Donation Brings Big Smiles
By Heather Mason
Medical Equipment Will Help Swaziland Clinic Expand and Strengthen Services
St. Theresa’s Clinic in Manzini, Swaziland, has been serving the community longer than any of its staff members have been alive. According to the clinic’s nurse-administrator, Sister Concetta Ginindza, St. Theresa’s was founded more than 70 years ago, in 1942.
The clinic sees hundreds of patients each day and offers a host of services. St. Theresa’s is one of the few public health clinics in the area that provides dental and ophthalmology services to those who can’t afford private doctors.
St. Theresa’s is affiliated with the Catholic Diocese but doesn’t receive funding from the Church and gets only a nominal grant from the Swazi government. The clinic funds itself almost completely through the fees paid by its patients. However, many patients cannot afford to pay for the services they receive.
“Those who can pay, they pay. Those who cannot afford, they are treated. We never send anybody away,” says Sister Concetta.
The user fees collected by the clinic are often barely enough to cover the staff’s monthly salaries, let alone to buy the equipment and supplies needed to keep the clinic functioning smoothly. The staff at St. Theresa’s is highly experienced and qualified. But without the proper equipment to do their jobs, experience and qualifications can go only so far.
A recent donation of medical supplies and equipment, coordinated by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and Project C.U.R.E., is helping to fill gaps at St. Theresa’s and enable the clinic’s staff to provide quality services.
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A Dental Therapist Without a Dental Chair
Karen Chino, St. Theresa’s dental therapist (the clinic does not employ a dentist), sees 30 to 40 patients a day and has the training she needs to fill cavities. But until now, since the clinic did not have a functional dental chair, Chino wasn’t able to make use of that training.
When a patient comes to St. Theresa’s with a cavity that needs filling, Chino has to refer the patient either to a private dentist, which is financially out of reach for most patients, or to the government hospital in Mbabane, which is far away and often has a weeks-long waiting list for dental procedures. In most cases, patients opt instead to have Chino extract the tooth altogether, which is the only treatment she is able to offer without a proper dental chair.
“I don't like to remove teeth, especially when you know that something can be done about it,” says Chino. At least once or twice each day, Karen is forced to remove a tooth that could be fixed with a simple filling.
Children on treatment for HIV are particularly prone to tooth decay, as pediatric HIV syrups contain lots of sugar. Chino has removed permanent molars on children as young as 8, and recently removed a baby tooth on a 2-year-old.
“We were looking at buying a [dental] chair—we got quotations,” Chino says. “The money was just so much … hundreds of thousands of rand [thousands of U.S. dollars]. We can't generate that money.”
St. Theresa’s also runs an outreach dental clinic near Big Bend, in eastern Swaziland, with even less equipment than at the main clinic in Manzini. Karen travels to that clinic once a week and is able to provide only the most basic services.
“The chair [at the outreach clinic] is very old,” Chino says. “It makes my life so difficult.”
“It’s a challenge,” says Sister Concetta. “All the nurses and doctors are paid from the user fees. We have to take care of salaries [before buying equipment].”
“Referring Patients for Nothing”
The St. Theresa’s maternity ward has an impeccable record. According to Sister Concetta, in the 20 years since Catholic nursing sisters took over the management of St. Theresa’s, the maternity unit has never lost a baby or a mother during labor. Yet the ward suffers from lack of medical instruments and equipment. The clinic does not have a labor bed or an infant resuscitating machine.
“If you preserve the health of the mother, it is an advantage, whether her child is born HIV-positive or HIV-negative,” says Dr. Mohammed Ali Mahdi, country director for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Swaziland. “If the mother is alive, the chance of that child's survival is high.”
Until the EGPAF/Project C.U.R.E. donation, St. Theresa’s also lacked a bed and lights for the operating theater (room), rendering most surgical procedures impossible. If a woman suffers complications during labor or delivery and needs a cesarean section, the clinic has to act fast and transfer her to the hospital.
“There are some cases that don't need to be referred to a big facility – we can attend to them here,” says Ngoie Mulume, M.D., the staff physician at St. Theresa’s. Mulume is capable of performing cesareans but can’t do so without a theater bed or theater lamps.
“But we don't have the proper equipment and we have to refer those patients [who need cesareans],” Mulume says. “We are referring patients for nothing.”
“The Best Instruments for the Best Results”
In February 2013, representatives from Project C.U.R.E., EGPAF, and the Swazi Ministry of Health (MOH) visited St. Theresa’s and worked with the staff to assess the clinic’s equipment needs. The dental department and the operating theater emerged as priorities. When the truckload of donated equipment finally arrived at St. Theresa’s in January 2014, Sister Concetta was overjoyed.
“I was so excited,” Sister Concetta exclaims. “I said ‘A dental chair!’ What we really needed down there. Now we have the equipment for doing fillings. Because she [Chino] can do it.”
In fact, the clinic received not one, but two dental chairs from Project C.U.R.E., which will allow St. Theresa’s to expand the dental department. Once both chairs have been installed, Chino can use the larger chair for filling teeth and the smaller chair for extractions, improving patient flow during the department’s busiest times. The old chair will be moved to the outreach clinic.
Other dental department items in the Project C.U.R.E. shipment include a sorely needed X-ray machine (the clinic did not have an X-ray machine before), dental ultraviolet lights, and an amalgamator (an instrument for mixing chemicals).
“We are just so happy to have all these things,” says Chino. “With the amount of money that we charge the patients, it’s not like a business … The money is not even enough to pay the workers, let alone to buy equipment. We didn't think it would happen, but it's a reality now.”
Sister Concetta is also thrilled about receiving a theater bed and theater lamps, although she notes that the lamps—as well as the larger dental chair—must now be expertly installed. The clinic is in the process of collecting estimates to install the theater lamps and the dental chair and to renovate the theater to make it suitable for surgeries.
St. Theresa’s also received many smaller medical instruments and critical supplies from the Project C.U.R.E./EGPAF donation, including a microscope, a hematology machine, lockable cabinets, a pill-counting machine, wound-dressing kits, theater instruments, and many other items.
“Now we know we have the best equipment for our clients, rather than improvising—the best instruments for the best results,” says Sister Concetta. “We are happy that we have the best instruments, and now we will be expected to provide the best services.”
St. Theresa’s still faces challenges, including lack of space, lack of training, and a need for equipment that was not included in the Project C.U.R.E. donation. The clinic is in particular need of an autoclave, a devise used to sterilize medical equipment with high-pressure steam. St. Theresa’s staff currently sterilize its instruments using a metal pot that must be heated with a portable gas canister.
But the donation from Project C.U.R.E. is a big step in the right direction. “This facility is very old, and it was not growing up. But we want to improve—we want to grow up and become a big facility,” says Mulume. “So we were very happy to receive the equipment, and maybe make our dreams to become a reality. We can go a little bit higher than we were before.”
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has partnered with Project C.U.R.E.—a Colorado-based charity that donates medical equipment around the world— to strengthen the health system in Swaziland. This partnership, supported by EGPAF’s “Elimination of Pediatric AIDS in Swaziland,” seeks to improve maternal and child health by providing necessary tools to 12 health centers like St. Theresa’s Clinic.
On Dec. 27, 2013, a 40-foot container of equipment and supplies arrived in Swaziland via the port in Durban, South Africa. In late January 2014, EGPAF began distribution of the equipment to hospitals and clinics throughout the kingdom.