The Lesotho Rural Initiative

The FXB Center continues its collaborative work with Partners In Health (PIH) and Brigham and Women’s Hospital to strengthen the health care system in Lesotho in southern Africa. This project provides quality care to address issues of HIV/AIDS, multi-drug-resistant tuberculosis (MDR-TB) and hunger for thousands in Lesotho.

Comprehensive Rural Health Care

The Lesotho team has succeeded in tackling HIV/AIDS and MDR-TB in one of the highest prevalence locations in the world. As a comprehensive training, research and practice initiative, the Lesotho Rural Initiative has opened a total of six clinics — Nohana, Bobete, Nkau, Lebakeng, Tlhanyaku, and Methalaneng — located in four rural districts; three more clinics are in the planning stages.

Each clinic site poses distinct challenges. The Lebakeng clinic, for example, is located five miles from the nearest road, yet the team has successfully established comprehensive health services. Prior to our arrival, no one in these communities was receiving testing or treatment for HIV or TB. In less than two years, the project has tested more than 12,000 men, women, and children for HIV. Of those tested, 29% have tested positive. More than 1,900 patients have started lifesaving anti-retroviral treatment, and over 700 have been diagnosed with TB.

With the help of more than 750 trained village health workers, dozens of new nurses, and a full time physician in each clinic, these remote communities are now able to access health care services for the first time. The clinics provide comprehensive health care services (including women’s health, pediatrics, malnutrition, and trauma); training for health care professionals and others (including expert patients, village health workers, and traditional birth attendants); and food distribution and supplementation services. With additional support from Irish Aid, we are transforming the minimal clinic facilities, building new treatment and diagnostic facilities, as well as new housing to support the increasing number of staff.

Child-Focused Activities

Lesotho has the highest per capita orphan rate in the world, with an estimated 25% of the country's children having lost one or both parents to HIV. In collaboration with Catholic Relief Services, we are one of the leading implementers of the Mountain Orphans and Vulnerable Children Empowerment (MOVE) project, supporting orphans and vulnerable children in the mountains of Lesotho. The MOVE project has already identified 2,000 orphans in the villages that surround the Bobete health center. In late 2007, we helped secure additional funding from Irish Aid to support MOVE scale-up in the areas surrounding our Nohana and Nkau health centers.

Equally important, we are working to stem the tide of new at-risk children. In each of our rural sites, we provide a comprehensive PMTCT (prevention of mother-to-child transmission) program to keep both mothers and children as healthy as possible. We are working with traditional birth attendants to identify, screen for, and treat not only HIV and other sexually-transmitted infections, but for malnutrition status as well. In addition to seeing HIV and TB patients, our physicians also work closely with the Ministry of Health nurses and nursing assistants in the general outpatient clinics. In several of our clinics, more than 100 patients are seen each day; about one-third of these are children. Weekly clinic days for children under age 5 are very successful, and visits include vaccinations, weight monitoring, and nutritional information.

Food Crisis

Nutrition information has limited usefulness in the face of acute hunger and shortage. When we first arrived in Lesotho, clinic staff saw one or two children per week who were suffering from malnutrition, usually due to pellagra, a disease caused by lack of niacin (vitamin B3) and protein. One year later, however, malnutrition cases increased dramatically. Children were the first group at risk when a severe drought led to significant food insecurity, especially in the mountain regions served by the rural initiative. Staff began seeing as many as 20 malnourished children per week — ten times the 2005 rate. Doctors and nurses at the clinics also documented a sharp rise in severe childhood malnutrition — both kwashiorkor (malnutrition caused by inadequate protein intake) and marasmus (a severe form of malnutrition caused by inadequate intake of both protein and calories). The project team reacted quickly. It procured extra food supplies and ready-to-eat foods to treat malnutrition, as well as funders to help support the emergency food program. Village health workers were trained to collect height and weight data on children. This quick action ensured that food was distributed quickly to those most in need. As the harvest this year ends, the team is ready to spring into action again if necessary.

Multi-drug Resistant Tuberculosis

With funding from the Open Society Institute, and in partnership with the Ministry of Health, the team in Lesotho launched the country’s first community-based treatment program for multi-drug resistant tuberculosis (MDR-TB). Based at Botsabelo MDR-TB Hospital in Maseru, the project is one of the most ambitious MDR-TB programs in any high-HIV-prevalent community. Previously a leprosy hospital, Botsabelo Hospital was converted in 2007 into a 20-bed facility for the treatment of critically ill MDR-TB patients, many of whom are co-infected with HIV. The team also renovated the Maseru TB Clinic to improve infection control of this highly contagious drug-resistant form of the disease. Simultaneously, PIH supported the renovation of the TB Laboratory in Maseru. A new pharmacy on the hospital grounds makes it possible to effectively manage the distribution of up to 50 pills each day which many co-infected patients require for MDR-TB, HIV/AIDS, and drug-related side effects.

The project in Lesotho provides most MDR-TB treatment at the community level, supported by paid and carefully trained community health workers who visit patients in their homes twice a day. The project trains health care staff on MDR-TB and MDR-TB/HIV co-infection throughout Lesotho, and all patients with suspected MDR-TB are referred to the project for treatment. By late May, over 100 patients (including several children) had been diagnosed and began the arduous treatment regimen for MDR-TB. Our first patient started treatment in July 2007.

Related Partnerships

Our project in Lesotho would not be possible without a solid partnership with the Ministry of Health and Social Welfare. Other key organizations include Mission Aviation Fellowship, the Clinton HIV/AIDS Initiative, Catholic Relief Services, the United Nations World Food Program, UNITAID, the Foundation for Innovative New Diagnostics (FIND), and the World Health Organization. In addition to our FXB Center funding, we are grateful for the generous support received from Irish Aid, the Open Society Institute, The ELMA Foundation, MAC AIDS, and the Elton John AIDS Foundation.