When Dr. Jennifer Furin started treating patients in Lesotho at the Nohana Health Center in July 2006, many of her patients had never had access to a doctor. In fact, after walking hours up and down mountains to reach a clinic, patients would often find it locked and unstaffed. If the clinic was open, basic medicines and supplies were scarce, and the nurses could offer little comfort to their patients who were suffering from highly infectious diseases such as HIV/AIDS and tuberculosis. Almost none of the patients – in spite of HIV rates in Lesotho approaching 30% – had ever been tested for HIV, let alone had access to lifesaving anti-retroviral therapy (ART). A mere handful of patients were being treated for TB.

Nohana is one of approximately fifty health clinics scattered across the mountains in rural Lesotho – each more logistically challenged than the next. About a dozen of these remote clinics (including Nohana) have access to a nearby airstrip – enabling staff and supplies to arrive from the capital, Maseru, in approximately 30 minutes. Via land, the treacherous trip from Maseru to Nohana would take 6 hours or more by car, traveling the edges of steep mountains on barely visible dirt paths. Now, with assistance from the pilots and planes of Mission Aviation Fellowship (MAF), the Partners In Health Lesotho (PIHL) team can adequately supply and staff these clinics, ensuring that they are open and that care is available whenever our patients make the long journey to seek medical treatment.

In February 2008, a small team from the Harvard News Office visited two of the PIHL mountain clinics – Nohana and Bobete. They were able to capture the essence of our programs in Lesotho via stunning text, photos, and video – accessible here. I’d like to direct you to a two part photo/video story filmed in Nohana, featured below. It is the story of Kazabelo – a tiny, malnourished 15-month-old baby on the edge of death.

For Kazabelo, the story ends well – at least in the short term. She has survived this round of her life’s battle, and is a plump and healthy toddler (see picture) less than six months later.

Whether our patients come to Nohana, Bobete, or one of the four other remote clinics operated by PIHL in four of Lesotho’s most rural and mountainous districts, the care they receive is essentially the same. We staff each of our six clinics with a full-time physician, who is trained in management of HIV/AIDS and TB as well as primary care and trauma. In addition to treating patients, the PIHL physicians work closely with clinic nurses who are paid by the Lesotho Ministry of Health and Social Welfare – training them in infectious disease management and other critical skills. The doctors and nurses are supported by a cadre of lay health workers, who handle various administrative tasks – including HIV testing and counseling, and food distribution.

The physicians also hire and train Community Health Workers (CHWs) – the key to finding and treating so many patients in the remote villages served by our clinics. Our CHWs visit HIV patients daily to ensure that they are taking their medications properly and consistently, and to check for side effects and other problems of poverty (such as lack of food or water) which might interfere with treatment. CHWs are the vital link between clinic and community, encouraging neighbors and friends to visit the clinic for testing and treatment, notifying the doctors when patients are too ill to make the long journey themselves, and supporting chronically ill patients through months and even years of treatment for HIV/AIDS and TB.

Unfortunately, Kazabelo’s painful story is not unique. There are far too many underweight, malnourished infants and children in Lesotho – and worse, many of them do not arrive to our clinics in time. In a country where an entire generation of adults is being wiped out by the dual epidemics of HIV & TB, too frequently very young children are left in the care of their aging grandmothers. Current estimates peg the orphan rate in Lesotho between 16 and 30% – very likely the highest per capita orphan rate in the world. How old will Kazabelo be when her grandmother can no longer care for her? Will she survive long enough to witness the right to health care become a right realized by everyone in Lesotho?