Keith Cavalli works for Médecins Sans Frontières as a logistician. He has recently returned from a six- month placement in the Shiselweni region of Swaziland, where he was helping modify houses for people with tuberculosis.
What is Médecins Sans Frontières doing in Swaziland?
Médecins Sans Frontières has been in Swaziland since 2007, helping the Ministry of Health to manage the HIV and tuberculosis (TB) crisis. This is a well-established project, so I was there helping it run as well as it possibly could. I was involved in everything from managing a fleet of vehicles with supplies and medicine to treat patients in remote areas, to handling the logistics of the TB and HIV testing labs, to building homes for people with TB, and working on public awareness.
"These homes make a real difference in people’s lives: hospital is an incredibly lonely place to be for an extended time, so returning patients to their families is a big deal"
What about this placement stood out most for you?
The most interesting and rewarding part of the TB project was the building or modification of patient homes. The treatment time for drug-resistant TB is usually at least 18 months, so rather than keep a person in a ward we prefer to return them to their families so they can undergo the treatment at home. However, this requires the modification of an existing home or building a new home. As TB is airborne, the new homes are designed with proper ventilation as well as a separate entrance to the rest of the house. These homes make a real difference in people’s lives: the hospital is an incredibly lonely place to be for an extended time, so returning patients to their families is a big deal. In one case, a mother told me that she hadn’t been sleeping ever since her child had been admitted to the TB ward, but now that her child was home and recovering there, she could sleep again at night and was really thankful for that.
What challenges did you face?
This placement was incredibly challenging in many ways, but the most significant challenge was the maintenance of the biosafety level 3 laboratory [a laboratory requiring strict safety precautions] for TB testing. It’s located in a rural area of Swaziland where you can’t get equipment serviced, and supplies have to come in from overseas. The dynamic of that situation is a constant challenge, but the best thing you can do is keep solutions in the pipeline and keep on top of the problems as they come up.
I also worked on repairing the Manzini clinic, after the roof was completely ripped off by a storm. Water was pouring in, the electricity was on, we had vaccines and blood samples in there. This clinic was responsible for servicing a huge region of patients on ongoing treatment. The good news is, within 10 days we had a temporary clinic set up, had returned service to the community, and we were able to partner with Swazi Public Works to begin repairs on the roof. There’s always going to be frustrations in this work, just like with any job. But it’s so rewarding seeing the results from your efforts. It’s a real honour to be there to help people in tough situations.
Médecins Sans Frontières is currently managing 97 patients with drug-resistant TB in this region of Swaziland.