned by family. We had gone to Siteki and Maphiveni on Saturday to pick up more clothes for her and a month old x-ray that they had failed to send along with her when she was transported to Mbabane Government Hospital. With no family to care for her in the hospital, all her clothes had become soiled from constant vomiting and diarrhea. The hospital supplies nothing. Teresa had met a compassionate lady on the house keeping staff who was doing what she could for Tema. We were going to approach her today to see if we could pay her a little extra to take Tema's clothes and wash them.
Please pray specifically for Teresa. She needs His strength to continue. She has His heart and compassion.

CD4 Count of 3

Then there is the man (Mlungisi) with the CD4 count of 3! A normal CD4 count should be in the 1000’s. I received a call from Lori a few weeks back that this man was very sick and they weren’t sure if he was going to make it through the night. Jabulani took him to the hospital and they gave him IV fluids, as he was very dehydrated. They couldn’t admit him to the hospital, because there were no empty beds, so they sent him back home after midnight. Jabulani had to turn around the next morning and bring him back. They didn’t start him on ARV’s that day because he was still too weak. I went to visit him on Friday of that week, and he was feeling stronger. He was started on ARV’s earlier in the week. When he was walking towards me, I saw that he was literally holding his pants on his body with his hands. He was so thin! When I touched his shoulder bones, it almost felt sharp, because he has absolutely no tissue, only skin over his bones! I could see he was getting tired just standing for a few minutes, so I asked him to sit before he fell. We prayed with him and I felt led to ask him if he knew Jesus. He said that he didn’t, so we explained how to receive Jesus and that He would be his best friend and live in his heart and forgive him of his sins. I asked if he wanted to accept Jesus and he said he wasn’t ready. I told him that all he had to do was to ask for forgiveness and receive Jesus into his heart.
About 2 weeks later Jabulani received word that Mlungisi was ready to receive Christ! Praise the Lord! Pastor La’Salette, Lori and visitors from Phoenix were able to go and lead him to the Lord, as well as several other family members! They have also done some work on his homestead, which was falling apart. What a blessing!
Unfortunetly, about 3 weeks ago, Mlungisi had to be hospitalized. He was able to eat and feeling better. I received a call that he was not doing well and was on oxygen to breathe. I received word that he has gone on to be with the Lord! Although this is very sad physically and emotionally, it is a victory spiritually! He is now in the presence of our Lord and Savior, Jesus Christ! If he had died just 3 or 4 weeks earlier, he would not have gone to heaven, where he is right now! Praise God! Please remember Mlungisi’s family in your prayers!
Sad but True
We have lost 3 of our CHIPS patients in the past month. First was a 19 year old girl who was diagnosed with abdominal TB. She had been hospitalized only for about a week before she died. The day I went to visit her 10th June, she was breathing very rapidly, talking out of her head and looked as if she was scared to death. I asked Jabulani if she had been like this the day before and he said no this is new. We reported to the doctor, who said he would see her. I received word the next day that she had died during the night.
The next one was a man named Patrick, who has been sick for a long time. Jabulani brought him to the hospital on several occasions and they did not admit him. He was finally admitted about a week ago and then he died on Friday 19th June.
The third one is of course Mlungisi, who died the 22nd June, 2009. Although, very discouraging, I know that God is in control and we are doing what He led us to do. So we must keep doing what we know He wants us to do. Please keep all of these families in your prayers, as well as the CHIPS staff. Pray specifically for Jabulani, who is on the front line everyday with these precious, sick people.

Transfer to Mbabane Government Hospital

We facilitated the transfer of Tema to the MGH on Friday. Teresa is working with the doctors she knows here to verify the diagnoses made at Good Shepherd Hospital in Siteki. If confirmed, they will start the process of having her sent to Pretoria to have the corrective surgery performed. The doctors here said they would not be able to perform it here because of inadequacies in the Intensive Care unit. Winter has come with a vengeance this week. It is probably a full 10 degC cooler here than in Siteki now. Tema came with only what she was wearing. The past few mornings have dipped down to 0 degC (freezing for those used to degF). There is no heat in the hospital wards.
Teresa and Joelle went thru some of Joelle's outgrown clothes to give to Tema to help keep her warm. And with only a thin blanket from the hospital, she was shivering when Teresa went to visit her. We took out two of our blankets that we had not been using and gave them to her (I think they were hand made by my grandmother years ago).
Please pray for Tema. We have had three caregivers in CHIPS pass away within the past few weeks. All of these and Tema came into the program very sick and have had to struggle to survive. Three have lost and we feared Tema would give up as well.

CHIPS

Tema is a middle aged woman in CHIPS. She is a caregiver for two children and has no immediate family in Maphiveni. She was hospitalized in April as she was getting too weak to stay at home any longer. We visited Tema in the hospital a few weeks back. She seems to be getting weaker, and giving up hope and she is unable to keep anything down. She says that she vomits everything that she eats. She is so weak, that her voice can barely go above a whisper. She also has an abscess on her hip where she has been given frequent injections for nausea. I asked what we could bring that she felt she could eat. She couldn’t tell me anything that sounded good to her. As I talked to her, tears fell down her face and onto her jacket. She was started on ARV’s in March and on TB meds in January. She is in the isolation ward along with several other women. I was able to pray with her and encourage her to believe that Jesus would heal her and she would be able to eat again without vomiting. I asked her if she believed that Jesus is our Healer, and she said that she did. I asked her to agree with me that He was going to heal this nausea and she would be able to eat without vomiting. While I was talking to her, a woman in the back room was wailing and crying! The nurse that was interpreting for me went to check on her and I followed her. The young girl was very sick and crying that her feet were swollen and painful! I was also able to pray with her that the Lord would heal her and remove the pain! These ladies are so pitiful and so lonely, as not many people visit on the TB ward. I called Lori and asked if she and her visitors from Phoenix could go and visit Tema the next day. They were able to do that and were a great blessing to all of these ladies!

Update Tema

We have now discovered through a recent x-ray that Tema may have an esophageal stricture, which means that her esophagus is too small to get food down it, and that is the cause for her vomiting. We are now in the process of having her transferred to the hospital in Mbabane to have her re-evaluated see if she can be sent to South Africa through the Phalala fund to have surgery to correct the stricture.

The doctor at Good Shepherd Hospital in Siteki wanted us to transport her in the CHIPS khombi to Mbabane. That is something we are defintely not equipped for, so we may have to pay for an ambulance. The cost of just the ambulance trip is around $120USD. Her hospital bill will have to paid at Good Shepherd as well before they will release her. With no family and impoverished herself, that cost will fall on CHIPS (around $150USD). While we do have a small monthly amount budgeted for hospital and drug costs, it is no where near the amount we'll need to help Tema.

May Update!

Dear Friends,
CHIPS continues to expand and have a life saving impact in the areas we are working in now. We have found the children’s HIV infection rate to be about 6% of those we have had tested. That is tremendous news as we expected the infection rate to much higher. For those 6%, CHIPS is the difference between life and death. The infection rate for caregivers however is about 50%. Fully half of the caregivers we’ve facilitated testing for are HIV+. That is an astounding rate. Over time, that would mean at least a doubling of the number of orphans as these caregivers would succumb to the virus and the diseases that follow it.
It is a huge blessing to see someone who was too weak to even stand, now active and able to take care of their children.

As one of our supporters, you are a part of this!

We have taken the next and crucial step in developing the youth skills program. Beginning in May, Daran started teaching the “Money Matters” course originally developed by Peter Kopp of African Leadership Partners. The alternative title is “God’s Answer to Poverty”. The first all-day class was taught at Christian Family Church International in Tambankulu. Roughly 30 people attended that class. Daran is also teaching a 6 week version of the course to fifteen people at the Mbabane UPC on Monday evenings. We have plans to repeat the class at both these churches and to expand to other churches. We’ve been asked to work on an all siSwati version for non-English speakers in the rural areas. We also are in the beginning stages of developing a “Money Matters 2” course. These courses will form an essential part of the youth skills program.

Teresa continues to be active with the Swaziland Breast Cancer Network (SBCN). It looks like there may be funding to proceed with setting up chemo treatment here in Swaziland. Daran is working with several churches here to develop children’s homes based on the New Life Homes model. Each organization faces hurdles in either finding land or finding funding sources. Please pray for the Holiness Union Church that the land issues there will be resolved and for Christian Family Church that Swaziland registration issues will be resolved so promised funding can be made available.
While aid and development work can be good in itself, offering it in Christ’s name can have an eternal impact on those who receive!
Gabby has started looking at colleges in the States. A parent’s lament: it’s hard to believe our “little baby” will be leaving home soon (even if it’s not for another year and a half). Danielle and Nathanael are helping with worship at HPC-Swaziland. Joelle is as loud and boisterous as ever.
We would ask that you continue to pray for our family’s protection: physical and spiritual; and wisdom and discernment for the effective implementation of the programs we’ve started and you are a part of here.
As we look forward to funding requirements through the remainder of this year and into next and we look at support from all sources (one-time and annual gifts, monthly support, stipend from SBCN), we continue to have a monthly shortfall of approximately $1000USD. We would ask that you share this ministry work and vision within your circle of friends and associates.

Blessings & Peace!
Daran & Teresa
Gabby, Danielle, Nate, & Joelle

www.AfricanLeadershipPartners.org

African Leadership Partners, Inc.
PO Box 994044
Redding, CA 96099-4044

CHIPS - Progress!

Sikhumbuzo is a little boy who is part of CHIPS. He is 7 years old, and still very sick. He was born with HIV and His mother is HIV+. He has been treated for TB in the past, but we are not sure whether he completed the treatment. He was started on ARV’s a couple of weeks ago while he was hospitalized. The first time I saw him, his stomach was very swollen and his breathing was very rapid. He was a very sick little boy. Each time I see him he seems a little stronger! I first saw him in church after he was discharged from the hospital. When he saw me, he gave me a big smile, which melted my heart. We visited him this past week at his homestead. He has a runny nose and a cough, and some sores around his mouth that may be herpes. I instructed Jabulani to keep a close watch, and if he was unable to eat or the cough was worse take him in to be checked again by the doctor. It is very important to watch these little ones closely. They seem to get sick so quickly!


Praise God, we were able to bless them with some clothes that visitors from Australia brought for them. Sikhumbuzo's mother was so happy. She also has a daughter who is younger than Sikhumbuzo who is not HIV+. The Prevention of Mother to Child Transmission (PMTCT) program seems to be working!



Baby Joshua is another little one in our program. He is 9 months old and his mother is the sister of Sikumbuzo’s mother. He was in the hospital after Sikumbuzo. His mother is also HIV+. We are not yet sure if Joshua is positive or not. He will be tested again in a few weeks. He was hospitalized for dehydration, diarrhea, and malnutrition. When we visited him in the hospital, he was having horrible diarrhea, and his mother had no more diapers for him. While I was standing there, he had diarrhea all over his mother and my feet. As she was trying to clean him, he was continuing to have diarrhea. We asked the nurses for towels to clean him, but they had none. The nurse brought a diaper that was big enough to fit an adult and it covered his whole body up to his neck. We ran to town to get diapers, towels, and blankets so the mother could keep him clean. When we returned, she was crying. The baby was so lifeless and weak. I think she thought he was going to die. We prayed with her and told her to keep her eyes on Jesus, He will not leave us! Joshua is now out of the hospital as well. We visited him also this week. He was smiling and looked like a different baby! Praise God for answering prayer!
He is still very small and thin, but starting to pick up weight. I instructed his mother to work on his motor skills, crawling, sitting, and standing. She said that he was crawling before he got sick, but has now stopped. This is very common with sick babies and most of the time can be recovered.


And here is the CHIPS Khombi with Jabulani, Lori, Teresa & Daran. Thanks to Claypotts Trust and all our collective supporters that make this possible.

Money Follows Wisdom (and not vice versa)

Daran has started teaching the Money Matters class (God's Answer to Poverty) that Peter Kopp with African Leadership Partners originally began here in Swaziland. The class is set up help people identify and confront cultural and learned behavior towards money and wealth that is counter Biblical. The first day long class was at Christian Family Church in Tambankulu. He is teaching a six-week version of the class at the United Pentecostal Church of Mbabane. We had over thirty in attendance in Tambankulu and are averaging twenty at the UPC.
The first step in addressing poverty is to teach a Biblical perspective on the responsibilities, uses, and accumulation of wealth. But also to show that poverty is a multifaceted problem that has to be addressed as a connected system: material poverty, physical weakness, isolation, spiritual poverty, powerlessness, and vulnerability.
Maybe a key point of the first half of the class is that even our natural talents, abilities, and dreams are resources that God has given us to use and are a starting point for working out of poverty. It was great to see the proverbial light bulb go of in some of their heads that the cultural and learned response to managing resources (or not) was flawed and the Bible offers concrete principles for managing same. The class ends with a look at the family and finances and teaches about budgeting, planning, saving, investing and borrowing.
Daran has started researching a "Money Matters II" class that will begin where this one left off in teaching business and entrepreneurial skills, business ethics and morality (with the Bible as the moral compass), critical thinking, and problem solving.

A Grieving Father

Sorry, this is a father's reflection. When our children were younger, we set boundaries and basic "game rules" to make sure nobody got hurt. And when they did have the cuts and scrapes, the hurt was short lived. But we still wanted to take on their pain and "make it better". As they grow older, into young adulthood, they must learn to set their own boundaries. Hopefully we did a good job of instilling a knowledge of right & wrong, a correct and valid moral compass to gauge their world, but ultimately, they set the boundaries. Or push the boundaries. So now when they get hurt, as much as we want to come along side and "make it better", we can't. Pretty much all we can do is stand and watch. And grieve.
It struck me that is what God does with us. The Bible speaks about God's heart being broken because of our own obstinance and pride. In Luke, Jesus is quoted saying: "O Jerusalem, Jerusalem, .... how often I have longed to gather your children together, as a hen gathers her chicks under her wings, but you were not willing!.." Jesus knew full well what was in store for Jerusalem. But because of their embrace of religions form and function and their rejection of the heart and spirit of God's plan, they doomed themselves to banishment and destruction. And all Jesus could/would do was stand to the side and watch. Grieving.
How often do we turn from what we know, from God's desire, to go and do what we want. Obstinance and pride. How often do I break God's heart by my actions, choices, inaction, thoughts, words, and deeds? And while we continue to love our children, God even continues to love us; while we wait and hope for our children to make right choices, God waits and I dare say hopes we do as well.
I'm looking to the day of no more broken hearts. I'm sure God is too.

They are all No Codes!

As an oncology(cancer)nurse in the states, if a patient or family agreed that they didn't want to be resuscitated, they signed a paper saying that they were "no code" status. Which means that if they stop breathing and their heart stops, no CPR, or resuscitation measures would be taken.

Most patients in the states want all measures taken to resuscitate them. When a patient that is not a "no code" stops breathing, and/or their heart stops; a code is called. A team of nurses and doctors rush to the scene and do everything possible to bring this person back.

I was on the ward today at the Government Hospital, visiting a couple of our breast cancer patients. One of them had a mastectomy a couple of weeks ago, the other one was getting ready to go to (theater)surgery, to have her mastectomy today.

While we were visiting, I heard a lady crying out "MaMa!","MaMa!". I thought that it was someone having a nightmare or talking out of their head! Then I saw a woman standing by the bedside of an older woman. She was shaking the woman and crying out for her to wake up. The older woman was limp and not breathing. She had a large bandage on her neck. I realized that the older woman had just passed away and her daughter was calling for her in a panic! Finally, the nurses made their way, casually, not hurriedly, to the patient and pulled her daughter away. They layed
the patient down flat and covered her head with the sheet, and closed the curtain around her bed.

"I thought, is that all, is that it, you are not going to do anything else?" I wanted to run and get the crash cart, call a code, and try to save her. I looked around the room full of patients. The wards here just have bed after bed, no individual rooms. None of the other patients were reacting at all. Their faces were blank, no emotion! I was amazed! It was as if nothing was happening!

I asked the nurse that was visiting the patients with me if they ever try to resuscitate patients when they stop breathing, intubate them,or try to do CPR? She said, no usually they can't even get a doctor to come and they don't have the proper equipment to intubate them.

This was a HUGE REALITY CHECK as to where I am working! I realized that they are all No Codes here! How very sad! I also realized that they see death so much that it doesn't affect them unless it is their own family. I was able to go back to the ward later and I saw the daughter sitting in the hall on the floor. I told her I was so sorry for her loss and asked her if I could pray with her. She said yes and I prayed and gave her a big hug! I asked her if she knows Jesus and she said yes.

Zodwa

Zodwa Hlope is a 45 year old woman who had a cervical biopsy in March of 2008. She only received the report from the biopsy in February 2009. The Central Laboratory in Manzini had difficulty finding her report. She now has stage IIIB cervical cancer, which is an advanced stage, after waiting so long for a diagnosis. She is having severe pain all around her waist, difficulty urinating, bleeding from her vagina, and is feeling very weak. This lady is a single mom with 4 children at home, 2 in primary school, and 2 in secondary school. The oldest is 16 years of age. Zodwa is no longer a candidate for a hysterectomy since the cancer is so advanced and is now growing outside of her cervix. She has great difficulty sitting and walking because of the pressure of the tumour. She needs to go to South Africa for chemotherapy and radiation to shrink the tumour before anything else can be done.
While I was visiting her in the hospital, her 14 year old daughter came to visit. The girl had been beaten by an older male relative, who thought that since Zodwa was being sent to South Africa for treatment for cancer (and would surely die), he could kick the kids out of the house and take over the house. She also received a letter from her son’s school that she must pay E2, 500 in order for him to stay in school. She is asking for assistance with school fees for her son. This is just one more issue for this sick mother to worry about while going to South Africa for treatment.
She received word from the SMO’s office that she should be going to South Africa this week, if can get all medical visa issues completed. Her children will be left alone, except for her sister and mother who live nearby and check in on them from time to time.
It was such a blessing to be able to visit Zodwa in the hospital. I was able to minister to her and pray with her about her needs . She was so grateful every time that I was able to go by and see her. I gave her a devotional book that has scriptures for circumstances that we go through in life. When I came to see her the next time, she was so glad that she had the book to encourage her in the Lord. Her family was supposed to bring her Bible to her from home, but they forgot, so she was thankful that she had the devotional book.
In the picture is her mother, her sister, and a friend. A friend of mine and I were able to pray with all of them as well! She has started her treatments in South Africa by now. I will give a follow up as soon as I hear from her again! Please keep this precious sister and her family in your prayers. Let’s pray especially for the protection of her children and that her treatments go well with good response!

Note to Susan

Teresa. Remember where you are. I know that you want the patients to receive the same care as they do in the states. But, is that realistic? I think that you should pray and ask the Lord to direct you. You know that nothing happens in God's world by mistake.....Everything, if it is supposed to, will work out just fine. It is NOT up to YOU but to him all things are well done....You are not alone. He called you there. He will help you, believe in him....
Love you! Susan

---

I would rather have the calculators, I think they would be more accurate, but whatever you can find will be fine. I just wanted to throw in the towel and quit on Thursday. I get so frustrated, the surgeon won't answer his phone and won't return my calls. We have several very difficult cases that I need to discuss with him and my oncologist is leaving on Monday to go back to Cuba for 6 weeks. I really feel like it is all on my shoulders. One lady had a lumpectomy which came back as ductal carcinoma, the oncologist said that he could only get part of the tumor. He knows there was still disease there, as well as positive lymph nodes. Her mastectomy specimen got sent to the government lab instead of the private lab where we send breast specimens. The report came back that it was fibrocystic disease and no lymph nodes reported on. The oncologist says this report does not belong to this patient. I can't fight with the pathologist, I need the surgeon to call and take care of this. Another case, the surgeon says the tumor is too big to do a lumpectomy. Her FNA came back as hyperplastic ductal cells, which my oncologist thinks is probably cancer. He wanted the surgeon to do a lumpectomy for a definitive diagnosis. The surgeon says he needs to do a core biopsy, but doesn't' have the needle to do it. So I am checking with the private hospital to see if they have it. This patient needs chemo and RTX before mastectomy, but we can't send her to south Africa for chemo without a definitive diagnosis. I just feel so helpless sometimes! Thanks for trying to get these for me! Keep me in your prayers, please!
Teresa

Moringa

On Friday, we went to Tambankulu for the day. Teresa went with Jabulani into Maphiveni to visit CHIPS children and caregivers. Jabulani wanted to visit those who are getting ready to start ARV's and those who have just started to encourage them, and one more time, talk to them about adherence (taking the meds at the prescribed times every day (at least until there is a cure for HIV). Teresa really enjoys getting to visit at the homesteads and meet with the families one on one. It is a good chance to minister and pray with them.
An ongoing problem is improving nutrition for those who are HIV+ and starting on ARV's as well as the whole community in general. We have been asked if we will provide food to those in the CHIPS program. Besides not having the resources to give out food, this is really a non-sustainable and counter productive effort to promote nutrition. While a help in the short term, handing out food will never be a long term solution to the needs here.
We've come across another organization here (SwaziAid) that is introducing another approach in Swaziland. A multipurpose tree called Moringa is being introduced in several areas here. The leaves of the tree are highly nutritious and when used as a food supplement, can greatly help the nutrition value of the staple diet (a fine ground corm meal called pap).
The country rep for SwaziAid (Thokozane) accompanied us on Friday from Mbabane. We planted a "high density" 5mx5m plot of the seeds at Pastor Duarte's garden in Tambankulu on Friday. Hoping all the seeds germinate, in three months we should have meter tall trees that we can start harvesting the leaves from. Once dried and powdered, we'll introduce the powder as a food supplement in the communities CHIPS is working in. In time and as demand increases, we hope to be able to introduce the trees into the community so they can grow them themselves. As another positive by-product, this could also be a means to generate income for the homesteads as they can sell surplus powdered leaves and seeds (which are also a good source for cooking oil).

Mother Bear

We had the privilege of taking Connie Parker, the wife of the American Ambassador to Swaziland, and Vanessa from the American Embassy to the Vuvulane area in eastrern side of Swaziland. The two areas that we visited are both squatter camps fit between breaks in trhe sugar cane fields here. Both are full of extremely impoverished people. Connie and Vanessa both said that these were the poorest areas that they had seen since being here in Swaziland. These are the areas that we will take the CHIPS program into next.
Connie and Vanessa are working with the Mother Bear project which provides beautiful hand made bears for children either affected or effected by HIV. These bears are all made using the same pattern, but all have the unique touch of their own individual makers. The bears are sent from the United States with love to bring comfort to these children.
We got many smiles and giggles from the children blessed by these bears. They were all very happy to receive the bears and we are very grateful to the women (and men) who made these bears and sent them to be a blessing to the children of Swaziland!
Accompanying us on the visit were Pastor La'Salette Duarte from Christian Family Church in Swaziland who works in this area, Lori (who took these wonderful pictures), and Jabulani, the CHIPS driver.
Thank you Connie and Vanessa, and the US Embassy for making this possible, as well as all of the people in the U.S. who made the bears! May God richly bless you all!

January Update

CHIPS

The CHIPS (Children’s HIV Intervention Program in Swaziland) is envisioned to be a way to help the 15,000 children in Swaziland who are HIV+ (age 0-14, 2005 estimate). A number we can assume has only increased since then. The goal of the program is to make the available health care accessible to these children and their caregivers.

Jabulani was hired and sent to training for HIV counseling last year. He began working in the Maphiveni community mid-December to generate awareness and help the community to start identifying children who would be candidates for testing. Through the end of January, 141 children and caregivers were transported to the Good Shepherd VCT Clinic in Siteki (84 children, 57 caregivers). Of these, 9 children and 28 caregivers tested positive. Two things to note: as our pre-screening of children improves, the percentage of HIV+ children taken for testing should improve; the second thing is the high percentage of caregivers that are positive. The percentages for adult HIV infection in Swaziland range from the mid twenties to the low forties, depending on whose numbers you choose to use. These high percentages are reflected in the high number of caregivers we are seeing that are positive. It also shows that PMCT (Prevention of Mother to Child Transmission) programs are showing some effectiveness in stopping HIV from being passed to more children (GOOD NEWS). We have chosen to continue to keep these caregivers in the program even though the children they are responsible for are not HIV+. It is essential to keep these caregivers healthy so they can actually care for these children. Swaziland does not need any more orphans!

Kudvumisa Glass Youth Skills Program

Few jobs, poor education, no dreams and nothing to look forward to are a potent mix for promiscuity, sex-for-food, HIV infection and a whole host of other destructive attitudes and behaviors. This is what a large segment of the youth in Swaziland (and for that matter southern Africa) have to look forward to.

We are continuing to develop the skills training program. The goal of the program is to help the youth develop healthy attitudes, uncover their God given talents, abilities and dreams, and develop business and entrepreneurial skills based on Biblical principles of management and finances. We are working with one young woman from Manzini now. She has spent almost a year working with glass etching and has developed a reasonable level of skill and technique. We hope to be able to expand the program to include more youth, classroom space and a computer lab this year.

With that in mind, we will need a teacher who can who can work in the classroom to teach the business and computer skills. So if you would want to invest some time in a project that can truly change lives and you have teaching skills, please pray about this! Of utmost importance is to disciple, teach and nurture a Swazi who can perform these tasks as well.

Family

Teresa is working with the Swaziland Breast Cancer Network (SBCN) to develop a treatment program for breast cancer in Swaziland from scratch (i.e., there is nothing here now). They are also hoping to start a cervical cancer program, again nothing exists here now for treatment (and very little in diagnosis). There is believed to be a high correlation between cervical cancer and HIV. Daran continues to preach at the Christian Family Church in Tambankulu under Pastor La’Salette Duarte. He has also received an invitation from a local church in Nkoyoyo. All the children are back in school, starting the new year. Gabby has started year one of the International Baccalaureate program while Danielle and Nathanael begin Form 3 (grade 9) at Waterford. Joelle begins grade 5 at Sifundzani Primary. They are all involved in church, soccer and various other sports at school.

We would ask that you pray for two things for us here (if God puts more on your heart, please be obedient): protection: physical and spiritual; and wisdom and discernment for the effective implementation of the programs we’ve started here.

Daran’s trip back to the States last year was a great success and we are grateful for everyone who helped make it one. He met many new friends who made him feel like family. As we look forward to funding requirements through the remainder of this year and into the next and we look at support from all sources (one-time and annual gifts, monthly support, stipend from SBCN), we still have a monthly shortfall of approximately $1000USD. We would ask that you share our ministry work and vision within your circle of friends and associates.

Blessings & Peace!

Daran & Teresa

Gabby, Danielle, Nate, & Joelle

www.AfricanLeadershipPartners.org

African Leadership Partners, Inc.

PO Box 994044

Redding, CA 96099-4044

"New" Bike for Banele

We gave Joelle’s old bike to the orphanage where Pepe and Banele are living now. Sandra, a friend of mine from Children's Cup, took the bike and had the brakes fixed, air in the tires, etc, to get it into good working condition. Banele has been asking for a bike for a while. We took it to him this past Sunday. It was a delight to watch all of the kids attempt to ride the bike. Sandra and I did not think about them never having the opportunity to learn to ride a bike before. They enjoyed chasing after each other on the bike, fighting over whose turn it was to ride, and posing for pictures with the bike. They sang for us, gave of lots of hugs, and smiles, and taught us how to play hand-clapping games. It was a pleasure to see them enjoying themselves with their new gift!

Pepe is going into grade 4. She did well the last term of grade 3, when she returned to school after being out for several years while she was fighting multiple pneumonias and TB. She is now healthy and strong, and happy! It was so comforting to see her smiling, talking, and playing! A year ago, she was not able to do any of these things. Banele has also improved greatly in this past year! He is healthy, strong, and happy, as well!

Children's HIV Intervention Program in Swaziland

Sorry I have not put anything out for a while. The holidays are over and we are back in full swing! The CHIPS program has started and is going well. We are concentrating now in the community of Maphiveni. As we work out all the procedures and protocols. we'll begin expanding into neighboring communities. Since our start up in December, we have taken 141 people, (children and caregivers) to be tested for HIV. Eighty-four of the 141 are children; the remaining are caregivers. Twenty-eight of the caregivers tested positive and nine of the children tested positive. We have been pleasantly surprised at the low number of positive children so far. The highest percentage of HIV+ people here in Swaziland are between the ages of 25-45. We believe it is very important to make HIV treatment for these caregivers accessible so that they live healthy and productive lives to be able to take care of the children under their care.

There is one little boy that touched my heart last week with his big swollen belly (ascites). He is very sick and his CD4 count is very low, which means that his immune system is very weak and he needs to start on treatment as soon as possible. Unfortunately, the machine to check the chemistries (blood work that shows kidney and liver function) has been broken for a month now. They are very hesitant to start them on treatment without this blood work. We have been transporting blood samples back to the city of Mbabane, where the blood can be tested.

I brought some samples in on Friday afternoon, to find out that they did not accept samples after noon on Fridays. I thought, oh, no, we do not need any delays for this little one. We had already drawn his blood the week before and the results got lost in the system, so we had to re-draw them and we had to stick him twice this time. All I could think was, surely we will not have to do it again! I took the blood to the private clinic lab and spoke to the manager, who I know from my work with the Breast Cancer Network. It just so happened that her husband is the one that is working on the machine in the hospital where we take them for treatment. She said he should have it working by next week. She also said that she would run the tests for us without charge and the results would be ready in one hour! I wanted to shout, “Praise the Lord!” God is good and He is in control, even when we feel very out of control!

I sent the results back down over the weekend and the boy, along with several others, should be starting on treatment soon! Please keep this program in your prayers, as we move forward. We are praying for God’s divine wisdom and guidance!