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Blog: Nursing in Swaziland, with the world's highest HIV infection rate

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Nursing Times' newest blogger Susan Elden on the unique challenges of nursing in Swaziland - including the highest prevalence of HIV and TB on the planet.

I could probably start off by setting the scene and describing the context of where I work.

I am an RGN by background and developing public health programmes at Good Shepherd Hospital, a hospital that serves the Lubombo Region of Swaziland (about 250,000 residents).

I work with the HIV and TB programmes in the hospital as well as providing outreach for HIV testing, TB screening and provision of HAART (highly active anti-retroviral therapy) in the rural clinics. I have been here for nearly 2 months and will stay for one year.

Key HIV and TB Statistics for Swaziland

  • Swaziland has the highest prevalence of HIV and TB in the world.

  • The number of people living with HIV is estimated at 190,000.

  • There are approximately 56,000 orphans here due to AIDS.

  • About 26% of the adult population is HIV positive.

  • People living with HIV and AIDS (PLWHA) are 30 times more likely to develop TB and children are even more vulnerable than adults.

  • 50% of deaths in HIV infected patients are attributed to TB

  • 60 cases of Multidrug resistant (MDR) TB were identified in 2005. Cases are increasing as well as the emergence of extensively drug resistant (XDR) TB cases.

Grim realities

These statistics were not a complete surprise to me. Before I arrived here, I had heard the grim figures. Like most nurses, I had seen patients back in the UK that had originated from sub-Saharan Africa with HIV and TB. I had worked with other nurses, doctors, physiotherapists who came from Southern Africa.

Prior to my arrival, the statistics gave me a background understanding but didn’t feel “real” to me. They didn’t help me appreciate just what I would encounter. I had wrongly assumed that with the development and provision of HAART (highly active anti-retroviral therapy) that patients were now living healthy active lives.

Upon my arrival on the first ward round, seeing wards full of people dying of late-stage AIDS, Kaposi sarcoma and multi-drug resistant TB gave me a feeling of hopelessness.

When I later visited the rural homesteads to follow up on our MDR TB patients, I was met with an even greater challenge - how to manage these patients in the community.

There are no national policies to guide me, no coordinating team, no TB doctor for this region.

What I do have is the most dedicated team of nurses, community workers, adherence officers, and expert patients who have the first-hand knowledge, experience and clinical skills to manage these patients.

We are lacking in resources, medication, staff, vehicles but each day the nurses I work with come up with new ways to encourage patients to test for HIV, and encourage them to seek early treatment for HIV and TB.

Over the coming weeks and months I will have individual stories of patients and experiences here. Whether it is the patient that was too weak to walk and was pushed in a wheelbarrow to the nearest clinic for daily TB treatment, the HIV positive grandmother who has lost her daughter to AIDS but has adopted five orphans and feeds them using local donations, or the 16-year-old who had been raped and came to the clinic for her HIV test and was told she was positive.

These are some of the experiences I encounter here on a daily basis here in Swaziland.

I hope over the coming weeks and months to not just tell my stories but the stories of the nurses who have lived here all their lives, some who have worked here for 10 to 15 years. Their stories are the most important of all.

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