OG Travel Bursary 2007

Henreitta Mair

Lesotho is a small country, totally surrounded by South Africa. It is the highest country in the world; all of it lies 1400m above sea level, earning it the title the “Kingdom in the Sky”. Until recently few people I spoke to knew of its existence, but various BBC and other reports (not least Prince Harry’s visit) have helped put this beautiful country on the map.

Mathato, her daughter and a friend in front of King Moshoeshoe II's grave

When I decided to take a Gap Year, I knew that I wanted to do something on my own, something worthwhile and something related to my chosen career (medicine). Africa really appealed to me; somewhere I had not been to before and with a very different culture from that which we have at home. I was fortunate to have a contact with an organisation called CPTM (Commonwealth Partnership for Technology Management) which had recently hosted their 2005 International Dialogue in Lesotho. They were able to give me an introduction to the Health Ministry in Lesotho which agreed to take me as a volunteer.

Henrietta giving her OG Day Presentation

Myself and Ntate Faso in QEII Haematology lab. Ntate Faso was my manager and friend throughout my time in Lesotho.

With the help of the Old Girls’ Bursary I financed the trip myself by working at the Meath Home for persons with epilepsy, Godalming. Here I was an activity leader and would take groups of between 5 and 10 adults for sessions ranging from music to sewing! All the residents at the Meath have quite severe learning difficulties as well as their epilepsy, which was challenging at first but I really loved working there. Staff and residents are so happy despite the challenges each have to deal with, which was truly inspiring.

I left for Lesotho in April, late into my Gap Year, to allow for my medical interviews, but also Lesotho’s General Election which can make life in Maseru (capital of Lesotho) a bit tense. When I left I wasn’t at all certain what I would be doing which added to the intense feeling of apprehension!

I started working at the Queen Elizabeth II hospital, Maseru; four days after I arrived in Lesotho which gave me a chance to settle down a bit. I was to be working with the CD4 machine (CD4 cells are killed by HIV and therefore a CD4 count provides a useful statistic when considering how badly a patient is affected by the virus at a given time) in the haematology lab. It was not a machine I had seen whilst on work experience at the Royal Surrey, though I recognised others.

A typical Lesotho landscape. Families live in up to three small houses grouped together - one for the parents, one for the children and a third for cooking etc.

Mohale Dam - the largest dam in Africa where the wall is not cemented together

QE II hospital was built in the 70s and is badly in need of replacement. The lino floors are peeling and dirt is caked into the exposed concrete. The walls are stained and dirty and many doors hang open also caked in dirt. There are few signs up and the lighting is poor giving the whole thing a grey tinge. The haematology department is identified by the word “Laboratory” which someone has scrawled in marker pen on the door, whilst the Extremely Drug Resistant TB isolation ward (just opposite) has no sign. I had about five power cuts whilst in Lesotho, and the hospital has no working generator. The casualty department is run down and overworked, and the hospital has no intensive care unit or any of the machines usually found there. When I first visited the hospital I asked Mathato (my “guardian” in Lesotho) if she came here; the reply I received was “You would only come here if you wanted to die”. It is state funded and most people have no choice, but all those who can pay for private treatment do so; even a private GP for a sore throat. This, I think, is part of the problem: senior government officials may not be aware (or perhaps prefer to remain unaware) of the appalling conditions in their hospitals.

I felt the hospital and workers were badly managed and with little money some small changes could have been made to improve conditions. Rubbish was allowed to build up in great piles outside the hospital, including bio-hazardous waste such as used needles, waiting for collection, attracting rats, insects and other pests. More collections would require more money, but this money might be saved due to improved hospital hygiene. Employing more hospital cleaners would have a similar effect.

It would have been easy to despair in such conditions but my colleagues and the doctors I came into contact with were, for the most part, hardworking and dedicated, and without them the hospital could have been a lot worse. My first two weeks or so at work were quite hard as I was so different from everyone else working there, but eventually we bonded - over my extremely old fashioned phone - a “skotoko” in Sesotho slang. They couldn’t believe that a “rich”, white person could have something so ordinary and from then on began to realise that I was not some female Bill Gates and it became much easier to find things in common and to develop friendships.

This was something I couldn’t explain to people who saw me shopping or in the street and I was already attracting enough attention from being a young, single woman. Wherever I went people would shout things at me or come over and ask me for money. I wouldn’t have minded this had it not been that the people asking me were often other hospital workers who needed the money much, much less than many of the people being treated at the hospital. In the end there was barely anywhere I could walk alone - the exception being the local fruit and veg shop, about a block away from the hospital. I used to walk here on my lunch hour, always on a different day and at a slightly different time to avoid being tracked, to buy anything from spinach to mango juice.

HIV has decimated the Basotho (people of Lesotho). It is estimated that 35% of the Basotho population has HIV/AIDS but in practice this figure is much higher. Lesotho’s mountainous terrain makes it very hard for aid to reach a large proportion of the population and, probably more significantly, makes it very hard to educate people about preventing transmission of the disease. In Maseru, whilst infection is no less prevalent, most people are HIV aware. Billboards around the capital proclaim messages such as “sharing razors and toothbrushes can transmit HIV” and the red HIV ribbon is painted on the hillsides. The government were slow off the mark but anti-retroviral drugs are now available free once the patient’s CD4 count has dropped to 200.

This necessity for getting a CD4 count done results in staff in the haematology lab receiving over 300 HIV positive blood samples per machine, per day which is more than they can cope with. The “Know Your HIV Status” campaign when viewed from the outside is working well, but little attention seems to be paid to the infrastructure supporting it. Lesotho has no facility for training doctors so relies on South Africa and others. With the wages being so low in Lesotho medics are not flocking in and 90% or more of the Lesotho-trained nurses leave the country to work in organisations like the NHS. In terms of healthcare this is detrimental, but as things stand economically at least the nurses send money back to their families.

I stayed in a Ministry of Health bungalow by myself for 10 weeks, which became lonely as it was not safe for me to go out alone ever, it got dark at 5pm as it was winter and towards the end there few a few curfews because of a suspicious fire in the government buildings and general unrest. Contrary to popular belief there are parts of Africa which are cold and Lesotho is one of them; night time temperatures in the low lands (where I was) frequently dropped to minus, with temperatures in the mountains dropping much lower than this. My flat was poorly made with gaps in the windows and around the doors which made it very cold, and central heating does not exist in Lesotho. Eventually I bought a small electric heater, and slept wearing five layers (including my skiing jacket), covering up with another three.

At weekends Mathato would take me out, when she could, to visit places outside of Maseru. The Mohale Dam in the Lesotho highlands is one of two dams so far that have been built in partnership with South Africa. Water is Lesotho’s most valuable resource and by selling water and hydroelectric power to South Africa hopefully some money will be put back into the community. I also climbed King Moshoeshoe the First's mountain fortress, visited the site of the first English missionary to Lesotho and the first church and visited some 19th century cave houses. This is as old as historical sites get in Lesotho, even today people still live in small villages far from each other in a very traditional way using mostly mud, straw and animal hide/fur as building materials. Driving through Lesotho countryside is really beautiful. Mountains rise seemingly out of nowhere from corn fields, and villages nestle on the sides of hills. The landscape is harsh, dry and rocky but really impressive. I arrived after the wettest season - summer -
and when I left - in midwinter - everything was looking much drier.

Culture is really important in Lesotho, and Christianity, brought in with the first missionaries, seems to fit around it. This is sort of fine, but when culture promotes multiple concurrent partners for men which encourages the spread of HIV I feel the church ought to use its influence to try and stop this. Almost everyone goes to church in Lesotho but people don’t seem to try very hard to follow the teachings. In fact I feel that some church leaders exploit the HIV situation; posters were up over Maseru advertising “God’s Healer” and people could pay to be “healed” of HIV and other serious diseases. The only thing Basotho people seem to save for is funerals, which must be as lavish as possible despite the burden on relatives. People go without food to buy an expensive funeral dress; when a work colleague’s father died we were all expected to contribute towards the cost of the funeral. “Eat today for you may have none tomorrow” is a popular saying and as it is customary to enter a neighbour’s house and take food if you require it; it is true that saved food may not stay for long. I was really shocked when a well dressed woman I had never seen before came to my door, declared she had brought nothing for lunch and demanded some from me.

I had mixed feelings about Lesotho whilst I was there. There were many things that I would run differently, and feel that they would be better like that, but then as an outsider and having grown up in a totally different culture I may not have understood everything I saw, or looked at it in the right context. As the time for me to leave approached I felt increasingly fond of the people I’d met and the things that I’d done and feel sure that I will return there in the future.

Two weeks after coming back to England, CPTM asked me to give a short presentation on “Human Capital and Capacity Building” to Commonwealth High Commissioners in London. Once I had deciphered the title I wrote down some of the changes in hospital management I would have made and presented them; they seemed to be well received and understood. Perhaps I have made some small difference then; it would be great to know that I had given something back to the country that helped me discover more about myself and more about the world.