So, last week it was Lesotho (the week before, East London, this week Durban, and next week Swazi). Carey (the Program Development Manager for Lesotho who splits her time between there and Cape Town), Johannes (Operations Research Specialist in DSITS), and myself left very early Monday morning and few into Bloem. (That would be Bloemfontein. For some reason, South Africans seem find it necessary to shorten every name possible. Thus, Bloemfontein = Bloem, Johannesburg = Joburg, Zimbabwe = Zim, Zambia = Zam, Botswana = Bots, Swaziland = Swazi, etc…you get the picture. At any rate, use of the full name of a commonly abbreviated place is a good way of telling everyone you haven’t been in South Africa that long, so I do my best to fake it and make an attempt to “blend in.”) Bloem is the capitol city of the Free State (located in sort of the northern central part of South Africa). To give you an idea of what Bloem is like, we were waiting at the airport for our flight and found it a bit disconcerting that our flight wasn’t coming up on any of the reader boards, despite the fact that it was almost time to board. Carey looked over at the people sitting next to us (dressed in knee length jean shorts, with t-shirts tucked in, calf-high socks and hiking boots, along with canvas hats, and of course, huge mullets) and simply said “don’t worry, we haven’t missed our flight because they’re going to Bloem.” Perhaps that gives you an idea of who lives in the Free State. I’ll give you a hint: think redneck Afrikaner farmers.
Anyway, after an uneventful flight to Bloem, we sorted out our rental car and were soon on the road to Lesotho. (The only way to fly from Cape Town to Lesotho would be to go through Joburg, so in some ways it’s just easier to drive from Bloem.) The drive was beautiful. Rolling, golden fields and big, blue skies.
The scenery of the Free State
It was about a 2 hour drive to Lesotho. Once we got to the border, we crossed our fingers we weren’t going to get stuck behind a ton of taxi travellers needing to go through immigration (of course most people in the area don’t have cars, so they rely on minibuses (also called “taxis”) to shuttle them around, and each one can be packed with 15 people or so), and luckily, things went pretty smoothly.
Heading into the mountains of Lesotho...
...of course, behind a taxi
Made it to Lesotho - so beautiful!
Maseru (the capitol of Lesotho) is pretty much right on the border, so once we passed immigration it was a quick drive to our hotel. It was a cute place, and we each stayed in our own rondavel!
Maseru is quite small, which isn’t surprising given the size of Lesotho itself. Officially the “Kingdom of Lesotho,” Lesotho is a small country completely surrounded by South Africa. I think I remember reading somewhere it’s about the size of Maryland, with around 2 million people. The Basotho people somehow managed to fight off the Dutch back in the day, with the help of the British (becoming a British protectorate in 1868), so they were able to keep a piece of their homeland and remain independent from South Africa. They gained independence from Britain in 1966. Unfortunately, Lesotho is one of the countries with the highest HIV prevalence rates in the world – around 23%. Numbers like that are just so high, it’s hard to wrap you’re head around them sometimes…
Anyway, downtown Maseru kind of felt like it was the size of Hamilton, haha. And talk about “small town” feel…I was looking to connect with another Princeton in Africa fellow based in Lesotho, but she had told me via email that she had just lost her phone, and of course my South African phone wasn’t going to work in Lesotho, and I previously didn’t know where we were staying or where the office was, so we weren’t quite sure how to find each other. But then, as we were checking in, Carey of course sees one of her expat friends in the lobby, who happened to be working from the hotel for a conference that day, and asks if she knows a Whitney and if she could possibly help us get a hold of her, and her friend is like “yeah, do you want her work number or her roommate’s number?” So there you have it.
The metropolis that is Maseru
Having arrived mid-day on Monday, we then went to the office and met with staff there to explain the project and let them know why we were there. The view from the office was pretty nice, I must say!
Proof of how cold it was: little kids dressed in winter jackets
Lesotho in general is gorgeous. I had really wanted to travel there before leaving South Africa and was in the beginning stages of planning a trip for myself, so the fact that I was able to go with m2m instead was quite fortuitous. Lesotho is known for its rugged beauty, and you know me, I like mountains! It’s located in the highlands of the Drakensburg Mountains. (FYI, J.R.R. Tolkein was born in Bloemfontein and supposedly some of the scenery he wrote about in his books is based on the Drakensburg .) So yeah, the high elevation also meant it was COLD – as in frost-in-the-mornings cold! (Which is hard to take when you haven’t encountered that for an entire year, haha!) I may be mistaken, but I’m guessing Lesotho is probably the only place in Africa where you can go skiing. There are truly some very remote areas there – so much so that we have to give our Mentor Mothers motor bikes so they can get out to the rural clinics (since the roads are so bad and you would need a 4x4 otherwise.)
Anyway, after working a few hours, we headed back to the hotel and then got ready for dinner. I had managed to reach Whitney, so Carey, Johannes, and I went to meet her at an Indian restaurant in town. It was funny because Carey had been talking about how she really wanted to catch up with her other friend (the one who gave me Whitney’s number) at some point, and lo and behold, Whitney brought her to dinner, without even knowing the connection to Carey. She also brought another expat friend who Carey knew well, so again, Maseru is a small town, if you know what I mean.
You might not have guessed it, but the one Indian restaurant in Lesotho serves AMAZING food. Johannes even said it was some of the best Indian food he’s ever eaten. It was really fun to meet new people and share good conversation. Amongst us, there were 2 black Americans, 2 white Americans, 1 person from Sierra Leone, and 1 Indian who grew up in Hong Kong. We had a very interesting conversation about race and peoples’ different experiences in South Africa. Some areas, like Bloemfontein and Stellenbosch, are extremely white and the black people amongst us talked about how uncomfortable they felt being in those areas given the mentalities of the populations who live there. We talked about how truly separated Cape Town is, in terms of black and white populations rarely intermingling. We talked about what it was like to be West African in South Africa, where everyone assumes you must be from Nigeria and are taking their jobs. We talked about how, despite being 50-50 white and black, UCT is not an integrated place –Johannes, who used to teach there, even said there was a palpable divide between professors. We talked about how black Americans are often more accepted here by whites than black Africans, and how that is more symbolic of being accepted for being American and not for being black. There are so many issues South Africa has to sort out. It’s definitely not exactly the “Rainbow Nation” it declares itself to be. But I digress – back to Lesotho…
The next day we worked from the office in Maseru all day, and nothing too eventful happened. For lunch, I did get to try a drink made of a mixture of sugar cane juice and ginger beer, which came from the street market served in a used water bottle. I was a little afraid of getting sick, but it was good, and I decided to risk it and take advantage of all things local. Later that day, we shared maize off the street, which was delicious – an ear of corn grilled until the kernels turn brown and then you eat it kernel by kernel (which are hard and crunchy). I also worked hard to try the local beer, Maluti – definitely an African beer (very light), but still good.
Wednesday morning, Carey and I left the hotel at 6am to get on the road and drive up to Butha Buthe, a town about a 2hr drive north. (Johannes had to catch a flight out to Joburg that day, so he didn’t join.) The drive was extremely beautiful, especially as the sun was rising.
And you probably know by now, I love driving through Africa. So many interesting sites to absorb! There is always a steady stream of roadside foot traffic, and it was interesting to pass through little villages and see the hillsides dotted with rondavels and get a feel for what life is like in the area.
There are also a lot of herders and people who ride donkeys around – a very rural country, as I mentioned before. In Lesotho, many, many people wear these traditional colorful Basutho blankets wrapped around them, which I loved seeing.
We spent the day working from a small room in the Butha Buthe hospital, along with the m2m Site Coordinator from there. She was a pretty amazing SC – single handedly going out in the community and convincing tons of men to come join their partners at our support groups (it’s pretty rare to be able to get men involved). Even though I’ve seen a lot of resource-poor hospitals in South Africa, it felt like we were one more step removed working out there, as you would open the door and chickens would be walking around everywhere and all day we could here animals outside. For lunch, Mojalefa (the Monitoring and Evaluation Coordinator in Lesotho, who helped us all week) and the SC took me out to get food (Carey decided to stay in the office), and once again, I ended up eating things that I thought for sure would make me really sick. (It all worked out in the end, and I think this trip was a good lesson for me that I shouldn’t always be so uptight about things, haha!) We pulled up into the taxi rink (the area where the minibuses load passengers – tons of people milling about, as you can imagine), where the car could barely navigate over the trash piles and mud puddles to park, where I stepped out of the car and everyone started asking Mojalefa and the SC why they were with a white person (I got the feeling Carey and I were the only white people in the whole town), and we walked up to this completely dilapidated small store front where I discovered we would be eating lunch. Needless to say, this place would not exactly have passed any food inspection regulations in the U.S., haha. Mojalefa ordered beef stew with paapa (the maize-based, thick, porridge-like starch that is the food base of many Southern African cultures – in South Africa it’s called paap) and then he ordered me stew with rice (though he was speaking in Basotho, I could understand “rice” and “paapa”). I then interjected and said I wanted paapa too, at which point Mojalefa and the women working behind the counter started laughing hysterically and kept asking me again and again if I really wanted paapa, as they couldn’t believe a white person would want to eat it. Well whatever, I actually like it! We were also served more ginger/sugarcane juice, this time with lots more interesting floaty things in it, including hair, but I still drank it. When in Rome…
This isn't the exact place where we ate, but it's representative, haha
After a long day, we managed to leave the hospital just in time to watch the sunset as we drove home, but most of the drive was in the dark.
Driving in the dark is certainly not ideal when there’s that much road-side traffic, often with people dressed in all dark colors walking along in the middle of the road. Sadly, on the way home, we passed one person who had been completely mauled by a taxi. Sometimes I think the real danger of in living in Africa isn’t crime, it’s road safety. I still don’t know how I haven’t been run over/run over someone here, given how people drive and the positions pedestrians put themselves in.
Thursday morning was another very early morning, as we had to drive 2 hours south this time to Mafeteng.
More beautiful scenery
And great clouds
And endless cornfields
Really, it shouldn’t have been a 2 hour drive, except that there was so much road construction. At one point we had to just sit and wait on the side of the road for about a half hour. Though Carey and I were skeptical that there was any method to the madness of which cars were allowed to go through vs. when which cars had to wait, you gotta love at least the attempt to inform you of what was going on:
Waiting...
As locals know there is a good opportunity to sell things when people are stuck waiting in their cars, there were a lot of people milling about while we sat and waited. Carey bought breakfast (boiled eggs) from a cute old woman wrapped in her big blanket sitting by the side of the road. I think each egg was 2 rand (like 25 cents), and after selling to us, she said “I need to go make more money” and headed off to the next car behind us…while Carey pointed out that if that were a man, he probably would have sat there begging us for money as opposed to getting back to work. There was also a guy with a cardboard sign taped to his back symbolizing he was selling airtime. And then there were the taxi drivers, who got out of their taxis to talk to their friends and smoke cigarettes.
It was really funny to just talk to people and observe the goings-on of the day. Carey asked one guy talking to us what he did for work, and he answered “door slide.” We almost died laughing. Probably only those of you who have experienced Africa would get that. Minibuses/taxis/combis – whatever you want to call them – are ubiquitous all across Africa, and typically how they are set up is that one guy is the driver while another guy works yelling to people on the street, collecting the fares, and operating the sliding door to let people in and out. Usually these helpers are pretty crazy, completely hanging out the windows, yelling all the time, shoving people in and always managing to make one extra person fit and somehow also managing to hoist themselves in as well as the taxi starts to move away. Sometimes they don’t even bother to shut the door while the taxi is in motion. Anyway, it was just hilarious to have someone sum up that crazy, crazy job as “door slide” – I never knew it had an actual name, haha! I guess you had to be there. It was an entertaining wait, needless to say. I also saw one of the funniest sights I have ever seen (funny just because of the combination of the setting and people’s attitudes, and it being another just plain African moment): a group of young teenagers walking through the cornfields about to cross the road, one of them a bit bigger than the others and clearly the “cool” ringleader, with this cool kid wearing his big winter jacket, along with hot pink mini sunglasses. Yes, HOT PINK. And they were clearly way too small for him. I don’t know, it was just really funny to see this kid thinking he was so cool wearing little girl sunglasses in the middle of winter in Lesotho. Perhaps another “you had to be there” moment…sorry…
Arriving in Mafeteng
Mafeteng Hospital
Meeting the staff in Mafeteng was really nice. One of the Mentor Mothers pulled Carey and I aside to tell us that she just got back the results from her baby’s second PCR test (you’re supposed to have two, one at 6 weeks, and one once you have stopped breastfeeding to make sure the virus wasn’t transmitted later through breastmilk) and that they were negative. She was truly glowing, and then she high-fived both of us. I know it sounds really cheesy, but it’s moments like that that just make you feel really good about going to work everyday. Anyway, the hospital in Mafeteng was a bit less rural than the one in Butha Buthe. At least we weren’t distracted by crowing roosters all day. No, instead we were serenaded by m2m support group members. It was so lovely – and honestly, quite moving – to hear all these women who come together through m2m to support each other, all with their beautiful voices singing things that, though I couldn’t understand a word of, you just know are very uplifting thoughts. I can’t imagine a random group of white people getting together and being able to hold a tune, haha!
Luckily it was an uneventful drive back to Maseru, though Carey and I couldn’t help but wonder how this beautiful new paved road would probably actually be less safe in the end as people would speed so much. Yeah, with intermittently spaced roadside signs that read “Please don’t kill us,” it obviously tells you how dangerous it is to be a pedestrian along these roads.
Friday morning, I had a flight to catch at 11am, but before I left, Carey was kind enough to arrange a site visit for me to the largest hospital in Maseru, called Queen II.
Outside of Queen II (FYI it's really hard to try and take a picture discreetly from the back seat of a moving car...so this is definitely not the best shot)
It was by far the best site visit I have been on this year, and I’m really thankful to Carey and Molebohang (the Country Manager) for arranging the visit just for me. It was just so interesting to be at such a big facility and really get a feel for client flow and what happens to a pregnant women who walks in the door of a large hospital in Southern Africa. Yes, I’ve worked at large hospitals in South Africa, and yes I’ve been on many site visits before, but never with the real opportunity to see the details of everything.
When we first pulled up, there was a line of people stretching around the corner, as parents were bringing their kids to get the measles vaccine, following a recent measles outbreak in Lesotho. With all those people, it was a bit difficult to get through the door to see our site staff. Inside, it was just as crowded. The Site Coordinator took us around and showed us the room where pregnant women first go. All pregnant women who don’t know their status are pre-test counselled as a group and advised to test for HIV. Of course I knew this before, I guess I was just typically naïve in picturing it in my mind as a large waiting room with chairs lined up. No, this was literally a closet with equipped with an old wooden bench that could barely fit all of us in there. Being at the hospital that morning with so many people in such little space, everything felt so crazy. I can’t imagine how you would feel going into the hospital and trying to navigate your way through everything – another reminder of how lucky we are to have the facilities we do in the Western world.
It was also interesting to see how closely m2m staff works with facility staff to connect with all pregnant and postnatal women who come to the clinic before they leave. Mostly it’s just nursing staff there. Yes, in this large, crowded hospital in the capitol city, I was told that the doctor comes one day a week for OB/GYN needs – the rest of the time, it’s just the nursing staff. That doesn’t count the delivery wards though, which are in a separate area of the hospital. I had never seen delivery wards in any of the sites I’ve been in, so it was also really interesting to visit that area.
Molebohang also took me to see the hospital lab, where they process all the blood samples for HIV tests, blood transfusions, CD4 counts, etc. I really loved the opportunity to see that area (and I wasn’t supposed to be there, but Molebohang’s close friend worked in the lab, so she let us in). Apparently they process 300-500 blood samples for CD4 counts per day – that’s a LOT! I don’t know how they keep them all straight. Most of you know this, I’m sure, but it’s really important to get a CD4 count (a measure of the immune cells in your blood) when you’re HIV+, because once you drop below a certain number, you need to start anti-retroviral therapy for the rest of your life, and it’s especially crucial for pregnant women to know their CD4 count because it determines which medications they take during their pregnancy to get their viral loads down low enough so as to reduce the likelihood of transmission to their children. (People with low CD4 counts are experiencing more advanced stages of the disease and have higher viral loads.) The lab at Queen II processes CD4 samples for clinics all over the country, as many clinics aren’t equipped to run the tests on their own. I was told how, previously, there was a huge problem in getting the blood samples to Maseru what with so many clinics in such remote areas – blood samples would be taken and then they would just sit there in the clinics with nobody taking them anywhere, eventually clotting and becoming useless. Recently Elton John stepped in and helped fund a program called “Riders for Health” which employs people whose sole job is to transfer samples to and from remote clinics to major hospitals by using motorbikes that come equipped with coolers on the back. Apparently it has made a huge difference. Again, talk about something simple and practical that is so crucial – transporting blood samples – but yet so easy to overlook in these types of settings. And again, talk about really making a difference – I must say, you really have to hand it to Elton John.
As we were about to leave the hospital, a doctor came up to Carey and warmly greeted her “hello neighbour!” It was funny how he had just mistaken her for another white person. It was actually interesting to talk to him beyond that though – he was a doctor from the DRC who could no longer work there because of the pay and the situation in that country. Apparently Lesotho has a lot of imported Congolese doctors, as they don’t have enough skilled workers on their own (or rather, the people who are able to often leave Lesotho to work in South Africa…and then some aid agencies help bring in foreign doctors, none of whom speak Basotho of course…not exactly the best scenario, especially when you stop and wonder with this system, who is still practicing medicine in the DRC?).
After the site visit, I had to hop in a taxi to the airport, and once again, I found incredibly useful to be able to talk about soccer, haha. The Maseru International Airport was the smallest airport I have ever seen (not counting those landing strips in the middle of rural Botswana).
The airport, truly in the middle of nowhere
There was not a single thing to be sold in the airport – nope, I don’t think you could even buy a bottle of water if you wanted to. After checking in my bags, as I was in line to go through customs, a guy came over and pulled me aside and said there was something in my bag he needed to check. So he took me out back where he was scanning the checked luggage and showed me on the screen what he was looking at and I tried unsuccessfully to explain that they were ankle weights (which I use to do exercises to strengthen my bad knee) and he absolutely did not understand, so I had to unzip the bag and take them out and show them to him. I’m pretty sure he thought I was the weirdest person ever, haha.
Sadly, it was a very quick trip to Lesotho, but I really enjoyed it and feel like I learned and absorbed a lot while there. Unfortunately, I didn’t get to take very many good pictures – it’s hard to take pictures from a moving car, and I generally try not to take pictures of people out in the open for fear of making them seem like spectacles…oh well, next time, I suppose! I really would love to go back someday. Everyone in Lesotho was just so amazingly nice, and the country was stunningly beautiful. I’m really thankful I had the opportunity to visit. I guess if all else fails with med school, etc. I perhaps have another option: door slide
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