Adventures in Lesotho: Zero Rand

Last Monday marked my first day surveying TTL clients while on outreach. I wasn’t actually expecting to conduct any interviews that day, but in typical TTL fashion I ended up being pushed right into it!

As you’ve probably gathered by now, I do not speak the native language here, called Sesotho, so I had to hire a translator to help with my research. TTL’s finance director quickly told me she’d found someone who would do the job for all 5 weeks, which I greatly appreciated. I was expecting an older woman, someone who knew just enough English to get me by, and someone I probably wouldn’t ever see outside work. Well, I got quite the opposite! Instead, that Monday morning I was greeted by a young girl, only 19 years old, very beautiful, with perfect English. Amen! (I’ll call her S until I ask if I can use her name here.) I’d planned on just going over my consent form and survey with S before sending her home for the day with a copy to look over that night. We soon discovered that outreach was seeing two children on ARVs and instead decided to dive right in! So there I was again…with R and T (who I spent my first day on outreach with) and S, a complete stranger who was about to aid in my survey that asks a lot of personal questions. To say I was nervous is definitely an understatement.

Driving on top of this plateau.

We headed out of Mokhotlong in the opposite direction from outreach day 1, and for a while were driving on the top of a large plateau, which meant beautiful views and a pretty smooth ride. Wow, I thought to myself, the roads out here aren’t that bad. Ha…I definitely spoke too soon! Seriously, driving in Lesotho puts a whole new meaning to the words “off-roading.”

Down we go!

For my project on TTL’s outreach services and its effectiveness for ART adherence, I developed my own survey by researching obstacles to adherence, tools that have been shown to promote good adherence, other outreach programs, pill-taking behavior, and survey design. After months of editing, re-editing, and editing some more, my final survey ended up with seven sections: demographics, adherence practices, transportation and clinic visits, pill taking behavior, perceptions about adherence, work and nutrition, and outreach services. There are 84 questions in total (don’t worry, many of them are yes/no answers or get skipped) and one interview takes about 25 minutes to complete. Some of the questions ask very generally about clinic visits and daily medicine routines, whereas others dig deeper and ask personal things like how much money a household makes each month or how often a child goes hungry because there isn’t enough food. I was pretty worried that people wouldn’t respond well to me or feel comfortable with the questions I wanted to ask. Part of me honestly thought that some caregivers would refuse to answer my questions and my whole project would turn out to be a flop.

R taking the MUAC of a young girl.

When we arrived at the first rondavel the caregiver wasn’t home. I was relieved that my first interview could be put off just a bit longer. I had to start my research at some point, though, and that time came when we reached the second rondavel. The caregiver and child arrived at the second stop like a scene out of a movie. Out from a backdrop of maize fields and endless mountains came a very pretty woman wrapped in a colorful blanket, baby tied to her back, riding an elegant white horse. Not going to lie, I was a bit intimidated by her entrance! After R and T did their outreach duties, S introduced me to the woman and read the consent form…and she agreed to talk to me! All was good in the world of Annie’s research! And the interview went surprisingly well. As always in Basotho culture, S and I sat on a bench while the woman sat on the floor of an essentially empty rondavel. I learned that she was actually the aunt of the three-year-old boy she was caring for; she took him in in addition to her own four children after her sister passed away. She responded to all of my questions (what a relief!), but also threw me for a loop with some of her answers.

I knew that a lot of people in Lesotho did subsistence farming, meaning they grow crops in order to provide food for their families, but I kind of just assumed that they made some money in other ways. How does one provide for a family without any money? Well, somehow, she does. As a matter of fact, so do a lot of the people I interview. When I asked her, “How much money does your household bring in each month?” I about died when she said, “Zero rand” (rand is the $ of South Africa). I was in such shock that I asked the question again. Her answer remained the same. For the first time, I was face to face with a person who before now was just a statistic to me: one of the 43% of Lesotho that live on less than $1.25 per day…and it truly stunned me. I went on with and finished the interview, trying to hide the expression of disbelief on my face, but her answer to that question hung with me for the rest of the day. No wonder she was often concerned about having enough food for her family. I actually still think of this moment during every interview I conduct, and cringe a little while waiting for others’ answer to that question.

I was happy to see that the young boy, who’d only been out of TTL’s safe home for a short time, looked healthy and joyful. He played with a long stick throughout the interview, pretending to ride it like a horse.

Before the day was over, we went back to the first rondavel and I interviewed a father there. This man has one leg and is taking care of three young children while his wife is off working in South Africa. Each caregiver I meet seems somewhat remarkable in his or her own way. I actually saw this man walking in town the other day and I knew he recognized me when he gave me a big smile after I greeted him from across the street. I was elated that my first day of interviews went well, that my translator turned out to be excellent, and that I started making progress on my research. I just hope that in some way, even if not immediately, the things I find out from my survey and the suggestions I make for TTL’s future outreach are able to have a positive influence on these care givers and their young children.

Pictures from day 1 of interviews!