"Yes, she asks a lot of questions!" (Outreach Day 1)

I woke up early on my first day in Lesotho to head out with one of TTL’s outreach teams in order to observe how the whole outreach process works.  If you ask me now how the day went, I would tell you it was absolutely amazing, but to be honest, I was beyond nervous while getting ready that morning.  I hadn’t even been at TTL for 12 hours and I was just being thrown into the thick of things!  Actually, I was being thrown into a car with two male outreach workers I’d just met and would be spending the next 7 hours with, just the three of us.  We were headed out to visit two of TTL’s clients in Linakaneng (pronounced “dee-na kee-nayng”), a community of villages 2.5 hours outside of Mokhotlong with a population of approximately 4,500 people.  The outreach workers were actually very friendly and taught me a lot on this trip; I will refer to them here as “R” and “T” since I didn’t ask permission to use their names.

Our first stop along the way was when we got pulled over for a police check.  Apparently they have a lot of those here along the main roads, especially in the morning.  I couldn’t understand exactly what the cop was saying, but judging by how quickly R and T put on their seatbelts, I’m guessing that was the topic of conversation.  We got away with a warning, which I was happy about because I learned that they fine you right on the spot here in Lesotho.  I think I just found the one thing about the American police ticketing system that I like…

Almost immediately we were driving along a dirt road again, and this time by dirt road I mean rocks with some dirt filling in the spaces.  Anyone with motion sickness would definitely not have enjoyed this ride.  If I thought Jenn did well driving on Lesotho roads, then R must be the “sensei” of all Lesotho drivers.  Some parts of the road were smoother than others, but all I can say is thank God for four-wheel drive!  The most terrifying moments on this road were when I saw another truck or taxi approaching.  Luckily, R handled passing them with ease.  The “taxis” that passed us quite often are actually big white vans stuffed with more people than should really fit inside.  Since the large majority of people in the villages don’t have access to cars, a taxi is the only way for them to get to the main town of Mokhotlong.  T told me there used to be large buses that would transport people to and from Mokhotlong, but this was only possible when the dirt roads were new.  This long, winding road through the mountains was actually very well-planned at the time it was built, but rain and falling rocks destroyed the road over time leaving behind the bumpy trail we were traveling.

White taxi approaching us on the road.

The road (or should I say rocks) ahead!

Can you pick out the path of the road here?

A glimpse of the rocky road winding through the mountains.  The slopes are steeper than they look!

About two hours into our trip we reached the first outreach destination, which was a small rondaval (what the traditional circular homes with thatched roofs are called) situated on a pretty steep slope.  When we entered the home, I was immediately invited to sit down at the small table in the center of the circular room.  For homes that do have tables, it is a cultural courtesy to invite the guest to sit down at the best spot in the home, the Basotho insist upon it.  I took my seat as directed and began to take in the scene around me.  The walls inside were a beautiful teal blue.  There was one bed, a dresser for clothes, a small table with a few chairs, one light, and a dresser that served as kitchen storage.  Surprisingly, this rondaval had electricity whereas most of them must use candles for light.  The home was humble, but very tidy…maybe that’s just because they knew visitors were coming.  In talking to other experienced volunteers at TTL, this rondaval was equipped with many more amenities than most others (for example, most of them have no real furniture).

First home we visited on outreach.  Very remote!

The client we were visiting was a baby girl cared for by her grandmother.  R told me that the girl’s mother passed away when the baby was just 1 day old.  When I asked R her cause of death he said they were unsure, but they do know that she was on ART treatment for HIV/AIDS and the grandmother said something about a tetanus shot.  I also asked R if the baby was on ARVs since her mother was HIV positive and he said they were still waiting to get the test results back.  I immediately said a prayer that the test comes back negative.  I also learned that this baby had stayed in TTL’s safe home for 5 months after birth.  What a rough start to life for this adorable little girl.  Outreach did their thing for about 20 minutes while I sat and watched, then we were off to the second stop.

At the second rondaval we were greeted by an elderly man, two elderly women (in very worn out sneakers), and the one of cutest little boys I’ve ever seen.  This boy is also taken care of by his grandmother.  My advisor told me recently that many of the women here have children out of wedlock and eventually the father is not at all in the picture.  I guess that fact and the high prevalence of HIV/AIDS are the main reasons TTL sees so many orphaned children.  Outreach did their duties outside of the home at this site, so of course I took a bunch of pictures!

So the first thing the outreach worker does is look at the child’s Bukana.  The Bukana is essentially the medical record book of each person here.  Every time a patient sees a doctor or nurse, he or she writes the diagnosis, prognosis, and treatment recommendations in this book.  All vital signs and measurements are also recorded in it.  As you might be able to guess, the Bukana is sacred to the job of TTL’s outreach workers.  After outreach looks at the Bukana and asks all the necessary questions of the caregiver, they record any new information on special TTL forms.  They then weigh the child on a hanging scale (both children we saw freaked out during this part), measure the length of the child on a human-sized ruler, and take the child’s MUAC.  For the non-global health students reading this, MUAC stands for Middle-Upper-Arm Circumference, which is used as a measure of malnourishment.  T and R gave one of the elderly women money, too, because she helps transport the mother from a village even farther away to these TTL outreach visits.

"T" weighing the young boy.

"T" measuring the length of the baby.

Taking the MUAC.  The red area means sever malnourishment...

...but we were happy to see this boy in the green!  Nutritionally in the clear!

Bag of nutritional supplements for the family, with the yellow Bukana sitting inside.

I really enjoyed this second visit because I saw a lot of little things that were exciting.  First, I noticed that just as the first baby we saw this little boy was wearing a string of beads around his waist.  I have yet to learn what the beads mean, but they are obviously something traditional in Basotho culture.  I also enjoyed the solar panels connected to an old battery sitting outside the rondaval.  T told me this was used for radio.  We also had the car radio on during this outreach visit since we were outside and I really enjoyed hearing one of the elderly women sing along with the traditional music resonating from the car speakers.

Solar panel connected to the battery sitting outside the second home.

Eventually we headed back to TTL, but not before passing amazing views of the rolling "Mountain Kingdom".  By the time we got back all of my clothes, my backpack, my notebook, and my face were covered in dust from the dirt roads.  I asked R and T probably a hundred questions during this entire trip, so this post could go on and on and on (as if it wasn’t long enough already).  Amusingly, I fulfilled the stereotypical white person character by asking so many questions, as part of the Basotho culture is to not ask many questions about anything.  I was pretty positive I annoyed R a bit with all my questions, and I got affirmation when he told a TTL fellow, "Yes, she asks a LOT of questions."  You can take the girl out of the west, but I guess you can’t really take the west out of the girl!  I figure telling you about outreach itself now and then putting shorter posts about all of the other things I witnessed and learned about will probably keep you from getting bored.  Outreach was an absolutely incredible experience, one I just had to share details about because I wish I could bring everyone with me to experience it all!  I hope this gave you a good taste of a major piece of TTL’s work and the setting in which I will be doing my research.  Talk to you soon!

Views from the ride through Linakenang.  Enjoy!