Lesotho map showing PIH sites
Since beginning work in Lebakeng last September, PIH Lesotho has begun working in the community of Tlhanyaku in January, with Methalaneng to follow before the end of March.

In recent months, PIH has accelerated its expansion to remote clinics high in the mountains of Lesotho. The logistical challenges faced by the Lesotho team have multiplied even more rapidly, given Lesotho's rugged mountain terrain, as PIH Country Director Jen Furin and her colleagues quickly discovered in Lebakeng.

Literally translated, Lebakeng means “the middle of nowhere,” which perfectly describes the location of the site where PIH Lesotho started working last September. Without access by road, or even a rutted path, the only way PIH staff could get to Lebakeng was on a single-engine plane flown by Mission Aviation Fellowship.

About one-third of Lesotho’s adult population is infected with HIV (the third highest seroprevalence of the disease in the world), so one of the main purposes of this initial visit was to assess what would be needed to initiate HIV therapy in the remote community. 

“We had been warned by many that Lebakeng would pose more challenges than the other sites,” Jen Furin recalled. “I must confess part of me was hoping we would not see as much disease in Lebakeng and that we could start things a little more slowly there as we got more on our feet. Those hopes were dashed almost immediately.”

In a single afternoon in the clinic on this “site visit,” Furin and other PIH staff tested 13 women for HIV; six were found to be positive. Of these six, all were in their third trimester of pregnancy and in desperate need of antiretroviral therapy (ART) for themselves and to prevent transmission to their children either in utero or during childbirth. The team was faced with a dilemma: start providing treatment in Lebakeng right away or wait until they were more “ready,” potentially sacrificing these women and their children. “It is the type of decision we have to make all too often, but it felt very acute with Lebakeng,” said Furin. After much discussion, they decided they could not wait. They soon began training village health workers and treating patients.

From the very first weekend of working in Lebakeng, the team faced a relentless stream of challenges. “We were all sleeping on the floor of a tiny house in a violent hail and snow storm. The roof leaked,” said Furin. And because of the site’s remote location and lack of infrastructure, just about everything required fancier logistical gymnastics than anything PIH Lesotho has performed to date (which is saying a lot, as described by Rural Initiative Project Coordinator Archie Ayeh in the November 2007 e-Bulletin). All supplies had to be flown in, or ferried on the backs of donkeys.

Moreover, the site was overwhelmed with incredibly sick patients. “And as is always the case, once we showed up more and more of them started arriving,” said Furin. “Clinically, Lebakeng pushes us all to the limit, as the patients are so acutely ill with so many various diseases.”

In a few short months, the Lebakeng clinic documented more than 1,200 patient encounters, diagnosed over 190 people with HIV (of whom about 80 are now on ART), and provided training to more than 47 community members.

 Woman helping to build a new health clinic in Lebakeng
Woman carrying a stone for the new health clinic in Lebakeng

It quickly became clear that the tiny facility would very soon be unable to cope with the steady influx of patients, so the staff and community began building a new clinic. “This is harder than it sounds, given our inability to get building materials that will fit into the small single-engine Cessna planes flown by our dear friends at Mission Aviation Fellowship,” said Furin. “So we are using local stone. By 5:30 this morning, the sound of rocks being dug from the quarry echoed across the clinic compound, as did the voices of the women who are carrying the rocks, one by one, on their heads down a long, steep path. These rocks will be used to make the clinic. It is a labor of love on everyone’s part, tiresome and tedious at times, but buoyed by knowing that the clinic will stand strong and proud for all the work that has gone into it.”

Lebakeng was the fourth site for PIH and its partners in Lesotho. Ambitious plans to begin work in six more sites in 2008 (a new site every other month) are already underway. At least one or two of the planned future sites are about as remote as Lebakeng. But with the PIH Lesotho team's experience "in the middle of nowhere," they are prepared to tackle these new challenges, even if it means carrying one stone at a time.

published March 2008