Authors: Rachel Golin, Senior Technical Advisor, USAID/OHA, and Elizabeth Conklin, Deputy Country Director, USAID/Eswatini

Nestled among the rural rolling hills banking the Usuthu riverside in Eswatini sits a 200-acre property that hustles and bustles with activity. This campus serves as the hub of operations for The Luke Commission (TLC), USAID/Eswatini’s clinical local implementing partner. The team started in 2005 with three staff members providing limited medical services through outreach in rural communities and has expanded to an organization with a staff of more than 600 serving some of Eswatini’s marginalized and often neglected residents. TLC’s Miracle Campus hosts a multi-building health facility that provides comprehensive outpatient and inpatient services. Between the fixed-site facility and mobile health outreaches, TLC hosts more than 120,000 patient visits annually.

The far-reaching impact of TLC’s HIV service delivery model is what compelled Dr. Elton Chakanyuka to move his family from Zimbabwe to Eswatini in 2018. Since then, Dr. Elton has considered TLC’s Miracle Campus home and he affectionately refers to the team as family. When Dr. Elton relocated, he knew he would have the opportunity to serve thousands of individuals affected by HIV. His clinical acumen swiftly extended to multidrug-resistant tuberculosis along with providing HIV care to thousands of individuals each year. Then, in March 2020, his professional career took a dramatic turn as Eswatini was fiercely affected by the COVID-19 pandemic and TLC became a primary referral center in Eswatini, serving the majority of critical care cases.

After enduring two COVID-19 waves, Dr. Elton paints a vivid picture as he recalls the workload resulting from Eswatini’s recent third wave, “On each day, we started to get six to eight admissions per day and this was not being matched by discharges. [There were] more admissions than discharges. Over the next couple of weeks, at the peak, we admitted 22 patients [in one day]. So our numbers ballooned from the usual 30 [admissions] to at one point, 140 patients on oxygen. We increased our capacity to five times our normal capacity within three to four weeks, which translated into a workload that was five times more than normal [and] about a third [were] on non-invasive ventilation.”

Dr. Elton examining a critically ill individual admitted for COVID-19.

Ms. Echo VanderWal, TLC’s co-founder, and a physician assistant, had tears in her eyes as she recalled the experiences during Eswatini’s second wave as TLC staff were forced to decide which patients would receive the limited supply of supplemental oxygen. TLC mobilized its staff to rapidly construct an oxygen production plant and in 52 days, the team had constructed a plant that produces 2500 litres of oxygen per minute (the U.S. Government funded procurement of oxygen generators and cylinders for refilling). This oxygen plant was operational just in time to respond to the needs of Eswatini’s third wave and continues to provide oxygen in cylinders to several other facilities and emergency service providers throughout the Kingdom.

Oxygen plant on TLC’s Miracle Campus.

Although TLC had a full supply of oxygen, the country’s third wave still took an immense toll. Many who passed away during the first and second waves were older or experiencing chronic comorbidities. During the third wave, Dr. Elton started to treat many individuals in their 30s and 40s. Seeing young, healthy individuals admitted and requiring critical care respiratory support is discouraging for Dr. Elton, but despite the immense physical, mental, and emotional strain, Dr. Elton still does not lose hope. He considers it a privilege to have cared for individuals who went from the brink of death to being able to walk out of the hospital laughing and joking with staff members. As he describes it, “When they walk, they walk. They can walk home.”

Outside of the hospital wards, Dr. Elton finds comfort and pride in being a part of a community of dedicated colleagues who provide holistic support, including looking after his emotional and spiritual needs. Psychosocial support staff deliver daily encouragement through seemingly little comments spoken at just the right time. “Hey, how have you been?” and “Don’t lose hope” are two phrases that spur Dr. Elton to keep pressing forward.

Dr. Elton encourages all who are on the frontline of the COVID-19 pandemic to dedicate time to self-care. “While the physical exhaustion may quickly be addressed by hours of rest, one cannot lose focus on one’s vision.” Dr. Elton is energized by the confidence that his calling is to serve others. This calling drives him to serve others in capacities that exceed the normal.

To healthcare colleagues around the world who face immense pressures and responsibility, Dr. Elton shares these words, “Let’s not lose hope. I know sometimes the work can be very challenging, emotionally draining, and physically demanding. Even if you have discharged just one patient, it may just look like a statistic of one patient, but [to] their families, you have managed to save a mom, a grandmother. You have saved so much for their families. When you think of it in numbers, it may not look like you’re doing much, but when you think about it as an individual, think about how much [of a] difference you’ve made. Continue to fight.”

During Eswatini’s third COVID wave, TLC received and cared for clients around the clock.