Tuesday, April 24, 2012

the road home

Yesterday on Outreach we drove through rain, snow, and fog so thick you could barely see the next bend in the road. We went over some mountains, through a few streams (or washed out road sections depending on your perspective) and waited patiently for oncoming vehicles to pass because the mud was so deep that the already narrow mountain roads have become limited to a single track. We drove for about two and half hours, reaching a maximum speed of 30km/h so we could navigate the constant obstacles of potholes, boulders, and herds of sheep. And even when we were bouncing up and down dirt tracks that look (and feel) like the equivalent of rockslides down a mountain – this little guy managed to sleep through the whole thing.
I guess it was a good thing that he was getting his rest because it was going to be a big day – after four and a half months in the safe-home, Puso was being reunited with his family. Little Puso woke up just before we pulled up to his village where we found his grandmother, siblings, and neighbours all happy and excited to welcome him home. 
November 2011 - Puso's intake into the safe-home. He had already been in the Outreach program for 2 months but his mother's health was getting worse and Puso was not gaining weight. At 6 months, he still weighed only 4kg.
April 2012 - Now 11 months and over 7kg! Puso is successfully taking ARVs and for a baby who doesn't like to eat, the bo'me have been very successful at getting him to regain all his chubby baby fat.  
Puso and his grandmother outside his new home.
Learning about Puso's medications...
Puso with his siblings and neighbours.

Monday, April 16, 2012

Five Days Old

Although Rachel already touched on the triplets in her last post, I hope you'll indulge me in sharing my perspective. I think the story of these triplets has had a big impact on all of us at TTL, one that really motivates us to continue the work we do here.  


As I duck through the doorway, I am met repeatedly by hushed Sesotho greetings, "Lumela, ausi."

Hello, sister.

My sun-drenched eyes cannot yet make out how many people gather in the dark rondavel.

I know we are here to check on the health of a newly born baby, but I have missed many of the details in the rapid Sesotho conversation that have lead us to this rural mountain village.

As my eyes adjust I take in a sisterhood of woman gathered together...the hardships and joys of a remote village life are apparent on their faces, in their dress, and in the obvious bond they share.

It is not until sometime later that I notice a young woman leaning against the rondavel wall.

The pains and exhaustion of childbirth linger on her face.

The outreach worker I am with explains to the women that we are here to offer our assistance because we have heard through the network of Village Health Workers that there is a baby in distress.

The women nod in understanding.

It is clear they have firsthand knowledge of Lesotho's devastating infant mortality rate.

One of the women, who appears to be the grandmother, slowly begins to pull back a pile of blankets gathered in the center of the room.

From the folds, she pulls a tiny, sleeping baby...at that moment I'm sure it's the smallest baby I've ever seen.

I look up at the young woman still resting against the rondavel's dirt wall.

I imagine her giving birth in this same rondavel...no doctors, no nurses, no pain medication.

I imagine the boundless strength and courage that must have taken.

We carefully weigh the baby, measure her length, and take her middle arm circumference...all standard measures used to quickly assess malnutrition.

All the while I wonder if you can assess malnutrition in a baby who, I've come to learn, is only five days old.

As I stare at the tiny features of this infant, I see the grandmother pull another tiny figure from the pile of blankets....a third quickly follows.


My breath catches.

This mother - at just eighteen years old - gave birth at home...in a remote village...in one of the poorest countries in the world...to triplets.

At no point did she receive an ultra sound to let her know to expect three children.

Three girls.

Three tiny baby girls.

More rushed conversations in Sesotho follow.

The mother isn't producing enough milk to sustain three babies.

Their small size greatly concerns everyone huddled in the rondavel.

It is soon decided that we must take these five day old triplets to the hospital in Mokhotlong.

Images of the roads we traversed to get to this village flash through my mind.

Our outreach vehicles routinely traverse boulder-strewn hillsides to reach those in need.

But the roads we have just traveled are some of the worst in the region.

We have just spent four hours bumping up and down...our heads practically hitting the ceiling....lurching left and right...as our four-wheel drive vehicle lumbered it's way to this small village.

I can't imagine how we will possibly make this treacherous journey with three infants.

No car-seats....just cradling these tiny girls in our arms, hoping to shield them from each jolt of the car.

We leave the rondavel followed by the sisterhood of women - the grandmother and mother nestled in amongst the women who have been there at each pivotal moment of their lives -  and weave our way down the mountain to our vehicle.

The infants are tied snuggly to the women's backs, in the traditional Basotho style.

When we reach the car, it is decided that the mother and grandmother will travel to the hospital with us.

They will each hold a baby and I will hold the third.

As the grandmother places her tiny granddaughter in my arms, our eyes meet.

We do not speak the same language.

I cannot communicate to her all the things I am feeling right now, nor she to I.

But I do my best through smiles and gestures to express my gratitude that she should trust me with one of her most prized possessions.

I pull the baby close, the blanket thick with the smells of the rondavel ... woodsmoke, dust, and roasted maize.

As our car pulls away from this small village, I reflect.

I reflect on the profound difference between my life at eighteen and this young mother's.

I reflect on the conditions that have allowed HIV, TB, and malnutrition to pillage this small nation.

I am brought back to the present by a particularly sharp jolt of the car as it lumbers over yet another boulder.

I look down at the bundle in my arms.

These twists and turns, bumps and bends seem to faze five-day old slumbering babies little...sleep is much too pressing a need.

As we make our way through the mountains of Mokhotlong toward the hospital, I am thankful that so many people have come together to help these babies.

From the village women, to the hospital doctors, to the dedicated staff of Touching Tiny Lives, each will play an integral role in helping these triplets become laughing, chubby toddlers...inquisitive, jubilant teenagers...and someday, strong, devoted parents themselves.

While uncertainty reigns in these little lives for now, the love and collaboration of those around them overflows.

In reality, it is hard to say whether this will be enough.

But in this moment, I feel hopeful...because how else can you feel with a 5 day-old baby in your arms?

Friday, April 13, 2012

twos and threes

I feel like twins abound in Lesotho. People tell me it’s probably because I have never spent so much time with babies as I have over the past seven months. Or, it may be that TTL is more likely to support a family where there are twins because two young babies places that much more pressure on a struggling household. So many Basotho women are malnourished because of a lack of food security - I can only imagine the strain carrying and breastfeeding one baby can have on their bodies, let alone carrying and breastfeeding two at the same time. All I know is I have met more twins (and now triplets!) during my time in Mokhotlong than in my life up until now. Two of TTL’s newest clients have continued this trend -
Tsepang is an 18 month old boy who came to the safe-home a week ago. Brought to the Outreach team's attention at a rural clinic visit, both twins were malnourished but Tsepang was by far the worst off and showed signs of TB (suggesting a good explanation for why he wasn’t developing as well as his sibling). He is now on TB medication and spending time in the safe-home to support his recovery while his twin stays at home and the Outreach team makes regular visits.

Also last week, a Village Health Worker in the St. Martin region – one of the more isolated parts of Mokhotlong – referred TTL to a household where triplets had been born only five days previously. The Outreach team immediately brought the mother and three little ones to the Mokhotlong hospital where they will now stay until the babies weigh 2 kg. After we heard about the story of the triplets, myself and the other volunteers sat around talking about how amazing it was that the mom and three babies were all relatively healthy. The mother is young – around 17 or 18 – and while this is not her first child, the idea of giving birth to three little babies in a mud rondavel with no medical support in the rural mountains of Lesotho astounded us all. I’m continually amazed by the strength of Basotho women and this story has now only furthered my awe of the many challenges these women overcome to raise healthy children.

Tsitso, one of the many twins I have met during my time in Mokhotlong. He spent time in the safe-home from October 2011 to February 2012, going from weighing a tiny 1.7kg to a healthy 5.7kg. Now 7 months old, he is back at home with his twin sister and the Outreach team continues to make regular visits.

Tuesday, April 10, 2012

something to talk about

As we continue to celebrate "1,000 children", we wanted to say thank you to all our volunteers and donors!

Thursday, April 5, 2012

Too Few Doctors

The Touching Tiny Lives campus is located adjacent to the Mokhotlong Hospital. This provides TTL with the necessary support in caring for those babies that are too sick to remain at the safe-home. It also allows us to take children at the safe-home for regular check-ups to ensure that they're making progress and growing strong. Without this additional care, many of our babies suffering from HIV, TB, or malnutrition would not be the lively, laughing children they are today.
Tiana and Hannah, volunteers from Georgetown Medical School, take Tholohelo and Tlotlisang to the hospital for check-ups. I promise there are actually babies bundled up in those blankets!
Needless to say, not everyone suffering from HIV/AIDS in Lesotho has this immediate access to medical care. The low number of trained health care workers in Lesotho is somewhat startling. Lesotho has only one physician for every 20,247 people. Compare that to the United States with one physician for about every 370 people. Of the four countries with the highest prevalence of HIV and AIDS, Lesotho has the highest discrepancies between physicians and patients.  There is only one physician for every 3,034 Basotho living with HIV and AIDS and there this is only one nurse for every 240 Basotho living with HIV and AIDS.*

Okay, this is the part where I admit that I’m a bit of statistics nerd and show this same information in some graphs.
Pretty astounding, isn't it?

In North America, we are assured a doctor’s visit within a relatively short time of coming down with even a minor condition. Combine these health system limitations with the challenges of poverty and the rural nature of Mokhotlong and perhaps some insight is provided into the challenging and devastating nature of this epidemic in Lesotho.

*The data in this post was taken from Reviewing" Emergencies" in HIV and AIDS-affected Countries in Southern Africa: Shifting the Paradigm in Lesotho, 2009.