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.