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Twins In, Twins Out

January 31, 2014, 12:41 am
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If good things come in pairs, are two sets of twins a pair of pairs and twice as good?

This week in the Safe Home, we said goodbye to Tlallo and Ntlalleng, who have been with us since October 2013. When this brother-sister set arrived, they were suffering from acute malnutrition and very delayed in reaching developmental milestones. After three months, they are sitting, laughing, working up to a crawl, and noticeably chubbier!
Tlallo sitting with one of the Bo'me
Ntlalleng testing out the new Bumbo
Compare their astounding progress, now at 9 months old, with a different set of twins. Teboho and Liteboho are 17 months old, but about half the size of their counterparts.


Such comparisons are common in the Safe Home. The staff working day and night to care for these most vulnerable babies pay close attention to the specific needs of each child. Little by little, the Tebohos and Litebohos grow to be like Tlallo and Ntlalleng – heavier, healthier, happier and back on track for a stronger childhood.

We will be the first to admit: it is bittersweet to see our healthy babies go, especially when several reunify with their families at once. However, we are proud of the strides our first twins made and are eager to see the same results with this second pair.

You are sure to see photos of their time in the Safe Home, so stay tuned for twice as much fun!


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Ready, Set, Grow!

February 7, 2014, 6:47 am
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wire push car

It’s fascinating to watch children experiencing this world. Play is truly child’s work. Children in Lesotho create toys out of items considered rubbish in more developed regions. Devoid of prefabricated toys, the world of play fosters a mind-boggling amount of inventiveness. Balls are made of plastic bags or rubber bands; tires and rims are rolled along with sticks; intricate wire cars bump along the road. Items that the developed world would resign to the trash bin are transformed into toys in the most imaginative ways!




Often we see older children out and about, playing in their villages, but rarely do we witness much play in the early childhood years. Yet that is the period when play is so vital for adequate child development.


'M'e Nthabeleng providing caregiver
education during a safe home reunification


In an effort to promote integrated early childhood development, TTL has been working with caregivers to encourage play and interaction beginning at birth. In addition to performing a monthly developmental assessment of each child, the Outreach team provides individualized counseling to caregivers based on the child’s age and abilities. Caregivers learn appropriate play to promote physical, cognitive, emotional, and social development.






Over the past few months, we have worked to create tools to assist caregivers as they help the children under their care grow. With the new TTL child development cards, comprised of both pictures and words in Sesotho, caregivers will have a clear and handy reference tool. The Outreach team looks forward to utilizing these cards to help caregivers foster the growth of our clients and other children in the household. Together we can work to help these children develop to their fullest potential.

A caregiver reviews her early childhood
development tool
'M'e Kokonyana reviewing how caregivers
can support child development


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Basotho Rains

February 13, 2014, 3:05 am
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Mokhotlong is a place of extremes: extreme elevation, extreme beauty, and extreme impacts from even the slightest environmental changes. Take, for instance, the rainy season.

In the arid mountain climate, rain is highly valued. Every summer the skies douse Lesotho with torrents of rain, watering crops and softening the dry earth. In recent years, these rains have grown heavier (one could say more extreme) and the effects have put a strain on every facet of daily life.

The growing season in the highlands is necessarily short. Late snows delay planting, and the risk of early frost pushes the harvest forward, sometimes by several weeks. Without rain, of course, these crops cannot grow, but oversaturation is a problem as well. Fields are damaged by hail, washed away by rushing rainwater, and yellowed by sitting too long in wet soil. Even TTL’s garden shows the effects of some of the rains we’ve received this season.

Failed crops mean more families struggle to feed themselves, especially in rural areas where food delivery is difficult. Rain also contaminates potable water sources, increasing illness. Just when many TTL clients need additional help, we face one more rain-induced barrier: the roads.

Normally this road is crossed by a shallow stream, easily driven through, but each summer the rains create a river and traversing the water is suddenly unpredictable.
TTL’s Outreach Workers must cross bridges, like the one pictured below, to reach some of our remotest clients. With each heavy rain, the river rushes over the road making it impassable despite our strong will and powerful vehicles, and we must delay appointments. This reality weighs heavily on our staff, since we cannot predict when we will next be able to reach these children.

Each season presents a new set of obstacles as we battle the effects of HIV/AIDS and malnutrition, but the work continues day after day. At TTL, we operate on our own extreme – determination – to support the most vulnerable children of Lesotho, rain or shine.
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Lipuo

February 17, 2014, 6:02 am
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The first time I held her, it was as if I was holding a body filled with air. She looked to be about 7 or 8 months old, though her actual age was 14 months. For nearly 6 weeks, she yo-yoed between the TTL safe home and Mokhotlong Government Hospital, stricken with various maladies exacerbated by acute malnutrition. It was as if she was vanishing before our eyes, each day finding her frailer than the previous. I truly didn’t know how much more her fragile body could endure. Though we were afraid to utter the words, we all questioned her future.


Some weeks before the holidays, we noticed a slight change. Though she remained quite malnourished, illnesses were no longer repeatedly plaguing her. Her food intake and her ability to tolerate medications were improving dramatically. Slowly, her blank expressions took on a twinkle of hope; there was a noticeable sparkle in her eyes and intention behind her actions. We were cautiously optimistic. We watched her flourish, tentatively at first, then with what I can only describe as conviction. We breathed a collective sigh of relief and, as her weight and health continued to stabilize, we began to speak of reunification.



We frequently spoke of Lipuo’s miraculous recovery. We compared the illness-plagued toddler with the chubby, inquisitive, talkative, and very mobile little tot in our midst. The transformation was truly magical.

Last Thursday, 13 February, we said goodbye to Lipuo. In a span of a few hours the fierce toddler, who less than one day before stood independently for the first time, was gone. Her loss is tragic and we are reeling.

The safe home is subdued these days. We miss the incessant mishmash of high-pitched chatter from a certain little girl who appeared able to conquer the world.
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Mud, Mountains, and Gravity

February 25, 2014, 11:10 pm
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Driving in Lesotho is a bit of an adventure. The roads are tortuous, often narrow, deeply rutted, and bulging with rock. The rainy season adds yet another nerve-wracking dimension – mud. Approaching a boggy section of road results in a bit of panic; mud is unpredictable and unforgiving. However, with families awaiting our arrival, the only choice is to persevere. Sometimes the crossing is successfully navigated and other times the mud, mountains, and gravity conspire to mire the vehicle. Unfortunately, the latter was my experience some days ago.


 a bit of a predicament

While traveling to the homes of Outreach clients, we encountered a particularly muddy and flooded section of road. We slowly approached the quagmire. I glanced at the staff, “This looks interesting.” I uttered, and proceeded with the utmost caution. The mud pushed our sturdy truck as if it were a matchbox toy. We found ourselves sliding down, skating off the road onto a swampy embankment that offered neither traction nor an opportunity for recovery. Not only were we stuck, we were perched at a very precarious angle. We nervously clambered out of the truck and phoned the office for help.




Villagers and shepherds to the rescue!
As we were waiting for a TTL vehicle to rescue us, Basotho from the surrounding villages came to investigate our situation. Soon, we found ourselves surrounded by several village men and nearby shepherds who discussed a plan to assist us. Some older boys appeared with a shovel. Two men appeared with trucks and promised assistance. We were overcome with appreciation. Together the villagers and a TTL driver successfully pulled the truck out of the mud. As I moved from villager to villager, shaking hands and offering thanks, I was struck by the humility of our rescuers. As I offered a sincere thank you and apology, each man in return thanked us for our hard work to help their children. They insisted that it was an honor for them to return the favor and assist us with our work.






Stories such as this one are but one example of the obstacles we face working in the most remote regions of the Eastern Highlands, especially during the summer rains. However, this is also a story of humanity and solidarity.



Neither people, nor trucks, nor maize were injured in the incident.
I can't say the same for my ego




Oh, and ‘M’e Nthabeleng…I’m fired from driving in the mud!
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The Forgotten Kingdom

March 7, 2014, 12:03 am
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There is a certain beauty in seeing a movie that was filmed in a place you know well, maybe even call home. Many people feel that brief thrill and pride in recognizing local landmarks and favorite hangouts. However, that experience is completely foreign to most Basotho. Until now.

The Forgotten Kingdom is the first full-length feature film to be shot in Lesotho. The movie tells the story of a young Masotho named Atang living in Johannesburg and estranged from his homeland. He begrudgingly returns to Lesotho to bury his father, but gradually reconnects to his country through old friends and new acquaintances who teach him the value of Lesotho. There is more to the mountain kingdom than first meets the eye.

On the first of March, The Forgotten Kingdom premiered in Maseru. The debut screening was an event studded with stars, VIPs, and a theater filled with Basotho eager to watch a film not only about their nation, but in the Sesotho language. In the days following the premiere, the director and a team of crew began touring around Lesotho – returning to the communities where the film was shot and sharing the finished product with hundreds of Basotho.

TTL has supported this project and helped coordinate the screening to take place tonight in Phuta and tomorrow in Mokhotlong camp town. In return, our Managing Director ‘M’e Nthabeleng was invited to attend the premiere in Maseru; she knew little of what to expect that evening.

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I asked her to reflect on the experience and share her thoughts:

‘M’e Nthabeleng, tell us about The Forgotten Kingdom. What did you like about the movie?
For me, I really appreciated that the movie is in Sesotho, so it’s easy for many Basotho to understand. This is such a great opportunity for Basotho to connect with their stories and country. Some of our Basotho actors were a part of the movie, which also makes me so proud. This was really a movie about Lesotho and for Lesotho.

How did the movie portray Lesotho? Do you think this was accurate? 
I think it showed many different parts of the culture of Lesotho – you could see people working in the fields and the traditional dress and dances – and the landscape in different areas of the country. It showed what Lesotho is really like.

Part of the movie showed some people’s real response to HIV – the stigma in the rural communities. The father’s shame over his daughter’s illness forced him to move to an entirely different part of the country. Even though the stigma is lessened today, it remains a problem. Fortunately the movie also portrayed the support systems that exist in Lesotho for HIV+ people. There is education available and clinics that can help provide treatment. That was really important to show.

Would you recommend the movie to your friends?
Yes – that’s an easy one!

Describe your reaction when you first saw the VIPs.
I was sitting in the audience and all of a sudden, voilà! One row behind me was sitting the Prime Minister and the royal family, which showed how important the movie is to Lesotho. It was a really great moment and one I was not expecting.

I had never been to that slick movie theatre before – every time I’m in Maseru I’m so busy I never have the opportunity to relax and enjoy the city. This gave me the chance to enjoy my capital city, meet some actors (and take pictures with them!), and feel proud of Lesotho.

Who were you most excited to see/meet?
I was most excited to meet Zenzo Ngqobe (who plays Atang) because I had seen him in other TV shows. Also, the little boy (Lebohang Ntsane) because he did such a great job in the film. Oh and don’t forget Lillian Dube. Everyone, really!


What was the best part about the entire evening?
Oh my gosh, at one point while I was trying to take a picture with Zenzo I knocked over one of the waiters and broke a whole tray of glasses. He kept asking if I was okay, which I was, but I was so excited I forgot to help clean up! It was so nice to have a night out and meet celebrities and hang out with friends. Also the food was so good.

Anything else you'd like to share?

I want to thank Andrew Mudge (the director) because this is a really life-changing experience for Basotho, especially in the rural areas. For an American to make such a beautiful movie about Lesotho and then bring it to show the Basotho shows real love and respect for the culture. He could have made and produced this movie and then only showed it in America. I feel, on behalf of the full Basotho community, I should extend thanks. I am really touched.
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Happy Moshoeshoe Day!

March 14, 2014, 12:45 am
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King Moshoeshoe I
(photo credit: lesothokualalumpur.org)
King Moshoeshoe I is revered in Lesotho, which goes without saying considering he was the country’s first reigning monarch. Some describe Moshoeshoe (pronounced ‘Mo-SHWAY-shway’) as a man of great wisdom, character, and diplomacy, arguably good qualities in the leader of a new nation.

Amidst the 1868 conflict against the Free State in modern day South Africa, Moshoeshoe led his people to the top of Thaba-Bosiu, the ‘Mountain at Night.’ For nine days, the mountain became a fortress against invasion as Moshoeshoe strove to find a peaceful resolution. He ultimately succeeded and today Thaba-Bosiu has become a symbol of nation building, closely associated with King Moshoeshoe himself, who is now buried there. Each year on Moshoeshoe Day Basotho travel to pay their respects to the beloved leader.

Thaba-Bosiu
(photo credit: Wikimedia Commons)
The 11th of March commemorates the death of Moshoeshoe. As a solemn occasion, however, the holiday celebrations are small and personal to each Masotho. Many will wear traditional dress on this day; local businesses are closed; and communities may gather for a drink and good time. Around the world, Moshoeshoe Day festivities are aimed at celebrating Basotho heritage and the Sesotho language. It is also an opportunity for non-Basotho to learn a bit more about the little Mountain kingdom.


So next 11th of March, be sure to wish your friends and neighbors a Happy Moshoeshoe Day! 
Sala hantle (stay well).
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Strengthening Partnerships

March 21, 2014, 12:49 am
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Since taking in our first client in 2004, TTL has constantly striven to improve and expand our high-impact services. For this we rely on an intimate network of partners, many of whom provide quality services complementary to our own.

The Lesotho government has proven to be a strong partner over the years. Not only have national health campaigns reduced the prominent necessity of TTL’s PMTCT efforts, but local ministry offices have also frequently referred us clients and shared new information about medical treatments in Lesotho.

Recently, TTL partnered with the Ministry of Social Development to ensure that our clients with special care needs can benefit from the full range of available services. Over the past few weeks, we have collaborated with the Mokhotlong Senior Social Welfare Officer to develop an official referral form - a small achievement, perhaps, but one with great impacts.  The first step to receiving government aid begins with a referral from a trusted partner. Now for the first time, TTL has authorization to directly refer our clients in Outreach and the Safe Home to the Ministry of Social Development whenever necessary.

This new tool has expanded our capacity to serve the vulnerable children of the mountain districts. We are grateful for the trust and support we have received from the Ministry of Social Development and look forward to supporting the many children who face extra difficulties in leading healthy lives.


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Lesotho Highlands Water Project, Phase II Launch

March 27, 2014, 8:48 pm
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Today marked the official launch of Phase II of the Lesotho Highlands Water Project (LHWP), right here in Mokhotlong District. Dignitary attendees included His Majesty King Letsie III, Prime Minister Tom Thabane, President Jacob Zuma of South Africa, …and TTL of course. We wouldn’t miss the chance to celebrate the launch of a major development project for Lesotho.
His Majesty King Letsie III addresses the crowds, explaining the operations and benefits of the Polihali Dam, which will be constructed as part of LHWP Phase II.
The LHWP has been in progress since 1986, when the governments of Lesotho and South Africa first agreed to large-scale development. The bilateral treaty outlined construction plans for several dams on Lesotho’s main waterways that would create employment and investment opportunities, provide hydroelectric power, and build associated infrastructure for the mountain kingdom. In exchange, much of surrounding South Africa would receive access to safe and reliable drinking water. The first phase comprisingKatse Dam, Mohale Dam, and 'Muela Hydropower Station was inaugurated in 2004; now the second of four total phases has begun.

Just as South Africa relies on Lesotho for potable water, Lesotho relies on its only neighbor to meet many of its basic needs. For instance, all imports and exports must necessarily cross South African soil or airspace, including the import of foreign assistance. 
(photo credit: WFP)

Since 2012, the Lesotho highlands have faced a harsh food shortage that has increased cases of malnutrition among other problems. TTL has seen evidence of this firsthand both in our Safe Home and on our Outreach visits. The World Food Programme has striven to mitigate the severity of food insecurity and has worked closely with South Africa to deliver life-saving support. In time, more roads and other infrastructure could aid the delivery of regular food shipments and medical assistance to rural areas and, if needed, increase the speed of external support programs. 

Mokhotlong District will likely look very changed in five years. For the Basotho highlanders, we are eager to see the benefits of the many new opportunities promised by the LHWP as well as the strengthened partnership between Lesotho and South Africa. 
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11 Kids and Counting

April 4, 2014, 5:39 am
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No, TTL is not being profiled in an upcoming episode with the Duggar family – although I am certain they would have a great time hanging out with the kids and staff! Rather, the number of babies in our Safe Home has reached double digits just as the season turns toward winter in earnest.

For a time in March, it seemed as though each day brought a new client through our doors. Now with twice as many babies as February, the playroom can sometimes sound just a few decibels shy of your high school gym during a pep rally. Usually around meal times.

Our newest addition arrived just in time to celebrate April Fool’s Day and spends most of his time wrapped burrito-style in a pale yellow Basotho blanket. The bo-‘m’e caring for all eleven babies have found a particularly soft spot for this tiny bundle. He may not be ready to play with the other kids yet, but he has made himself right at home all the same.

Autumn tend to be difficult for many Basotho families in the highlands as the harvest lessens and the chill sets in. The TTL Safe Home has frequently gone from a handful of the neediest cases to a full house during this time.

Several of the current Safe Home kids now boast full cheeks and bellies and are preparing to head back to their families. While we celebrate their growth and development under our care, we are ever mindful that more sick children will likely fill their places. The changing seasons can often bring changes for the worse for children already at risk. Much as TTL relies on its own support network of friends and generous donors, these vulnerable babies need a similar system to help them through critical periods. All the staff at TTL work each day to fill that role.
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World Health Day 2014 - TTL Honors Lesotho's VHWs

April 11, 2014, 7:00 am
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According to the World Health Organization (WHO), this week began with World Health Day. Each year in April, the international community observes a day of special recognition for broad-scale efforts to combat disease, for improvements in global health practices, and for all supporters of universal health and wellbeing. If it sounds grandiose, it is. 

But days of recognition are important for the average person to pause and remember that big changes must start small – at the personal and community levels. That’s why this week TTL wants to say a special thank-you to Lesotho’s Village Health Workers.


We’ve called them ‘Our Eyes and Ears’ and it couldn’t be more accurate. Without the help of Village Health Workers, we could not stay as intimately connected to our clients and their communities. TTL relies on a system of referrals to ensure that we identify the danger signs of acute malnutrition and other serious illnesses long before they become severe cases. We do our best to keep children with their families and caregivers, bringing them to the TTL Safe Home only as a last resort.

These dedicated men and women help TTL to identify children suffering from the adverse effects of HIV/AIDS, TB, acute malnutrition, and complications with the home setting. When our Outreach team goes to visit current clients in a community, Village Health Workers frequently assist them by introducing particularly needy children who could benefit greatly from TTL’s services. 

The small daily efforts of the Village Health Workers all over Mokhotlong and Thaba-Tseka districts definitely add up. We are especially grateful for the consistent support provided to the youngest and most vulnerable in the highlands of Lesotho. 

From all of us at TTL, rea leboha (thank you) to Village Health Workers and to all others who serve their communities in small ways each day. 
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Let’s not be late in Lesotho: Reflections from Mokhotlong

April 29, 2014, 3:18 am
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The following is a guest post from Georgetown medical student Kenny Witmer, who visited Mokhotlong for several weeks in April. Dividing his time between the Mokhotlong Government Hospital, the TTL Safe Home, and Outreach visits, he put his medical training to practice and gained valuable cross-cultural experience.

“This is Africa!”

This succinct phrase, uttered by a physician in Mokhotlong’s government hospital, was said humorously to explain his lack of punctuality on our second day. However, it quickly became an inside joke on the team. Time was only the first obstacle that we adjusted to in Lesotho. Planning to meet at 8 likely meant beginning an hour later. Everything started late.

Sadly, being late too often applies to the patients seen in the communities, clinics, and hospitals. In a country where the prevalence of HIV (largely co-infected with tuberculosis) is as high as 23%, many of the patients present to the hospital at such late stages of disease that they are in tragic physical condition. From this experience, I now understand more of what HIV/AIDS must have looked like when it first began to appear in the 1980s. Both children and adults, completely emaciated and malnourished, were often carried into clinic by their family members. However, more eye opening to us as students was the apathetic response of the physicians, staff, and even family members. This, of course, was not for lack of caring on their part. They were simply desensitized to a patient presentation that was so commonplace in both hospital and community.

Although there is certainly a shortage of resources in the hospital and clinics here, the physicians are trained to do more with less. I could not imagine hospitals in the US functioning without basic labs, EKGs, oxygen, or CT scanners. 

However, care here is relatively affordable, and most medications are available. More commonly, the causes of advanced presentation include an inability to gain access to the clinic/hospital and a lack of education. Often, the patients live incredibly far from the hospital, and many still rely on traditional healing methods. What pass for roads here are often insurmountable even with off-road vehicles. They don’t call Lesotho the “Mountain Kingdom” for nothing.

In more recent years, numerous organizations have made huge strides in halting the HIV epidemic in Lesotho. As a future Urologist, I was excited to participate in a circumcision clinic with the physicians at the Mokhotlong hospital. Circumcision, itself, has been shown to decrease the spread of HIV by 60%. Each male volunteer also underwent HIV testing and counseling prior to the procedure. However, even with treatment programs and more available medications, the prevalence remains high. HIV/AIDS is the leading cause of death at 33%. So, how can we intervene before the patients present so late in the disease process?

This is where Touching Tiny Lives excels and targets the community’s most vulnerable population: children suffering from the terrible triad of HIV, TB, and malnutrition. I was humbled by my experiences with the program and blessed to be able to travel out into the communities on site visits. TTL literally goes off-road to bring screening and early intervention to the community while supporting mothers and families in need of food and HIV medications. Additionally, during TTL’s Outreach efforts, education and primary prevention are priorities. By identifying vulnerable children early, TTL has already prevented numerous children from presenting to the hospital in the later stages of disease. For those children who are in need of extra support, the Safe Home on site is full of loving Bo’M’e to nurture the children back to a healthier state of well-being. Afterward, these children continue to be followed closely by the Outreach staff to ensure continued progress.

Overall, TTL’s simple strategies for addressing the problems of malnourishment and HIV in children in Lesotho have taught me a lot about how to address high-risk problems in underserved communities: 

  • First, be willing to go the distance to reach families who don’t have adequate access. If the families cannot afford food, they cannot reach your clinic or pay for medications. 
  • Second, prevent the problem by educating the mothers and the communities. Simple topics such as nutrition and developmental milestones can go a long way. 
  • Third, support and love all the children that are vulnerable regardless of the circumstances. A child with a frustrating family is the one that ultimately suffers. 
  • And lastly, find those that are in need of support early and intervene.
Let’s not be late in Lesotho.
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Many Hands are Better than One: Supporting Moms with a lot to Carry

May 7, 2014, 12:00 am
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The following is a guest post from Georgetown medical student Claire Daniels, who visited Mokhotlong for several weeks in April. With a focus on child health, she spent much of her time at the Mokhotlong Government Hospital, in the TTL Safe Home, and on Outreach visits, where she learned about how Basotho culture impacts child health.

As a medical student, I have had a lot of practice reporting information, however, attempting to interpret these findings is a much more difficult task. Our mentors are always challenging us to reflect on problems and decide on a best course of management. During my stay in Lesotho, I have enjoyed collecting stories and observing interactions, eventually piecing together how the community functions in Mokhotlong and how TTL has found its home in this community.  But reflecting and considering how to affect change has been difficult. I find myself frozen — looking through the lens of life in the United States, when I should be looking through the perspective of the Basotho and their needs. 

One thing is learned quickly was that the Basotho do not need much. Life here is simple in that almost every action is geared towards survival. Still, death is a big part of their lives, especially when one in five people suffer from HIV and the closest intensive care unit is a bumpy 5 hours away by ambulance. The paucity of medical and nutritional resources has been jarring, and I have found it hard to accept these realities. In contrast, the Basotho recognize the limits of medicine every day, and carry on in whatever ways they can. 

When there is no oxygen for a child in respiratory distress, the mom will swaddle the baby on her back to keep him calm and focused on his breathing. When there are no medications to treat the child’s tuberculosis, the mom will turn to a trusted home cough remedy and will walk miles to the clinic each day to see if a shipment has arrived. Mothers are the backbone of this community and a worthy target for development strategies. 

To invest in a mother is to invest in her children.
TTL and healthcare workers understand the mother’s central role in the household, and make it a priority to empower these women. However, I have noticed that they face countless barriers in this process. 

First of all, communication can be difficult, as English literacy is not commonly encountered. The physicians we have worked with at Mokhotlong General Hospital all from the Democratic Republic of Congo and accepted their positions without speaking any Sesotho. They recognize this weakness and have translators available for outpatient clinics and nurses to translate during bedside rounds. I was relieved to see that the caregiver is given a chance to express her concerns and ask questions about the child’s health. 

Secondly, the medical team faces the challenge of explaining complex problems to caregivers that often haven’t finished secondary school. Education is the greatest resource that medical professionals can offer here in Lesotho. There are many families still participating in traditional medicine and waiting to seek medical attention until the condition is too grave to be managed in Mokhotlong. Simple solutions empower caregivers such as the addition of the recipe and instructions for oral rehydration therapy that have been added to the child's health record or "bukana." 

Finally, there is a disconnect between the availability of supportive services and the implementation of these services. In the hospital, we have made referrals to social workers, child development support, psychiatric support, and nutritional support with TTL. It would be prudent to assign an advocate to each child with special needs in order to help the family navigate this complicated network.

Every day in the hospital we identify a child who could benefit from nutritional support by TTL. The most common cause of admission to the pediatric ward is malnutrition. The hospital manages these children acutely with blood work, vitamin supplementation, antibiotics, and feeding with a nutrient-dense milk based formula they call "F75." 

Even after the children start to gain weight and the edema of their extremities disappears, they still have a long way to go. These children may be 18 months old and only been fed breast milk or formula. They have to learn to eat solids, use a fork, drink from a cup, and do all the other things a healthy child their age would do. They cannot afford to stay in the hospital for weeks or months to reach these goals — which is where the TTL Safe Home comes in. 

Here the child is put on a regimented feeding schedule and watched closely for weight gain and developmental progress. It is amazing how quickly they develop skills when they have this newfound energy to explore. My favorite part to watch is how the children in the safe home learn to play and communicate with each other.


We have had only a quick glimpse into the healing process, but through Outreach visits with TTL and sorting through detailed records kept on these children, it is clear that that the road to recovery is a long one-paved by many helping hands. It seems to me that the hardest part of being a caregiver would be to admit that you cannot provide for your child. Asking for help is not easy, but TTL has managed to gain the trust of communities and create a culture for supporting each other. 
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Happy Mother's Day from TTL

May 12, 2014, 12:15 am
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Touching Tiny Lives serves hundreds of clients each month through the Safe Home and Outreach programs. These children represent a range of ages (from five minutes to five years), villages, and reasons for referral to TTL services. The demands on their health are often heavy and their resilience is inspirational, but we know that these youngsters could not manage such feats of recovery on their own.

On this day of honor and remembrance, we raise a toast to the mother figure, the caregiver, whose own strength, love, and commitment ensure both immediate and long-term success as together we work to support stronger, healthier children in rural Lesotho.

Around the world, mothers provide the care and tenderness required for healthy growth from day one, but a mother may not always fit the traditional mold. We also want to recognize the 'non-traditional mothers': the fathers, aunts, uncles, grandmothers, grandfathers, siblings, and neighbors who have taken on the responsibility of primary caregiver for children not necessarily their own. Our work would have little chance at success without the determined dedication by caregivers of all stripes.

Rea leboha, mothers and caregivers. We appreciate you.
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Going Home

May 16, 2014, 2:26 am
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The TTL Safe Home has been quite busy in recent weeks! The number of babies and toddlers running the halls has hovered in double-digits since March without a single reunification for two months. But May has brought all kinds of changes, including winter weather and, finally, some well-deserved reunifications.

Here are some of our little friends who got to go home this month:

Maserame

Mahlomola

Seboko

Rebuselelitsoe
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Baby steps toward quality care

May 26, 2014, 6:31 am
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Nearly all of TTL’s clients are under the age of five, and the majority are younger than three. Working with children during some of the prime years of their growth and development can be very rewarding. 

With each monthly visit, our Outreach team observes monumental progress from babies gaining much-needed weight to meeting critical childhood milestones, such as reaching for nearby objects, babbling their first words, and taking their first independent steps. 

Inside the Safe Home, we watch the gradual process in real-time as sick children begin to recover. We share in some wonderful moments as these clients grow bigger every day and meet milestones along the way.

The TTL approach to battling acute malnutrition and other effects of serious illness mimics these same early growth patterns. Every step we take is small and intentional to go beyond service and provide quality care.

In Lesotho, like many countries with struggling economies, quality health care is not always guaranteed. Resources are limited and expert knowledge may not be available when needed. Yet by focusing on small achievements, the health care system gradually improves – baby step by baby step.


On Thursday, the Mokhotlong district was able to celebrate one such step. Thanks to the community investment and financial support of Letšeng Diamonds, the communities of Phahameng and Ha Senkoase cut the ribbon on their first stand-alone health posts. In these buildings, clients will now have the ability to see the doctor in a place that offers privacy and where medical supplies can be stored safely. Previously, these towns relied on community members to host the monthly medical visits.

A health post is not a fully functioning hospital, nor even a clinic with daily operations, but this small effort should not be idly dismissed. It is a baby step toward improving health overall in rural Lesotho and at TTL we are happy to support as many baby steps as it takes.
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TTL Turns Ten!

June 3, 2014, 9:22 am
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Remember that epic moment when you instantaneously transitioned to requiring two numbers to record your age? Double-digits at last! Ten years is a milestone for nine-year-olds the world over.

Similarly, ten years encompasses a full decade of successes and learning opportunities for a growing organisation and Touching Tiny Lives is no exception. The achievement is worthy of celebration. Fortunately, TTL knows how to party in style.

On the last chilly, windy morning in May, Mokhotlong turned out for a fun walk through the main street of town from the Senqu Hotel to TTL’s front door where a series of speakers – beginning with our own ‘M’e Nthabeleng Lephoto – recounted TTL’s remarkable history and extolled some highlights of significant progress to date:
  • Over 1,400 children have received TTL services since 31 May 2004.
  • More than 260 critically ill children have been rehabilitated under the watchful eyes of the Safe Home staff.
  • TTL has proudly graduated 800-plus clients from the program after the child has attained stable and sufficient weight gain and development.
  • Our services extend to 11 health clinic catchment areas.

Best of all, we set aside some time to honour one of TTL’s most dedicated employees, ‘M’e Mathabang.

Her hard work and unfailingly positive attitude have made the TTL Safe Home such a lively and welcoming environment for clients, staff, and visitors.

Representatives from major partners and donors arrived to show their support and to call for a continuation of TTL’s good work in Mokhotlong and Thaba-Tseka districts. 

But of course, no celebration would be complete without food, music, and DANCE! 


Guests enjoyed a community lunch, courtesy of TTL staff, and still more dancing continued long into the evening.

The next milestone birthday may be some time off, but the euphoria of ten years will probably last quite a while. Thanks to all of oursupporters who have stood by us over the years. We are proud of the services we deliver and are grateful that through your generosity, such quality care is made possible.

Rea lebohang hahalo! Salang hantle!
Thank you very much! Stay well!


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A new TTL Fellow arrives

June 13, 2014, 5:28 am
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Hello from the TTL campus in Mokhotlong, Lesotho!

My name is Julie Moore and my passion for global health and children's health brought me to the mountains of Lesotho this May. The weather is turning colder as winter sets in, but the kids, staff, families and visitors make up for it with their warmth. 

I have a background in nursing and public health which has taken me to several countries around the world for project development and knowledge sharing. Working with TTL is sure to be a great opportunity to practice some of what I know and become familiar with all the things I have yet to discover.  I am excited to be calling Mokhotlong home for the next year and I'm sure I will receive much more than I give during my time here. 

Warmly,
Julie
TTLF Fellows Becky & Julie celebrating the first snowfall of the season
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"In Resource-Poor Countries..."

June 18, 2014, 3:22 am
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Below is a guest post from Georgetown medical student Adam Knudson, who visited Mokhotlong for several weeks in April. Adam is studying internal medicine and joined the Outreach staff on site visits as well as volunteered at the Mokhotlong Government Hospital, where he observed many effects of the HIV/AIDS pandemic firsthand.

The Ntate shuffled into the outpatient clinic with the gait of a weathered octogenarian. From his physical appearance, I would have guessed him to be in his mid-fifties, but the birthdate on his Bukana said he was thirty-five. His stick-like arms and legs poked out from underneath his many layers of clothes and traditional Basotho blankets. With sunken cheeks, sunken eyes, and sunken temples, every contour of his skull was visible on his gaunt face, which was now little more than skin draped loosely over bone. Every rib was visible in his birdcage chest, and the concavity of his abdomen made me question how any internal organs could possibly fit inside. 

The Ntate’s belt measured his dramatic weight loss. A worn hole in his belt from when he weighed his heaviest was now eight holes away from where the belt was currently buckled. Still worse, having the belt buckled as tightly as possible in self-made notches wasn’t enough to prevent Ntate’s pants from falling off his hip bones. He tucked his thick wool sweater into his tightly secured jeans in order to hold them up. 

Like several patients I encountered at Mokhotlong Government Hospital during my month as a TTL medical volunteer, Ntate was suffering from AIDS wasting syndrome. While AIDS wasting syndrome is typically only seen in end-of-life scenarios in the US, sadly, it is not an uncommon way for adult patients to present here when they are first diagnosed with HIV/AIDS. In Lesotho, the HIV prevalence rate is an astounding 23.1%, second highest in the world according to World Health Organization data from 2012. Thanks to the efforts of Touching Tiny Lives, Baylor International Pediatric AIDS Initiative, Elizabeth Glaser Pediatric AIDS Foundation, the Millennium Challenge Corporation, and other global health initiatives, Lesotho’s HIV prevalence rate is actually down from nearly 30% a decade ago.

Despite the progress, many challenges remain. Limited resources create hurdles. Mokhotlong Government Hospital, which acts as a referral center for clinics in all of Mokhotlong District, has been without a functioning CD4 count machine for the better part of the past six months. It’s awfully difficult to appropriately treat HIV/AIDS patients without knowing whether their current treatment regimens are effective. Instead of using CD4 cell counts to stay ahead of the disease process, healthcare workers here are forced to resort to monitoring physical signs and symptoms and play catch-up when the disease gets out of hand. The few patients with the economic means to travel are told to go to hospitals in other districts to get their CD4 counts checked.

Social and cultural factors also pose barriers to preventative measures. Some of these issues are highlighted by the wide gender disparity in HIV testing rates. According to old UNAIDS data from 2009, 68.8% of females in the country had been tested for HIV at some point in their life, compared with only 39.3% for males. From my brief time in Lesotho, it seems that gender disparity hasn’t changed much. Female empowerment campaigns and Preventing Mother-to-Child Transmission (PMTCT) efforts likely contribute to the higher female testing rate relative to males. So too, I suspect, does a culture of male denial. Reading through a TTL baby’s intake packet and noticing that the baby’s mother was HIV-positive while the father’s status was “unknown and refused testing” was one of the more frustrating moments during my month at TTL. The silver lining was an HIV-negative baby, one of many PMTCT success stories.

As a soon-to-be resident in internal medicine, I am thankful for my opportunity to spend a month in Lesotho with TTL and Mokhotolong Government Hospital. My experiences here have been eye-opening, and my time in Mokhotlong allows me now to put faces to the phrases “in resource-poor countries…” and “in Sub-Saharan Africa…” from medical literature and medical school lectures. I leave Lesotho with a re-affirmed passion for global health. Despite the challenges and frustrations, I am optimistic that the successes and progress in Lesotho will continue, and I hope to contribute to that progress in the future.
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TB in children...more than just a diagnosis

June 26, 2014, 7:10 am
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At TTL, we spend a lot of time focusing on the two crises we deal with on a daily basis: HIV/AIDS and acute malnutrition. Yet another common illness that can severely impact child health, particularly if they already suffer from one or both of the other conditions, is Tuberculosis, or TB.

Lesotho has the fourth-highest TB infection rate in the world according to the World Health Organization, in part because over 75% of the population lives in rural and difficult-to-access areas. The steep mountains and harsh weather pose significant challenges for Basotho trying to access basic health care services. People can walk up to five hours over harsh terrain just to reach the nearest medical facilities, and many patients only present to the hospital when their physical condition has deteriorated to late stages of illness. In a country that also has the third-highest HIV/AIDS infection rate worldwide, the struggle to access critical health care can have a very high cost.

TB in Lesotho is associated with HIV and AIDS co-infection, difficulty with treatment adherence, social and economic strain, limited access to treatment, and the constant threat of resistance to TB medications. For people living with HIV/AIDS, their compromised immune systems make them increasingly susceptible to the effects of TB. Government hospitals and numerous other organizations work hard to manage the high numbers of TB clients, but the scarcity of space, human resources, and supplies makes providing care an ongoing challenge.

Hospitals and clinics are not alone in this struggle - TTL also faces difficulties with infection control and maintaining the health of each child who comes into our care, especially at the Safe Home. We work with vulnerable children under five who battle acute malnutrition, HIV, overcrowding, and poverty, all of which are closely associated with TB and lower treatment success rates.

The World Health Organization reports that childhood malnutrition puts kids at greater risk for TB and exacerbates the severity of TB if it is contracted. High numbers of childhood TB are especially frustrating when you consider that most TB deaths and adverse effects are preventable with proper health care services for diagnosis and quick initiation on treatment. A lack of knowledge about infection control and when to seek medical attention is likely a contributing factor to children being exposed to other TB-positive individuals in the family and community.

The issues of space and infection control are very salient for TTL. We want to provide care for malnourished children when they are referred to the Safe Home, but do not want to expose them to a child who may be TB-positive. TTL works directly with clinics, such as the Baylor College of Medicine Children’s Clinicin Mokhotlong, to ensure that vulnerable children under-five receive prompt medical attention when presenting symptoms of respiratory illness. TTL also works closely with the Mokhotlong Government Hospital, often moving children to and from each service when it’s most appropriate. The hospitalhas both a pediatric ward and a designated TB ward, but the ongoing patient demands often result in overcrowding and difficulty implementing proper infection control procedures.

While we rely on our partners at the Baylor Clinic and Mokhotlong Hospital for testing and treatment, test results are rarely immediate and the child remains in need of treatment for malnourishment. Not wanting to turn children away from receiving care, TTL strives to adhere to good infection control practices in a resource-strained environment. We are committed to developing and strengthening our infection control policies and practices through the support of our local and international partners. Improving our TB infection control strategies will help ensure that we provide the best level of care possible for each tiny life. 


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