SWAZILAND: Rural clinic gives AIDS patients a lifeline

Thab'sile Nkambule, 29, struggles with her breathing and endures crippling headaches, chronic diarrhoea and weakness that make carrying water from the stream to her homestead in rural Swaziland her most difficult task, yet this mother of three says she is one of the lucky ones.

"I am getting better; I know why I am sick," she said, sitting in the Sigombeni Clinic, a Red Cross facility 20 minutes north of Manzini, Swaziland's central commercial hub. Nkambule knows her HIV status.

Despite living in a country with the highest HIV prevalence rate in the world - according to UNAIDS, one in three adults are infected - but many Swazis have never been tested.

"You are so scared that you might have AIDS because they tell you there is no cure and you just die. But they treat you at this place. I know - I have a cousin who was at death's door, and she is now healthy again," said Nkambule.

Tikhona Nkhabelo, the head nurse at Sigombeni Clinic, says HIV-positive patients are coming in increasing numbers. "People see their relatives getting better, and they come. We treat them, and they refer this place to others who are sick," she told IRIN/PlusNews.

Since 2004, when one of the area chiefs became the first traditional leader to publicly declare his HIV-positive status, some of the fear and stigma associated with the disease has also lifted.

Unlike government hospitals, the clinic has not experienced interruptions in its supply of critical antiretroviral drugs (ARVs). "We have never run out of ARVs since we started to dispense them in 2004," said Nkhabelo. "The challenge we face is to keep people on their [ARV] programmes."

Medicines are primarily sourced from government's Central Medical Supplies depot, but supplementary sources from international donors have ensured unbroken supplies.

In one of the sunlit examination rooms, a nurse scrutinises a thin, bearded man in his twenties. "You complain of sore feet, lower back and abdominal pain, lack of strength and weakness, but, man, you are a defaulter!" she tells him. "You must take your meds all the time, and not skip."

The patient replies that he was told he must take food for the ARVS to work, and what little food he has at his homestead he gives to his children and elderly mother. The nurse makes a note, and promises that the home-based care unit will drop off a food package at his home when they make their rounds in the community that afternoon.

In the past ten years, the number of patients with HIV/AIDS has increased to the point where they now outnumber other patients. About 20 people a day come to the clinic for primary healthcare, compared to about 40 HIV/AIDS patients. In addition, two home-based care units visit the small farms scattered across the surrounding hills and valleys.

"AIDS is so bad that one out of every two homesteads has a family member who is HIV-positive, or has someone with AIDS living there. But every single homestead is affected by AIDS - some family member has died or is living with the disease elsewhere," said Muzi Dlamini, head of the home-based care operation.

"We have more AIDS patients at their homes, too weak to come to the clinic, than walk-in AIDS patients. But many are getting better," she added.

Sigombeni clinic is staffed by 11 nurses on rotating shifts who provide primary healthcare, childcare and family planning, as well running as HIV/AIDS programmes. A specialist doctor from either the Mbabane Government Hospital, in the capital, or the Raleigh Fitkin Memorial (RFM) Hospital, in Manzini, is in attendance on Tuesdays.

"The ailments depend a lot on the season. We are getting into the wet summer season and we can expect patients with diarrhoea. If the water situation does not improve [Swaziland has been experiencing severe water shortages], there is a danger of cholera," the head nurse said. "We just finished the dry winter season, and we saw a lot of skin conditions like rashes and scabies. Flu - people get the flu anytime."

The clinic is set amid widely dispersed small farms, so few patients can walk there. An untarred road, the area's main travel artery, is close by but is so rutted that bus owners complain their vehicles are destroyed. "We have a transportation problem. The road is bad, there are only two buses, and they run on alternate days," said Nkhabelo.

Other than a few computers for writing reports, the clinic has no X-ray machine or advanced technology. Patient records are handwritten and stored in overflowing filing cabinets, but there is an ambulance for transporting patients to the RFM Hospital in emergencies.

In another consultation room, a nurse is ticking boxes on a form to indicate that Mandla Dube, one of about 350 community members on the clinic's ARV treatment programme, is adhering to his regimen.

"My family gave me up for dead; there was much crying at my home. I myself thought I would never see my children grow up," said Dube, whose SiSwati name means 'the strong one'.

"That was when my eldest was in first grade. Now she is in the fifth grade and you can see I am still here. It is because I have the will to live, and I know they can treat me."