skinned knees, full hearts

I am manoeuvring in the space between. I memorised my mobile number, but I have a singular, borrowed bowl. I can employ visual or tactile differentiation between emalangeni coinage, but I rely on pitied benevolence as currency for transport. I held a productive working session with the Accounts Officer of the National Malaria Control Programme (NMCP), but I stammered through a presentation before all the programme implementers. I tend not to fare well during periods in limbo (self-doubt, self-doubt), yet... I feel okay. Is that okay?

On Saturday, we ventured past the world's oldest mine, Ngwenya, to Swaziland's mountainous NW border with South Africa, Malolotja, for a morning hike that rapidly descended into five hours of pushing past parched brush, through thorny tangles, rappelling sans rope, engineering river crossings, crawling up loose earth, and not seeing any elephants. Our water ran dry, both my knees bled, I lost my iPhone, I found my iPhone, apparently we dropped 1.5 Empire State Buildings before climbing back up. It was awesome. I am still sore.


In the evening, we went to a friend's new house in Ezulwini (an exquisite Spanish villa of sorts) to warm it with our presence and to bid farewell to two of the Baylor doctors and a TechnoServe volunteer. I started with four glasses of sangria, ended with four servings of homemade Italian cheesecake, and all the while attempted French. You know what it means when I think I can speak French...

The next morning, I attended a double-birthday potluck brunch (this time, think luxury cabin in Canmore). It appears every expat in Swaziland is the Barefoot Contessa. The made-from-scratch spread: sesame bagels, maple bread pudding, apple crumble, oatmeal strawberry squares, salted chocolate chip cookies, buttermilk pancakes, zucchini muffins, eggplant parmesan, shakshouka, mushroom frittata, Bloody Mary's, pineapple citrus champagne punch, and Mardi Gras king cake. Swaziland Sixteen is my new Freshman Fifteen; meanwhile, two-thirds of Swazis live on less than $2/day. I struggle to make sense of this.

I also struggled during afternoon frisbee with the kids. We threw in this additional session, because it would be one of the Baylor doctor's last. Waterford Kamhlaba UWC's pitch looks rather different by daylight. As usual, my couple decent catches were followed by flubbed passes. The older boys are good coaches though, and I am confident I will leave Swaziland with one decent throw to my name.


Yesterday, I tagged along with an NMCP officer for data collection. The programme is conducting a survey of the country's private health facilities, investigating the extent to which they comply with national diagnosis (ie; clinical presentation must be confirmed by RDT and microscopy), treatment (ie; artemether lumefantrine, not chloroquine), and reporting (ie; immediate SMS to facilitate case detection around the patient's homestead) guidelines. Public health facilities are generally compliant, but achieving WHO elimination certification (ie; no locally acquired cases for 3 consecutive years) requires comprehensive coverage.



We drove to two mission clinics past Mankayane near the W border with South Africa and then to one closer to Manzini. The first with a portable laboratory sponsored by ICAP and USAID was hosting a TB screening with MSF, the second was lined with primarily HIV/AIDS patients and surrounded by livestock. All three are located in the non-endemic highveld region. As such, the first two have diagnostic capabilities only and refer the rare confirmed case to the nearest government clinic. A febrile, nauseous, jaundiced patient who traversed mountains to receive this diagnosis may not traverse farther for (hopefully non-counterfeit) Coartem. So, rare? Yes. But should such a case go unreported, rendering follow-up impossible, onward transmission may occur, rendering elimination intangible. That is not okay.