TTLs 1000th Child!

Today we had a big party at TTL to celebrate the 1000th child that the organization has taken in. All of the kids and BoMay came, as did a few doctors from the hospital and some local community members. We had a traditional Lesotho meal of papa (which is kind of like grits, and is made from maize), chocalaca (which sadly does not contain chocolate, it's like hot sauce with vegetables in it), cooked collard greens, and sausage. We sat with the doctors, who are all from the nearby Democratic Republic of Congo. We discussed a number of matters of utmost inter-cultural importance, including why Americans use debit/credit cards, online shopping, and the purpose of iTunes. All of the doctors are fascinated by american culture, and have tons of questions for us.
We decided to take a break from cooking this evening and headed to one of the two local restaurants, the Mokhotlong Hotel, for dinner. People get quite excited about this place because they serve pizza, which is apparently quite the delicacy in Lesotho. The restaurant had only one menu, but luckily we were the only customers. We had a very lively dinner with Rachel, Julie, Lyle, and Jen who is a friend of Lyle's and a peace corps volunteer from Swaziland (another country within South Africa). Jen, Lyle, and Rachel are going on a big hiking trip this weekend through the mountains and sleeping in huts in local villages along the way. Tiana and Julie and I aren't quite adventurous enough for such a trip yet, so we'll be staying back at TTL. Lyle and Jen have really interesting Peace Corps stories to tell. Lyle has lived in Africa for 15 years, working in the peace corps and for a number of NGOs. He told us a story about when he was in the peace corps in Ghana having to cross the border and exchange his currency on the black market and smuggle it back in his shoes just to be able to buy food when he was a peace corps volunteer 15 years ago! I think things have changed a bit, but hearing about the total immersion these people do in very rural areas makes me realize that the peace corps is not in my future. He also told a story about the time he was served bat soup by a family for dinner. Apparently the peace corps volunteers are taught that it is very rude to refuse food, so halfway into his bowl of soup when he saw a bat floating in the bowl, be just kept going because that was what they were taught to do. I don't think I'd last a day out there, but have tons of admiration for the people who do. They sure have amazing stories and make for excellent dinner company.
Tomorrow will mark one week in Lesotho. So far so good!
H

Theater

Today was SO cool! I spent the day in the "theater," which is what they call the operating room. I observed in the first 2 surgeries, and got to assist in the second 2, which is where you are scrubbed in and helping the surgeon. That's what I'll be doing in residency, so it was cool getting a head start. I know not all of you have a stomach for medical pictures, so I'll only post the ones suitable for everyone. Later I'll do a composite post of all the unusual things I've seen here, which you'll have to read at your own risk.
The operating room is much like in the US, and it was surprisingly easy to figure out my role despite being on a different continent. A few things, however, were different. First, the patients are brought wide awake completely naked into the operating room. In the US we pay a lot of attention to patient modesty and comfort, but here you're just naked in the middle of the room for all to see. Our first patient, (who was actually pretty sick), lays down at the table, and the doctor actually says to her "you are fat, you've been eating too much." She just laughs, and doesn't seem offended. Perhaps it's just a cultural thing, because no one batted an eyelash, but I think my jaw was on the floor. This woman maybe weighed 170lbs and was 5'5". And she was pregnant. Tough crowd! Anesthesia is also do different here! Everyone gets spinal or epidural anesthesia, which means they're awake for surgery but numb from the abdomen down. There is no local anesthesia to numb them before they get the epidural. The doctor just tells them to bend over and hold still and shoves a huge needle into the patient's spine. These people are so tough, it looks incredibly painful. After the surgery is over, the patient (now numb and paralyzed from the waist down), gets dragged by their limbs onto a recovery cot. They turn them on their side, I think because it's easiest to move them that way (they call this the "recovery position"...it looks very uncomfortable), and push the cot into the hallway and leave the patient for the ward nurses to come pick them up. No recovery room, just the hallway.
The first surgery of the day was the woman with the ectopic pregnancy. In the US this is a laparoscopic surgery, but because they don't have that equipment here, they did it through an open incision, which was cool for me because I could see everything! The ectopic pregnancy was in the tube, and was as big as the uterus itself! The doctors thought it was days from rupturing, which has a high maternal mortality rate. This is the natural consequence of an ectopic pregnancy, because a tube cannot sustain the pregnancy, so eventually the tube ruptures and the mom goes into shock from blood loss. Thankfully this was diagnosed before that happened! We took out the tube on the right side, but she will still be able to have future pregnancies from the other side. She is doing very well now!
The second 2 patients had hydroceles, which I had also never seen. A hydrocele is where fluid from the abdomen can leak into the scrotum through a small hole in the abdominal wall, kind of like a hernia. The Besotho don't seek medical care for small problems, so needless to say both hydroceles were impressive. Both procedures went well, and I actually got to assist with the second one!
The fourth surgery was both exciting and overwhelming. It was a C-Section and tubal ligation. This was the woman's third C-Section, so it was a challenging surgery due to lots of scarring from her prior surgeries. The baby came out and it was pretty small, and blue and not breathing. In the US, there would be a neonatologist to assess the baby. But, in Lesotho, it's just us. And the anesthesiologist, but he has left the room at that point...something that also doesn't happen in the US. So, I do the only thing I can think of, stick my suction tube in the baby's mouth and start rubbing it and smacking it's bottom trying to stimulate it to wake up. That's all I could think of from my pediatrics rotation. Eventually a midwife comes in and takes the baby and resuscitates it. Once I hear it crying I am relieved. I look back down just in time for the doc to say, "there's another one!" Oh, a surprise twin you say? Now, with twins, after one baby comes out the uterus starts to clamp down, so it's important to get baby #2 out quickly. The second baby is bigger and appears to be stuck. The doctor yells for me to push (which it takes me a minute to understand because she speaks broken English with a thick French accent). I push with all my might, and at one point am laying on top of this woman's abdomen trying to push the baby out from above. I did this wearing 3 layers of clothing in a room that must've already been 90 degrees. By the time the baby came out I was sweating and shaking. I was so relieved to hear its strong cry. Mom and babies survived the operation relatively unscathed, which I consider a personal victory. I was very excited about the twins and congratulated the mother afterward, who was equally surprised. She already had 2 boys at home and was really hoping for a girl. Instead she got 2 boys, so I don't think she was very happy with us. After my first c-section was a third surgery in an HIV positive woman with surprise twins, I should be ready for anything in residency, right?!
I think I am adjusting well to the Lesotho culture, but am receiving quite a culture shock in the hospital! Things are so extreme here, and literally anything could walk in the door, and the doctors here, who call themselves General Practitioners, take care of it. Anything from surgical emergencies, to poisoning, to pregnancy, to tuberculosis. I know I've pointed out the many ways that we do things differently in the US, but I have great respect for these doctors and the vast knowledge they must have to practice here. It's much more than I could ever handle. Seeing the severity of disease and lack of resources here makes me thankful to have the chance to train in a place with such wonderful resources. In the meantime Im going to learn as much as I can here...they seem very willing to help me get hands on experience. Enjoy the pics!
H

Blue Jean Shoes

Thanks to everyone who's been reading along and leaving comments! It's great hearing that so many people are interested in what I'm up to, and it always brightens my day to read the comments you leave.
Tiana and I spent today at the hospital. We got tours of the pediatric ward, women's ward, men's ward, operating room, and the outpatient clinic. All the windows are open in the hospital, perhaps to reduce the spread of airborne diseases, but as a result is it terribly cold. Good thing everyone has their besotho blankets with them! We were present for rounds this morning, which is where the doctor sees all the patients and establishes a plan of care. Rounds in Lesotho are much different than in the US. First of all, the attending was wearing a leather jacket and BLUE JEAN SHOES! I seriously want to bring these things into fashion in the US. I had to be very sneaky to get a picture of these, posted below.
Rounds on 5 patients lasted approximately 10 minutes. We did not actually examine any of the patients, we just talked to them from the foot of their beds. In the US, rounds last hours, and it is expected that you will always examine patients. However, at least these patients are spared the annoyance of being woken up by a medical student while it's still dark.
After rounds, we spent the day in the outpatient clinic. These visits were similarly short, with minimal physical examination. We mustve seen 20 patients in the morning and afternoon. Basically the patient comes in to see the doctor, hands over their Bukana which is essentially their medical record, and the doctor asks a few questions and writes down an order for medications or lab tests or X-rays. Visits lasted approximately 3 minutes each. I saw many things I've never seen in the US, including Typhoid, a bone tumor in a child, and PCP pneumonia (only occurs in severely immunocompromised individuals). I'm glad I got all my immunizations before coming here! The doctor also got a call about an emergent surgery for an ectopic pregnancy (pregnancy in the tube instead of the uterus, which can rupture and be life threatening), which we are going to operate on tomorrow morning. We also diagnosed a breast mass that I will help biopsy next week. I posted some pics that I took of the hospital below.
After we finished at the hospital we went into town to "fruit and veg." this is really just a roadside stand where they get fresh-ish fruits and vegetables every Wednesday, so we go get what we'll need for the next week. I also bought myself a souvenir besotho blanket in town today, it is so nice and warm! I will need it, considering how cold it's getting here. One of the nurses told me its supposed to snow soon!
I'll be back at the hospital tomorrow, and hopefully will have positive results to report after the surgeries.
-MayHannah (that's what they've started calling me around here. You say May before any woman's name.)

Outreach

Today we went on outreach, which is basically follow-up for kids who have left TTL. The kids are assessed for nutritional status, and we count their pills to make sure they are taking the medications correctly.
We visited 3 kids today, each in a different village. The roads we drove along to reach the kids were pretty scary. I use the term "road" liberally...these were more like tire marks along the side of a mountain where maybe a dozen cars had driven before. We drove through a few creeks, and right near some very steep cliffs! The views were spectacular but Tiana and I were holding on for dear life. I can't believe the outreach people do this in the winter when the mountains are full of snow and ice. Needless to say, four wheel drive is a must... I'm glad I don't have to drive!
2 of the kids we visited were doing really well, growing and taking meds as directed. It was hilarious to see them examine the kids. Basically they strip them down and put them into a little harness and hang them on what looks like a fruit and vegetable scale in the grocery store. I wanted to get a picture of it but felt kind of guilty because the kids clearly dislike being weighed. One of the kids peed on the outreach worker while she weighed him, the only form of revenge he could get I suppose!
One little boy, Thletlotlo went home about 2 weeks ago from TTL and wasn't doing so well. His mom died a week after delivery and so he is living with his father and sister. The sister is 13 and is his caregiver. The family is very poor, and has been eating the food we are bringing for the little boy. To encourage the 13 year old to stay in school, TTL is paying the feed for Thletlotlo to go to a daycare (which is a one room hit with 20 kids in it), and today the teacher told us that he comes to school hungry and dirty everyday, and that the family isn't taking proper care of him. The father understandably doesn't want to give Thletlotlo up for adoption, but it is a very sad situation because clearly the family is unable to care for the baby. We will go back to see him in one week. In the meantime we left more food with the teacher.
After we returned from outreach we went to meet the district medical officer, who is basically the head honcho at the hospital. He said they'd love for us to come and help at the hospital, and we'll get to help with procedures whenever they happen. He said they mostly do C-Sections. Score! We start tomorrow at 8am.
I'm adding some picture from our journey today, and some people we met along the way. Lesotho kids don't quite know how to smile for the camera, it appears. Maybe I should work on learning how to say "smile" in Sesotho!
I also added a few pics of Mokhotlong and men riding donkeys in their Besotho blankets to yesterday's post, in case anyone is interested!

Dumela May

I am slowly learning a few Sesotho words. Dumela=hello. May is woman, Ndade is man. That's all I know so far. Luckily, being white everyone knows I can't speak Sesotho and tries to speak to me in English. The only drawback is that they also stare at me. I am one of 3 white people I've seen here.
This morning we took 2 of the babies back to the hospital for a check up. As part of their HIV treatment they get a lot of blood tests, which they were going in for today.The little girl from yesterday, Lulu is doing a bit better today!
I am learning more about what TTL does, and I think some aspects of the organization have changed recently. There is very little maternal health aspect to the program. There is now a global initiative to help reduce transmission of HIV through pregnancy, so now women are cared for at the local clinics and hospitals, where they also receive medication. TTL focuses more on the kids. The kids here have a variety of diseases, including HIV and TB mainly. Most of them are at TTL due to their disease and severe malnutrition. When they come to us they have growth and developmental delays, but children are resilient and it has been amazing to see what nutritious food and proper
medications can do! The kids live at TTL for a few months, usually so they can be stabilized and their nutritional status improved. Many are from remote villages outside Mokhotlong, and their families are unable to bring them back and forth for care. A few of the children are orphans, but most have one living parent. Often, of the mother dies, the fathers are unable to take care of the kids themselves because the women raise the children almost exclusively. At TTL, the women who care for the children are the Bomay, which is just the plural of women in Sesotho. There are around 25 Bomay who alternate, and they are here 24/7 taking care of the kids. We mostly help with feeding the kids at mealtimes, and taking kids to medical appointments.
We got a tour of the hospital today, and met some of the docs. None of them are from Lesotho, most are contracted to come here from nearby countries like Zimbabwe. There are 4 doctors for a population of 100,000 people. I'm excited to spend time in the hospital and hopefully deliver some babies!
Lyle told us yesterday that it is considered bad luck in Lesotho culture to acknowledge that a woman is pregnant, because they believe talking about the baby invites evil spirits to cause problems with the pregnancy. When women go into labor, rather than saying so, they simply say they're "not feeling well." What an understatement! I will try to keep all these things in mind if I encounter pregnant women here.
In the afternoon we finally walked into Mokhotlong and did some shopping. There is one street in town, and "stores" are basically shacks with 3 sides where people sell things along the side of the road. There are a few grocery stores, which are pretty basic. The fruits and vegetables are always old, as it is a long drive from the capital to Mokhotlong and shipments are infrequent. There are a couple souvenirs i am excited to purchase here. First, a Besotho blanket. (pictured below) The locals wear these and they come in many beautiful patterns. The way you wear your blanket has meaning. You wrap it a different way of you're engaged, married, pregnant, in mourning, etc. The women carry their children wrapped in these blankets on their backs, like a makeshift baby bjorn!
We ran into some local kids on their way home from school today and asked to take a picture. They didn't quite get the idea of smiling for the camera, but I'll share the pic anyhow.
Tomorrow, we are going on outreach, which is where we visit the villages where former TTL kids live, to check on them and see how they're doing since leaving.
Hope everyone's well in the US.
Love from Lesotho!
H

Pics of Touching Tiny Lives and Hiking in Mokhotlong

Today was our first full day in Mokhotlong. I awoke to a beautiful Lesotho sunrise and could finally take in my surroundings and explore the TTL campus. The campus consists of 3 buildings: the safe home where the kids and caregivers stay, a building with our rooms and kitchen and bathroom, and a building with a big meeting room and extra kitchen. There are also 3 Rondavels (pronounced roundavall), where more long term staff members stay. We have a small, relatively well equipped kitchen, and have the capability to machine-wash laundry. The water is warmed using energy from the solar panels on the roof, which I included a picture of. There is an ample garden, but the kids eat most of the food grown there. The whole campus is surrounded by a tall barbed wire fence, and we have guards at night. The consensus is that this is probably excessive considering that Mokhotlong is pretty safe, but I think everyone sleeps a bit easier at night knowing someone's keeping watch.
Today, we were treated very well, Rachel cooked us some delicious meals. We will cook all of our food here, but I think they're trying to ease us into it. Cooking here takes a long time, because of the altitude, and because the stoves they have are old and lose half of their heat out the sides. So, needless to say we appreciated Rachel's cooking.
Next we went to the safe home to see one of the babies who was not feeding well. No one at TTL has any medical knowledge, so they were appreciative of any insight we could offer. The girl was 1 year old and had HIV and TB. She was very lethargic and didn't look well. Tiana and I examined her and after finding she had a high fever, recommended that she be taken to the hospital. They have an area of the hospital called Casuality, which is essentially an ER. We took the girl there, and waited an hour for the doctor to show up. There is no triage system here, so we had to wait until everyone else had been seen, even though this child looked worse than anyone there. The doctor examined the baby for 3 minutes before giving her a shot of penicillin and sending us home with Tylenol. In the US, this baby would've been admitted to the hospital in a heartbeat, and many medical tests ordered. Things sure are different here..we've been keeping a close eye on the little girl, and she is perking up a bit, but still has a ways to go.
After we returned from the hospital, a local woman who lives next to TTL came by to introduce herself and invite us to a barbecue at her house to welcome us. I couldn't pronounce her Lesotho name, but she said we could call her Hilda. (I think these people try to choose a "typical" American name that'll be easy for us to remember, but I don't know anyone named Hilda and am having a very hard time remembering her name...) it turns out that Hilda is the magistrate for all of Mokhutlong and it's districts, which total around 100,000 people! She told us the most common crime in the area is livestock theft. All in all, a Lesotho barbecue is much like an American one: beer and grilled meats. I still haven't tried the mutton--yet.
After the barbecue, Lyle, one of the long-term staff members took us on a hike down along the Lesotho River. Lyle speaks fluent Sesotho (language of Lesotho), having lived here 10 years. He knows the area very well and it was great to get a tour from someone familiar with the local language and customs. The views were gorgeous, and we encountered a few young herd boys and their sheep and horses along the way. The kids go nuts when they have their picture taken, and love to see picture of themselves afterward.
After our hike I returned to find that FINALLY the Internet had been fixed. I was feeling cut off from civilization. We had a lovely curry and rice dinner that Rachel cooked for us, and with bellies full headed to our warm beds and out of the cold Mokhotlong evening air.
Lots of pics below of the TTL buildings, as well as from the hike!
H