May 24, 2007

This mornings praise and worship was beautiful. Today was Russell’s last day. Mathebesang asked him to sing for the patients. He sang ‘Blessed Assurance’ in a remarkable tenor voice. He exuded such passion. The patients stood and sang to him, a tribute to this man they have come to love.

This man, a hospital administrator from Ottawa, has lived in Leribe and worked at Tsepong for 2 ½ years. The only Canadian staff member who has been here since the beginning, he has been the heart and soul of Tsepong. The Basotho consider him family and are eternally grateful for the work he has done. Living in a country, isolated from all that is familiar, struggling against seemingly insurmountable problems, he is brilliant, vibrant, compassionate and wise. This man had a big dream, a great vision and he pursued it with courage and passion. He will live with the tremendous fulfillment that comes with having helped save the lives of 7,000 people. This man. This one man. Well done, my friend. Go well……tsumea hantle. It has been an honor sharing time with you.

HOPE. As necessary for survival as the air we breathe and the food we eat. Today I saw evidence of hope.

Mpho Mataoe is 15 years old.

She lives in a small, rural village just outside of Leribe, Lesotho. She was born in Lesotho. She lives in a small thatched roofed hut with her mother and brother. Each day starts the same for her. She wakes up, dresses in her clean, neatly pressed school uniform, fetches water from the village well for the morning meal and walks to school shortly thereafter with her school friends. In the evening she fetches water from the same well. Life for her has always had this same slow pace, this recurring routine, this beautiful rhythm.

Forty eight hours ago, she was raped by two men, at this same well. Life for her, as for so many women on the continent of Africa, will never be the same.

Thirty million people in sub Saharan Africa are infected with HIV. Eight million of them are between the ages of 15 and 24, and seventy percent of these are women. Like Mpho, many of these women were raped as young teenagers by men who believe that having intercourse with a virgin will rid them of the infection or by men who are encouraged by ancient traditions to be sexually active early, and without limits.

Mpho Mataoe and her mother know about Tsepong. They are women of courage who will face the consequences of social discrimination and stigma in order to survive. They are women who have been educated and understand how to protect themselves.

She came to Tsepong for testing and PEP. She was tested, treated and cared for. Five years ago, Mpho would have stayed quiet. Telling anyone would have increased her risk for being shunned by her community, tossed out after this kind of assault, blamed for the attack, left alone often pregnant and infected with HIV. Many women across Africa still face these horrific circumstances. The presence of this clinic has created a new environment of understanding and education. It has provided the opportunity for women to protect and defend themselves and their children, to believe in their rights as human beings and as equals. It has provided HOPE.

Mohlukoana Moekta 23 years old

He is a father and a husband. He has a two year old son and a father and mother that love him. He has end-stage HIV and came to Tsepong with a CD4 count so low that his chances of responding to ARV’s is significantly lessened (CD4 31 and 1%). He has been having headaches lately. Forty eight hours ago, he developed a fever and today, he wouldn’t wake up. He was brought to Tsepong by his aging father. He is obtunded and unresponsive- bacterial meningitis, the ubiquitous killer of young adults all over the world. Canada has a vaccine.

Today, Tsepong has an infectious disease specialist. Tsepong has an infectious disease specialist, a Canadian infectious disease specialist.

Chris admitted him, started IV antibiotics and over the next 5 days, watched him like a hawk. Within 48 hours he was still alive and slightly more responsive. All weekend long, Chris rounded on him. On Saturday, we spoke to his mother who had been at his bedside constantly, her packed bag at the side of his bed. We instructed her as to how to crush his ARV’s and poor them down his throat. She was so concerned, so eager to help save her sons life. I leaned over and looked into Mohlukoana’s eyes as they stared blankly at the ceiling. “Lemela, O phela joang?” I said. Miraculously, he looked at me and answered, “ I am well mam, how are you?”. He is still there, his brain is still functioning, he is still a Basotho, contagiously polite.

“Please Lord, save this one. For his gracious and kind mother, for his son and wife, for his country, save this one.”

Mantina Nkosi

Thirty two years old, brilliant and completely fluent in English. She is not yet on ARV’s and is doing well but has developed a painful case of shingles on her face. She had been given the wrong dose of Acyclovir and told by the outpatient physician that the rash was a sign that her disease was advanced and that she would likely die. Here she sits in front of me, her rash temporarily disfiguring her face, in intense pain and absolutely terrified.

“You are going to be well. This in no way represents a progression of your HIV disease. You are on the wrong dose of medication. I need to quadruple it and you will be well.” I said.

An intelligent, philosophical and passionate conversation ensued.

“Why cannot we receive the same treatment? My country is dying. We are all ignorant of this disease and we are all dying as a result.”

“Amen Sister!” I said. We are all African, we are all brothers and sisters. What I have, you deserve to have. We are no different.”

Of course, I than encouraged her to get her beautiful, brilliant bottom moving and become and AIDS Activist for her country. A generation of young, female, Basotho AIDS activists could save this country. We need to empower them, encourage them, protect them and support them.

Taballa Mothetsi

Twenty six years old and here with her mother. She has such a beautiful face with soft features and haunting eyes. I cannot make her smile, for the life of me I tried, but I could not make her smile. I asked Mathabesang to ask her if she was depressed, but Taballa would not answer. She stopped taking her medication three months ago and has not been seen at Tsepong for six months. She missed her last appointment and was too afraid to return to Tsepong, ashamed that she had not followed the rules and would face the reprimand that the native counsellors would inevitably give her. These people understand the significance of missed appointments and missed pills and they are bent on encouraging strict compliance. Mathabesang tried to reassure me that she was not depressed, just ashamed.

Later that day, as we were shopping in the village, I caught a glimpse of her walking through the crowd, her haunting beauty, unmistakeable among this sea of other faces.

She still looks sad to me.

Twenty six year old

A woman

In Lesotho, Africa

With HIV

Her life expectancy is 37

She has every right to be sad.

Lefa Khamokha 9 years old

The sickest child I have ever seen. He weighs just 15 kg and was diagnosed with HIV in April and admitted with TB on May 1st. He is here with his terrified mother and while he sits on her lap, he holds his head in agony. He is in agony. He is breathing at a rate of 60/minute, his belly is bulging with fluid from his failing heart, the muscles in between his ribs indrawing, fighting to breath against these sick, now rigid with infection, lungs.

Chris and I shared anxious and gravely concerned looks. We threw everything at him. We treated his pneumonia, his heart failure, his thrush, his headache……..and than we sent him home. He won’t survive……….He won’t survive.

Is this OK with you? Is this OK with any of us? Is this OK with our nation, with all first world nations? Is …..this…..OK….with you?

It is not OK with me!