Ending the HIV Epidemic
Davis resident Brian Sway re-engineered more than 300 clinics in South Africa to speed up the fight against HIV and AIDS. This June, the U.S. State Department honored him with one of the most prestigious awards an American can receive.
Sway, a UC Davis economics graduate now in his late 60s, has been fixing problems all his life. He worked as a tech consultant and “solutions architect” at the global IT company CGI in Sacramento for almost 11 years, until in late August he said he saw a post on the Peace Corps Response website that would change his life trajectory.
Peace Corps Response is a program that sends American professionals on assignments of up to 12 months to provide assistance to local communities. In that listing, they were seeking short-term volunteers with Sway’s qualifications willing to travel to South Africa and provide assistance to local communities.
Joining the Peace Corps had been a lifetime aspiration for Sway and his late wife, Susanne Rockwell – who held undergraduate and graduate degrees from UC Davis, where she worked in communications for 30 years. Family complications prevented them from going together to Uganda four years ago. But this trip, Sway said, would be a fulfillment of their “joint dream.”
“Everything happened very fast,” he said, “I quit my job in mid-October and got on a plane to South Africa the first week of November.”
Sway said experts and officials from across the country were organizing a hands-on HIV and AIDS intervention in Pretoria, one of the largest cities in the South African province of Gauteng, known locally as Tshwane. The United Nations estimated that about 8 million South Africans were living with HIV and AIDS in 2018, and both private and governmental agencies were looking for immediate, drastic solutions to stop the epidemic from spreading further.
Lack of efficiency was identified as a primary concern of public health care facilities in Pretoria’s outskirts. Efficiency was Sway’s field of expertise, so that’s where he went.
The clinics where Sway volunteered were highly congested, chaotic and understaffed. On average, the facilities were smaller than a medium-sized elementary school in Sacramento, but hosted 600 to 1,000 patients every day, together with medical staff and other health care workers.
“People are always waiting,” Sway explained. While on average clinics opened at 7 a.m. or 8 a.m., patients began lining up at 5 a.m. outside the front door, sometimes protecting their spots by force. Doctors were in short supply, and nurses, often the only staff available, had to serve as “line referees” to keep the patients from breaking into fights in the overcrowded halls.
Getting to the front of the line could take a full day, Sway said. And the wait wouldn’t stop there. Patient files were disorganized and lacked a consistent management system. When Sway began the project, it took a clinician more than three hours to find a patient’s file, if they found it at all.
“Some had to open a new record, which meant that clinicians were operating blindly to a degree,” Sway said. “But most people had lost confidence in the clinic’s ability to keep their files, and they were taking them home with them. That’s illegal in South Africa, and it’s highly discouraged.”
He was assigned to a year-long re-engineering project by the President’s Emergency Plan for AIDS Relief, an HIV- and AIDS-focused program of the U.S. Centers for Disease Control and Prevention. Together with a team of locals, Sway created a new Standard Operating Procedure and training program that “re-engineered” the way facilities organized, sorted and accessed files.
Sway said he spent his first eight months working with managers, staff and even patients to break down and address their concerns, and make sure changes could be sustained over time. “Change is always slow: You have champions of change and you have people who are apprehensive about change,” Sway said. “But we can’t do it to them, we can only do it with them.”
Positive results began to show immediately. The clinics that embraced Sway’s new system reduced file search times from over three hours to under five minutes.
On June 5, Sway was rewarded for his contribution with the Benjamin Franklin award for Public Diplomacy, the most prestigious honor an American citizen can receive from the Department of State for advancing U.S. ideals across the globe. But Sway said to him the award was meaningless compared to the satisfaction of having made a lasting contribution.
Wait times rapidly decreased while quality of care increased, according to a Peace Corps news release. Clinicians told Sway they could finally focus on providing treatment, and patients said they felt more respected and appropriately taken care of.
Sway’s Standard Operating Procedure has since been implemented through the Centers for Disease Control and Prevention in more than 300 clinics in South Africa, according to the release. The South African National Department of Health is also encouraging thousands of clinics nationwide to try it out.