APPE in Swaziland

Combating an Epidemic in Swaziland

It’s a desperate scene.

People lined up along the wall of an overcrowded hospital, most coughing and wheezing, some crying, struggling to breathe. Some tightly wrapped up in blankets; others being rolled in wheel barrels by loved ones, curled up in fetal positions, sweating and shaking profusely from the chills, fatigue, and fevers brought on by late-stage AIDS.

This is what sixth-year student Katie Conklen saw every day during a 13-day rotation at Raleigh Fitkin Memorial Hospital in Swaziland, Africa.

“(Some people) couldn’t even get up the steps. It was awful,” she said.

“And you want to do so much, but you can’t,” she added, with a sigh. “We just provided supportive care. That’s all we could do.”

Conklen was joined on the Advanced Pharmacy Practice Experience (APPE) trip by fellow sixth-year student Belma Muharemovic, Dr. Kenneth Schafermeyer, Ph.D., professor of pharmacy administration at the College, and Dr. Kevin Mallinson, Ph.D., professor at Barnes-Jewish Hospital’s Goldfarb School of Nursing. Mallinson, who has made over a dozen trips to Swaziland, asked Schafermeyer to join him, who, in turn, invited Conklen and Muharemovic to come along for APPE experience. Schafermeyer had a specific assignment from Swaziland’s Ministry of Health to develop a pharmacy assistant program at Southern Africa Nazarene University in Manzini, Swaziland.

Schafermeyer said that in four meetings, he helped college officials “define credit hours for the program, what level of knowledge they needed and what they wanted to achieve.”

He chose Conklen and Muharemovic to join him after working with them on International Service Learning Class trip to Costa Rica last year. He is in the process of starting an international studies department at the College, with more trips to come.

During their trip in May, the students and professors found themselves in the middle of an HIV epidemic of historic proportions. According to the Central Intelligence Agency’s World Factbook, Swaziland recently surpassed Botswana as the country with the world's highest known HIV/AIDS prevalence rate at 25.9 percent of adults. Over 50 percent of adults in their 20s are infected with HIV. Not surprisingly, the country has one of the lowest life expectancies in the world at 49.42 years of age. The United Nations Development Program has written that if the epidemic continues unabated, “the long term existence of Swaziland as a country will be seriously threatened.”

Despite these disturbing facts and figures, Conklen saw hope in the country’s people.

Sitting in a well-lit, air conditioned hospital cafeteria in Springfield, Ill., talking over a chicken salad ripe with bright red tomatoes and purple onions, Conklen spoke about how the people of Swaziland seem to do some much with so little. She noted a man without a college education who started a clinic for nurses infected with HIV.

“They were having problems with the health care workers who were sick and not (seeking) treatment because they were embarrassed,” Conklen said. “They were supposed to be taking care of (others), but they also had HIV.

“Now they’re starting clinics (in all) the hospitals for these health care workers,” she added. “It’s very effective.”

Conklen talked to a farmer with AIDS that helped tend the garden at an HIV clinic. He was near death before the clinic treated him. Like many, he never got tested for HIV although family members had contracted the virus.

“After he got better, he grew heads of lettuce like I have never seen before,” Conklen said, stretching her arms out wide and wrapping them around an invisible lettuce head. “He said, ‘Well, why don’t I start gardens at these other clinics to provide food?’

“He just randomly thought of this. Now it’s a food source that helps provide for these clinics,” she added.

Conklen once found herself out in the countryside waiting for a taxi bus with a woman. The two talked for almost an hour about Mothers to Mothers, a program that recruits mothers who are HIV positive and have babies who are HIV negative to be educators of other mothers. The organization educates women on how to take their medications, among other things, Conklen said.

“The woman said, ‘People discriminate against me because I am a Mothers to Mothers (participant). But I don’t care; I know I’m HIV positive,’” Conklen said.

Conklen really connected with the women involved in the Mothers to Mothers program, yet their conversations brought up the inherent problem with trying to combat the AIDS epidemic in Swaziland.

Schafermeyer and Conklen agreed that Swazi culture is much more male-dominated than that of the U.S., which has an adverse effect on HIV-prevention initiatives such as circumsion. Conklen said circumcision is preventative in that HIV cells are most commonly found on a man’s foreskin, so being circumcised reduces the likelihood of contracting HIV. But Conklen believes that Swazis are overestimating the benefits of circumcision.

“They’re taking it as, ‘If I don’t have foreskin, I can’t get HIV, even if I don’t use a condom,’” she said. “Some of the signs they handout don’t explain that it only decreases your risk.”

“It’s almost hard for me to understand. It just reads that, “Oh, you won’t get HIV,’” she added. “That’s just another thing that’s adding to the problem that (foreign missionaries and volunteers) are bringing in to their country.”

Conklen knows that Swaziland still has a long way to go before it can recover from its current epidemic. The country has very limited resources in the way of supplies and health workers. According to the CIA World Factbook, the country has .16 physicians for every 1,000 people and 2.1 hospital beds for every 1,000 people.

“We have so many resources (in the U.S.), but there they have nothing,” she said.

Conklen said Raleigh Fitkin Memorial Hospital was doing (slightly) better on staffing and space, where there were two pharmacists and a handful of technicians and clerks dispensing medications for approximately 200 inpatients and 700 outpatients per day. Conklen estimated that during her rotation the hospital had a total of eight physicians.

More often than not, though, the health workers at the hospital were helpless to the epidemic. Conklen recalls a particularly haunting experience in the pediatric ward.

“(A child) was slowly dying and the doctor was not there at the time,” she said. “We called him in. He said, ‘Well last night he had too much fluid and that’s why his heart is failing.’”

“Here in America we’d be doing anything and everything for the child,” Conklen added. “There, the only thing we could give him was managed care. The doctor took us aside and said, ‘This is all we can do.’ We sat and watched the child’s breathing get slower and slower. Then he passed away.”

Schafermeyer echoed Conklen’s sentiments. “It makes you wonder: if we would have done more, would the kid still be alive?” He specifically mentioned the hospital’s dated equipment and tainted medicine.

Still, he said the Swazis do a lot with what they have. “They have limited resources, but are really dedicated people.”

“It’s a hardworking culture; very amazing people,” he added.