Medical Care

Emergency Transport to Hospital

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Each day of the year, the Home Based Care team at the Good Shepherd Hospital visits those who are infected with AIDS, tuberculosis, severe endemic disease and malnutrition within the poorest rural areas of Swaziland.

There are thirty two rural communities which are visited each month (one community is visited each day)

As stated earlier many of these patients will die if they are not urgently transported to a hospital and usually cannot afford the transport fees.

Possible Dreams International works in conjunction with Home Based Care and provides funding for these critically ill patients to reach a hospital.

Once at hospital many patients cannot afford to be seen by a doctor, to pay for investigations like blood tests and X-rays, or treatment and ongoing medical care.

The Daily Emergency Fund provides these critically ill patients with a lifeline. A chance to reach urgently needed medical care and treatment.

Current HIV/AIDS situation in Swaziland

According to NERCHA, “The Kingdom of Swaziland is facing an enormous challenge in preventing and controlling the HIV and AIDS epidemic, which is growing at an alarming rate. The first AIDS case was officially reported in 1986 and since then the number of AIDS cases has increased every year. HIV infection levels among pregnant women attending selected maternal clinics increased rapidly from 3.9% in 1992 to 42.3% in 2004. Life Expectancy has dropped from sixty-years-old in 1997, to thirty-one-years-old in 2004 (the world’s lowest). According to a recent World Bank report, 15,000 people die annually in Swaziland. Whaley (2007) states HIV/AIDS “is now reversing all of the gains that the country had made, more importantly, it threatens to destroy Swazi society.” Increased morbidity and mortality as well as an increased number of orphans characterize this AIDS epidemic. The demand for health services has increased, surpassing the resource capacity for healthcare.”

The 2010 United Nations Swaziland Millennium Development Goals Progress Report discussed how 49% of all children who die before their 5th birthdays attribute their deaths to HIV/AIDS. AIDS is a global epidemic. According to a 2010 UNAIDS report, globally 33.3 million people were living with HIV, 2.6 million people were newly infected with HIV, and 1.8 million people died of AIDS/AIDS related diseases. Encouragingly, these statistics show that progress has been made in recent years in stemming the tide of new HIV infections. However, according to NERCHA and the UN, Swaziland still has the world’s highest HIV prevalence rate: 25.9%.

Currently more than 310 000 Swazis are HIV+. Although ARVs are free in Swaziland, just over half of the people who need then are actually receiving them. As at 2010, Swaziland (a country the size of New Jersey with a population of 1.2 million people) was home to an estimated 180,000 orphans and vulnerable children who struggle every day for the bare necessities of life. This represents 15% of the country’s total population.

The number of these young orphans is rising daily. The numbers of children who are trying to raise their younger brothers and sisters by themselves head over 33% of all households in the country. According to the WHO report on Swaziland, the epidemic has been fuelled by poverty, unemployment, a large migrant population, conservative religious and traditional beliefs against condom use, and frequent multiple sexual partners. All of these contributing factors have severely affected Swazi society and the economy. UNAIDS discussed how HIV/AIDS has the potential to claim two-thirds of all Swazi children under fifteen years old. This high HIV prevalence rate is slowly destroying an entire adult population, leaving the elderly population to care for the orphans and vulnerable children (OVC) and increasing the number of child-headed households. The absence of an adult population could potentially have insurmountable effects on the workforce and food supply in Swaziland. As it stands, almost 1 in 2 Swazis (46% of the total population) are children under the age of 18.

According to NERCHA, “while there is a growing class of well-educated, professional Swazis, the majority of citizens are subsistence farmers or livestock herders. Their primary crop and staple of their diet is maize, or corn. Compounding longer-term issues such as overgrazing and floods, the lives of rural families have been made difficult lately by a severe drought that’s now in its sixth year. Lack of food and lack of water are very real issues in Swaziland. Beyond these factors lies another: the high rate of HIV/AIDS. Unlike other diseases, which tend to strike the very young or the very old, AIDS kills people in the prime of their adult years – at the height of their working and earning power. Not only are individual families left poorer when their breadwinner sickens or dies, but the entire economy suffers increasingly from the growing lack of people to do needed work, from teachers to police officers, from business managers to construction workers, from shopkeepers to farmers.”

According to a 2009 UNAIDS report, 68% of HIV cases are in Sub-Saharan Africa. Furthermore, 92% of all HIV cases in children under 15 years of age are in Sub-Saharan Africa. Young women are at a particularly high risk; in Swaziland 49% of women aged 25-29 are HIV+. In a 1996 report, former Director-General of WHO, Dr Hiroshi Nakajima stated, “The world has lost sight of its priority to reduce poverty through better health and foster development by fighting disease. Today, infectious diseases are not only a health issue; they have become a social problem with tremendous consequences for the well being of the individual and the world we live in. We need to recognize them as a common threat that has been ignored, at great cost, for too long, and to build global solidarity to confront them.”

An October 2007 WHO report stated “Over 90% of children with HIV are infected through mother-to-child transmission, which can be prevented with anti-retroviral, as well as safer delivery and feeding practices. About 20 million children under five worldwide are severely malnourished, which leaves them more vulnerable to illness and early death.” When a child’s immune system is compromised, they become more susceptible to contracting diseases and are less capable of combating diseases that a healthy child’s immune system, along with proper nutrition and medical attention, can overcome. Several of these diseases include pneumonia, diarrhea, and malaria, which are all prevalent among Swaziland’s impoverished rural communities. In the same October 2007 report, WHO stated, “Nearly 10 million children under the age of five die each year – more than 1000 every hour – but most could survive threats and thrive with access to simple, affordable interventions. From one month to five years of age, the main causes of death are pneumonia, diarrhea, malaria, measles and HIV. Malnutrition contributes to more than half of deaths. Pneumonia is the prime cause of death in children under five years of age. One African child dies every 30 seconds from malaria. Insecticide-treated nets prevent transmission and increase child survival.” All of these factors contribute to a person’s capacity to properly undergo ART.

In developing countries, only 36% of HIV+ people actually receive ART. According to USAID, several barriers hindering the effectiveness of ART include the following: unclean water, poverty, low status of women, high levels of other sexually transmitted diseases, extreme sexual violence, social instability that result in family disruption, and ineffective leadership during the critical periods in the spread of HIV. According to a 2003 WHO World Health report, “infectious and parasitic diseases remain the major killers of children in the developing world, partly as a result of the HIV/AIDS epidemic.”

Aside from the obvious medical implications of the virus, HIV/AIDS greatly affects developing nations through a loss of available workforce, food security issues, negative economic impacts, education, and a breakdown of community and support networks. Because of the deaths of large numbers of parents, caretaker systems are strapped as other family members or friends attempt to care for orphans and vulnerable children. De Waal stated that “Many famine-coping strategies need skill, experience, and a positive outlook on the future. An important skill is knowledge of wild foods and how to prepare them, which is handed down from mother to daughter. If young women do not have this key knowledge, they may go hungry because of their ignorance. Undernourished individuals are more susceptible to being infected with HIV than are those who are well nourished. Nutritional status is also an important determinant of risks in mother-to-child transmission of HIV.”

Murphy (2005) states that efforts to advance our understanding of the impact of AIDS involve advancing conceptual models of how HIV/AIDS intersects with: food security, nutrition, agriculture, extension, rural technology, community development, and humanitarian action. Piot elaborates on this idea, “AIDS constitutes one of the most serious crises currently facing human development, and threatens to reverse progress in the most severely, affected countries by decades.”

Aids Care

Swaziland has the highest prevalence of HIV/AIDS in the world; 26% of the population is HIV+. It also has the highest death rate globally. With a life expectancy of a mere 46 years, Swaziland also has one of the world’s lowest life expectancies in the world. There are currently estimated to be over 180,000 AIDS orphans in Swaziland. In a country with a population of 1.2million, this means that over 15% of the total population are children who have been orphaned by AIDS.

There is 1 doctor to every 10 000 patients in Swaziland. Because of the extreme poverty, huge numbers of Swazi people simply cannot afford medical care and so endure extreme suffering as a consequence of terminal AIDS and its sequel..What is more, most terminal AIDS patients live in extreme poverty and so cannot afford the transport fees (bus fare) to reach hospital. Some choose to walk the usually very long distances to reach hospital, but not all complete the journey.

Possible Dreams International provides a lifeline to these patients through the Daily Emergency Fund.

Gogo Led Households

Swaziland has a paucity of orphanages meaning that orphans usually live in one of two situations:

  1. A Gogo is a grandmother; usually retired and of advancing age. In Swaziland, it is not uncommon for a Gogo to take in 10 to 20 orphaned grandchildren into their care after the death of their children from AIDS or endemic disease.
  2. As Gogo’s are usually unable to work, these families of orphans endure incredible difficulties in accessing food, water, clothing and education.

Orphan Led Households

There are currently tens of thousands of orphan led households in Swaziland. These children are exquisitely vulnerable to malnourishment and starvation.

One of the major issues faced by orphan children and families, who take in multiple orphans, is food supply.


Aug 02,nd,2010
On Gratitude

May 18th 2009 06:00 Siteki, Swaziland Early one misty morning my friend Anna Zwane (we call Her Matron) and I ventured out in a borrowed truck to deliver some food parcels to Gogos (grandmothers) in deep need within the some …

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