December 19


Homeward Bound



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As the saying goes “The road to hell is paved with good intentions”.    I certainly intended to write more blogs to share with all of you who were interested.  But instead I did manage to email many of you and did a bit of Facebook.  However, now I am feeling guilty so I will try one final blog.

Today is my last day at CHAI Swaziland. Six months flew by, which is scary but also reassuring.  I tried to make the most of the experience in multiple ways.  Certainly the program I was placed in-“Pre exposure Prophylaxis or PrEP” was a huge part of my life here.  We initiated the study on time August 1st and it continues to go well.  Over 200 patients are in the study and 80% of them are young women.  It has been very moving to go to these rural clinics and watch women who lack enough education to read the consent form, proudly sign up to protect themselves and their babies, using a thumbprint.  One of my first clinic visits was to a very remote facility that had no heat, no electricity and no running water in the building.  That is where I learned that each clinic in Swaziland has Expert Clients (ECs) and also Mothers 2 Mothers (M2Ms). The ECs are women and sometimes men who are HIV+ members of the community who help educate others by example.  The M2Ms are women who share their HIV+ status with other HIV+ women who are pregnant and/or breastfeeding and need to adhere to their regimen of antiretroviral in order to protect their babies.  That really impressed me, as admitting your HIV status to your friends and families still carries significant stigma no matter where you live, but especially here, and yet these people are trying to help others in their communities.

Going to the clinics was probably the favorite part of my job. I learned so much about the challenges faced by these dedicated nurses and staff.  They really function as mini- emergency rooms because a hospital is likely many kilometers away.  I’ll admit that was one big concern for me—an acute illness here could be dangerous as Johannesburg medical care is 4 hours away.

Poverty. Children everywhere. Lack of education. Cows, goats, chickens, dogs.  No reliable transportation.  Subsistence farming.  Lack of modern appliances.  Virtually no one in my office had a washing machine and for sure no one had a dryer.  We joked about hanging clothing on the line, which I have never done!  I will admit I never understood third world poverty until I saw it up close in multiple countries.   The nice ladies who clean my apartment will walk 20 kms (12 miles) to come to work and others walk over the mountain and back every day! I will feel ashamed to drive half a mile to the grocery store at home.

And yet the people are so welcoming and always greet you with a smile. I have had so many pleasant encounters with complete strangers it has renewed my faith in basic human kindness.  And the country is beautiful.  Swaziland is 4000 feet elevation and populated with huge boulders everywhere.  I have done lots of challenging hiking here and feel re-engaged with nature as it surrounds you.  Every day on my walk to work I may see guinea hens with chicks, monkeys, many birds, a snake, blue headed lizard, and a couple of Jack Russell terriers I have become quite fond of.

And I have learned more about Access to Medicines. GSK has been at the top of companies providing access to medicines for the past 5 years.  But that statistic never really meant much to me.   It does now.  It means that women in Swaziland have no access to the HPV vaccine and therefore have one of the highest rates of cervical cancer in the world!  Almost completely preventable. It means a coworker lost her brother at 34 years to Hepatitis C because they don’t have the drug that can cure it. It means that if you have breast cancer there is no active chemotherapy unit here because they can’t get the drugs anyway.  Your mammogram probably can’t be done or read by a radiologist.  And if you have diabetes you may end up on dialysis early because you never were diagnosed and given medication to control your blood sugars.

On the positive side, several major pharmaceutical companies have made agreements that they will provide some drugs at generic cost or less to undeveloped countries. So here there is excitement because generic dolutegravir for HIV will be available in 2018 at $75 a year. And there is a big initiative to do the same with oncology drugs.  The PrEP study will also advance the availability of the drugs that prevent HIV infection.  But this is only after it has been proven to the Ministry of Health to be feasible to implement.

Progress is slow in many areas and yet NGOs abound and public health workers are devoted. Many are young, inspired and they all want to make a difference.  This 6 month assignment was positive, instructive, uplifting, challenging, and educational for me.  I know I may never come back to Swaziland but I take the memories with me.  I have renewed pride in GSK for offering this unique opportunity to its employees. I am so fortunate to have met a wonderful GSK colleague here, Sanjeev Singh from Mumbai.  He has added so much to my Swazi experience with his humor, thoughtful ness, and energy.   I can’t thank him enough for being my partner on so many activities.  And I need to thank my many coworkers for covering my responsibilities while I was away.

It was a gift to me.

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So– time for me to leave colorful, fragrant, chaotic Africa. I have seen the Big 5– leopards, rhinos, elephants, buffalo and lions and been to the Roof of Africa.  I’ve been to 6 African countries that I never dreamed of visiting before (Zambia, Zimbabwe, South Africa, Swaziland, Kenya and Tanzania).  My family will join me here this week for a few safaris and a trip to Cape Town before landing back in Ohio December 30th.  A once in a lifetime trip for all of us.

I’m not the same person I was before, but I am a better person. More thankful and more giving I hope.

You can’t choose where you are born. I am a lucky woman.