LUKE COMMISSION INC

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The Luke Commission has grown from a small medical outreach to address HIV/AIDS in Swaziland, the country with the highest HIV/AIDS rate worldwide, to a sophisticated and effective mobile medical outreach model recognized as a leader in the field. TLC provides free, compassionate, comprehensive healthcare to under-served rural populations through mobile medical outreaches. The Kingdom of Swaziland, Ministry of Health has upgraded these from clinics to mobile hospital outreaches, since they provide the same types of services in the field that hospitals do (medical intake and medical history, surgery, pharmacy, lab, x-rays, assistive devices for people with disabilities, triage, doctor visits, diagnosis and referrals for treatment). TLC will see an average of 650 patients in a day and up to as many as 1,000, because they do not leave until every patient is seen.

Process:
TLC works with community coordinators to mobilize outreaches in isolated locations. The coordinator secures a local primary school for the day and engages the entire community in the day long event. TLC transports staff and equipment to set up a mobile hospital with rooms for medical intake, triage, lab, pharmacy, x-ray, surgery, counseling and testing, doctor visits, vision screening and assistive devices. They depart early in the morning and often travel up to 2 hours or more to reach a location. They set up the unit while a community dialog is taking place with the 1,000+ community members waiting to be treated where key health issues such as HIV and TB testing and treatment are discussed. Then each patient is seen by a Swazi staff person for a detailed medical history, lab tests, doctor visit and referral for follow up and medications at the pharmacy. Additional services such as vision care and assistive devices for people with disabilities are also going on at the same time. A room is set aside for voluntary spiritual counseling and support. All medical instructions and prescriptions are provided in siSwati.

The staff:
TLC has a very strong locally trained team of Swazi's who provide counseling, translation, testing, and administrative support for the mobile outreach. The medical team is led by Dr. Harry VanderWal and his wife Echo VanderWal (PAC) with a team of 3 nurses.

Results:
TLC delivered 50 mobile hospital outreaches in 2012 and saw 24,000 patients, in 2013 they increased 50% to seeing 36,000 patients in the most inaccessible locations in Swaziland. They test more patients in a single day (100+) for HIV than all the rest of the providers in the country combined and have the highest percentage of patients who successfully enroll and maintain treatment. They perform more male circumcisions than all the rest of the providers in the country on an single day and have the highest rate of followup with patients and the lowest rate of complications.

Since their beginning in 2006, TLC has seen more than 150,000 patients and delivered more than 350,000 medical services. The Kingdom of Swaziland has embraced them as an extension of the national medical system, USAID and the CDC recognize their outstanding performance in the field reaching the most isolated populations.

Funding Sources:
The Luke Commission is funded by donations from individuals, churches, corporations. In recent years, some additional funding has come from grants with USAID and the CDC.

Expansion:
TLC has purchased 30 acres of land and is building a permanent campus in the heart of Swaziland as a base from which to expand their capacity in country and to become a training site for teams from other countries to replicate the mobile medical outreach model that they have perfected.

As a volunteer and supporter, and professional development specialist working across southern Africa. I am extremely impressed with their commitment to the patient, the dignity and compassion with which they approach their work is exemplary. Their vision for what the patient needs to be successful and their drive to remove the barriers preventing them from accessing care and being retained in treatment sets a new standard for the field.

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