The first thing that really caught my eye in Swaziland was a box of condoms. I had flown into Johannesburg that morning, hopped on a minibus headed to the Swazi capital, Mbabane, a four hour drive eastward. As we approached the South African – Swazi border, the bus began climbing steadily and finally stopped at the crossing that was nestled in a low mountain pass. We were instructed to disembark to present our documentation to the immigration officials.
The driver led us into a low-slung building where we queued up at a window, handing over our passports to be stamped one by one. It didn’t take long. I hardly had time to read the few posters on the wall reminding one and all of the deleterious effects of graft and corruption on the Kingdom. When my turn came and I approached the window, there it was on the shelf in front of me – a big box of condoms free for the taking.
However odd the placement appeared, this no doubt was a public service with a message. And it certainly served as a reminder of what had brought me here. Don’t get me wrong, it wasn’t a pleasure jaunt…
The Kingdom of Swaziland is a country smaller in area than Vermont and a population about twice its size. But the salient point is that somewhere in the neighborhood of one in four people is believed to be HIV positive. By some accounts, it has the highest positive test rate per capita in the world.
I had come to spend a month with the Swaziland Homeopathy Project, an organization founded in 2008 in response to the urgent healthcare needs of the population. At its inception, the Project provided homeopathic care mostly to women in a series of clinics in rural areas across a wide swath of northern Swaziland.
As time went on, its mission expanded into servicing the general population in rural, urban and community clinics. It has also undertaken the training of Swazi homeopaths who are charged with carrying the project forward as a self-sustaining program.
Swaziland is land locked, surrounded by Mozambique to the east and South Africa on the other three sides. ‘Kingdom’ is not a mere honorific, the country is ruled by an absolute monarch - although there is a parliament whose powers to govern seem quite auxillary. A British colony for much of the 20th century, Swaziland gained independence in 1968. Today, it appears to be a peaceful and relatively prosperous place, to the extent that the government has launched a campaign to make it a first world country by 2022.
If one were limited to the Mbabane (pronounced something like ‘em-ba-ban’), that aspiration might not seem too far-fetched. There wasn’t so much as a village in the area when the first Brits arrived to prospect for tin in the late 19th century. At the time, they erected a few buildings and a few years later, in 1902 to be exact, the site was chosen as the administrative capitol of the colony. By 1990, it had developed into a town of 30,000 and has tripled in size over the last 25 years. Today it feels nearly urban with shopping malls, big modern grocery marts, electronics shops and streets full of traffic. Not to mention KFC…
But drive a few miles outside the city and one is introduced to a very different reality. The landscape doesn’t conform to the stereotypical image of Africa as an expanse of flat, baked plains. The mountain valleys and fields are softer, more intimate and often breathtakingly beautiful. In place of villages, people live in ‘homesteads’ that are small compounds of a few buildings housing an extended family.
I had the good fortune to stay in a cottage at the homestead of the Project’s founder Barbara Braun and her husband Bruce. Over thirty years, they have developed a four building compound imaginatively designed out of stone and thatched roofing reminiscent of the Hobbit shire, all with stunning vistas. The mélange of flowering flora of every description, fruit trees, an assortment of dogs, cats and chickens, tenants, workmen, housekeepers, visitors from near and far, not to mention a rambunctious 13 year old girl made it an altogether hospitable environment.
But life in the rural areas where the vast majority of people reside is generally not so bountiful. Most are barely eking out a living as subsistence farmers living on Swazi National Land. And there are the twin afflictions of drought and HIV with which every day Swazi must coexist.
Water has been scarce for a number of years in all of southern Africa. In Swaziland the situation is pretty dire. People are not planting their crops because they can’t water them and there are periodic blackouts because the water levels are insufficient to produce enough hydroelectricity. Crossing a bridge over the main reservoir for Mbabane, one can see that the water is beyond low – it virtually empty.
However problematic the water shortage is, the social disruption caused by HIV has been even more severe and persistent. Although the epidemic began in the 1990’s, it really reached critical proportions a decade later. It is estimated that about 7000 people a year, about 0.6% of the population, were dying from the disease annually. (That would be the equivalent of about 2 million people dying every year in the United States.) Between 2000 and 2009, average life expectancy dropped nearly 50%, from 61 years to 32 years. This was in large part due to a high infant mortality rate of 57 children per 1000 born, nearly half of which is from HIV/AIDS. Complicating matters further is the significant presence of tuberculosis.
The government response to the crisis has to a great extent been sustained by a plethora of international agencies. A dizzying assortment of mostly European and American NGOs, the Gates and Clinton foundations, the WHO, pharmaceutical companies and research universities are all involved in various capacities with the effort.
While modest in size and resources compared to these organizations, the Homeopathy Project provides a unique, cost-effective modality of healthcare that not only augments and compliments, but also diversifies available treatment options.
PART II
Barbara Braun’s favorite word is ‘hectic’. To the ears of an American, her use of the word sounds a bit idiosyncratic, as in ‘that guy is just so hectic’ or ‘I’m feeling hectic’. Maybe it's a British turn of phrase or a Swazi colloquialism. Whatever the provenance, it’s not surprising the word is a mainstay of her vocabulary.
After spending a month as a guest in her home and a volunteer on the homeopathy project she founded, one can only describe her life as positively hectic. Braun tends to approach life with more than a modicum of agency, actualizing her vision of what can be.
Perhaps there is a touch of noblesse oblige that comes with being a white Swazi born toward the end of British colonial rule, a sense that in a small country where so many have so little and the specter of HIV looms large one can transmute a position of privilege into a force for the common good. An American might simply say she is imbued with a ‘can do’ attitude, and no doubt she does quite a lot. Sponsoring a child’s education or providing a needy person with employment, starting a school or creating a medical project that reaches out to an underserved population.
Originally, Braun trained originally as an osteopath in England and afterward took her qualifications as a homeopath. The initiative to make homeopathy widely available across a large swath of Swaziland was perhaps inspired by the success of the Maun Homeopathy Project in nearby Botswana where HIV is present in epidemic proportions.
As of the latest available data from 2014, over 7,000 persons have received homeopathic treatment at one of some 30 different monthly outreach clinics that bring homeopaths to community centers, work cooperatives, day care centers and other locations where people gather. From my observations, many – if not most – of these patients take advantage of these services on repeatedly. This provides the opportunity for an ongoing relationship to develop between patients and providers that allows for more comprehensive treatment.
It also makes it possible to accumulate data that quantifies the efficacy of the treatments provided.
Braun is very keen on data – and for good reason, or good reasons: it furnishes information on the macro level indicating whether homeopathy is effective in the population of patients overall, likewise, efficacy of treatment can be evaluated on any subset of the population, it can provide feedback for individual practitioners on the efficacy of their particular efforts, and finally, it can act as a shield of sorts against a coterie of people who might charity be classified as ‘homeopathy deniers’.
The deniers appear to be people who know little about homeopathy per se except that it doesn’t make sense to them and therefore they deem it quackery without actually making the effort to observe whether it works on not. (There are, after all, many things in our lives, especially these days, that work quite well without the average person having a clue how they work… like this computer, for instance.)
Unfortunately, the efforts of homeopaths around the world, but especially, it seems, those working with the HIV+ population in Africa, are being trolled by the deniers. Their declamations can play havoc with the work of these projects by engendering suspicion and disfavor amongst officials and bureaucrats with whom the projects must co-exist.
Thus, the data collected on the HIV/AIDS subgroup of patients treated by the Swaziland Homeopathy Project in the 6 years between 2008 and 2014 is of particular value. It was published as the “Retrospective observational study of people with HIV and AIDS receiving homeopathic treatment in Swaziland” and presented at a 2015 conference in Rome of the Homeopathy Research Institute (https://www.hri-research.org/).
The study was based on the combination of objective and subjective evaluations of therapeutic results for each of 1003 HIV+ patients, 856 of whom were female, over the course of treatment. The objective evaluations were provided by the case practitioner and the subjective evaluations by the patients themselves. The HIV+ group was further broken down into those receiving conventional antiretroviral therapy (ART) patients (606 patients) and the remainder not on ART drugs.
The degree of improvement was evaluated on a numerical scale by both patients and practitioners starting with an initial assessment at the first consultation and re-evaluated after each subsequent visit. The analysis of these numbers showed that 66% of patients experienced an improvement of symptoms at the first follow-up visit and that 65% of all the presenting symptoms were ameliorated as well. The best results were seen in the first two follow-up visits, although there was a continual steady improvement as treatment progressed further.
The data revealed that treatments equally benefited patients receiving ART those who were not. Although not part of the study or included in its conclusions, it is interesting to note that while project practitioners never encouraged the discontinuation of ART drugs, the results do indicate that homeopathic treatment has the capacity of being a frontline treatment for HIV+ populations.
A further benefit is that homeopathy is quite effective in treating both long and short-term side-effects of the ART drugs. These side-effects are quite common and can be very disabling, often worse than the symptoms of the disease.
Another distinct advantage of homeopathic treatment is that above and beyond the improvement in physical health, it is uniquely suited to treating the mental and emotional symptoms - the grief, shock and trauma - that individuals experience as not only they themselves, but also their families and communities become caught up in the epidemic.
Overall, as Braun wrote in the conclusion, “the study provides evidence to substantiate the use of homeopathy as a complementary therapy in the treatment of people living with HIV and AIDS in Swaziland”.
Having launched the project and trained a team of practitioners to carry it on, Braun herself, while maintaining her emeritus status as well as her own private practice, is onto new projects – embarking on a research project into the homeopathic properties of the Baobab tree and, along with her husband, creating the first Montessori high school in Swaziland. She remains one busy lady.