We received great news last month.

Doctors Without Borders (Medecines Sans Frontieres) will be coming to Zombodze’s health clinic. Not just once or twice, but every Wednesday for the foreseeable future. They’ll bring an RN and sometimes a doctor to treat patients and provide critical services our clinic can’t currently provide. The most significant of these services are TB testing and monitored TB treatment, HIV testing, counseling and treatment, and CD-4 counts.

We’re thrilled. Their decision to come to Zombodze had nothing to do with us, but we’ll make sure to support their efforts here, especially regarding referrals. We can now do targeted homestead visits, looking for people who need medical attention (esp. TB cases) and help them get to the clinic on Wednesdays. Before, all we could do was encourage them to go into Nhlangano’s health center—but many can’t afford the kumbi ride into town and back, and there’s something troubling about directing a TB-infected person to use crowded public transportation…which left us with no good options to help. Now we can refer them to the clinic on Wednesdays, then show up ourselves to see who does and does not come, then do follow-up visits to those who didn’t show.

In this manner, DWB’s presence in Zombodze will undoubtedly save lives. They are here to stop a TB epidemic. In and around Nhlangano (the nearest city, 19km away) they’ve identified something like 26 cases of MDR-TB (not XDR, thank God), which is a highly lethal form of TB that’s developed resistance to the typical drug treatment. So DWB has likely drawn a “catchment area” around Nhlangano and are now hurrying to get doctors into those communities to try and halt a nasty epidemic. Furthermore, cases of XDR-TB, the worst and most drug-resistant form of TB currently known, have been found in the South African state of KwaZulu-Natal—which directly borders our chiefdom. So when Zombodze’s high HIV infection rates are combined with this heightened regional TB risk, there’s no question as to why DWB is setting up shop. And we’re overjoyed that they’ve come. I cannot help but think that, had they been here back in November/December, Gogo (grandma) Nkambule might still be alive: she didn’t get tested/treated soon enough and TB quickly killed her, leaving about 5 young kids without a caretaker.

As I’ve noted before on this blog, Swaziland’s HIV-TB co-infection rate is (by far) the highest in the world, at 80%. HIV weakens the immune system, TB infects the vulnerable person and—unless they get rapid treatment—swiftly kills them. Thing is, TB is curable. But it requires the patient to adhere strictly to a drug-treatment regimen for the full duration (usually 6-9 months), which is difficult. When adherence breaks down, resistant forms of TB emerge. That’s where the highly lethal MDR and XDR strains came from: they’re essentially manmade super-bugs—and an HIV patient with a low CD4 count does not stand a chance against them. Anyone who’s read “Mountains Beyond Mountains,” or is otherwise familiar with Paul Farmer’s work, knows what’s up with this resistant-TB thing… it’s serious, it’s devastating, and it’s preventable.

So here’s the short of it: thanks to DWB, we’ve been given the opportunity to help stop an epidemic of MDR- and XDR-TB from sweeping through this community. Accordingly, this development shifts our project priorities a bit. Homestead visits, for example, now take on an entirely new level of importance. We’re in a great position to help—we know the area’s homesteads by now, we know enough siSwati to ask the right questions and check people out for symptoms and tell them when/where to go, and we’re healthy enough not to be vulnerable to sickness ourselves. We’ll help DWB train and support the local RHMs (Rural Health Motivators), we’ll finally be able to encourage people to get an HIV test right here in Zombodze, and we can help with adherence follow-up on those receiving TB treatment.

Our basic goal is to make sure that DWB staffers are busy every Wednesday they spend in Zombodze.

As we walked over to a meeting to meet with a DWB rep, we brainstormed a wish list of things we wanted them to do in Zombodze. Before we got there we went through a “magic wand” scenario: if we could have them do anything we wanted in our community, what would it be? We figured that this exercise would prepare us for the unlikely event that someone asked us what we wanted from DWB. And when we sat down in the meeting and the DWB rep explained what services they’d be providing, she basically described our whole “magic wand” scenario. Every single thing on our little DWB wish list was named and will be coming to Zombodze—even some things we hadn’t thought to wish for. Hearing of these plans was, for both of us, a stunning moment. Thank God for DWB.

We’re so very glad to be here.