Thursday, April 29, 2010

A dark, rainy, surreal delivery...

Some events here have a tendency to seem surreal...

One such event occurred Tuesday at about 7:30 p.m., when a large delivery truck showed up in the cold, rainy darkness with a surprise delivery of food provisions.

The truck was from the country's Disaster Management Authority, and had come unexpectedly to TTL to solicit our help in distributing "Famine Relief" provisions of milk, brown sugar, tomato sauce, rice, maize meal, flour, beans and cooking oil throughout the districts we work in.

The flatbed truck was massive, with a dark green tarp laying over it and tied down with a mesh of rope. As the man in charge of the delivery unlatched every last side panel of the flatbed, allowing them to fall to the side of the truck one by one, exposing the boxes of food packed under the tarp, I shivered in the rain -- less from the cold than the surreal sense of the meaning behind it all.

The job seemed a bit overwhelming at first, but the heaviness of the phrase "famine relief" far outweighed the bags of food, and the promise of being able to provide our clients with an extra boost of sustenance smothered any hesitation. We just got to work.

The next hour saw Kirsten and me, our security guard Motsi, a couple of the overnight safe home bo'me and the delivery guys unloading 435 bags or boxes of food and carrying them through the rain and the mud into TTL's main building, stacking them along hallways, in the staff room and in our accountant office.

The next morning, we surveyed again what we had received, and our outreach teams started planning deliveries and restocking the food in one of the open offices in our new building.

Already, we have started distributing the food, partly during an outreach trip yesterday to see former safe-home baby Mpolokeng and her family. Mpolokeng just graduated from the TTL program, and we drove out to her extremely remote village to take her and her family a nice supply of the provisions as a parting bit of support.

The trip, down and then back up the worst, rockiest, steepest road I've been on since my arrival here, showed me that TTL was the perfect organization for the government to turn to for help in the Mokhotlong and Thaba Tseka districts. Simply put, we go where this food needs to go, which is saying a lot.

In part, I suppose the entire experience was a bit surreal because I never thought I would participate first hand in an elaborate system of delivering famine relief. But, then again, so it goes...

Tuesday, April 27, 2010

S.P.@.T. -- V2

By popular demand: Sticking Points @ TTL -- Volume 2:

1. The human neck is capable of balancing a very large tub of water atop the head, with no help from the hands. This has only been observed in the female of the species.

2. Steamed bread is delicious, especially toasted.

3. Butchering a sheep carcass can be simultaneously gross, educational and amusing.

4. Purchasing office furniture from a coffin maker is a melancholy experience.

5. When it comes to potholes, it's not size, but quantity, that really matters.

6. The phrase, "It's reallllly early in the morning," can be understood to be a funny joke.

7. Pronouncing a letter that is, at once, a recognizable syllable and a click of the tongue is a tricky task.

8. Hiking up a mountain is often easier than hiking back down it.

9. Live television is not a necessity in life; television series on DVD are awesome.

10. Dancing toddlers crack me up.

11. You can bribe small children to dance by offering them small pieces of chocolate. In the future, they will remember this business transaction and attempt to negotiate. This is hilarious.

12. A cooked chicken foot is a suitable afternoon snack. It is also very salty. It is also mostly cartilage and skin.

13. Five minutes with a laughing toddler can brighten even the most tedious work day.

14. A small, hand-held mirror in the bathroom provides a sufficient amount of self-viewing in life.

15. Spending the "winter in the mountains" is much more hardcore with no central heating.

16. Every partnership starts with a proposal.

17. Losing a few pounds can go unnoticed. Losing 10 pounds, not so much.

18. Altitude is for real.

19. You can always build a new fire pit. That's the great thing about fire pits.

20. "Ntate Kevin" can sound like a lot of things coming from a 3-year-old, all of which are funny.

Friday, April 23, 2010

Running with Letsema

After spending a long period of time in Mokhotlong, it's easy to forget the physicality of the greater world around you. In your head, everything outside of Mokhotlong is condensed into a series of remote contact points, which you reach out to and get feedback from but forget to consider in a physical sense.

The isolation breeds a certain level of self-sustainability, which is a good thing, but it can also make you forget from time to time that, especially here in Lesotho, there are hundreds of other people actively working toward goals similar to your own.

It was partially in light of this reality that I took great pleasure in attending an event in Maseru on Tuesday night hosted by Sentebale, UNICEF and the Department of International Development to officially launch the newest product of what must have been a long, labor-intensive collaboration: the Letsema Directory of Service Providers for Orphans and Vulnerable Children (OVC) in Lesotho.

The Letsema initiative was first developed in response to the ever-growing number of OVC in the country, of which there are now an estimated 270,000, and "seeks to bring together all service providers and donors to enable cooperation and a collective response to this enormous problem."

The directory is a large binder with profiles and contact information of more than 300 OVC service providers in Lesotho, one of which is TTL.

At the event, which I attended as TTL's representative, there were speeches from Sentebale's Acting Country Director Bahlakoana Manyanye, UNICEF Deputy Country Representative Dr. Naqib Safi, and Principal Secretary of the Ministry of Health and Social Welfare Dr. Karabo Mokobocho-Mohlakoana.

Manyanye encouraged everyone in the room to work hand-in-hand as a collective body toward combating the problems facing the country. Safi urged the group to look at the new directory as the first step in an on-going movement toward progress. Mokobocho-Mohlakoana praised the spirit behind the initiative and echoed the sentiments of Manyanye and Safi.

I spoke with both Manyanye and Safi during the event and both spoke highly of TTL. Both Sentebale and UNICEF are existing and important supporters of TTL and its mission, and both men are good friends to have. It was nice to have a few minutes to chat freely with them.

With the large Letsema directory in hand, I came away from the event encouraged by the show of care by those in attendance, and with a new resource in expanding TTL's partnerships within Lesotho. The event was one of promise.

As I drove away, through the streets of Maseru, I was buoyant.

It was then that I saw a young boy, alone and probably not more than 10 years old, sitting huddled in a corner of sidewalk, holding his hands out to a small fire he had built with twigs and spare trash.

The sight yanked me back down to reality. Despite all the groups doing good in the country, there are still so many orphaned and vulnerable children in need of help, living on the street or wasting away in a village where no one is providing for them.

Still, as I continued driving, the discouragement of seeing the small, orphaned boy on the street was replaced with a new resolve to make sure TTL does something positive with the new directory -- that it takes this new resource and runs with it.

And that's just what we plan to do.

A lost battle...

Sad news: Ithateng passed away Wednesday night.

Kirsten was feeding her when it happened. It was quick.

Her death was not for a lack of fight. Ithateng had been battling, holding on, swimming as best she could against the swelling tide of her illness and dehydration, day after day after day. The bo'me did their best, providing her 24-hour attention and care. Along with medical students Katie and Sean, who just left, Kirsten worked diligently to figure out the best course of action for Ithateng's treatment, working with various partners at the hospital and elsewhere.

On Monday, Dr. Amy, who works for the Baylor International Pediatric AIDS Initiative and is a close friend and partner of TTL, put a nasogastric tube into Ithateng's little stomach because Ithateng just wasn't swallowing anymore. While I was out of town in Maseru this week, Kirsten and the bo'me continued their constant efforts to get Ithateng to hold something down. She kept vomiting.

Wednesday night, it all -- the vomiting, the diarrhea, the subsequent dehydration, the malnutrition, the HIV, the unknown factors of illness -- became too much, and Ithateng lost her brave fight.

I find I can't help but to curse the system, the lack of resources, and we all mourn the life that could have been lived. But I also look at TTL and understand again how important it is, how many little lives out there are vulnerable or on the verge, and how much work still needs to be done.

I won't soon forget Ithateng's big eyes looking back at me, her gaunt face, her visible discomfort. Neither will I forget the moments when she was comforted and calm, warm in a blanket and held tight by one of the bo'me, drifting off to a quiet sleep.

Now I hope she rests in peace, free of discomfort, finished with fighting...

Thursday, April 15, 2010

Empathy in a Sea of Sympathy

Making comparisons is never a pure endeavor. It's always a matter of impression, and often a matter of judgement that depends more on your own self-imposed view of the world than on concrete similarities. Its a process one is less and less comfortable with when the balance of privilege is skewed...

Sometimes its difficult to find similarities between Mokhotlong and back home. And sometimes it's hard to relate to situations people go through here, to have a source of true empathy, rather than sympathy.

But when such similarities pop up, I like them. My middle name is McKeown -- a great-grandmother's maiden name -- and there just so happens to be a Sesotho name, Makione, that is pronounced the exact same way. Nthabeleng now calls me Makione sometimes -- my Sesotho name by default.

And when the still rarer opportunities for real empathy arise, I find I am transfixed for just a moment, absorbed...

For instance, last week, when I spoke of Ithateng's vomiting and diarrhea -- she is still fighting well, but is not out of the woods -- it was with a ton of sympathy and regret. But I couldn't really remember the last time I'd gone through something similar, physically. Thinking back, it may have been a dozen years ago. I am not sick often, and almost never have stomach issues. You forget, when you aren't sick yourself for a long time, what vomiting and diarrhea can be like when their forces are combined.

This week, however, my sympathy was joined with empathy, as some vile bug invaded my stomach and left me, for a night and day, with Ithateng's exact symptoms. Walking from my rondaval to the bathroom through the starlit darkness every hour of that long night of queasy, internal betrayal was a starkly odious experience. I do not exaggerate. You should never need a bucket when you are already in the bathroom. I became dehydrated, seemed to have lost weight rapidly, was lethargic and tossed and turned in bed between jolts to the bathroom.

I am better now, half a CIPRO prescription later. And even though it was horrendous while it lasted, I am now, in a way, glad my quick illness happened. Three months into my stay here, I am still constantly reminded of differences between myself and the people around me. I am reminded of my privilege, my health, my resources, my supportive family. I wish I could share more of what I have been blessed with. I wish in whatever hand they were dealt, they'd been given just one of my aces...

So it may be selfish, or represent some ugly form of solipsism, but it feels good, in a way, to be able to be able to share in the pain that has otherwise missed me, to have a legitimate dose of empathy for once, as opposed to the ever-constant sympathy.

Friday, April 9, 2010

An unsteady rhythm of time well spent

Time is a strange thing here. It flows to an unsteady rhythm of unexpected twists. It can seem precious and oppressive at once. Some days pass slowly without any critical issues arising. Some days are happy. And some days are whirlwinds of crises, when the ominous presence of death looms heavily on the safe house and every minute is potentially a small child's last.

This week has been a strange mixture of such days, an emotional roller coaster that has made me appreciate TTL's presence here even more and, at the same time, made me wish there were still more that could be done, that there were more resources, more options, more equality…

Liteboho went home on Tuesday, his respiratory issues having been resolved. I drove to his rural village last week, hiked up a mountain into a cluster of rondavals, and found his grandfather eating lunch alone in a haze of mid-afternoon cooking smoke. Matello, our outreach coordinator who was with me, informed him that Liteboho would be coming home, and the grandfather smiled and offered his thanks. I had the sense that Liteboho's young mother, who wasn't in the village at the time but was expected back soon, won't be alone in the struggle to care for him -- a reassuring thought.

Seithati turned 3-years-old today -- an un-promised milestone in her young life, as when we found her two months ago, she was in rapid decline and weighed less than a healthy child two years her junior. Back then, my first week here, she was a silent, shy child who was lethargic and unresponsive. Her limbs were tiny sticks protruding from the dueling spheres of her distended stomach and seemingly outsized head. She was deferential, indifferent, shadowy.

Today she is the life of the playroom. She's rapidly putting on weight. She is talkative, mischievous and hilarious. She is quick-witted, sometimes irreverent and often challenging. She's fully alive, visible, present and demanding of attention. She is boisterous and happy. She is released from her former prison of lethargy. When I first saw her two months ago, I had no idea -- no hint -- that the sharply smart, engaging little girl I see now was inside that frail, emaciated body. Today that little girl is unmistakeable and on full display.

As Seithati continues to burst out of her former shell, Ithateng is sadly falling into one of her own -- induced by severe dehydration that we have been battling all week long with Katie and Sean, two Georgetown medical students who have been visiting TTL since last month.

When Ithateng first came to TTL, she had severe oral thrush, which we all assumed was the leading cause of her being underweight. When she drank from a bottle, I was relieved. But it wasn't long before she began vomiting what she was taking down. The bo'me continued doing their best trying to feed her, but diarrhea also began. Thrush can cause gastrointestinal issues, so we hoped that by curing the thrush we would put Ithateng on the right track.

By the start of this week, however, the thrush had largely disappeared but her vomiting and diarrhea were not stopping, and she was becoming more and more dehydrated. Since then, our frustrations have mounted as her health has continued to fluctuate.

Through Katie and Sean's efforts, we finally got an ARV treatment settled upon to help Ithateng start battling her HIV, but she hasn't had much success keeping those medicines down either, nullifying their effects. Critical medicines that Katie and Sean are familiar with in the U.S. and are used in the battle against dehydration aren't available here. Ithateng is anemic, which complicates things. She's also malnourished, which means any attempts at rehydrating her have to be balanced against the threat of overwhelming her tiny heart. Because of a lack of resources at the hospital, we can't check her electrolytes either.

Katie, Sean and I went with Ithateng to the hospital today, and I watched helplessly as the chief medical officer and a nurse searched, at first unsuccessfully, for a vein they could put an IV into. Finally they found one in her foot, after failing twice in her tiny hands. Despite the struggle of finding the vein, Ithateng at least got some fluids from her couple hours on the IV, but too much would have overwhelmed her, and she's back in the safe house now.

The only other thing we've been able to provide her with is oral rehydration, a slow process that requires someone encouraging her to swallow even the smallest amounts of sugary water anytime she rouses. That process continues. Wednesday, Ithateng seemed distant, and we all sat around the play room together, wondering if she would survive the hour, much less the night. Yesterday she looked a little better. Today she is worse again. We are all hoping for the best, fearing the worst, and cursing the lack of more resources.

Another little girl, 13-month-old Mpinane, arrived at the safe house yesterday. She is underweight, and her young mother is struggling to save enough money to provide care for her. Hopefully, Mpinane's stay here will allow her to gain some weight and allow her mother to figure out the best course of action for caring for her. She's shy still in the playroom and watches Seithati and Nteboheng closely.

A new 16-month-old baby girl from the Thaba Tseka district arrived today as well. Ntseliseng is malnourished and has tested positive for HIV. When she got here, it was clear she had a severe rash or skin irritation of some sort that extended all over her tiny body. Looking over her Bukana, or health booklet, I suddenly noticed that two weeks ago she had been diagnosed as having scabies, or little mites that burrow into your skin.

I told Katie, who did a quick once-over and confirmed Ntseliseng still has the scabies -- a good thing to know before she became integrated with the other babies. Sean and Katie headed over to the hospital, where they scooped up some lotion to treat the horrible infestation.

Hopefully the little bugs will be wiped out quickly, and little Ntseliseng will soon be on her way to recovery, feeding well and receiving all the medications she needs. Hopefully we can also figure out a plan to get the rest of her household treated for scabies, and her actual rondaval cleaned of the mites, before she returns home.

Looking back, each day this week seems to have taken a lifetime, but the week as a whole has flown by.

The best thing about time here is that it is time well spent.

Tuesday, April 6, 2010

Sticking Points

On a day-to-day basis here in Mokhotlong, little, random thoughts seem to pop into my head and stick there. They are miniature observations of life that have enormous staying power in my own growing conception of my surroundings here. They are lessons of a sort and everyday reminders that make me laugh. Some are important, others aren't. But I figure they are worth sharing.

So, here is the first entry of Sticking Points from TTL, which I might turn into a regular series on the blog.

1. Toddlers are easily amused after lunch. Not so much before.

2. True to their reputations, sheep are blind followers, donkeys are stubborn and bulls are aggressive. These traits are most clear from behind the wheel of a car.

3. It's extra important to check if the gas tank is full when driving to a place where gas stations don't exist.

4. When you speak English to a 3-year-old girl who only speaks Sesotho, she might think you are speaking gibberish and respond in kind. Adults who speak Sesotho can confirm this.

5. Bisquick pancake mix, Boboli pizza crust and bottled spaghetti sauce are luxuries, but food from scratch always tastes better.

6. Cinder blocks can be used for lots of things.

7. Life goes on despite the lack of paper towels.

8. Low in the Southern Hemisphere, the moon sprints out of the horizon.

9. "Pologna" is not as good as bologna. It's also more orange.

10. Older toddlers will pinch smaller ones when they feel it is deserved. The urge to reprimand such an action diminishes exponentially when it is, in fact, kind of deserved.

11. The best way to endear yourself to a child who is scared of you is to accidentally hurt yourself.

12. Dangerous-looking dogs are scared of getting rocks thrown at them. Thus, rocks are good.

13. Coloring is an enjoyable activity for 2-year-old boys. So is eating crayons.

14. A 4-year-old boy is better at keeping his family's dog away from his food than a stranger could ever be. This is because the little boy can punch the dog in the face, while the stranger most certainly cannot.

15. Contrary to popular belief, it is possible to run at full speed in gum boots.

16. Animals outside your rondaval can sound like they are in your bed with you, given the direction of the wind.

17. The sun is really efficient at drying clothes. Rain is really efficient at making them wet again.

18. Shy malnourished children can turn into gregarious healthy children.

19. As a foreigner in Mokhotlong, everyone on the street wants to know who you are, where you are coming from and where you are going -- especially other foreigners.

20. Children who are never told that bruised bananas are bad do not come to that conclusion on their own.