Sunday, June 29, 2014

Lesotho photos

I have some exciting news to share.  Remember Hananja, my friend from Hermanus?  Of course you do, because I blog about her all the time.  Well, she is in Lesotho!  Way back in September when I was first getting to know Hananja, she told me that she was interested in missions and in sharing her professional dietitian skills in a place where they're needed.  So I said, "Well, there's this hospital in Lesotho..." and thus began a discussion about her maybe coming to St. James for part of the time that I am here.  I'll tell you a bit more about the work she's doing in my next post.  But for now, not only do I have the pleasure of her company, I also have the use of her laptop!  So please enjoy some of the promised photos from Lesotho.
These first few photos are from the Hands on Health meetings we had during my first week here.  This is one of the small groups during one of our brainstorming sessions. 
I am sharing  my group's plans for a guideline tool about HoH

Thabiso is VERY excited about HoH!

I had only been here a couple of days when we got a dusting of snow!  See?  I told you it was cold!  But the snow was really pretty and I enjoyed seeing it.

The hospital's garden

Just a guy.  Riding on a donkey.

The hospital complex as seen from the road above.  The brick house with the red roof that's right in the middle of the photo is my house!

Patients wait for the outpatient clinic to open in the morning.  The big white building is the main part of the hospital.

Dr. Mack, one of our three physicians, posing outside of the clinic in Ha-Mafa.

A full moon over a very Lesotho landscape

The 'road' to Ha-Popa.  Again, the photo doesn't really capture how bad the road actually is, but I guess you can sort of get the idea.

When I was in South Africa, I sometimes invited friends to my house for Mexican food, which I would make using taco seasoning packets that Jacob brought me from the US.  We called these nights 'Mexican Monday' or 'Taco Tuesday'.  Well, Hananja and I continued this trend and had a 'Taco Thursday' in Lesotho!  And yes, I know I look a bit like a gangster.  Remember, the style is 'missionary chic'.

Filling my bucket at the garden tap.  The hospital's water issues are really becoming a problem.  None of the buildings, including the main hospital where the patients are, have had running water for about two weeks now.  This tap in the garden is the most reliable of the outdoor taps.  Sometimes it's on all day, but often it only comes on after 5 PM, which means there is no running water available anywhere on the hospital grounds for most of the day.  This is bad enough for me, who is used to having running water in my house all the time, but it really is difficult for the hospital.  Imagine trying to clean surgical instruments without running water. Yeah, it's a problem.

These guys saw me taking photos on a walk yesterday and asked me to take one of them.  The guy on the right in the front is wearing one of the traditional Basotho blankets that I've mentioned.  You can also see the round stone huts with their thatched roofs, which is what most Basotho homes look like.

Lots of times when I run, kids will just kinda follow along behind me.  These kids were following us for quite a ways, and Hananja (being Hananja and therefore adorable) obviously had to get them to skip down the road with her.

... and some cows in the river.
So there you have it.  A few photos to give you a bit of a picture of Lesotho.

Saturday, June 21, 2014

Stuff that's different

First, let me give a giant shout out to Martin!  Martin, in addition to being my very favorite nursing colleague ever, was the only person who commented on my last blog post and asked me a question.  And since I promised to answer any questions in my next post, here you go:

Martin asked me how severe is the burden of HIV disease in Lesotho?  

There are actually several different statistics you could use to measure the prevalence of HIV and how it affects delivery of health services.  For my purposes here, I am going to use data I got from the CIA World Factbook, which ranks every country in order of the estimated percentage of people age 15-49 who are HIV positive (known as the adult infection rate).  The most recent estimated adult infection rate from 2012 was 23.1%, ranking Lesotho second highest in the world behind only Swaziland.  This is a sobering statistic, but I have heard estimates that are even higher, up to 26% (again, it depends on exactly who and how you're counting).  The two main goals of the government's anti HIV campaign are to provide free ART to infected individuals and to prevent mother to child transmission.  A few years ago, the CD4 cutoff for ART initiation was raised from 200 to 350, and all health centers follow strict guidelines for HIV testing and prevention of transmission during pregnancy, labor, and breastfeeding, including lifelong ART initiation for all pregnant and breastfeeding women (Option B+).  So, yes, there is a huge burden placed on the system by the prevalence of HIV, and dealing with this pandemic takes quite a lot of time, money, and manpower.

Thanks for the question, Martin!

I mentioned in a previous post that life in Lesotho is very different from anywhere else I've ever lived.  So I will now describe a few day-to-day 'normal' things that are quite different in Lesotho.

The steps involved in making your bed:  My bed at home is made with a fitted sheet, a flat sheet, and a pretty bedspread on top.  My bed in Lesotho, on the other hand, has an electric heating pad underneath the fitted sheet, a flat sheet, a wool blanket, the thickest fleece blanket I've ever seen, and a comforter.  Also, I sleep in long pants, two pairs of thick wool socks, a long sleeved shirt, and a hooded sweatshirt, and even with all that, I STILL wake up shivering in the middle of the night.  

What you wear to work:  In Lesotho, everyone wears a coat ALL. THE. TIME.  Got a pretty shirt you want to show off?  Forget it!  It is very cold here, even inside the buildings, so most people never take off their coats in winter.  It basically looks like we're all wearing the same thing every day because we never take off our outer layer.  It's a good thing that people are too busy trying to cope with the hardships placed on them by lack of infrastructure that no one really cares what you look like.  I long ago gave up on trying to dress pretty and rather just dress in whatever will keep me warmest, usually about 4 layers of sweaters, so I look a bit like a marshmallow.  I have dubbed this personal style 'missionary chic'.  

Where people congregate at 5 pm after work:  After work, we all go to the Mantsonyane version of a bar, namely, the water tap in the garden.  Really the atmosphere is kinda similar to a bar in that there can be some jostling of position as people fight to get their beverage before it runs out, but that's where the similarity ends.  We're not here for a cocktail, we're here to fetch enough water to do things like wash the dishes and flush the toilet.  Oh, and if you're not me, then yeah, you'll be drinking the water you fetch.  Some people call me paranoid for buying bottled water, but I had a discussion just last week with one of the nurses in the outpatient department about how you can tell when the water quality goes down because you see a spike in patients complaining of nausea, vomiting, and diarrhea.  So yeah, I am happy to wash my dishes with the water from the garden tap, but I'll be sticking with my bottled water from Maseru as much as possible, paranoia or not.

The process of doing laundry:  Oh, laundry.  Never my favorite task.  In the division of household chores at home, Jacob usually does our laundry because he says I fold his socks wrong (OCD much honey?), but here in Lesotho, doing the laundry is particularly unpleasant and time consuming.  Forget a washing machine and dryer (Ha! A dryer... what's a dryer? I haven't seen one of those in nearly a year!), here I do my laundry in a bucket.  Even worse, I actually had to go through the embarrassing situation of asking someone how to do laundry in a bucket, because I genuinely did not know.  Do you soak it first?  For how long?  How do you know when it's clean enough?  Hot water?  Cold water?  Warm water?  Thabiso was gracious about explaining the process of laundry in a bucket to me.  He didn't even make any snarky comments about me being a spoiled American girl, and I would have deserved it if he had.

The oven:  I have a nice gas oven in my kitchen here.  Unfortunately, the way you turn it on is to open the gas valve, turn the dial all the way up, strike a match, and stick your entire arm inside the oven to light the flame which is of course at the very back.  Y'all, this is not a good idea for me.  I don't have the best track record with flames.  I once set a YMCA bus on fire.  (If you've never heard me tell that story, then next time you need a good laugh, ask me about it.)  But really, I am quite accident prone, and I say a little prayer every time I want to bake something.

Transportation:  There are two main modes of transportation in Lesotho.  They are called right foot and left foot.  If you're wealthy and you want the latest in transportation elegance, you don't get a BMW or a Mercedes.  No, you get a shiny new donkey.

The meaning of the word 'road':  Now, I don't want to be unfair or overly judgmental.  There is a beautifully maintained tar road that leads from Maseru to Mantsonyane.  Yes, it is very, VERY windy, and yes, I do suffer from horrible, debilitating motion sickness, so my opinion of this road is that it is an evil, tormenting beast, but it is a quality road that that is well-graded and pothole-free.  But turn off the main road and head up past the hospital in the direction of our surrounding clinics, and 'road' becomes a term for that pile of rocks you walk on to get from one place to another.  Last Wednesday, I again accompanied the medical team on a visit to another of our satellite clinics in Ha-Popa.  I had been warned that the 'road' to Popa was 'bad', and indeed it was.  It took us over two hours to travel 25 kilometers in a 4 wheel drive vehicle.  I tried to take a picture of the road, which I will post whenever I get access to a laptop, but really the photos don't do it justice.  You'd have to see this 'road' to believe it.

The perils associated with being a runner:  Anywhere in the world, there are always some potential hazards to running on the road.  In Lesotho, the likelihood of getting hit by a car is pretty slim, and the possibility of getting mugged for my iPod or something is basically nonexistent.  But tripping over one of the sheep that's blocking the road?  Very possible.  In fact, it might have already happened.

On a more serious note:  I know that there are a lot of terrible things happening in the world right now, and in times like this we are asked to spread our compassion so far that it can be stretched thin.  There are many truly horrifying situations going on, but I feel I must ask you to please add the kingdom of Lesotho to your prayer list.  I am sure this isn't even making the news in the US because 99% of Americans don't even know that Lesotho exists, but the three party coalition formed following the 2012 elections is collapsing, and parliament has been suspended.  So far there hasn't been any violence, but as the situation continues to develop, or rather, deteriorate, I ask you to hold Lesotho in your prayers.  After just three weeks here, I have developed a deep and abiding respect for the Basotho nation, and I am in awe of what has been accomplished here.  In a part of the world with a long history of foreigners taking over and decimating the local culture, the Basotho have managed the impossible and maintained not only their independence, but also their identity.  I hate to see this nation struggle like it is now.  So please, pray for peace and unity in the Mountain Kingdom.

Saturday, June 7, 2014

A different world called Lesotho

I have a confession.  A year and a half ago, I had never heard of the country I'm living in.  Honestly, had you ever heard of Lesotho?  And would you know how to pronounce it if I didn't tell you (it's Lis-ou-too, by the way)?  Even after I learned that I might be placed here and started to do some research, I didn't really believe that a place like this existed.  I had read that Lesotho is still a very traditional society and parts of it, particularly the mountainous middle of the country where Mantsonyane is, are still very similar to the way they were 100 years ago, the way they've always been.  Yeah, I had read that (thanks Lonely Planet!) but I didn't quite believe it.  Well, I'm here to tell you it's true.  This is one of the most remote places I've ever been,  and it really isn't Westernized at all.  Herd boys really do wear their Basoto blankets and walk up and down the mountains after their sheep or cattle.  Men ride around on donkeys or Basotho ponies.  Women leave their round, thatched roof huts to go to the river to get water.  And there are villages on the sides of mountains that have no roads in or out.  I can see one on a hill across from the hospital.  Let me assure you, places like this DO still exist in 2014, and I get to live here for the next two months!  It's like going back in time, like arriving on an alien planet.  You really cannot imagine how utterly different life is here.  Yet people are still just people, and the Basotho people I've met so far are warm and friendly and wonderful in every possible way.

I have to admit that life in Mantsonyane is challenging.  Here are some reasons why:

There is no hot water.  Which means bucket baths are the only possible option. You heat some water in a kettle or urn and use that to wash, which is neither very glamorous or very fun.
Sometimes there is no running water inside the house at all.  This seems to happen daily, for anywhere from a couple of hours to most of the day, the water just stops coming out of the taps.  I don't know why.  Luckily, there is a tap on the hospital grounds that has water even when the water in all the buildings has stopped flowing.  So you just go fill your giant bucket at the outside tap.  Well, if you're me, you ask someone to help you because that bucket is heavy when it's full!
Obviously you can't drink the tap water, or the water you fetch in your bucket, unless you want to boil it first.
It is VERY cold here at night, well below freezing, and there is a dusting of snow on the ground.  I know, y'all were polar vortexing all winter while I was lying on the beach in South Africa, but it's not a fair comparison.  You had central heat.  I do not have heat.  Or hot water.

And that's life on the hospital grounds, which believe me, is much more modern than the surrounding villages.  For example, here are some things I have that the average person living in the next village over does not have:

The outdoor tap with running water.  Many people have to walk to the river to fetch water.
A large house.  The hospital really gave me a great place to live!  It's a little bigger and similarly furnished to my house in Hawston.  There are actually four bedrooms, enough space for 6 people, but I have it all to myself.
Internet access.
A gas oven and stove.
A gas heater, otherwise known as my new BFF.  It doesn't heat the whole house, or even the whole room, but it is a big help on these frigid nights.
Access to and money to buy bottled drinking water from Maseru.
A fridge.  Not that you really need one, you could just stick your food outside and it would stay quite cold.
A TV that works.  My TV in Hawston didn't work, so this is actually an improvement!

As you can see, I am very lucky.  

What sort of work will I be doing here at St. James?  One of my goals is to support for the Hands on Health program.  HoH is basically a public health initiative with the goal of getting local communities to be more involved in taking care of their holistic health.  Facilitation teams comprised of staff from the hospital, local clinics, the Anglican church, and other interested people conduct visits to community residents and talk about their concerns.  It's basically a grassroots way of identifying needs in the community.  HoH is still in its early days, so I will be working with the coordinators to develop some written guidelines for how to conduct visits and record information.  I will also be spending some time in the hospital learning from the nurses here, particularly in the labor ward, OR, and outpatient department.  The hospital has asked me to help evaluate the way they capture and organize their patient care related statistics.  Finally, I'm going to help the hospital look at the effectiveness of the health education they provide their patients.  I think it will be a busy two months!

So that is an overview of what is going on in Mantsonyane right now.  After I spend some more time in the hospital next week, I can tell you a little more about what it's like.  And I promise I am taking lots of photos, but I don't have access to a laptop right now to download them from my camera, so just wait a few weeks, then I'll show you some.

Until then, stay well!