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.
