Exploring

Had a lovely weekend here in Mokhotlong. We spent Saturday morning watching the Fab Four because of a staff workshop. I think they are finally really comfortable with us—evidenced by the fact that we managed to get all four of them to sleep for a nice chunk of time. Awake, they were loving Reid’s guitar playing.

The outreach workers prepared a traditional Basotho meal to be served at the end of the workshop, and we fortunately got to join in the feasting. They had papa (the cornmeal porridge staple), chopped spiced cabbage, chicken, and Chakalaka (a kind of tomato salsa/sauce that tastes almost as awesome as its name suggests), along with “drink”, a ginger-pineapple punch. It was pretty fabulous.

Afterwards we headed to the river, about a half-hour walk from TTL. We found the cave recommended by Dan and Mo (we think—is this it, guys?),

but decided that it might be nicer to sit and read in the sun.

We lasted until the wind got the better of us, and then wandered further down the river until we found a way to cut back up to TTL.

The next morning we decided to tackle Thaba Telle (apparently something like “Tall Mountain”), the mountain behind TTL.

The hiking is different than anything else I have experienced: no trails, and a strange mix of grassy shrubs and rocks. At the top, you are climbing almost straight up over boulders and rocks. From the summit you can see the whole town as well as all of the surrounding mountain ranges. Gorgeous.

Those of you who know me well might be able to guess that the climb up was much less intimidating to me than the return downhill.

Going straight down over sliding gravel and rocks is pretty much my idea of terrifying, but we persevered and made it down (slowly!).

Came home and prepared a curry and my first batch of African chocolate chip cookies to welcome Nicole and Claire, the two med students who arrived Sunday. We were joined for dinner by Nthabaleng and her friend Kefue. A very good weekend.

Ups and Downs

This post written by Reid.

I returned yesterday to San Martin, the same village where Bridget and I made our first outreach visit last week. We were headed there again to follow up with Tholang’s grandparents to let them know he is doing well, to provide an HIV positive mother and baby with formula, to visit the pregnant woman who we met with last week to determine whether she had yet given birth, and to check if the clinic had any more referrals.

The first three goals were met easily. We quickly found the pregnant woman, who had fortunately not delivered yet, and loaded her in the car for transport to the Mokhotlong hospital – three hours away. In the US, children almost never contract HIV from their mothers because there is good ante-natal care, the right drugs, and a safe place to deliver. In Lesotho nearly 25 percent of children born to HIV positive mothers inherit the virus. By transporting this mother to the hospital – where she will get a good portion of the services so critical in the US - the chances of the child getting HIV are drastically reduced. This is the “front-line” and preferred option for “treating” vulnerable children. If the child doesn’t acquire HIV in the first place, the whole game changes. We then delivered the good news to Tholang’s grandparents (after nearly getting eaten by some village dogs). Finally, we delivered formula, along with training on how to properly use it, to the HIV positive mother.

Three-for-three and feeling pretty good at this point, we headed on to the clinic to check for any new referrals.

We sat in the nurse’s office at the clinic, a cold room with outdated and crude medical equipment, tile floors peeling away, and old furniture piled in the corner.

The health worker on duty (not a nurse, and definitely not a doctor) brought in a woman. On her back was a three year old, Mokete, who weighed 15 pounds.

As the mother sat down and unwrapped the child, the outreach team and I could not help but look away. The mother started to cry, perhaps embarrassed at the condition of her own child, or perhaps relieved that someone had finally arrived that might be able to help her son.

Mokete is the sickest child I have ever seen, presenting a sight more jarring than I could ever be prepared for. His whimpers were faint and consistently timed, almost as if the whimper had become a reminder to himself that he was alive. We lifted his shirt and saw his ribs protruding from his chest, skin taut against them. We lifted his pant leg to see a twig – seemingly not an ounce of muscle between his skin and his leg bone. His face was sharp and sunken. Completely ravaged by TB, Mokete seemed as close to death as he did to life.

We quickly loaded Mokete and his mother into the car. As we pulled away, a woman ran from the clinic and knocked on the window. We stopped, and she reached through the window to hand Mokete’s mother some money for the journey and the indeterminate amount of time in the hospital, so far away from home. I choked up as the money exchanged hands. Four Maloti – about 50 cents.

It occurred to me that children like Mokete don’t die from TB. They die from poverty.

The Fab Four and the Wee Ones

Not a bad band name, right?

Since these little guys are what TTL is all about, I thought I would share a little information on each of them. Also a good way to put names with faces—pretty cute faces, at that.

Reid and I have started thinking of the eight babies here now as two different classes: the “Fab Four” who are the big guys over 1 year old, and the “Wee Ones” who are all around 6 months. Basically there are four who scuttle around, try to stand, and generally get into everything, and four that mostly resemble large lumps of blanket that cry every so often.

The Fab Four

Retsilisitsoe:

Yeah, quite the mouthful, I know. Pronounced something like Ruh-sid-ee-seet-sway. Because L’s are D’s, and oe’s are w’s. Got it? Yeah, us too. Anyway, this little guy has the most cuddly personality ever.

From the first day he has thought I am Mo, so I have received unearned affection. He loves to watch everything going on around him, preferably from a comfortable lap. His favorite game to play is “ja dijo” (eat food), though he generally shows a lot less enthusiasm when it comes to eating his real food. Though it is hard to imagine, R was very, very sick when he first came to TTL. His HIV-positive mother died shortly after giving birth, and he too tested positive for HIV several months after arriving. Though both parents have passed away, R has grandparents who are willing to care for him when he is stable. Now on ARVs (anti-retrovirals – drugs that help control, but not cure, HIV), he is completely lively and happy.

Lerato:

The oldest, though smallest, of the Four. Lerato has a great laugh and smile, and is probably the most active of all the kids, constantly crawling around and trying to get involved in everything. He was the biggest fan when Reid brought out his guitar, swaying to the music and then deciding that he wanted the guitar for himself.

Lerato is also HIV-positive and on ARVs. His mother is still alive, and hopefully he will be reintegrated with her in the next few months. When he came to TTL he was malnourished and sick. Now, other than a rash that comes and goes, he is also doing very well and has the big belly to prove it.

Kananelo:

The only girl of the four, and, of course, also the most advanced. (Just kidding. Kind of). She loves to imitate everything, and you can tell she is just on the cusp of talking. She has a love/hate relationship with Reid—she generally sobs the first time he tries to play with her, but then becomes a little bit fascinated and watches his every move until he attempts to play again.

Kananelo lost her mother, though hopefully her father will be able to find support to care for her.

Kananelo is HIV-negative, and overall seems to be doing very well.

Thoriso:

Everything is either sunshine or storms with Thoriso—he has the cutest laugh and smile, but if you thwart him—watch out! He is your typical boy—loves balls and getting tossed in the air, the more action the better. He and Retsilisitsoe compete for attention—if one of them is involved in something the other will be scurrying over to see what’s happening.

Thoriso is HIV-positive and on ARVs as well, but is healthy and will eventually return to his paternal grandparents.

Reading back through this, I already see the bittersweet progression of these kids—from deathly ill infants, to healthy and protected babies, to children who will have to leave a place that they have known as home to return to a world in which they will have to learn to live with a disease that has both threatened their own life and in most cases taken the lives of their parents. I don’t want to dwell on the negative, and merely looking at the pictures you can see the positives. These kids are healthy and happy because of TTL, and thankfully there is also a system in place to provide continued support to them once they return home. Still, perhaps good to keep looking towards a future in which the negatives can be further mitigated.

I will post bios of the Wee Ones in the next few days, so look forward to more cuteness!

Snow!

For all of you who assumed we would be sweltering away in Africa:

Yep, big snowstorm here on Saturday! We woke up in the morning to a drizzly rain, which suddenly turned into large flakes of snow. Our plans to climb the mountain behind TTL thus put on hold, we confined our movements between the house and the safehome (luckily, they keep the babies pretty warm, and nothing cozier than holding a swaddled baby in front of a gas heater!). Since our room is not so well equipped (i.e., freezing cold) we borrowed a little electric heater from Nthabaleng. At the end of the day we began preparing dinner in the kitchen, looking forward to a cozy night with our heater and maybe a movie on the laptop.

Then the electricity went out. We ran to grab our headlamps from the room, meanwhile marveling at the transformation of our surroundings into total blackness, except for the now exceptionally bright stars. Still, hard to appreciate the beauty of the snow and stars when you are contemplating a night with no heat. Anyway, retrieved the headlamps and resumed cooking dinner on the gas stove, which by this point we were huddling around for warmth as much as anything else. Here’s a short clip—us a little slap happy at being snowed-in in Africa:

(TIA—This is Africa. Thanks for the very useful phrase, Conor! Just bet you didn’t think snow would be part of it!)

After dinner we made tea and climbed into bed with as much clothes on as possible and played some cards.

The morning was gorgeous, the skies clearing up and the snow just beginning to melt.

The electricity was, thankfully, back on. Now, two days later, the snow is almost gone, just a chill in the air remaining.

More on Outreach

This is Reid here, taking a stab at my inaugural blog post. I thought I would write a bit about “outreach,” to elaborate on what Bridget posted earlier this week about our first outreach trip.

Before arriving in Mokhotlong, I was aware that “outreach” was a key component of the TTL mission. But I didn’t quite appreciate what that meant until experiencing it firsthand. This week, however, TTL may have “accidentally” saved three lives just because of outreach. Some explanation is in order.

Outreach is not glamorous. It involves driving for hours on some of the worst roads you can imagine. Trips often take 2-3 hours. At times, the roads are so bad that even the Land Cruiser – built to handle punishment - can go only 5-10 km/hour. These are bumpy, hit-your-head-on-the-ceiling sort of rides.

At the end of these rides, a TTL outreach team – consisting of one to two outreach workers and a driver – will usually see one or two clients in a rural village. A visit can consist of anything from delivering some formula to a HIV positive mother so she doesn’t have to breastfeed (thereby increasing the chance of passing along HIV to her baby), to bringing a baby back to the safe-home for rehabilitation. There was a little of both this week.

Many of these visits are planned and occur regularly. For these clients, there is no substitute for TTl. Without TTL, the mothers would not get formula, the babies would likely deteriorate slowly in their homes until death, and other services – otherwise available from the government or international organizations - would be inaccessible to those in the remote villages. There is usually no one else visiting these areas. There is no way around the long drives that others don’t want to take.

Much of this I already knew. But these outreach trips – in addition to serving the clients TTL has already identified – are also crucial to finding others in need. Three lives directly affected by TTL intervention this week were all “accidental.”

One baby – Tholang (who Bridget wrote about earlier)– we found just because we happened to be in his village, 3 hours from the nearest hospital. Severely malnourished, he is doing much better after just 4 days, smiling, alert, and eating well.

TTL also “stumbled upon” a pregnant woman on a separate visit. Orphaned by both her parents, 18 years old and un-wed, she had not had any pre-natal care and was nine-months pregnant. She was scared and ashamed, hardly able to look at the outreach workers when she talked. TTL transported her to the hospital, and we heard yesterday that she delivered a healthy baby girl. Te report of healthy mother and healthy baby got quite a few smiles around TTL.

These cases – the ones that we didn’t even know about at the beginning of the week – really resonated with me as evidence of the value of TTL’s approach. Pretty cool stuff.

Mokhot-LONG Nights

Today is Friday, and almost the end of our first week in Mokhotlong. It is funny how certain things have already become familiar. Other than the driving, I think I am feeling pretty comfortable. I’m sure we will look back at this time in a few months and laugh about what we didn’t know, but at least at this point I can see us here for the year. Though our life in D.C. seems almost incomprehensibly far from the experiences we have so far had here, it seems that humans are almost scarily adaptable!

Having the Baylor doctors, Dr. Tony and Dr. Jill, and Tony’s wife Heather, around this week has been nice, just to be able to discuss our impressions of the country so far and to hear from some Americans who have much more experience in Lesotho than we do. Last night we ordered pizza from Senqu (the hotel that provides pretty much the only dining-out option in town) and sat around and talked, which felt reassuringly familiar, though of course we were sitting in a rondavel instead of a bar in DC.

One thing that I could see being very hard to return to after a while here is the pace of life in the States. Though everything is certainly slower here, it does make you stop and think about what we gain by being super-efficient in America. Sure, you can microwave dinner in 30 seconds and stick your dishes in the dishwasher and walk away, but what do we generally do with the time that we gain? Little of worth, to be sure. Not that painstakingly lighting the stove, and peeling vegetables, and washing dishes are necessarily more worthwhile, but at least I do feel that we aren’t missing much (except for cable, right Tim? I admit that I’ve been humming the “No Shoes in Lesotho” song quite a bit since we got here).

Anyway, just to give a glimpse of how we’ve been spending our nights here (as opposed to days, which have all been pretty varied and intense), I thought I would describe our Wednesday evening.

We went on a short hike up the mountain behind TTL, and got caught picking our way down the dry shrubs and rocks in the dark after the sun started setting around 6:30. Coming back to the house (hmm…not really sure what to call it…not quite a house, but more of a long structure with different rooms all opening up to the outside. I will call it the house to differentiate between it, the safehouse, and the rondavels, which are all on the TTL compound), I baked an experimental batch of soda bread for our breakfast the next day, while Reid whipped up some homemade mayo for pasta salad (thanks for the inspiration, Dan!).

We ate our dinner sitting outside on the dark stoop in front of the kitchen, looking up at the incredible number of stars. After we finished, Heather came out of her room and we all made tea and the three of us stood outside for twenty minutes waiting for the moon to rise over the hills. We were shocked to find out that the moon rises an hour later every night, and, compared to our observations the night before, had moved significantly in position over the range. One week in Mokhotlong, and here we are, amateur astronomers. After the moon rose - at about 8:45 for the record - Reid and I got ready for bed and tucked in to read by the light of our headlamps for an hour before falling asleep.

So there you are, a full night in Mokhotlong.

Tagging along with the Baylor Docs

On Thursday, we were fortunate enough to be able to tag along with the Dr. Tony and Dr. Jill (From Baylor’s Pediatric Program—they are here once a month up from Maseru to check in at the hospital and several rural clinics) for their day at the clinic in Libibing (pronounced “Dibibing”—L’s are D’s if they come before I’s and U’s—yeah, it’s really fun to try to figure that one out…).

Reid and I posted up on an unused exam table in the corner, assuming our so-far-customary positions as silent observers. This week we have basically been sponges, trying to soak up as much information about the Basotho culture and the medical issues being faced in the country as we can, so that hopefully in the not TOO distant future we might actually be able to contribute something of use. We initially planned to overlap with Dan – our predecessor here - which would have helped to avoid this lag where all of his hard-earned gains have temporarily been put on hold while Reid and I acclimate. But, you know, the best-laid plans… (Dan, if you’re reading, everyone has been asking about you! We tell them that hopefully you’ll be returning in the near future… They are also impressed when we tell them how full of metal your leg is now).

Anyway, it was a very informative day, and helpful that the nurses were translating for Tony and Jill so we could also have some idea of what was happening. They were handling primarily ART (anti-retroviral therapy) patients—both those already on treatment and potential new patients. The major frustration of the day (and this is saying a good deal for a clinic at which seemingly half the drugs that the doctors attempted to prescribe were out-of-stock), was that all the CD4 labs (the measurement used here—instead of the more advanced analysis of viral loads used in the U.S.—to partly determine the severity of the disease) that had been taken the previous week and that people had walked for hours to find the results, were unavailable because the machine at the hospital in Mokhotlong was broken. Because of this, many people who might have needed to be put on ARVs were not, and they all have to return twice more for blood tests and then results. None of the patients seemed to protest much against this failure, an attitude that struck me as a sign of how familiar these people are with frustrations and delays.

I was surprised at how many older men and women were being treated at Libibing for HIV. The stereotype is more of the promiscuous young man or woman, but many of these patients were in their 50s and 60s, and only recently diagnosed. Dr. Tony speculated that the high incidence of transactional sex taking place in these villages might mean that older men were having sex with young women, perhaps in exchange for food or favors, these men then going on to infect their wives. Horrible all around. Dr. Tony also told us of a study he read that found some evidence that being married in this region actually RAISES the risk of contracting HIV.

One sad story in particular: A 45-year-old woman with a low CD4 count was supposed to start ARVs yesterday, but when she arrived she said that she could not start treatment without the consent of her husband, who is working in Maseru. I am not sure of all the implications here, but she said something about him having “rights” over her, which prevented her starting the drugs that could save her life. What is so absolutely infuriating is that these “rights” almost surely led her to becoming infected in the first place. Dr. Tony asked a poignant question: “What rights? The right to decide whether she lives or dies?”

Though we didn’t specifically treat any babies at the clinic, I do think that being there was helpful to our work at TTL in its contribution to our overall understanding of the conditions in the rural villages and of HIV treatments.

The First Outreach Trip

Hi! Welcome to any readers of this blog! As a lot of you probably already know, Reid and I took off a few months after getting married to spend a year in Mokhotlong, Lesotho, working with Touching Tiny Lives. Here we will try to update about our life in Mokhotlong and about the work being done at TTL. If you are all really lucky, M'e Nthabaleng, the managing director of TTL, might do a few guest posts along the way.

Since this is our first week here, and most readers might not know much about the everyday happenings at TTL, I thought I would write up a pretty detailed account of our first day going on outreach--a major part of TTL's mission that involves traveling to remote rural areas to contact new potential clients (sick babies and pregnant women) and also TTL babies that have been reintegrated with their families after rehabilitation.

9/16/08
Yesterday was our first day on outreach. After starting to feel relatively adjusted and at home on the TTL compound, we knew that this would once again thrust us out of our comfort zone. We had to abandon our 12 hour sleeping habit (ah, jet lag) in order to make it to the safehouse by 8am for a briefing with M'e Nthabaleng and the outreach workers, Kokonyana and Mamareka.

Our intention was to go to St. Martin (which has a Sesotho name that I do not know--something like Mahoabo) to assess a malnourished child who had been reported by the first outreach attempt in the area. (During this first contact, over 300 people requested HIV-testing. Outreach coordinated with medical workers to provide the tests a few weeks later). Our second task was to contact a pregnant woman who had tested postive and, though we had no drugs for PMTCT (Prevention of Mother-to-Child Transmission), see if we could develop a plan of action.

The ride to St. Martin was...brutal. After the first 30 km or so the road was unpaved, a dirt ribbon winding along the side of the stark mountainside. The outreach workers chatted happily throughout the drive, as I clutched Reid's arm and prayed that we wouldn't roll off the cliffs (you would think a Colorado native would have a better stomach for heights). We arrived at the first village, a windy place with rondavels sprinkled atop a steep hill. The village seemed empty, all the men and children at work and school. The grandmother of the baby we were looking for came to meet us, though for the first 15 minutes or so I did not realize that the chubby faced baby was the malnourished one who had been reported. Then Kokonyana called for the scale, and when the baby was taken out of its wrappings its wrinkled and scrawny legs and evident ribs were finally exposed.

The grandmother was reluctant to give the baby to us because its parents are alive and in Maseru, but Kokoyana convinced her to speak with the grandfather and other relatives and told her we would be back after our stop in the next village (all of this, of course, I am mainly inferring, with some translation from Kokonyana, as our lack of Sesotho prevented us from doing much more than standing by and nodding supportively).

The dirt roads we had been traveling on started to seem luxurious in comparison to the roads that took us from the first village to the second, which seem to consist primarily of large boulders. The Land Cruiser handled these pretty impressively, though I'm sure it would be amusing to watch how its inhabitants were tossed around like rag dolls. Still, my mental state does better with bumps than high speeds and potential free falls, so I can't say I entirely minded the change.

At the second village we wound our way up a steep path to where the pregnant woman lives. She emerged from her rondaval at the calls of Kokonyana, disheveled and hugely pregnant, with bare feet and a dirty blanket wrapped around her large belly and skinny body. She told Kokonyana that her due date was Sept. 2, making her almost two weeks overdue. Because of this, the outreach workers decided not to bring her back with us to the hospital in Mokhotlong, and to visit in a week or so. Reid and I were somewhat confused at this, and frustrated that there were no drugs to bring to this woman. This goes back to Dan's well-put point from last year--it is infinitely easier to bring drugs to pregnant women than pregnant women to drugs. As we spoke with her, another woman with a child strapped to her back came by and mentioned that she had tested positive for HIV. She didn't want to breast-feed, since she knew the risks to her child, but had no formula to substitute. So now there are two priorities for returning to this village in the next few weeks.

After we left this village we bumped our way along to the closest clinic. Here, we heard reports from the clinic staff and its Zimbabwean doctor. The clinic has basically nothing that it needs--no testing kits, no ARVs, no nevirapine, and no formula. After relaying this disheartening news, they told us about a baby they had seen earlier in the day that appeared to be sick and malnourished. One of the girls on staff offered to take us to his village, so she hopped in the car and off we went. This turn of events certainly cemented in my mind the necessity for the outreach program and its widening--so much of this system seems to rely on word-of-mouth and happenstance.

We arrived at the rondaval of the baby, and entered into a very bare room. An elderly man and woman sat within, the woman holding a small bundle. A small, smoking wood-burning stove and a bowl of plain papa sat on the floor next to her, but otherwise there was nearly no sign of any comforts (or necessities, for that matter). Kokonyana spoke with the couple, the grandparents of the child, explaining our mission and how we could help the baby. Mamareka unwrapped the baby, and we could see its shockingly small body. We weighed the baby--3kg (about 6.6 lbs!) at 4.5 months old. The baby, Tholang, had the characteristically sharp face of malnutrition--making him look like a small, wise man. The grandparents were again reluctant to part with the baby, as its mother had departed for the hospital on Sunday. Reid asked Kokonyana to tell them that we could return with updates on the baby's progress, and, seemingly, this cemented their decision. The grandmother began rooting through a small pile of suitcases and clothing on the floor next to her, and emerged with a new shirt and diaper. She gave them to Mamareka, who began changing and dressing the baby. I still was not sure at this point what the result of our intervention had been, but the next thing I knew we were out of the rondavel, baby and Mamareka leading the small procession.



From here we headed back to the first village. Now children played in the yards, still in their school uniforms. We climbed down to the rondavel and were greeted by the grandfather of the child. This rondaval was much cleaner and livelier than where we had found Tholang. Two small boys stood next to chalkboards scrawled with school lessons, and the grandmother sat in the middle changing the baby into a fresh set of clothing. The decision had apparently been made, and she handed us Relebohile almost without discussion, accompanied by a letter from the chief granting TTL guardianship for the immediate future. Relebohile joined us in the now-crowded car, gazing around silently for a while before falling asleep.

Back at TTL, the bo'm'e and outreach workers sprung into action. The babies were washed and changed, and we sent for Dr. Tony, conveniently here this week from Maseru. Dr. Tony showed Reid and I how to evaluate for malnutrition, since if a similar situation occurs after-hours without him here we will have to perform these assessments. Both babies were found to have acute malnutrition--Relebohile slightly more severe than Tholang. Relebohile had been tested for HIV during the previous outreach visit, and was negative, so we tested Tholang. Thankfully, at least according to the initial rapid-test, Tholang is also negative.

After the babies had been taken by the bo'm'e, Reid and I headed home (headed in the quickest sense, as "home" is about 20 feet from the safehouse), mentally and physically exhausted by the day. I can't really express all of my thoughts and feelings regarding all we saw yesterday--I know that bringing these sick children back to the nurturing environment of TTL seemed like a true victory, but also that the image of Tholang crying silently, so weak that he could barely protest against six strangers handling and examining him, must certainly be the saddest thing I have ever seen. And, of course, for all the celebration accompanying every success story at TTL, the underlying tragedies of orphaned children, starving families, and rampant HIV remain.

Now, three days later, both Tholang and Relebohile are doing well, eating a lot, and already livelier than they were a few days ago.