Tsepong Journals August 09 - Part 2

August 26th, 2009

An evening email:

Hey guys,

I am sitting here in our little apartment writing by candle light. The mayor is a great room mate and I love her dearly. She has had a rough day. We all have. I just finished a walk up the mountain with Phil, Rob and Brenda. Unfortunately, I lost them but we were able to meet back at the Whitehouse before dark. This is the new compound that Noma Vales built which is way too nice for Lesotho. We are cosy and comfortable with hot water, electricity and showers daily. Spring is here and I am way over dressed. It is stunningly beautiful with blossoms everywhere. I so love this place.

The patients at Tsepong are healthier with everyone now being started on ARV's when their CD4 is 350 instead of 200. I am doing rounds on an 11 month old who weighs 5.5 kg. I have never treated a severely malnourished baby before. A pediatrician from Zimbabwe is walking me through it. I don't think he will survive. He is the new "sickest child I have ever seen." I was in charge of all the new diagnoses and ARV starts this morning. The new patients are still so sick. With the economic crisis, hunger has become more evident and the poverty more severe. I can't believe that 3 years later, I am still on the verge of tears most of the time. Rob O'Flanagan is doing an outstanding job telling the story of Lesotho and he is relentless in this work. The mayor is sitting on the couch across from me, writing on facebook. She has been crying off and on.

We started treatment on a 47 year old man who is very close to death and walked here from a nearby community to look for work. He is starving. Off course there is no work for a dying man. He managed to make his way to Tsepong to be tested today. All I could do was take his blood for further testing and give him 5 kg of unimix- a protein supplement provided by the UN. Brenda became very agitated when we sent him out to the street. He can barely walk let alone carry a 5 kg bag. We saw him later wandering the hospital grounds. Where is he sleeping tonight? What bridge will he crawl under when he dies? Who will know he has passed? Rob attended praise and worship with all the patients today. He has been very solid emotionally up until now. We found him head down in tears in the resource library. A very hard day for all of us on this little Canadian Team. Oh, for a world without AIDS and poverty. Oh, that all of our hearts could be this broken.

Please pass this on to everyone you know.

AM

August 28^th

A 9:00 pm email

I need to describe the beautifully sad day I have had. Just delete if I am boring anyone. The Mayor of Waterloo leaves tomorrow. I will be the only one left in the compound. The guys on our team are living in town at a convent and the Student Reach kids left on Monday. Imagine that, me, a Canadian mom with remote( OK, not so remote) anxiety issues, living alone on the outskirts of Leribe. Be careful what you wish and hope for. I am writing as Brenda is packing. Her departure will be very difficult. Sisters, that is the only way I can describe the relationship we have developed. What a strong, remarkable, capable, loving woman. There was a front page article in the KW record today, beautifully written by Rob O'Flanagan. It is a must read. This afternoon she was flooded with emails on her ever present BlackBerry, very fitting for the Mayor of Waterloo. People are already stepping up to help. The Waterloo Bracelet of Hope Campaign is about to fly and when successful it will raise enough to keep Tsepong open way beyond 2012.

I spent the morning examining some of the people whose lives will continue as a result of her efforts.

This afternoon, a miracle happened in Leribe: Tsepong hosted the first HIV/AIDS anti-stigma rally ever held in Lesotho and hundreds; I mean hundreds of people attended. Dignitaries from all over the country arrived. The entire staff of the clinic was there along with many, many HIV positive people, proudly wearing anti-stigma T-shirts that read 'Leribe fights back against Stigma and Discrimination'. The event was held in the middle of a large field with the Maluti Mountains in the distance. It was a magnificent sight. I just cannot express how monumental this is for the country of Lesotho. Stigma is the main issue that keeps people from being tested and treated. Stigma allows for people to die needlessly. It pushes the transmission of the virus; it creates orphans and leaves communities in an HIV/AIDS death grip.

When the community found out that the mayor of Waterloo would be present, the buzz reached radio and the national newspaper. The article was entitled, 'Canadian Mayor fights HIV in Leribe'. There was dancing, singing, speeches and plays. Jamie White, Tsepong's project lead put this event together, despite the huge risk involved. He is only 29 years old. He accomplished a lifetime of achievement today. Matebisang, the clinic's well loved interpreter and counsellor lead the event. Five years ago, she made her way to Tsepong on foot from a distant community, just after the clinic opened. In the previous years she had lost two children and her husband to HIV. When she arrived at the clinic she had end-stage HIV. She sat among the other patients in the waiting room and waited to be treated. She came back again and again, and each time she was stronger and healthier. Matebisang has a remarkable faith and even more remarkable God. It was only natural for her to start singing and praising as she waited. Her spirit and the positive effect it had on the patients who waited with her impressed the Canadian doctors who very quickly hired her as one of the first clinic interpreters.

Morning praise and worship is now the signature event of each day at Tsepong. Imagine this woman, barely alive when she first arrived at Tsepong, now leading her community in this event. She looked stunning, dressed in a red traditional Basotho dress and head wrap. She proudly told her entire story and encouraged everyone to stop fearing the virus. She said, "Look at me, I am not dead, I am a beautiful woman".

Triumph.

Rob O'Flanagan leaned his mic toward me and asked for a comment. I told him that this was the miraculous result of a partnership between two countries and the remarkable power of one ordinary, now extra-ordinary woman.

The mayor spoke eloquently. Matebisang praised her Canadian friends and the country of Canada repeatedly. She coaxed me on to the stage at one point, not part of the agenda and I was certainly not prepared. She just thanked me and embraced me and then she made me dance with her on stage. I tried to get Jamie to join in but he absolutely refused. The crowd cheered. You see, they know what we are doing, they know what Canadians are doing and they are fiercely grateful and proud.

I walked home as the event continued, feeling so heavy and so sad.......not really sure why. Being here just doesn't get any easier. More beautiful, more intense, more miraculous but not easier.

Tonight, the mayor and I took one last walk up the mountain. If you climb to just under the peak, you will find this old village of clay, thatched roof rondevals. There is something mystical and magical about this village. People are desperately poor up here. Most have no running water or electricity. The mayor is magnetic when it comes to people. She can strike up a lively conversation with a stone. She was almost immediately drawn into one of the huts. She yelled for me when she was inside. There were at least 7 children but Brenda was drawn to the child lying on the mat on the floor. This was a well worn mat made of an assortment of rags and placed on layers of old linoleum. The child was actually 16 and Brenda, with her previous experience with disabled kids, immediately recognized that she had severe cerebral palsy. The surroundings were dark, stale and dingy but the atmosphere was one of complete joy and love. This was a well loved, joyful, almost gleeful child who beamed at us constantly from the floor. She has no shortage of care. The grandmother who cares for this brood welcomed us in and then, quite unexpectedly, she asked us to pray with her, dropped to her knees and prayed. We left, shocked and humbled and awed all at once. We also emptied our wallets. We didn't have much, but what we had, was theirs.

Sadness, joy, suffering, triumph, beauty, decay, life, death.......the contrasts are sometimes just too much to take. My IPOD and Hillsong are saving me this year. Thanks Adam, for downloading all of your great music. It has truly carried me through.

The mayor is on the couch, crying. She is stronger than I am. Her tears are mixed with wisdom and laughter.

Thanks for listening.

AM

August 29^th

It is 11 pm and I am alone. I have been quietly dreading this moment all week, and here it is. After a tearful goodbye to the Mayor at the Moshoeshoe Airport in Maseru, we roamed around the city a little aimlessly for a couple of hours watching Rob buy more hats, while Andy met with the sister of one of the children he sponsors through Help Lesotho. He was quiet when he joined us later. He had to leave this woman at her home in one of the tin shack shanty towns outside of the city centre. Hers was the room with the pink curtains. Andy hardly spoke all the way home. I don’t think I have met a man with a bigger, more kind and compassionate heart. We can’t pay him much for the work he does as Executive Director of the Bracelet of Hope Campaign. I don’t think he keeps much of what we pay him. He gives most of it away.

When we arrived back in Leribe, Phil, Andy and Rob got to work quickly writing for the next couple of hours as I made dinner. I felt pride again, proud of this group of men, pouring their skill, their hearts and their souls into this work that we are so privileged to do.

Rob has been challenging me to a game of poker, which I have never played. I bought two decks of cards at Shoprite last week. I agreed to play poker as long as he agreed to play bid euchre, which he has never played. The cards came out after dinner along with 20 rand each and wooden Basotho matches as tokens. Ok, ladies, I’d like you all to practice this lovely gesture as you read. Sit in a chair at a table, push yourself forcefully from the table with a self satisfied, slightly mocking sigh while stretching both your arms out in a relaxed, triumphant stretch………..I cleaned their clocks.

Rob is a seasoned poker player and Andy is no slouch either. It may have been beginners luck but winning was very empowering. Just the encouragement I needed. As I closed the door and finished cleaning up, I felt a little shaky. There is that old familiar anxious feeling again. There is a guard on duty outside and a large barbed wire fence. I snuggled into Brenda’s bed. Her room has two windows and a remarkable view of rural Leribe and the Maluti Mountains that I want to gaze at in the morning.

Many of you reading may not be spiritual or religious. Lesotho and my love for her, has drawn me very close to God. He has been nudging me to climb this hurdle and stay alone this week in this beloved country. This was once way, way beyond my comfort zone. Tonight, I will walk proudly past the final outer limit of that fear imposed boundary and tomorrow I will listen to His still, quiet voice.

You are a comforter to the lonely, a lifter of my hand.

I see you veiled in Majesty, I cry glory, glory to the Lamb.

I cry glory to the King.

To you, Lord my heart cries out, glory to my King.

My greatest love in life I hand you everything

Glory, Glory, I hear the angels sing.

Open my ears and let me hear your voice

To know that sweet sound, Oh my soul rejoice.

Glory, Glory, I hear the angels sing.

You are the Father to the Fatherless, the answer to my dreams

I see you crowned in Righteousness

I cry Glory to the King

Comforter to the lonely, lifter of my hand.

I see you veiled in Majesty

I cry glory, glory to the Lamb

I cry glory, glory to the King.

Hillsong, ‘Glory to the King’

My heart weeps for the fatherless, the orphans of Africa.

Sunday August 30, 2009

The sky is a soft blue, the mountains in the distance look misty and majestic. As I have sat here thinking and listening, several fences have been covered with fresh, brightly coloured laundry. I just watched a mother hanging crisp cleaned T-shirts on a jagged fence outside her cinder block, one room house. Her teenage son came out and helped her. I have sons that help in the same way. We both should be very proud. There is constant activity as soon as the sum comes up. The indoor environment is not so pleasant, but outdoors it is magnificent. The view outside my window is one of constant movement, creatures both human and not, mixing together in a beautiful, leisurely moving picture of vibrancy. Such contentment. These people live with such intention and purpose but always in the moment with a slow, leisurely, ‘take it all in’ pace.

I am at peace. I feel content, hurdle behind me and a new horizon ahead, with many more hurdles, I am sure.

I am off to church to sing and praise African style.

9:00 pm

Where do I begin? I now know that I can stay alone in Africa and I can sit through a 4 hour, that’s right, 4 hour church service. I loved every minute of it. This church holds seven to eight hundred people. It was packed last Sunday and it was packed again today. I was the only woman of colour in the place, and here that means white. I sat in the same section I sat in last week, creature of habit. This location just happened to be where most of the youth sit. I felt right at home. The music and singing started and I was immediately lost in a luscious sea of soul stirring, heart pounding praise. These people love God and they hold nothing back. Pure and absolute joy, start to finish. If I could capture just a small piece of it and implant it into your soul just so you could feel it for an instant, I would, in a heartbeat. These lovely, resilient, strong, beautiful, long suffering people know exactly where their souls are and they live in this soul-awakened state that is stirred into a Holy fire on Sunday morning. I was in absolute awe.

The teenagers in all the rows ahead of me and behind me were singing and praising without shame or self-consciousness. Thirty minutes in, the teenager beside me was beckoned to the side aisle and I knew right away what was happening. She sat back down and said that I was being called to sit in the front row with an interpreter. I tried to decline but, I had just mercilessly beaten three guys at poker the night before and spent the night alone in rural Africa. What could I possibly be afraid of?

I sat beside Emily Maloneo Ntsoft. She was beautiful and gracious. Rob had the same, ‘fall in love with your interpreter at church’ experience last Sunday when he was ushered to almost the same spot. The pastor made his way to the stage, immediately recognized me as the only ‘colourful person’ in the room. He knew I was part of this little Canadian Team and asked me where Rob and the mayor were. He warmly welcomed me. He went on to speak lovingly of Canada. I am now becoming skilled at receiving these very gracious accolades on behalf of Canada.

I am here for a reason. I was called here for a purpose. It was no coincidence that I was in this church for their first ever Women’s Day Service. The entire service was dedicated to women. A very young woman spoke of her love of mothers and the important lifesaving role they play in their families and their communities. She used a poignant metaphor. When trouble comes the woman holds onto the sharp end of its blade while men drop the handle altogether. Well said with respect to many of the men in Africa. When she left the stage, Emily told me that this woman was an orphan who has no children of her own yet. An orphan with a heart for and knowledge of mothers.

Another woman spoke for 90 minutes.She spoke of the strength and power in women and their ability to overcome the worst of human suffering. She encouraged women to come out of their comfort zones and run the race that was set before them. She called on women to set themselves free of the entanglements that held them back and move forward to take the promises of God as their own.

"We thank God for women. This is the day God has made for them. Today we break free of our limits and reach our potential. Africa is not limited because we are children of the King.”

Pretty powerful stuff. In a region of the world where women’s rights are almost non-existent, where the oppression and abuse of women runs unchecked in so many countries, and has allowed for the rapid spread of a horrific pandemic, this was a powerful message. As a woman who has a heart and passion for the widows and orphans of Africa, this was a tremendous thing to witness.

An HIV/AIDS anti-stigma rally on Friday and a call to action for women on Sunday…..something powerful is happening in this little country.

Enough for tonight. Tomorrow I will begin writing about Tsepong.

August 31, 2009- A Tribute to the Patients of Tespong:

This third trip to Africa has been very different for me. Instead of a member of a Canadian Medical Team, this time I traveled and worked as leader of a team of Canadians with the goal of encouraging my country to assist Lesotho in overcoming its AIDS pandemic. I am a seasoned physician with 20 years of experience in general and HIV medicine. I do not consider myself an AIDS activist or an expert in matters of social justice and human rights. I am a small town Ontario family physician and a mom who was lead to Africa by God. It was here that I fell in love with the Basotho people and their captivating, awe-inspiring country. It was here that I witnessed human suffering beyond my imagination. It was here that my heart was broken.

I don’t profess to understand the complicated, messy, human issues that have lead to such catastrophes as the global economic crisis, poverty or the AIDS pandemic, but I have tried to learn. I don’t profess to have an answer for the 1 billion people who live in extreme poverty on our planet or the 23 million who live with the HIV virus, most of them untreated, in sub Saharan Africa, but I have tried to take a step towards action and away from that soul smothering thing called apathy. I won’t even begin to excuse a world that stands by and watches while such things unfold when action is the only right response and solutions are at our fingertips.

Sir Edmund Burke said, "The only thing necessary for the triumph of evil is for good men and women to do nothing”.

Nothing, is just not an option.

It has been a privilege encouraging and leading the eleven Canadians who have been part of this trip and who have captured the vision of One Country, AIDS free: Abid Virani, Matthew Batista, Ashley Bondad, Nicole Malatesta, Perryn Kruth, Meaghen Morris, Brittany Martyn, Mayor Brenda Halloran, Rob O’ Flanagan, Phillip Maher and Andy McDougall. What a marvelous journey it has been. The time-honoured rules of confidentiality have prevented me from sharing with you directly the heart of my vision, the place that has inspired me and the patients whose lives OHAfrica is trying to save. I will dedicate these final pages to them. The quotes interspersed among these patient histories were collected by Student Reach from high school students in Leribe in response to the question, "What do you hope for?”

HIV is a viral infection that is transmitted through blood and body fluid exchange. The most common mode of transmission globally is through unprotected heterosexual sex. The most common person infected world wide is a woman. There is a 40 % chance that an HIV positive pregnant woman will transmit the virus to her newborn. The introduction of ARV’s at sixteen weeks of pregnancy, decreases this risk to < 1%. The use of one dose of an ARV at the time of onset of labour decreases this risk to <2%. Because of a national antenatal screening program introduced in Canada in 1996, all pregnant women have an opportunity to be tested for HIV and treated appropriately if they are found to be HIV positive at no cost to the woman. There has not been a child born with HIV in Canada since the introduction of this program.

Only 20% of pregnant women are offered the same prevention strategy in Africa. As a result, eighteen hundred children a day are born with HIV on the continent and most of them in sub Saharan Africa. A child born with HIV has a 50% chance of dying before the age of two, and an 80% chance of dying before the age of 5. Death usually occurs at the hands of a suffocating pneumonia called PCP. Many of these children die after one or more of their parents have passed. If both parents are deceased, the child is called a double orphan.

There are 15 million AIDS orphans and vulnerable children in Africa. Many of them are also infected.

Thirty three million people are infected with HIV worldwide, 23 million in sub Saharan Africa. Seventy percent of these are women. The pandemic is denuding the continent of its young female generation. Most of these women have no access to health care.

In the first world, there are 40 drugs available for the treatment of HIV. Only 7 are available in Lesotho. In Canada, the annual cost of a course of ARV therapy is $12,000. Through various public and private drug plans, every HIV positive Canadian, has free access to these drugs. The cost of ARV’s in sub Saharan Africa has been reduced to $139/ year / patient thanks to the incredible work of the Clinton Foundation. Those that receive care for HIV in Canada, can be expected to live a normal life expectancy. The life expectancy in 8 sub Saharan countries, including Lesotho, has been reduced to <40 as a direct result of HIV/AIDS, malaria and tuberculosis.

The Tsepong clinic in Leribe, Lesotho, was the first HIV clinic in existence in the country. Fully funded and supported by Canadians, this clinic now cares for 21,000 HIV positive patients. There are 300,000 HIV infected people in Lesotho. We need only treat 280,000 more and we will have accomplished something that has never been accomplished before: A first world country assisting in the termination of a third world country’s HIV pandemic, essentially preventing the extinction of this unique, beautiful and vibrant culture, a partnership that has the ability to set an example of global cooperation that could see the end of one of our planets most devastating human catastrophes. This is what I hope for.

What do you hope for?

I hope all orphans who’s parents are killed by HIV/AIDS can be helped in Lesotho: Sepono doriton maduna – Anonymous

Julia- age 53. She is a widow. She had 6 children but only two have survived. She cares for three of her grandchildren. She was tested after her husband and grown children died of HIV. She started on ARV’s two months ago. In 2007, the World Health Organization set a new criterion for the initiation of HIV treatment in third world countries to match the already existing criterion in developed countries. Instead of starting treatment when the CD4 count was < 200, third world patients are now expected to receive treatment when their CD4 is < 350. The CD4 cell is a vital cell in the human immune system. The HIV virus selects this cell and uses it to replicate itself, destroying the cell. As an HIV positive patient’s CD4 cell population is slowly destroyed by the virus, the patient loses the ability to fight infection and, untreated, eventually dies of severe opportunistic infections. As a result of the Tsepong clinic, Julia received anteretrovirals when her CD4 count was 342. Her immune system has been preserved. With the help of this clinic, she will likely live for at least 5 to 7 years. If other drugs are made available in Lesotho, she will live a normal life expectancy. She will raise her grandchildren. Three fewer children will be orphaned in Africa.

I hope for unity, world peace, education to everyone, racism to end, food for all and an end to cancer and HIV/AIDS. God bless you for what you are doing. – Anonymous

Ma Maliso- age 26. Recently diagnosed with HIV and is suspected to have Tuberculosis. Eighty percent of the patients seen at Tsepong are ‘co-infected’ with HIV and TB, a deadly combination. Ma Maliso’s CD4 is very low and she is responding very slowly to HIV medications. She is married and believes she is pregnant. She is very poor. The economic crises has deepened the already devastating effect of poverty in this country. She is wrapped in a very old towel, wearing used black Dickie running shoes, argyle socks and a long ,blue, worn synthetic skirt. As she moved toward the exam table, the toggle of her zipper fell to the floor. Her face is swollen and she looks very old, weary and worried. She was only 21 when Tsepong opened and was likely just infected with HIV The medications she is receiving will restore her health and prevent transmission of the HIV virus to her unborn child…….another save.

I hope for a better tomorrow for everyone. There should be peace and stability in every country in the world. All wars should stop and also viruses that cause destruction in our everyday life. – Anonymous

Ma Matusi- age 35. She was diagnosed and treated for HIV at Tsepong in 2005. She has a 15 year old daughter who is HIV negative. Her initial CD4 was only 155. Four years later, her CD4 is 500. Tsepong saved her life and allowed her daughter to be raised by a parent.

Seretse- age 9. Here with her older sister. Her mother died in 2007 of HIV and TB, her father a few months earlier of HIV. She is a double orphan. I had never heard this term before. In a poor third world country, if you are a double orphan, you are the most vulnerable person on earth. Seretse was just diagnosed today. She is sitting alone on a chair looking very anxious wringing a dirty hanky in her hands and shooting worried looks between me and the interpreter. Throughout the entire visit, she sat alone on that chair, her sister pre-occupied, out of sight, in a corner of the room………this child is completely vulnerable.

Thabiso- age 15. He too is a double orphan. He lives with his uncle and is watched during the day by a cousin. He is about the size of a frail 10 year old thanks to the growth stunting effects of HIV and TB. This little man is bright, feisty, determined and independent. He is a man on a mission and his main goal today is to get out