The fragile ecosystem of poverty: A trip to Swaziland

By Shalini Ponnampalam, Daffodil Anton, Kate Drummond & Madeline Tickle

Throughout the first few weeks of February, four medical students from Monash University volunteered in the Sub-Saharan African country of Swaziland. Swaziland is a landlocked nation nestled within the borders of South Africa and Mozambique where 87% of the population live in desolate, rural and remote regions, 63% in extreme situations of poverty (World Bank, 2016).

Working with the local non-government organisation Possible Dreams International (PDI), the destitution and subsequent vulnerability that imposes upon communities was distinctive. As we visited families of the Lubombo mountains, it became clear that one cannot escape poverty without empowerment as this particular health ecosystem is fragile, and easily disturbed by the subtlest of changes.

The families of rural and remote Swaziland share similar obstacles; many have experienced the same plight despite the diversity within each familial situation. It is this story that we want to share with you all. Meet Mduduzi*, Mbali* and their four children – a family living in the mountainous region of Mambane.

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Like 27.4% of the Swaziland population, Mdudzi is HIV positive (WFP, 2016) but he is also troubled by recurring bouts of multi drug resistant tuberculosis (MDRTB). With fatigue and weakness, he can no longer act as the primary breadwinner, placing this responsibility on his wife. She spends most of her day selling fatty cakes; this is the reason why she is not pictured here. Despite her determination towards supporting them, Mbali brings in between 10 and 100 rand ($1.00 – $10.00) a day, which is then used to purchase maize and chicken feet. This is the meal consumed three times a day; however, it is barely sufficient in sustaining the nutritional needs of their children. With the little strength he has Mduduzi grows both maize and cotton, yet his efforts have proved futile as rainfall has not touched this region. Without the support of water the needs of the community are dwindling, simultaneously decimating their food source and potential income.

With the scarcity of water, and their water tank empty, their eldest son Nkosana* walks approximately 2 hours each morning in the sweltering Swazi heat to collect water. We accompanied Nkosana on his walk to assess their water source. An ash-coloured puddle services the 600 individuals of their community. When presented with the reality of life here in Swaziland, it is not difficult to comprehend why 3.4 million people die each year due to water-related disease (WHO, 2009). Nkosana returns each day with 20 litres of water, precariously balanced on his head with no frustration or complaint. Hardworking, compassionate, determined – traits that are characteristic amongst the Swazis.

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However, in Swaziland, a family’s good fortune and their socioeconomic status are exquisitely sensitive to change. When one factor, such as water or income is affected, other variables such as food security and access to healthcare are also diminished. Mduduzi recently began to cough again, an indication of a recurrence of tuberculosis. When an individual develops an opportunistic infection that is secondary to HIV, a family is placed back into a delicate situation where resources are stretched. The three Australian dollars required for each bus trip to the clinic first for his TB appointment and then to receive a follow-up for his results is hard to obtain when income is limited.

In developing countries especially, treating medical problems is to treat poor health superficially. It simply isn’t possible to truly assist individuals when they present to clinic without understanding the root causes of their disease. The pathology is deeper than what is initially perceived and without addressing these underlying, systemic features of disease, we are unable to support these people. Along with their physical health, the agency of individuals to make decisions about their healthcare is compromised and this reduces their overall sense of wellbeing.

After returning home from such a singular experience of the problems facing the developing world it would be easy to become consumed by feelings of hopelessness.

The suffering of people in Sub-Saharan Africa reminds us of the startling inequities and pervasive social injustices that surround us. Here, we live in the first world. We are empowered and we are the unconscious recipients of extraordinary privilege. Acknowledging this privilege can be the first step in using it to ameliorate the suffering of others. There are 1.2 billion people who live in extreme poverty (World Health Organisation, 2013). By raising our voices for justice and equity we can join the conversation of change.

We live in an unequal, unfair, unjust world. It is a world of social disparity and economic dissonance. A world riddled by titles; the advantaged and disadvantaged, the privileged and unprivileged, the first and third world. Yet, every label has an issue. By classing communities or populations, we agree that this discrepancy in lifestyle is acceptable. Creating this third world allows us to consciously or unconsciously remove our responsibility as global citizens. We are able to live here absorbed within our materialistic possessions with little concern over the vulnerability of those living in less-fortunate circumstance. There cannot be a third world; rather we must all be unified in this one world. When we acknowledge that all human-beings share this common humanity, it will become harder to recognise this inconsistency in basic living and it will become harder for the third world to remain unnoticed.

In rural Swaziland, many families continue to suffer; they are desperate to be liberated from this disempowering situation. This often seems an impossible feat when there are factors such as the drought and a lack of income which counters their efforts. When families struggle, there is a sense of camaraderie in Swaziland, where everyone bands together and shares what little resources they have to sustain life. Together they strive and attempt to thrive but this is not sustainable.

Everyone endures hardships, everyone endures situations that appear impossible to escape from but we all deserve to be saved from the injustices thrust upon us. Possible Dreams International (PDI) is that organisation that brings back hope. They ignite the fire within one’s soul that change is possible. We reach out to comfort and support.

PDI is more than an NGO. It is a team, a family that we have witnessed firsthand in the field. It stays true to its vision of aiding and sustaining the growth of families within a context of extreme poverty.

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Possible Dreams International is lead by local Swazi people and works in 32 rural communities providing emergency relief aid and sustainable development solutions such as income generation, agricultural support and water access for families and communities in desperate need. PDI works within a ‘pay it forward’ framework, where an assisted family goes on to help others within their community.

PDI is united by compassion and a belief in the dignity of every human life. By donating to a worthy charity, we are signifying that we believe in communities and families who are attempting to make do with the little resources they have. Every contribution assists in bringing back light into a world that has been riddled by darkness. Our trip to Swaziland offered us a glimpse into the tangible hope that can be offered by development programs which are holistic, grass-roots and offer long-term, sustainable solutions to the deeply complex issues of poverty and endemic disease. The local team have a motto. They say:

Umuntfu, Ngumuntfu, Ngebantfu

It means I exist because you exist, I matter because you matter, I am because we are. If we are to break down a myriad of social and health inequities, it begins with this understanding of a common humanity which transcends our superficial differences and geography. Please consider donating to the work of Possible Dreams. For more information, please visit

*All names have been changed for the purposes of confidentiality

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