Home Visit in the Mountains of Lesotho:
A Doctor’s Journal

by Dr. Jonas Rigodon

I first arrived to Nohana in early August 2006. The clinic was bustling and I could tell that it was only going to get busier with time.

The head nurse, M’e Moso came to see me one day. She wanted to tell me about a Village Health Worker who had come to see her recently. This Village Health Worker told M’e Moso of all the people in her village who were sick. M’e Moso was timid to ask, but wondered if our team was available to make home visits. I told her that, indeed, that was part of our job in providing health care in rural settings. If people couldn’t come to clinic, we would go to them. Fortunately, Keith [another PIH doctor who is now our country director in Malawi] had also come to Lesotho to lend a hand as we were starting up. I knew that he could take care of things at clinic while I made my first home visit on a weekday.

	Dr. Jonas makes a house call on horseback

Having just arrived, I was unfamiliar with the terrain of the Nohana area. This was the second week of August, the middle of winter here in Lesotho. We didn’t have a vehicle at the site yet. But even if we did, it wouldn’t have made much difference considering that most of these roads are only navigable by foot or on horseback. I asked M’e Moso how long it would take to travel to this village. She  replied that it would take six hours by horse. I began my journey right away, because I knew that this might quite literally be a matter of life and death.

I asked one of our translators, Lesole, to accompany me. We rented two horses. It had been a while since I had been on a horse. It took a while for me to remember what it was like to ride a horse again. Even then, this ride was not like any I remembered. The steep mountains made for slow and rough riding. It was treacherous to say the least. Six hours later, we arrived at the village and the first person I went to visit was a young woman named Mathabo Posholi.

	Mathabo before treatment for TB and HIV

When I entered her house, Mathabo was too ill to sit up on her bed to greet me, though I knew she wanted to. She was coughing a lot and was extremely thin. Her skin-tone was not a healthy colour, most likely from anemia.  Because she wasn’t able to move, I couldn't weigh her but I estimated her weight to be only around 35 kg (less than 80 pounds).

At that time, Mathabo was 35 years old. She had lost her partner over seven years ago, most likely from AIDS. She had pulmonary TB three years ago and had been treated for pneumonia several times. Her symptoms included severe weight loss, coughing, night sweats, diarrhea, thrush, loss of appetite and loss of skin tone.

She gave her consent and I tested her for HIV. Her test showed positive. I also diagnosed her to have esopharyngeal candidiasis (an opportunistic yeast infection) and TB, so I started her immediately on TB medication and Fluconazole. I drew her blood to send for a CD4 count and gave her some money for food.

Unfortunately, we never received the results of her CD4 test. As I soon learned, many samples never make it to the lab. They simply disappear somewhere along the line of drawing samples, coordinating them, shipping them down with the pilots, then couriering them to the central lab in Maseru. Even when samples do get to the lab, the results often fail to make the reverse trip back to us in the mountains.

Two weeks after seeing Mathabo, I was visited by her Village Health Worker at the clinic. She reported to me that Mathabo was doing much better already. She had an appetite now, her fever had subsided and her cough had improved as well. I sent the Village Health Worker back with more medications and more food.

Another month passed before the Village Health Worker came to see me again. She said that Mathabo wanted to come in to the clinic but didn’t have enough money to rent a horse. She asked if we could help. I gave her money to give to Mathabo and two weeks later, Mathabo came to clinic to see me.

When she first stepped into the room, I didn’t recognize her.  I had to rely on the Village Health Worker to vouch that this was Mathabo. Her complexion was much improved and she had gained some weight. Although we still didn’t have a CD4 result for her, I decided that she was ready to begin ARVs. She no longer had any of the symptoms she had over a month ago and she weighed 46 kg (102 lbs).  I took another blood sample to send to Maseru for a CD4 count and enrolled her into our food program, where each patient gets enough food every month to feed him or herself plus four family members.

I have been greatly impressed by Mathabo’s rapid recovery. It is the first time I have ever witnessed anything quite this dramatic. Even in Haiti, I didn’t have patients like this. I am happy to report that today, eight months after she began treatment, she is doing very well.

	Mathabo eight months after starting treatment for TB and HIV

We recently had a little event at the clinic and Mathabo asked me if she could speak to the larger audience about her experience. She said “I want to talk to people who are sick and have HIV and tell them that they have to take their medicine. Today, I am alive because I took my medicine. I also want to thank the PIH team for all their efforts and for caring about the people in the mountains of Leostho. I never believed this day would ever come. Thank you.”

Dr. Jonas Rigodon is Chief Physician at the PIH health center in Nohana, Lesotho.

[published May 2007]