And then there were two more….

This post by Reid.

After Rethabile arrived at the safe-home last Thursday, two more babies came to the safe-home this week bringing to the total to 10, and leading to a very busy and action-packed weekend at TTL.

A quick note on each of the new kids:

Lebuoajoang (pronounced something like Lay-Boo-A-Jwang) – Lebuoajoang was previously an outreach client, and was brought to the safe-home after his situation started to decline following the death of his mother in June from complications resulting from HIV/AIDS. At 11 months old, he is somewhat malnourished, and his HIV status is unknown (we are awaiting test results). Although a little fussy the first few days, it seems like he is adjusting to life at the safe-home relatively quickly and plays increasingly well with other kids and caretakers.

Mokete – I wrote about Mokete three weeks ago after an outreach trip to San Martin that really jarred me. At that time, we transported him to the hospital for treatment of severe acute malnutrition, monitoring of his TB treatment, and HIV testing (sadly, but unsurprisingly, he tested positive). After two weeks in the hospital, he was discharged and spent a week with his mother and aunt waiting for a follow-up appointment at the hospital. The follow-up appointment showed insufficient improvement in his condition, and his mother agreed the best thing would be for him to be rehabilitated at TTL.

When he showed up at the safe-home, I was pulled in different directions. I was simultaneously terrified to see that he had improved so little after his time in the hospital, relieved that he would be at TTL, and concerned that a three year-old would have a more difficult time adjusting to life here than would a younger child.

Although I think this is the best place Mokete could possibly be, having him at the safe-home will be a challenge. As a three year-old he is fully aware that his mother is gone, he can speak (he told us outright that he does not want to eat the “PlumpyNut” therapeutic food prescribed to him), and, once he has recovered a bit, will be at a different level developmentally than the little ones.

He is now on a strict feeding regimen of F-75 (a sort of super-formula) to help him gain weight and give him strength to fight the TB and HIV, but he is suffering from some serious discomfort resulting from intestinal problems, constipation, etc, and spends hours at a time whimpering and pointing at his stomach. It is hard to imagine the amount of pain and suffering that he has already felt at such a young age, and I think we all feel a sense of impatience for the time when he will be relieved of even some of it.

Despite his struggles, we had a glimmer of hope yesterday when Ellen and Will managed to get a few smiles out of him with some goofy antics. Hopefully a few months at TTL will bring out a lot more of that.

Homeward Bound

This post by Reid.

Yesterday, we started the process of sending Kananelo, Retselisitsoe, Lerato, and Thoriso back to their families. It is sad to think about the safe-house without the “Fab Four”, but they are all in stable health conditions and have all started walking, so the timing is right for reintegration. The process will last about a month, during which time they will continue living at the safehome, but outreach workers will be actively working with their families. The first step is to take the “Fab Four” to visit their families, set some expectations, and agree on a timeline.

I went along with ‘M’e Mamareka to begin the reintegration process for Kananelo. She has been at the safe-home since she was just three-weeks old, arriving shortly after her mother passed away from HIV/AIDS. Her father is still alive, and the goal was to find him and develop a plan for how he - or the extended family - could provide care for Kananelo.

We drove for an hour and a half to Kananelo’s village in the Molikaliko area. As we stepped out of the car, two women rushed towards the car and called out “Kananelo!” ‘M’e Mamareka quickly handed over the star attraction, and much to our surprise, the usually skittish Kananelo went quietly into the outstretched arms. Mamareka and I then went into the family’s rondavel to speak with the father, who climbed down from the neighbor’s roof he was repairing when he saw us arrive.

Kananelo's father

Scarcely older than I am (maybe 30?), the father’s overwhelmed look was clearly that of a widowed man, raising 6 kids on his own, being asked to take responsibility for a seventh child - a one-year old baby girl who still requires diaper changes, spoon-feeding, and near constant attention. His eyes, when not pointed at the ground, registered fear, and he sighed quietly as he listened.

‘M’e Mamareka made quick work of explaining the situation – Kananelo is ready to come home – but the father seemed reluctant. “There is no food,” he explained. A small child came into the rondavel, leaned into his father’s ear to ask a question, and then quickly disappeared. Plus, the father elaborated, he has to work all day just to scrape by now, and would have no time to care for a one-year old.

Now it was Mamareka’s turn to sigh. “This is not good,” she explained. “He says he cannot take care of her.”

A family meeting was quickly organized. With little fanfare, children outside the rondavel were told to go fetch an assortment of relatives from around the village. Within ten minutes, there were eight adults crouched on the floor of the hut – five women, and three men.

Mamareka explained the situation again for the larger audience. The family discussed. It occurred to me that this situation would be repeated anywhere in the world under similar conditions: a woman dies and leaves her infant child; a family or community gathers to weigh their options; a decision is made.

“The aunt will take her,” Mamareka announced to me.

Kananelo and her aunt

Kanenelo’s situation is not ideal. The aunt who agreed to take her works part of each year in South Africa – as do many Basotho – and Kananelo will have to travel with her. But the family stepped up, and at least Kananelo will have a home and a caring relative to look after her.

As we stood up to leave, Kananelo’s new “mother” started to hand her back to us. Kananelo – who exchanged arms silently just an hour before –cried as Mamareka took her back.

Dancing Babies

As the “Fab Four” quickly go from babies to toddlers, they are learning all sorts of new skills, including dancing. Kananelo definitely leads the pack in this skill-set, wiggling wildly back and forth at the slightest humming, but all of them get into the action when a song is playing. The bo’m’e (caretakers) have a bunch of songs that they sing - songs that sounds like Sesotho versions of “If you’re happy and you know it clap your hands.” They are big crowd pleasers with the under 18-month crowd.

Reid has broken out his guitar a few times to get in on the fun (I think he kind of misses feeling like a rock star—and babies might be an even more appreciative audience than Rectorpalooza revelers). When this happens, Kananelo runs the risk of actually jarring her head loose from her body, Retsilisitsoe squeals appreciatively, Lerato tries to eat the guitar, and Thoriso is convinced that he could play even better than Reid.

The band is expanding, and the other day we had a pretty good show, with Will accompanying on the plastic bucket and Ellen and me on vocals. Though we need to brush up on children’s songs, we played a couple good-old American rock tunes for the kids and bo’m’e. Not surprisingly, I suppose, “Brown Eyed Girl” was the fan favorite. “Sha La La La La La La La La La La-la Ti Da” works in any language.



(I apologize for the very shoddy filming--I can only hope my poor skills as a videographer are redeemed by the extreme cuteness of the subjects!)

(Oh, and Dad, do you hear the song in the video? Quite possibly the first time John Prine has been heard in these parts!)

Introducing....Rethabile

A new baby arrived at the safe-home yesterday, Retabile. At 3 months old – born July 23^rd, 2008 – Retabile is definitely a “Wee-One”, swaddled in blankets and held by bo’m’e most of the day.

Retabile’s came to the safe-home because his mother recently passed away from an undetermined sickness. We know that his mother had a “headache” and “the right side of her body stopped working” – but are not sure of the underlying causes of her death.

Despite the tragedy of losing his mother, Retabile is doing pretty well. He is not showing any signs of malnutrition, and his rapid-test for HIV came back negative. In Lesotho, being HIV negative and well-fed cannot be taken for granted. But with Retabile’s current health, he has a real shot at living a decent life if he can just get through this most vulnerable time – 3 months old and motherless. TTL will get him through this vulnerable phase, and when he is safely growing and his extended family is ready, he will be sent home.

Although he doesn’t look like it in these pictures, Retabile is smiley and alert, and hopefully his time at the safe-home can be somewhat brief. But for now, the safe-home is back up to 8 kids, and jamming with activity.

Basotho Birthday

Monday was Reid’s 25th birthday.

(The whole crew: Claire, Nthabaleng, Will (in the helmet-?), Ellen, Nicole, Reid, Me, Jamie, Tony, and Heather)

Thank goodness for two weeks we can be the same age! Apparently it’s a pretty big deal here in Lesotho for the wife to be older than the husband. Nicole told one of the outreach workers that I was older than Reid, and she said that this stunning revelation caused Mamareka to stop in her tracks, appalled. Will and Ellen told us that when they were here last year they told a Basotho man that Ellen is a year and a half older than Will, and he paused, shook his head, and said solemnly, “Ah, that is not ideal. No, that would not be ideal for Basotho.” Ouch.

Despite the disturbing difference in our ages, the birthday party went off without a hitch. Dr. Tony (one of the Baylor doctors) and his wife Heather came, along with Nthabaleng. We made burritos and a big chocolate cake -
- and played a rousing game of Mafia (taking advantage of the first, and maybe last, time that we had a group of 10 people around to play).

Now that Jamie, Will, and Ellen have arrived, things have gotten a lot livelier around TTL. With seven people living on the compound it is starting to feel less ascetic and more like a college dorm, but I think that as a group we will really be able to encourage each other and increase our positive impact in Mokhotlong.

(Gratuitous awesome moonrise picture--Going back to our
burgeoning astronomical interests. This taken at 6:51, for the record.)

"Today is Today"

Last Wednesday was Reid’s first excursion as “driver” for TTL outreach. Says something about trust in male ability, since everyone seemed fairly unconcerned about the fact that Reid had never driven a vehicle on the opposite side of the road and in some of the most intense driving conditions you could imagine. I figured that I would go along and see how it went, perhaps shouting “stay on the left!” every so often to keep things running smoothly.

Outreach went well, and Reid did a commendable job driving on all of the “roads” leading to our clients.

At one point, driving straight up a mountain over what could only be described as rocky conditions, we looked up at our destination—a small village perched atop a windy hill—and then down to the seemingly empty valley below. Kokonyana - –the brave outreach worker accompanying us on this day - laughed, “yes, we always wonder why they build their homes so high!” Indeed.

Our first stop was to check up on a former safehouse resident who had been reunified with her aunt last month. We brought food, which TTL provides for both the child and as a supplement for their family, and weighed Reabetsoe. Unfortunately, she is not thriving as much as we would want, and frustratingly, she has been given two DNA-PCR tests for HIV, and both times the results have been lost by the hospital. TTL is going to try to set up a third testing when the Baylor doctors are next in Mokhotlong.

Next we headed to see Ntsetiseng, a child born to one of the mothers in the PMTCT (prevention of mother to child transmission) program. He looked chubby and healthy compared to Reabetsoe, though his mother reported that he had recently been ill. Ntsetiseng has been weaned for two months, and on formula provided by TTL, so we are hopeful that he will prove to be HIV-negative. The most jarring image of the day appeared as Ntsetiseng’s mother asked us to go see his father, recently returned from the hospital where he was started on TB and ARV treatment. The man lying on the mat in the smoky rondavel appeared so wasted and weak that he could barely acknowledge our entrance into the room. I felt strangely desensitized to the picture before us, because it did seem so much like a “picture”, the representation you have seen in books and newspapers of the typical TB or HIV patient. It seems unreal that an actual human being could degenerate into that state, that a being right in front of our eyes could look like that, and still maintain some spark of life despite his cadaverous appearance.

Claire, a med student from Tulane, was with us, and it was striking to have her input as someone who has recently been acquainted with American medical practices (as Reid and I are obviously far from medical experts). She was shocked by how a TB patient could be kept in a small room also occupied by the rest of his family, going about their daily lives, eating and sleeping. She described the intense precautions taken in American hospitals around TB patients, the immediate quarantine and use of masks and gloves. It does appear as a strikingly uphill battle if this man is being treated, only to eventually infect the rest of his family. These issues are somewhat outside the purview of TTL, but at the same time have a very direct effect on the lives of the babies we treat.

The third client we visited was a six-year old girl, Keketso, who should be starting ART. It is unusual for an HIV-infected child to remain healthy and undiagnosed for so long (I believe that around 80% of infants infected with the disease die before age five), but Keketso appeared healthy and well-developed.

The difficulty is in arranging transport from her village to Mokhotlong, since her local clinic has not begun providing ARVs. TTL told her grandmother that she would be reimbursed if she brought Keketso to Mokhotlong, but for some reason she seems reluctant to do so. We will be checking back in a few weeks.

At this point, we felt that we had had a good, full day of work, and returned to the safe house to eat lunch and tie up a few odds and ends in the office. Instead, Nthabaleng came out to meet our returning car, informing us that the outreach worker and driver in Thaba-Tseka (the neighboring district where TTL has a satellite outreach office) had run out of gas and were completely stranded, as apparently there was no gas to be had in all of Thaba-Tseka. She told Reid to eat lunch quickly, as he was going to have to perform a rescue mission and drive to Thaba-Tseka with containers of diesel, which would take about 6 hours round trip on gravel roads. Kokonyana would come to give directions (and perhaps to act as safeguard of the Land Cruiser), and I decided to tag along for moral support.

We filled plastic drums with diesel in town, strapped them to the top of the car, and headed into the mountains. I think I am adjusting to the roads, as they seem less terrifying than they did our first week. About an hour into the trip, Kokonyana thought we should check to make sure the gas containers were ok. We hopped out of the car, buffeted by strong winds on the hilltop, and, sure enough, they had both fallen over on their sides, slowly leaking. The only thing worse than driving 6 hours to deliver gas is driving 6 hours to deliver empty containers, so we tried various methods of tying the containers, to no avail. At this point, Kokonyana sighed. “Ah,” she said, “today is today.” Maybe because we were in the mood for profundity, Reid and I immediately took up the refrain. So true, today IS today. It’s a useful phrase, summing up both the negative attitude of, “it figures!” with the philosophic outlook that, even if today is downright terrible, it is only today. Tomorrow may be an entirely different experience.

Anyway, muttering “today is today” under our breath, the three of us managed to wrangle the containers into the back of the car and strap them securely to the trunk. The next two hours were fairly pungent, but with the windows of the Land Cruiser rolled down and striking mountain vistas all around, not so bad.

The return trip, in the pitch dark on winding, rocky roads, was exhausting but uneventful, and Reid quite proved himself as a driver. As we pulled back into the TTL, about 12 hours after we set out that morning, I realized, the first step in considering a place home is when, upon returning to it, you feel nothing but grateful relief.

"He is a foreign man...."

“Doesn’t speak the language, holds no currency….” Ah, how apt, Paul Simon, how apt. We are definitely out of the loop as far as the Sesotho speaking goes, and we have yet to successfully withdraw money from the ATM. Foreign life indeed.

We were talking earlier about how funny it seems that we have only been here for a little over three weeks. Perhaps because our plan is to be here for the whole year, we have already begun adopting the mentality of inhabitants, rather than travelers. We realize that we MUST adjust to life here—no telling ourselves that we will be back in our comfort zone in a few weeks. Still, we are complete novices here, and the advantage in that is the ability to describe certain strangenesses that probably recede in the consciousness as familiarity sets in. So here is a short list of things that we have found strange so far:

1) Basotho communication. Though we never really know what is being said, the way in which they say it definitely seems foreign to American observation. It doesn’t seem unusual to strike up conversation with strangers on the road, at the bank, at the hospital, etc. I wish I could tell you what they were all saying, as perhaps we could steal some lines in order to smooth social interactions in the States, but no such luck.

The other striking observation is that doors and window are no obstacle to Basotho dialogue. People carry on whole conversations that are nearly inaudible (and especially so when you don’t understand the language). As an example, we arrived at a rondavel on outreach last week and began the usual process of trying to locate our client. With the window still firmly rolled shut, the outreach worker proceeded to have an entire conversation with one of the villagers. Sure that something must have been lost in this muffled transaction, we nonetheless then made a beeline straight for our desired destination. Impressive.

2) From food products, to everyday household items, to lifesaving drugs, it is amazing to discover what is and is not available in Mokhotlong. Though of course it is an adjustment to work around the lack of butter, canned tomatoes, coffee, etc, these are easy to accept as the necessary and even exciting challenges you face when living in a foreign country. Much harder to understand is arriving at a hospital pharmacy only to be told that the ARVs prescribed to an infant at TTL are not currently available. Since ARVs require complete adherence, this could be a major problem. Even worse, in the rural clinics, as we’ve already mentioned, they seem to be out of about half the drugs that are prescribed (from antibiotics to painkillers). We haven’t been able to determine exactly where the supply chain is breaking down here. The drugs should be made available by the government, but, as we’ve certainly seen, no transportation is very easy here.

3) On a lighter note, though continuing on the theme of unavailability…we haven’t been able to withdraw any money from the ATM since we arrived. We spoke with the bank manager twice, and she was kind enough to say that she would call TTL when the problem was solved. She called earlier today, and we flew to the bank, envisioning all of the lovely produce (well, whatever produce happened to be available today—see above) we would soon be trucking home. After waiting in line at the ATM for 45 minutes, we received the same error that has taunted us every day since last Friday: “Your Issuer Is Not Available.” Ah well, they assure us that it will be fixed any day now. (ed. to add: I wrote this about a week ago. We have now moved on to them telling us: “Maybe you should really look into other options”)

4) The casual intermingling of life and death. In a country where the average life span hovers in the mid-thirties, and infant mortality skyrockets through a deadly combination of HIV, TB, and poverty-related health issues, it is hard to understand how the Basotho perception of death must differ from ours as Americans. TTL is located right next to the hospital, which you might think should be perceived as a life-sustaining place, but, disturbing to our American perceptions, within 100 yds of the entrance there are at least five coffin shops. The other day we were walking by one of these little huts devoted to coffins, as well as other carpentry wares, and were stopped in our tracks by the ostentatious display of two coffins outside of the shop. One, big and shiny, and another, a tiny little box obviously meant for infants. Though the explicit reason we are here is to help mitigate unnecessary infant deaths, this served as a stark reminder of the many children who have no such assistance. This isn’t to be a complete downer, but definitely another example of how adjusting to things, becoming comfortable and desensitized, might be good and necessary as we spend more time here, but also that sometimes it is just as necessary to stop and consider the differences that remind us of why we are here.

The Wee Ones

To see the four children that I posted about last week now, it is hard to believe that they too came here as sick and tiny babies. Since these other four little ones are mostly in the sleeping and eating phase, it is also hard to judge their personalities in the same way you can with the others. But as the Fab Four start to stand and walk, these signs of independence also signaling their imminent departures, these babies will be the ones that we truly get to see grow and develop.

Letlotlo:

I am including Letlotlo here, though he was actually reunified with his grandmother on Monday. Poor Letlotlo is always sniffling and snorting from some sinus problem, but otherwise he is happy and healthy. He was taken from his village because of malnutrition, illness, and the death of his mother.

The situation at home is not ideal, but luckily TTL will continue to pay visits and monitor his progress once he leaves. I hope we can share stories of Letlotlo and the others as they are placed back with their families.

Relebohile:

Relebohile was one of the babies we brought in with us from our first outreach trip. Though she is the oldest of the younger set (almost a year old), she is still very weak and so spends most of her day being held and watching the action. She is having a hard time eating her daily dose of Plumpy Nut (a therapeutic food prescribed by Dr. Tony), but definitely has more energy each day.

I wrote this italicized description exactly a week ago, and it is startling to realize the difference in her demeanor in that short time. You can see the great difference in the two pictures:

She has really begun to take an interest in her surroundings, and has been suddenly transformed from an ill-looking infant to a smiling and playful child. As I noted earlier, her rapid test showed that she is HIV-negative.

Tholang:

The really little guy we picked up on our first day. Though he appeared so tiny and weak, his condition was less severe than Relebohile’s and he is doing very well on formula.

He has a beautiful little face, which now opens up into smiles when you make funny faces at him. We found out that his mother (next door at Mokhotlong Hospital) tested positive for TB, which means that Tholang has to be watched very closely for signs of the disease, but he seems to be doing very well for now. Kokonyana took him to visit his mother last Tuesday, and said that the mother was doing well and overjoyed to see her son.

Tsepo:

The newest addition to TTL.

Tsepo did not come primarily for health reasons, but because his mother recently passed away and he was being insufficiently cared for by his widowed and elderly grandfather, who currently has the care of seven grandchildren. Tsepo is a case of prevention, since under the circumstances he might have soon deteriorated. As of now, he is adjusting well and seems happy and healthy.