Lunchtime!

Ithateng getting a bottle shortly after arriving at the safehouse, Seithati munching away, and Nteboheng smiling for the camera in her bib... Gotta love lunchtime!

Another victory, another goodbye!

My buddy Thuso, who I've written about on the blog before, just went home today!

The picture is of him and me just a couple days ago, playing around with his favorite toy: my camera.

...a mere 36...

I had never given much thought to tuberculosis before coming to Mokhotlong. While it is indeed a lingering threat in the United States, it often flies under the radar. Out of sight, out of mind, I suppose.

Here, TB is a large enough problem that it is front and center in most medical providers' minds, right up there with HIV and malnutrition. It is also a common threat to our young clients' health, whether they are infected themselves or someone else in their household is infected. Small, smokey, one-room rondavals in which everyone in the family sleeps and breaths and coughs together aren't exactly the best place to spend a night with someone with TB. There is a section of Mokhotlong Hospital next door devoted to patients with multiple-drug-resistant TB. Our outreach teams ask questions about TB history within the household each time they fill out a new client intake form and each time they perform a monthly client check up.

In the World Health Organization's standards for defining symptomatic HIV infection, tuberculosis is considered one of only four "major signs" of infection. Co-infection of the two diseases means a dire outlook for a patient, especially in a place like Mokhotlong. Already compromised immunologically by the HIV, such patients have an extremely tough time fighting their TB and few resources to aid them in that fight.

On Wednesday morning, I happened to be in M'e Nthabeleng's office as she was checking TTL's email account, which is provided by our Lesotho-based Leo Internet Provider. The company has a homepage where they post country news, and the headline that popped up on Nthabeleng's computer caught my eye.

"HIV, TB cut Lesotho life expectancy to a mere 36."

"Woooh!" Nthabeleng said. "That is all you get in Lesotho."

Even though I've become accustomed to stark and shocking statistics in this country, particularly the sky-high statistics on HIV infection among people in my own age group, the final age of 36 jumped out at me as being particularly devastating. I immediately thought of all I still want to do in life -- I'm 24 -- and what dying in just 12 years would mean. More important, I thought of what that statistic would mean to me if I were a Mosotho, how it would affect my ambition, my drive, my optimism, and how it would inevitably mean a long line of my loved ones would die young even if I weren't infected myself.

Turns out the article -- the original source of which I am unsure of -- was posted in light of the fact that Wednesday was World TB Day. As such days are aimed at spreading awareness, I figured I would share my above thoughts on TB in Mokhotlong, as well as the article in its entirety below:

HIV, TB cut Lesotho life expectancy to a mere 36

March 24

Medical workers are increasingly concerned that the lethal combination of HIV infection and tuberculosis may become the world's next major health crisis.

To mark World TB Day on Wednesday, Medecins Sans Frontieres drew attention to Lesotho, which has the world's third-highest prevalence of HIV, the virus that causes AIDS, and the fourth-highest prevalence of tuberculosis. Here, poverty and violence complicate treatment in a country where life expectancy is a mere 36 years.

Michael Sidibe, head of the U.N. AIDS program, fears the double infection could become the next new epidemic.

"I'm calling for serious attention to TB, and serious attention to TB-HIV co-infection," he said in an interview.

In this mountainous kingdom surrounded by South Africa, some patients battling HIV and tuberculosis must walk five hours to reach a clinic for their medication.

"It is a problem for us to come to the clinic because sometimes there are gangster men waiting down by the side of the river … and yes, sometimes women are raped," said Tlalane Tsiane, a 21-year-old woman infected with TB and HIV.

Many men in Lesotho travel to South Africa to work in the mines and some return with HIV and a form of tuberculosis that is resistant to multiple antibiotics. The World Health Organization believes drug-resistant strains present a major challenge to the global effort to control the disease.

Helen Bygrave, a medical coordinator for Medecins Sans Frontieres, also known as Doctors Without Borders, estimated that between 80 and 90 percent of Lesotho's TB patients are infected with HIV.

A person whose immune system is compromised by HIV is particularly susceptible to tuberculosis, which is caused by bacteria that usually attack the lungs. The disease is spread through the air when an infected person coughs or sneezes.

There are nearly 9 million new cases of TB worldwide and the disease kills more than 1.5 million people every year, according to the World Health Organization, even though it can be cured with a six-month course of antibiotics that costs only $20.

Sera Thoola, a retired miner of 47, believes that he contracted TB in South Africa. It is also where he first tested positive for HIV. He has multiple-drug-resistant TB, and is currently taking an average of 49 pills a day to control his diseases.

Most clinics in Lesotho were set up through partnerships between the government and international groups. In seeking ways to make the most of the scarce resources, Medicins Sans Frontieres is helping to support and run a program in which nurses are given training to take on roles doctors might have carried out. Community health workers later make sure patients are sticking to their treatment regime.

Ups and Downs

Here at TTL, our motto is "One Child at a Time."

I remember that every time I think about the constantly evolving roster of babies in the safe home.

Here's another update:

Mosele, a seven-month old girl from the St. Martin area with a giant smile and sparkling eyes, went home today after spending three months in the safe home. She got here on December 23 after TTL found her severely malnourished. Her mother was severely ill at the time and didn't have the capacity to care for her.

Today, it's a different story. Mosele's mother has recovered, Mosele is in good health, and they are reunited. Another TTL victory!

Our success in helping Mosele follows sad news from last week, when another tiny little girl passed away just a day after coming under TTL's care. She was severely malnourished and dehydrated, had a rash all over her body and was presumed HIV positive. Our outreach team in the neighboring Thaba Tseka district found her and brought her halfway to Mokhotlong, where one of our local outreach teams met them to bring her the rest of the way. One of our caregivers spent the night with her in the hospital, and Kirsten spent a chunk of the night and a chunk of the morning there as well, trying to rehydrate the tiny girl without overwhelming her heart -- a tricky thing to do with the little resources available in Mokhotlong and the shape she was already in.

Unfortunately, that morning, she passed away. Her dehydrated state was too much for her to overcome.

Deaths like hers are the saddest part of what we do here, and really show you just how close some of the babies we help are to death. I wish we had found her sooner. Frustration is alive and well when these things happen, but it helps drive our desire for successes like Mosele's.

Back on that note, just as we gained some space with Mosele's departure this morning, another baby arrived.

Ithateng is a small three-month-old girl who has horrible oral thrush. As an existing client from the Malefiloane area, one of our outreach teams had gone to perform a regular monthly check up on her when they realized she wasn't doing well and needed more thorough and immediate help. So, they brought her back to the safe house.

She drank half a bottle soon after arriving here, and we've already started giving her medicine for the thrush -- purple drops that make her gums purple as well. She's really cute and I think her time here will do wonders for her health and well-being.

I think Thuso might be going home soon himself, which will be sad in a way but also another success story. He is thriving and has come so far from where he was a few short months ago, when he couldn't walk at all. Seithati is still getting bigger and stronger. She just now walked down the hallway between the playroom and the babies' bedroom to say good night to me after I popped my head out of the office. "Ntate," she said, smiling as I picked her up. Now that's a nice way to end a work day.

Nteboheng, our oldest child in the safe home at almost five years old, who I just recently wrote about, is getting better and better as well -- despite the fact that her CD4 count last week was an astoundingly low 6. For reference, kids her age are considered to have a severe CD4 suppression when their count goes below 500.

Still, yesterday she was dancing to the rhythmic singing of the bo'me, and today she couldn't hold back her smile after I told her I was going to take her picture. She's opening up -- a great sign!

More than anything else, these ups and downs in the safe home are what strike closest to home for me. They make this HIV epidemic we are fighting and the malnutrition that is all too common in this country so real, so in your face, so immediate. They instill in me the most appreciation for what TTL is doing on a regular basis.

Up or down, it is like our motto goes: "One Child at a Time."

And then another…and then another…

Progress in Cowboy Town

In the popular "Lonely Planet" guidebook on South Africa, Lesotho and Swaziland, multiple copies of which have made their way to TTL, there is a small, one-page section on Mokhotlong that in my mind gives a pretty apt description.

"Mokhotlong," it says, "is the main town in eastern Lesotho, but it is still very much an outpost, and has something of a Wild West feel to it."

Constant herds of sheep, cattle, horses and donkeys aside, this is very true.

There is an undeniably slow-paced, cowboy-town atmosphere here, accented with plenty of potholed dirt roads, twisted barbed-wire fences, and just-outside-of-town expanses of absolutely nothing. A disorganized spread of rangy businesses and residences all seem to float closely together within the encompassing mountain range. A popular resistance to even the most resilient underpinnings of efficiency seems to be in full force. The vibe is one that simultaneously makes Mokhotlong seem an antidote to the hustle-and-bustle of the U.S. and a difficult place for progress to take hold or materialize visually.

Still, ever since I got here to TTL, things have been visibly changing all around me.

For starters, the brand new "Hesburgh-Amicus Centre" -- a building with 4 offices and one large conference room at the center of our property -- was just completed, and our outreach team moved into one of those offices this week. They now have more space to receive needy mothers and vulnerable babies seeking help, and more room to spread their proverbial wings as we continue to expand the number of children we serve each year.

The former outreach office in the main building has been transformed into a combined office for the TTLF fellows -- we were formerly using space in a small supplies room -- and our newly-appointed safe-home supervisor, M'e Mamosa, who is a longtime TTL caregiver and who will be working closely with Kirsten to ensure the babies in our care receive all the best.

We are constantly trying to maximize the efficiency of our operations here, and I know the new space will help in that cause.

It will also allow TTL to continue expanding its capacity for partnership with other groups interested in having a positive local impact. For example, one of the offices will soon be rented out to the European Union as their base in Mokhotlong.

It is exciting to see TTL's physical imprint grow as a bricks-and-mortar symbol of the organization's thriving potential. It will also be exciting -- and I think mutually beneficial -- to have more folks around on a daily basis who are looking to do good.

In addition to the growth of our indoor space here at TTL, our outdoor space is transforming as well.

We recently contracted with a landscaper who is already making TTL look like a more professional and welcoming place to visit. New plants are going in all over, including right at the entrance to the property and around the new building, where a memorial garden is being designed. We just got new marble signs for a number of our buildings brought here from the U.S. that will hopefully be bolted up soon. New cement paths are being put in to permanently connect the main building with the new Hesburgh-Amicus Centre and the three rondavals at the back of the property. Our handful of fruitful peach trees here are getting new attention as well, with short stone walls going in to strengthen the slope they rest on at the edge of the property.

Thanks to the continuing resolve of our staff and the continuing support of donors interested in bolstering our institutional growth, I think TTL's physical appearance is really starting to catch up with its community reputation.

In my mind, we are undoubtedly the shining jewel of this dusty Wild West, brightening the lives of countless kids. It's a great organization to be a part of, and it's only getting brighter.

Busy Month and Bravery

It's hard to imagine I am already into my second month here at TTL. But they always say that the busier you are, the faster time goes, and we've been quite busy here.

The number of babies in the safe home is now up to 10, with the addition last week of two more clients.

A new five-month old boy has the long first name of Matta a Morena, which means "power of the chief." He had long, wild hair on the top of his head that stood straight up when he first got here, and I've taken to calling him "Chief" even though the bo m'e promptly gave him a haircut and he lost his regal profile.

The other new child is Nteboheng, who is so brave despite everything. She is almost five years old, and is horribly thin. Being the age she is, she is entirely aware of everything going on around her, and is noticeably nervous.

TTL had to take her to see a doctor at the hospital the other day, and Kirsten said she kept saying she wanted to go home. She is shy around me still, but smiles at some of the antics I get into to amuse her.

Seeing her sitting silently in the play room, or eating slowly from a bowl of food prepared by the bo m'e, makes me think of a five-year-old child back in the states being separated from her family. I just see wails and tantrems and demands for "mommy," and yet with Nteboheng there is only the hushed requests that she be returned home and a stoic patience in the face of being denied that request.

Thankfully our bo m'e caregivers here are warm, and win the children over quickly. When Nteboheng lays down in the play room, still lethargic from her malnurished state, she often does so against the leg of one of the bo m'e sitting on the floor.

Seithati, our almost-three-year-old girl who has really started coming into her own, has been whispering reassurances to Nteboheng -- probably the sweetest thing I've ever seen.

It's amazing to see how many children have entered TTL's doors in just the last month. It's a testament to how many children here need a lifeline just like TTL.

Fire pit and more fun

Check it out: We built a new TTL fire pit!

When Reid, Bridget, Will and Ellen were here, they had their own fire pit that I think they used quite often -- both for cooking and lounging around at night and on the weekends.

That pit was swallowed up by the new building here -- which is nearing completion, by the way -- so for about six months the TTL campus has been without the joys of outdoor fires.

Well, no more.

TTLF all-stars Sheila Block and Maura Costello, who arrived in town for a 12-day visit last Friday, joined me last Saturday in the construction effort. We all set to work digging and designing, and successfully built what you see in the picture here -- a solid pit made of cinderblocks and rocks that we have already used to cook steaks, chicken and sausage.

The sausage was provided by the caregivers here at the safe house, who we had a big party with this weekend -- along with the rest of the TTL staff -- to send Sheila and Maura back home in style.

The party was a blast, with lots of ululating and dancing among the bo m'e, or women, and classic Basotho stick fighting among the bo ntate, or men. It was sweet.

As for the new pit, it's good fun to stoke the fire and chop logs -- something I've perfected at a novice level -- under all the stars here, and I'm excited about the pit's potential.

There is something about stoking a fire that just puts me at ease.

Check out these videos from the party:

A picture is worth...

...a thousand words.

Here are shots of TTL outreach in action; Thuso, who I have mentioned here before and who loves grabbing cameras; my rondaval; and Mokhotlong as seen from the mountain peak behind TTL.

VHW: Our Extra Eyes and Ears

This week I had the privilege of witnessing firsthand one of TTL's most promising initiatives: the Village Health Worker Program.

Since November 2008, our outreach workers have been meeting with local men and women in villages throughout the region in order to train them on important aspects of malnutrition, HIV/AIDS and breastfeeding options for HIV-positive mothers.

Dozens of matriarchal and patriarchal individuals have been driven to attend these meetings by a deep-seated desire to better their communities and protect their children from the ravages of food shortage and disease.

Our support and their commitment have translated into a new network of basic health workers who can call TTL with referrals whenever they see a sick baby in their remote communities -- essentially multiplying the eyes and ears of our outreach network.

The village health workers routinely use their training to check babies for malnutrition using weight scales, height length boards and MUAC strips to measure the babies' "middle upper-arm circumference."

They have also been trained to use World Health Organization Z-scores, which allow them to use a baby's weight and height to get an accurate measure of malnutrition.

I saw all of this in action when I accompanied two of our outreach workers and TTLF leaders Sheila Block and Maura Costello on a site visit to one of the villages participating in the program. Site visits are our way of seeing how things are going.

In an empty stone building with a corrugated metal roof at the center of a small village of rondavals, a dominate and matriarchal village health worker rallied her village together with the help of a group of other dedicated women.

A gathering of children sang to us at the urging of one of our outreach workers, then filed into the building, which was owned by the village chief, to have their measurements taken. Scores of women carried in younger children, many of whom cried torrents and screamed at the slightest clue that they would be weighed on a scale.

Regardless of the protests from the younger ones, we managed to weigh a total of 40 babies and toddlers. Of those, we found three in need of our help. One was already a client receiving our help, another was already receiving food from the WFP, and another one was wasting away with no source of help at all.

The third baby is a new client of TTL, and that reality is one that makes every last measurement made during that long day in the hot room worth it.

If it weren't for the Village Health Worker Program, these sorts of communal check-ups probably wouldn't be occurring.

And even though our outreach teams are already out in the villages and getting referrals from rural clinics and village chiefs, we may never have found out about this little baby if the village health workers hadn't helped organize this meeting.

Update on the Babies

SORRY I HAVEN'T POSTED IN A WHILE.

For one reason or another our phone line hasn't worked for the last week, meaning our super-slow dial-up Internet connection hasn't worked either. Ah well. TIA.

Anyway, last week was a busy one for the safe house.

First, Rapelang, the one-year-old boy pictured here, went home last weekend after about 7 months here.

Although his mother passed away when he was only a few months old, he thankfully still had a family to go home to. On Sunday he headed back to Thaba Tseka, the district where he is from, with some of our outreach workers. He was dressed in a new outfit and brand new shoes (which you can see in the photo). He didn't like the shoes at first because he couldn't walk in them, but he got used to them.

I'd gotten relatively close with Rapelang in just two weeks, and when I first carried him out to the car and handed him to one of the outreach workers, he screamed and began to cry, reaching toward me to take him back. I did for a few minutes as the outreach workers continued preparing to leave, and he buried his face in my neck and pouted. But then I had to hand him over again.

It was sad, and I'll miss him around the safe house. He was one of my first buddies here. He has a good laugh and a sweet demeanor.

But I know he has gone back to where he belongs as a healthy young boy, and that soon he will be running around his village with his own pack of friends, just like all the kids I see around town here in Mokhotlong. We'll continue checking up on him, and I think he will be happy.

Even with Rapelang's departure, the number of babies here remains at eight.

Midweek last week, a new baby named Liteboho arrived with a severe cough after having been discharged from the local hospital. His very young mother didn't know what to do with him, as he still seemed quite sick, so we took him on as our newest safe house resident. We'll be administering his medicines prescribed by the hospital doctor and hopefully nursing him back to good health.

He's a tough little guy who seems to be dealing with his wheezing OK for now, but hopefully he won't have to deal with it for much longer.

In other news, Seithati -- the almost three-year-old girl I wrote about before who we found malnourished at a rural clinic -- seems to be getting better and better. Since she got here she has become more talkative and engaged. She is still tiny for her age, but hopefully she'll start packing on some pounds. She is really smart.

She now screams quite a lot, not in a whining way but in a playful way. It's such a far cry from when we picked her up and she was so sullenly silent for a three year old. It may be that she was so malnourished before that vocalizing at all took too much energy. And now that's she's getting better, she's letting out everything that's been pent up in her for so long, hidden behind her lethargy. With that mindset it's difficult to get tired of her screaming, which shoots out of the play room and fills the office regularly.

Thuso, the other little toddler I've gotten close to, is still rambunctious and funny. He gets pretty difficult just before lunch when he's hungry, but other than that he's pretty happy. He chows down whatever he's offered in the way of food -- the other day I fed him his lunch of papa, sweet potato and beans -- and is super curious about cameras and cell phones and anything else he can possibly break.

When I first got here he would cry whenever I got anywhere close to him, but now he often walks right over to me when I walk into the play room and screams, 'Ntate!', which is how everyone greets men here. I think I've officially won him over.

The rest of the little babies all seem to be happy and doing relatively well also. Our youngest, three-month-old Nthati, is still tiny but seems healthily curious about his surroundings. I fed him a bottle the other day and he drank until it was half empty -- a good sign.

All in all, a lot going on in Baby World!