Day Twenty and Twenty-One (July 22, 2006)

I took a picture yesterday of a man whose wife’s name is Liphapang. She is a patient, he is not. I have not written positively about the men of Lesotho. This one may have redeemed at least some of them. This couple was listening to the radio and heard a government appeal for widespread testing of HIV. They decided to be tested together. She is positive, he is not. They have three children, all of whom now need to be tested. Many men would have deserted her and I have heard some wives tell me how their husbands left (their status unknown and likely positive) and took children with them, leaving only the nursing babies behind. This husband came to Tsepong with his wife and sat through the consult with me as I told her what a positive test means to her and her children. He breathed such a loving sigh of relief when I told them both that her CD4 was high and she would not yet need ARV’s. I congratulated both of them for their wisdom in coming forward early. This step may have saved her life, it certainly lengthened it. By following her now when she is well and introducing ARV’s before she becomes sick, her prognosis for a longer, healthier life is much better.

Than I looked at him and teared up for a second time that morning. My interpreter was Molanepoh. She said to me that you don’t find many men like him in Lesotho. He beamed. I have a wonderful picture of both of them. He asked if it was possible for them to have anymore children. They have three but he explained that most lose one or more children. To have many is a sort of morbid insurance that most will survive. I spent a very lively 15 minutes, describing, through an interpreter, how a discordant couple could safely conceive without exposing the HIV negative partner ( at home we call this ‘the turkey baster method on the dining room table’, for those of you who are medically minded and don’t mind a little too much information). This method works beautifully and doesn’t cost $4,000 which is what infertile couples pay a fertility specialist for artificial insemination. Okay, I might have gotten into a little too much needless detail for this couple but they seemed interested in the North American medical facts around this issue. Maybe they were just being polite. I made sure with the interpreter that what I was about to suggest wouldn’t offend them from a cultural point of view. She gave me the green light. The picture I took was snapped at the moment they understood what I was saying. I think they are laughing at me. What a beautiful couple, what a wonderful man.

Something must be said about the amazing job Tsepong has done to ensure compliance and adherence to medication. For ARV’s to remain effective, a patient needs to take every dose on time, morning and night, for the rest of their lives. Missing doses can cause a deadly strain of resistant virus to develop and in Africa, there are few, if any options to turn to if this happens. You can imagine that in a third world country where access to medical care and medicine has always been extremely limited, pill taking is not a part of the average mindset. Imagine telling that average African that now he/she must take pills religiously in order to survive. Tsepong has taken this issue very seriously and has succeeded through training, education and counseling. Almost every patient I see is adhering 100%, a fact that is confirmed at every visit through pill counting. These people want to live. They have learned to do what is traditionally not part of their culture and philosophy in order to survive. The intellectual advisors and pundits said it couldn’t be done in Africa, Tsepong proves that it can.

July 22-23 - my last weekend in Lesotho

I have spent the whole weekend with an image in the back of my mind. I see myself frantically holding on to this place with my heals dug in, dragging on the ground, desperately hoping time would stop. I never anticipated feeling this way. I love this country and everyone in it. I love this clinic and all who work there. My heart aches for all the sick and dying of Lesotho. It will be a tremendous and unforgivable loss if this country does not survive.

I drove to Bethlehem, South Africa with Justina on Saturday. There is such an obvious change in culture as you move across the border out of Lesotho. Much of South Africa has been modernized and ‘westernized’. The country side remains astoundingly beautiful and wild with few houses or people and many domesticated and undomesticated wildlife (one more point for Anne-Marie who is now officially beating Adam- we saw ostriches!). The towns in South Africa are very much like the towns in Canada- suburbs, playing fields, schools, community centers, a main street and downtown shops. Travel back into Lesotho, and it is like traveling back in time. People are walking everywhere and lining the roads, Women with buckets or branches on their heads and men on horseback or herding animals, shepherd boys on donkeys, everyone calling cheerfully to one another. All this surrounded by stunning, absolutely stunning mountain scenery. Driving on the roads in Lesotho is a bit like avoiding a game of human/animal pinball. Not the safest situation for a middle aged, conservative, North American woman to find herself in, but one of the best experiences of my life. At one point we dodged a cow as he lost his herd and came charging on to the road. It truly is out of this world.

What an indescribable shame if this piece of humanity, this unique and distinct culture, this nation, is lost.

This afternoon I had one of many ‘God moments’. Elizabeth asked me to spend some time today teaching her what I know about HIV. This women who has already saved hundreds of people infected with HIV, understands that there is always more to learn, a true sign of humility and wisdom. We sat at the dining room table as I drew pictures, quoted facts and tried to condense twenty years of HIV experience onto 6 pages. I realized what a gift this was, to lend what I know to someone who will carry on at Tsepong. What a special gift.

I took my last walk into the village alone. Barry and the kids will join us tomorrow. It was so exciting to realize all day today that they are now in the same time zone. It was a stunning walk. The sky was a spectacular blue and the sun made everything glow with such brilliance. The Mimosa trees are now in full bloom and the peach blossoms are just peaking out. This place must be amazing in the spring.

Tonight Elizabeth gave me my first manicure. Imagine an African, French manicure. She wouldn’t be too impressed if she saw me sneaking back to the living room when all was quiet to click these pretty little white tips away on the keyboard. This nightly ritual of describing the day’s events has become a quiet, restful and revealing time for me. It too will soon come to a end.