Aggressive Anti-Viral Therapy Could Derail Spread of AIDS - Health News | Current Health News | Medical News - FOXNews.com

Treat HIV infection to stop spread vs. just treating a late stage disease! We've often wondered why this approach hasn't been taken to decrease the number of new HIV infections.

Aggressive Anti-Viral Therapy Could Derail Spread of AIDS - Health News | Current Health News | Medical News - FOXNews.com

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Hope

I am writing today about one of the breast cancer patients, who we'll call Hope. She is 38 years old and was diagnosed with breast cancer last year in September. She came with a large tumor and she was also pregnant. The Cuban oncologist and surgeon wanted to abort the baby right away to save the mother. She already has 3 other children, and they thought that it would be better for the other 3 children to have a healthy mother. You see, the same hormones that are high during pregnancy, also feed the breast cancer and make it grow and spread. So, we had a meeting with the oncologist, surgeons, and gynecologists at the government hospital. The gynecologists did not want to abort the baby, mainly because it is against the law in Swaziland and they did not want to have to plead her case with government. They didn’t believe that it was a matter of life or death for the mother, which is the only way the government would allow an abortion. The oncologist and surgeons did believe that it was a matter of life or death for the mother. We decided to get a second opinion from an oncologist in South Africa.
The oncologist in South Africa said that she could give her chemotherapy since she was in her second trimester of pregnancy. So, the mastectomy was done first on September 10th, and the paperwork for getting her to South Africa was started. During this time, the oncologist in South Africa had stopped taking patients from Swaziland because the government hadn’t payed her in 5 months. It was becoming very expensive for her to continue buying the chemotherapy without reimbursement. So there were many patients waiting to go to South Africa for treatment by the time things were settled between the oncologist and the Swaziland government. The hospital transport was really busy and patients had to wait a long time for the appointment for transport. Patients need to start chemo within six weeks after the mastectomy. Many of them were way over that time frame. Hope was one of these, but the doctor said to send her anyway and she would see her. By the time she got to the doctor in South Africa, on the 2nd of December, she already had metastatic disease, which means that the disease had spread to her lungs and to a lymph node in her left clavicle area, above her chest.
The doctor was planning to start treating her before Christmas. She was scheduled to take hospital transport on the 21st of December. She traveled across the country to the hospital, ready to go, and there was no transport (the driver never showed up). Then she was scheduled again for the 4th of January, again, no transport (same story). By the time we saw her in clinic again on the 14th of January, she was very weak and short of breath. Also, we found something suspicious in her other breast. When we checked with the hospital transport, the next available date was the 26th of January. She was so afraid, weak, and crying. By this time, she was 32 weeks pregnant.
We (oncologist, nurses, and surgeon) all sat and felt like crying ourselves! What do we do now? Then I remembered that Daran (my husband) was going to South Africa the next day to pick up friends from the airport. I decided that I would go with him, and take the patient. I called the oncologist in South Africa, who was on leave, but had been corresponding with me via email. She told me to bring her and she would make the arrangements with her partner.
So, we started our trip to Johannesburg, South Africa the next day. I was able to talk to her about the Lord, a little bit, enough to understand that she does know Jesus and to tell her that we have people all over praying for her and her baby! That brought a big smile to her face. She was also complaining of sharp pains in the area of her mastectomy. At the border, she was so weak, I had to help her walk, and she couldn’t stand in line for very long. By the time we made it through the border, she was exhausted, especially since she had already made a 2 hour trip with public transport that same morning just to get back to Mbabane. She slept in the car. About an hour into the trip we had car trouble, but praise the Lord, we finally made it! She was admitted to the maternity ward, and I had to leave her soon after arriving to the hospital. We still had to go get our friends and get back to Mbabane before the border closed at 10pm and it was getting late. She didn’t want me to leave, but I told her that we were praying and that I would call and check on her. She is in good hands, the Lord and the doctors there!
Please keep Hope and her baby in your prayers! I believe that the Lord will protect this baby and bring healing to this mother, in the Name of Jesus! I will keep you posted on the progress of these two who are both very precious in the eyes of our Savior!

CHIPS Moves into Macethuka

A week ago we made our first official CHIPS visit into Macethuka. Macethuka (which means 'sleeping on your back') is a settlement of sugar cane farm workers who work in Vuvulane, a sugar cooperative. The people here are living as squatters, but allowed to stay as long as they work in the fields. Over seventy people attended our CHIPS introduction meeting. Teresa discussed the purpose of CHIPS and who is eligible to participate: primarily HIV+ children and/or HIV+ caregivers to the children.
Daran took the opportunity to address the men of the community to encourage them to take responsibility for their health. They, like most men around the world, wait till they are literally on death's door step before they will admit they need help and seek health care. It is a sign of weakness to seek medical help! For many that means a death sentence. In early January we received another message from Jabaulani that yet another man from Maphiveni (in his early 40's) had died just a week from being initiated on Anti-Retro-Virals (ARV's) with CHIPS. He had waited too long to seek help.
This past Friday, Jabulani and Mary visited Macethuka again to begin the process of registering people into the program (those who may already know they are HIV+) and to begin the process of educating and identifying children and caregivers who should be tested (because of ongoing health issues, family history, etc).
Mary was hired in November to give CHIPS the capacity to expand into additional communities. This is the first of two additional communities we'll move CHIPS into this year. Mary also brings the expertise to begin HIV testing in the community. If we can test in the community, it will reduce the number of people-trips required to Good Shepherd Hospital's HIV testing centre and make more seats available on the khombi (passenger van) for other CHIPS participants. We do however need to purchase an additional vehicle so Mary can get to these communities. We would ask that you would consider partnering with us to facilitate this. A decent vehicle that will survive the gravel roads will cost us about 35000 Emalangeni (about $5000 USD). CHIPS saves lives.

Syncretism

Syncretism - Reconciliation or fusion of differing systems of belief, as in philosophy or religion, especially when success is partial or the result is heterogeneous. Free On Line Dictionary
Christianity in Swaziland is a mix of traditional religions (primarily ancestor worship) and the fundamental principles or concepts of Christianity. According to the CIA World Fact Book, the Religions in Swaziland are: Zionist 40% (a blend of Christianity and indigenous ancestral worship), Roman Catholic 20%, Muslim 10%, other (includes Anglican, Bahai, Methodist, Mormon, Jewish) 30%. What these "official" statistics fail to show is that large percentages of the non-Zionist sects are still influenced greatly by ancestor worship: maybe not at an official level, but by a large number of the adherents in each of the other groupings. We have come across many people in working here that will consult a sangoma, go to the hospital, and also have a Christian pastor pray for them. It's called covering all your bases. A sangoma is different from an inyanga. An inyanga is primarily an herbalist: using medicines made from plants, herbs and animals. A sangoma relies on (ancestral) spirits to guide them in finding a cure. A Swazi pastor we respect greatly has told us he refuses to consult an inyanga because he is unsure where the spiritist and the herbalist draw the line (he is also in line to be a chief but has totally turned his back on his family line because of the ancestor worship and spiritual aspects of becoming a traditional chief).
So why this discourse?
I sat in a meeting yesterday where a very educated Swazi woman told her story of becoming a sangoma. It was interesting and she has every right to make those choices. However, the one thing that I found astounding was her proclamation that she was also a born-again Christian and saw no conflict between the two: a follower of the risen Jesus Christ, son of the Living God and listening to spirits of dead ancestors who guide her. Syncretism. Her defense was a reference to John the Baptist and that we still read what he said in the Bible 2000 years later(?). (I don't think most of us made the connection.)
From the beginning, Judaism had to battle the pressure of the "chosen people of God" to remain faithful and separate from the pagan religious practices of the nations that surrounded them. Ultimately the vast majority of them failed: thereby the judgment from God and the destruction of their temple and deportation to various other kingdoms. Christianity, whether Western or Swazi faces the same pressures: being faithful and separate from the practices of the surrounding pagan or Godless culture or trying to syncretize the two. The synctretization of Christianity and traditional Swazi ancestor worship flies in the face of Biblical truth. We have met very few Swazi's who are still not influenced by it at a high level and many less who will denounce it outright.
But, even as westerners, we probably do the same thing with different inflences, only more subtly. We need to be on our guard to protect the truth the Bible teaches without selectively ignoring or diluting it to match our selfish preferences!
I would ask that you pray for the nation and king of Swaziland. There are many examples in Kings and Chronicles of kings who chose righteousness and a break from the pagan practices that preceded them and the blessings that flowed because of it. 'nough said

Fana 1981 - 10 November 2009

The young man we spoke about in the last update passed away on November 10. We visited him on Friday, prayed with him and tried to teach his family how to care for him. One thing Teresa stressed to them was how important it was that he continue drinking. He had already stopped eating because of the sores in his throat and mouth. On Saturday we got a call that his family had called and he had stopped drinking as well. Jabulani put him in the CHIPS khombi and took him to Good Shepherd Hospital in Siteki. He was admitted.
We got the call on Tuesday that he had died.
He was slated to start on ART (Anti Retro-viral Treatment) on Thursday.
It is a shame that most men (and plenty of women as well) will live in denial until they are too weak to even respond to treatment. At that point HIV really is a death sentence.
Our hope and prayer is that even for those who choose to ignore the situation (and maybe the obvious), we will still have the opportunity to minister and demonstrate Christ's love to them and their family in an obvious way.

Children's HIV Intervention Progam

On Friday's we typically head to Tambankulu to visit with Jabulani (and recently hired Mary) who do the day-to-day operation of C.H.I.P.S. Yesterday we caught up with them at Good Shepherd Hospital (GSH) in Siteki. They had brought 6 people to the VCT for initiation, CD4 results, and doctor visits.
While there we visited with Sikhumbuzo, a 7 year old boy on CHIPS. He had been admitted earlier in the week for yet another bout of bronchial pneumonia. Teresa went to see him in the children's ward. He was eating with the other children and watching TV. Teresa gave him a hug and commented how clean and fresh he smelled. He was being taken care of by a person on the hospital staff, who also cares for upwards of fifteen other children. His mother doesn't come visit him at all. We were thinking he is taken better care of at the hospital than at home. He was recovering well and would probably be released next week. CHIPS will help cover his hospitalization costs.
From there we went with Mary to visit a bed ridden man on CHIPS in Maphiveni. His wife has been with CHIPS and on ART for several months and is doing very well; she is healthy, (very) pregnant and very close to her due date. He on the other hand has (like most men) lived in denial of any health problems (and maybe especially HIV) till it is almost too late. Now completely bed ridden, barely eating (because of sores in his throat), he is wasting away. We delivered adult diapers, gloves, and Oral Rehydration Salts given to CHIPS by the Home Care outreach at GSH. His CD4 count was 130 at the last test. He is scheduled to be initiated on ART next week.
Teresa knelt by his bed (blankets on the floor) with Mary to go over his medical condition and giving his wife and relatives instruction on how to best care for him. He should have been admitted to the hospital, but there are no free beds.
Teresa took the opportunity to talk with him about Jesus. Mary interpreted. He was too weak to respond.
Given he won't even be initiated on ART till next week and he is already so weak and has progressed so far with the disease, his chances of survival are small. We honestly don't think he will make it till next week but are hoping he makes it to ART initiation and begins to recover once on drug.
Please partner with us so we can reach children and caregivers much earlier in the disease progression. Their survival depends upon reaching them early and beginning ART early.

Moringa Study

As a supplement to the CHIPS program, we are growing a new food supplement, called Moringa. It is a tree that grows green leaves that are full of vitamins and minerals that act as a wonderful food supplement, especially to the HIV positive population. We have a crop that was planted in Pastor La'Salettes garden in February. We just harvested our first crop last week. The leaves are dried and pounded into a powder to be used as a food supplement. We are planning to distribute this powder to the surrounding communities through La'Salette's church. Once people start using it and see the benefits, we would like to teach them to plant a crop and take care of it and possibly be able to harvest for their own use, as well as be able to sell it as an income generating project for their families. Assistant Pastor Jabulani at Christian Family Church in Swaziland has been tasked with taking care of the plants, harvesting and drying the leaves, and pounding them into powder.
Ed Lin, with Impala Development Services has helped spearhead introduction of Moringa in Swaziland. He would like to do a research study with the children in our communities comparing the differences in body weight, arm circumference, disease assessment, etc. He would like to compare children taking Moringa on a regular basis with those who are not. This should be an interesting study. We will do monthly assessments for 6 months, hopefully utilizing a student nurse to assist us.

Kudvumisa Glass - Life Skills Training

These are some of the primary challenges youth face in Swaziland today:

• A culture that stifles innovation and creative thinking.
• An education system that does not have the infrastructure or capital to educate the children through primary or secondary grades.
• Rampant under and unemployment.
• Children growing up lacking the moral and social knowledge and life skills normally passed on to children by parents because of the loss of all or nearly all family members to AIDS.

In answer to this, a program whose goal is to help break the cycle of poverty is essential. Our approach is three-fold: 1. teaching personal and fiscal responsibility through a course entitled Money Matters , a second course we have developed which picks up with the practical implementation of the Money Matters course, 2. Participation in a working business model under Kudvumisa Glass, and 3. using Kudvumisa Glass to help develop the creativity and stimulate the imagination of the youth in the program.
We want to impart and establish lasting Godly principles in these youth that will change their lives by teaching sustainable business and personal skills; for these youth to move from a position of poverty and dependency to self reliance and confidence.

So I'm putting this out for prayer. I believe that art (art therapy?) can play an important role in reaching the goal of #3 above. If you have that skill and the desire to use it in a completely different arena than where you are right now, would you consider praying how God may be able to use you here in Swaziland? The youth in this program (and pretty much country wide) have experienced deep trauma due to loss of parents, siblings, exploitation, and drug and alcohol abuse. I'm an engineer with an engineer's approach. It would benefit the youth in the program to have art taught by someone who can use it to help heal the wounds of everyday life here.

CHIPS program

The Children’s HIV Intervention Program Swaziland is growing! We have approximately 150 to 200 patients on the program now. This includes children and caregivers. There are also many challenges with this program. Many of the adult patients that we have enrolled on the program have advanced disease, and many times it is too late for the ARV’s to be effective. We need to start doing more education in the communities to promote early diagnosis. Another challenge is to decide when a patient is dying, is it better to leave them at home with their family, or admit them to the hospital, where the care is sub-standard to die alone? Also, how much responsibility should we take, as far as paying for hospital admits, expenses surrounding death, such as casket, morgue fees, funeral, transport for family members, etc. This gets very expensive, and we need to manage what God has given us for this program appropriately.
We are now beginning year 2 of the CHIPS program, and we are ready to hire a second person so we can further expand. Jabulani has done an excellent job running the program. He is a patient advocate in many ways. When there is an issue with a patient or with the system, he isn’t afraid to go to the top to get the issue resolved. He contacted the TB Coordinator for the region, when he didn’t get the solution needed for the care of our patients. He helps at the hospital with counseling in the HIV clinic, which helps move our patients through faster, and also builds alliances in the system. The staff know they can count on Jabulani to pitch in and help them, so they are willing to help with our patients as well.
We have begun interviewing for the second position. Please pray for wisdom for us as we interview and choose our 2nd counselor for CHIPS. We want the person that God wants for us.

Two Steps Forward; Ten Steps Backwards

I found out last week that the mastectomy specimens at the government hospital, which have for the past year been sent to the private lab and been paid for by Breast Cancer Network, are now being sent to the government lab again. The reason we send them to the private lab is that the government lab takes months to get results back, and we get results back from the private lab in 7-10 days. For Zodwa, it took the government lab 11 months before her pathology report was available. This is just not acceptable for cancer specimens. Evidently, the pathologist has convinced the powers that be, in the government system that he is able to get reports back in 15 days. I spoke to the surgeon and told him, this just isn’t true. The last one that was sent on the 30th of July still wasn’t ready on the 8th of September. This is extremely frustrating to me, especially since it causes our patients treatments to be delayed. Please pray for wisdom for us in this situation! We are planning to keep track of the data, when specimens are sent and when reports are available and report this to the Principle Secretary of the Ministry of Health. I am just concerned about how many patients treatment will be delayed and outcomes affected!

Ethical & Moral Dilemma

We are doing two weekly breast cancer clinics in Mbabane and Manzini each week. This is an opportunity for women to have examinations free of charge . A lady in her mid-to late thirties that has just been diagnosed with breast cancer, just informed us that she is 3 or 4 months pregnant. She has small children at home to take are of as well. This is a very difficult situation, because the same hormones that sustain the baby, also cause the breast cancer to grow and spread. So if she continues with the pregnancy without treatment, the cancer grows and spreads. However, if we give her treatment during the pregnancy, the baby is compromised. I am very much against abortion, however, in this case, I don’t know what the right answer is. I have discussed my feelings with the doctor, but ultimately, the decision is not mine. Please pray for wisdom for the doctors and the lady in this situation, and for God’s perfect will to be done!

Late addition: we had a special meeting on Saturday with the doctors to discuss her case. It looks like we will be able to give chemo in the third trimester that may not affect the baby!

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.

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.