Tuesday, November 25, 2008

Mortuary

Last week I went to the mortuary with Nthabeleng to pay the fee for an 8-year-old TTL client who had passed away. The girl’s grandfather asked TTL to pay the fee and to transport her body from Mokhotlong to Molikaliko, a nearby town. The mortuary is on the hospital grounds, just across the road from TTL. We entered the building tentatively. A man wearing a surgical mask sat at a table taking notes, and to our left an open door exposed a naked male body lying on a table. Taken aback, I looked away.

The man gave us a slip stating how long the girl’s body had been at the mortuary, which we then had to take to another building where the bill could be calculated. We were also handed the girl’s bukana—the book that contains all medical records throughout an individual’s life. Flipping to the last entry, we saw an urgent note from the Mapholeneng clinic stating that the girl had presented as comatose after a period of vomiting, and that she had apparently been taking two prescriptions of ARVs for four days. The note ended with a command to stop all medications at once and refer to the hospital. Unfortunately, the girl died upon arrival.

Very hard to know what to make of all this. Against all odds, this girl had survived with HIV until she was 7 years old, when she was finally diagnosed and prescribed ARVs. After she started her medication her health improved, and the account in the bukana shows that on her last clinic visit she presented with no complaints. It is not entirely clear whether the overdose of ARVs caused her death, but the timing seems suspect. We spoke with an American doctor who saw her at the clinic, and she suggested that it could have also been meningitis, but that there appeared to have been some horrible miscommunication regarding the drugs as well.

Ellen rode in the outreach car the following day to bring the girl’s body home to her remaining family. They had to pick the body up at the mortuary, wrap it in a blanket, and place it in the trunk of the car. If TTL didn’t perform this service, apparently a family member would have to take a taxi to town, and then return with the body in a crowded combi. Though it seems like such a bare, bare minimum, at least TTL could do this small act.

Ellen said that the mourners were gathered at the rondavel when they arrived, and when they carried out the body the girl’s older sister began wailing hoarsely, like she had been doing nothing but that for days. She, who had buried her mother three years ago, then had to bury her sister, a victim, though perhaps in a different form, of the same terrible disease. Yes, very hard to know what to make of it all.

Sunday, November 16, 2008

Relebohile is Smiling!

For regular readers of this blog, you may remember Relebohile. She is the little girl we brought back to the safe-home on our very first day. When she arrived here - listless, floppy, and emaciated – she was diagnosed with moderate acute malnutrition. (Don’t let the word “moderate” confuse you. The operative words here are “acute” and “malnutrition”; on a scale of 0-4, four being the worst, she was a 3). At that time, it was hard to see the little child within the skeletal frame. But eight weeks later, her transformation to a happy and adorable little girl is nearly complete.

The Bo’m’e affectionately refer to her as “Plumpino”, after the therapeutic food, Plumpy Nut, she was prescribed when she arrived but refused to eat. Her arms and legs, formerly skin and bones, just last week became strong enough for her to crawl. Her smile and playful baby-babble are contagious.

For Bridget and me, Relebohile is the first baby we have watched go full circle, leading us to have a special affection for her. It probably helps that she is this cute:

Wednesday, November 12, 2008

Durban

This weekend we went on a little adventure to Durban, South Africa. Jamie served as our intrepid guide, having made the trip from Mokhotlong several times before. From our estimation, Durban is about 150 miles away (keep this in mind as lengths of trips are discussed below...). To keep things interesting (and out of sheer necessity), we decided to travel the 150 miles on “combis,” public transportation vans that make up most of the long distance transport in Lesotho and South Africa. These combis, about the size of a US minivan, are supposed to carry 15 passengers—three in the front row, three in the three middle rows, and four in the back. In the interest of cramming in passengers, they have no trunk or storage space. This, you might imagine, makes for pretty crowded conditions. To start out the first leg of our trip, from Mokhotlong to the South African border, 16 people piled in the combi. We squeezed in the back row, sure that we were at the absolute maximum capacity. But no…about an hour into the trip two shepherds dashed at our combi as we crossed over the mountain passes, climbed in on top of everyone, and we went merrily on our way. To give you a little taste of the experience (turn up computer to full volume to fully appreciate the Basotho music! Got to love the inspired mix of accordions and thumping bass):


video

Overall, though, the combi rides went smoothly, and three transfers and nine hours later we arrived in Durban. We hopped out in the middle of the bustling city center and caught a cab to our hostel in a more residential area of town. After a quick freshening up, we headed out, only to find ourselves in an empty Indian restaurant at 6:00pm. Not very cool of us, but the experience of eating delicious food at a real restaurant (albeit an empty one) was completely worth it. From there we headed to a club—also very far from the Mokhotlong scene. I think we even lasted several hours past our normal bedtime.

Reid sitting with the remains of our
"bunny chows"
--Durban's famous streetfood


Saturday we headed first thing in the morning to Victoria St. Market—a bustling covered market that sells both Indian and Zulu spices and crafts (Durban has a huge Indian population). Ellen and I had a great time buying fancy curry powders and cool crafts, while the guys drifted around. Being surrounded by the bustle and noise of a big city felt good—until we witnessed a violent beating of two boys who apparently tried to steal something from one of the vendors. We stood there stunned, while a man kicked one of the boys to the ground. Without understanding anything that was being said, or the reactions of the crowd, the experience felt even more disturbing and threatening. It was a stark reminder that the city’s bustle also contains an undercurrent of violence and instability.

For the rest of the afternoon we continued to wander around the city—still appreciating its vibrancy. I led the whole group on a fruitless search for a bookshop, but on the way we stumbled upon a variety of interesting markets where Jamie and Will could search for the perfect soccer jersey.

We had another leisurely dinner—Italian this time - and then headed to a bar at which we were quite possibly the oldest patrons, but which provided excellent people watching of college aged Durbanites and study abroad kids.

Durban was really lively...I swear.

The next day we finally found a bookstore (relief!), then walked down to the beach. The weekend’s weather was disappointingly drizzly and windy, but just the experience of the ocean and beach was wonderful and so far off our mountainous existence.

At around 5 we ended up at uShaka Marine World, one of the largest aquariums in the world, and, as we could get in half price because of the late hour, decided to go for it. The aquarium has apparently rejuvenated a whole portion of the Durban city centre and beach front—and it is HUGE! Beyond the actual tanks, a whole water park, shopping mall, and several bars and restaurants make you feel much closer to Disneyland than Southern Africa. Still, on a Sunday night the place was almost deserted, and we milled around the underground aquarium without seeing another soul. When we had seen enough sharks to satisfy, we had a few drinks at one of the swanky bars on the beach. The rain was blowing sideways against the windows, but when you are lying on cushions sipping a mojito it is very hard to mind such things.

But comforts are only exceedingly enjoyable in contrast with discomforts, right? Which made the return trip back to Mokhotlong the next morning so very meaningful. We left our hostel around 5:30, and had an easy start to the day as the first combi filled up (they don’t leave until they collect a full 15 passengers) and hurtled on down the road. The second transition—also as smooth as one could hope. As was the third. We started patting each other on the backs—“this is great, we’ll be in Mokhotlong by 1:00pm!” we exulted as we were dropped off in the field that lies between the Lesotho and South African borders.

The all-too-familiar field

We grabbed some sodas from the roadside stand and settled in to wait until the next combi filled. The woman at the stand said something like, “you want to sign your name?” but I said no, unsure of what she could mean.

An hour later, the field had grown crowded with Basotho toting apparently entire living room sets, and the combi driver started to gather people up. We lined up confidently by the van. Then, the driver started calling out names of people who had clearly already registered for a spot in the combi. Ach! (as the Basotho would say). Still, we were optimistic. And we pretty much continued to be so as we sat for the next three hours in the field. It was only the next two and a half hours when we started to get a little worried.

Chilling in a field: Hour Five

But finally around 5:00 pm – a mere seven hours after arriving in said field and after a small car repair and several false starts - seventeen of us squeezed into the car. Unluckily, it seems that people bring more out of South Africa than into it, so beyond the enormous volume of humanity was added hundreds of pounds of suitcases, bags, and apparently 300 blankets. Oh well, we sighed in relief as we finally got underway around 5:30 pm. About 100 yards later we opened the doors to two more men, who had given up on the combi some time earlier and started to walk back to Lesotho. They climbed in gratefully. We tried to compress our bodies even more efficiently to make room. About an hour and a half later they climbed back out, and we exhaled briefly, until a women with two small children took their place, handing one of the babies immediately into Will’s lap.

The rest of the ride, minus the sections where I was utterly certain that all 22 of us were about to plummet toward our deaths as the combi veered crazily down precariously perched winding dirt roads, was fairly uneventful. We arrived safely back at TTL and fell very, very gratefully into our beds.

Overseas Election Watch

One of the strangest things about living abroad is missing holidays and events that would be momentous in the United States, but fade to blips by the time they are transmitted 10,000 miles. Having already missed most of the build-up to the election, it still made me feel very far from home yesterday missing out on all of the excitement.

Reid, who is much more interested in and informed on such matters, had been in Thaba-Tseka with Jamie the week before the election and was a little devastated at the prospect of spending election day without phone or electricity. Will, Ellen, and I, however, were determined to participate as well as we could, so spent the night at Nthabeleng’s in order to have access to a TV. We set our alarm to wake us at intervals through the night to check the news—we saw at 2:30 that Obama was ahead and had taken Pennsylvania. After a few more hours on the couches we woke up at 5:30 to watch the final results.

Watching the South African coverage was frustrating in terms of getting the full picture, but pretty entertaining in other ways. The reporters, with a shockingly open bias, often threw in comments like, “Ok, Jim, now back to you in Atlanta, where we will hear more about what some of the right wing loonies think about the election." Not a lot of pretense of objectivity. We caught flashes of MSNBC live in DC, monitoring minute by minute results and interviewing top politicians, but the South African television story bounced between Chicago, where they interviewed people like Obama's barber, and Johannesburg, where the reporter hobnobbed with diplomats at a mansion, every now and then offering nuggets of political insight standing between cardboard cutouts of the two candidates placed on a lawn. Fascinating to see an American election from another angle!

Thursday, November 6, 2008

Prince of Thieves

This is a guest post by Jamie Martin, a Georgetown Medical student and a friend of TTL since it began in 2004.

A weird and wonderful thing happened this past July. Mr. Kearney—a retired principal from Ireland—presented me with a crisp, green envelope filled with nothing but money. Quite incredible, this Irishman entrusted me to use my judgment and his money for good works throughout Africa—effectively donning me a modern-day “Robin Hood” (though, sparing me the conflict of stealing from the rich!). Months later, I find myself in rural Lesotho, and I could think of no better place to begin my task…

This past week, Reid and I traveled to the neighboring district of Thaba Tseka, where TTL offers outreach services in collaboration with a local clinic. On the first morning we loaded the vehicle with the essential supplies – formula, multivitamins, a scale and length board, and food for the clients. We had a busy day ahead of us, aiming to see 11 clients.

Often, the setting of our visits is a dimly lit hut. The smell of burning dung lingers in the air, and shadows of curious children dance in the light of the doorway. During our fifth visit of the day, we were approached by a self-referred woman seeking the assistance of TTL. She seated herself across from us; her child bundled in her lap.

As the conversation briefly paused, Thabang translated that the child had been “coughing very much.” Three years of classrooms, hospitals and tuition behind me, I confidently reached only one conclusion—this child is very sick. Gazing at the child across the room, I began to count out the speed of his breathing. The rise and fall of his chest was alarmingly fast—nearly keeping pace with the secondhand of my watch. Laying the child flat to obtain his height, our fingertips were met by numerous, bulky lymph nodes along his neck and at the back of his head. These same bumps were found under his arms and at his waist, which cemented our decision to test the child for HIV.

Our fears were realized—this child was infected with HIV. The woman later revealed that the father was receiving treatment for TB, increasing the chance that this child also shared the same disease. This combination—HIV and tuberculosis—will mercilessly consume a body, and in children it does so with sinister speed. When asked why she had not taken her son to the doctor, the mother replied: “I cannot afford transport.” We remained expressionless in an effort to conceal our sinking hearts.

At moments like this, it is difficult not to throw up your arms and surrender. A child on death’s doorstep and the only barrier is a lack of a ride? This boy will soon succumb without the necessary – but effective – treatments. Hearing the mother’s response about transport, I reflexively reached into my pocket for money. Whatever is needed for transport, medicine and food, I thought. Heck, I even wanted to buy her new clothes.

Alternatively, the outreach staff reasoned for a more pragmatic approach—we would offer transport fare to the hospital. If the woman did seek medical attention for her son, we would meet her at the hospital to give her the return fare, as well as pay for any hospital fees.

The next morning we found the mother and child in the hospital waiting room. Because they were able to get to the hospital, the boy was admitted and able to begin treatment for TB and HIV. Though Reid and I were satisfied with the result, we cannot take credit…It was Mr. Kearney who paid for the fare. With each day spent at TTL, the necessity of the “direct intervention” that TTL provides becomes more and more apparent. And, it is only possible because of the hundreds of people like Mr. Kearney, who have also chosen to don the character of Robin Hood themselves.