28 Nov 14 17 Mar 17

Lesotho: First steps in a long walk for MSF's community treatment

In the “Kingdom in the Sky” of Lesotho, communities hope that the introduction of community models of care can help them access all-too-rare healthcare.

Perched on the side of a mountain and overlooking a magnificent valley is the MSF supported Fatima clinic. Here, deep in mountainous Lesotho, I’m chatting to Motseko Maknoae about why she's here.

“It has taken me two days walking to get here, I stopped with relatives overnight. I make the trip at least once a month.”

She’s much chirpier than I would be, especially considering she is 74-years-old and suffering from high blood pressure.

This, I’m told, is normal. It’s also normal for patients to be in ill health, pregnant, or making a long journey just to collect drugs. I’m 32 and in good health, so I probably should stop complaining about my bottom still aching from the two-hour rickety car journey that brought me here.

Travel on foot to reach clinic

Lesotho is remote, rural and filled with mountains jutting up all around. Its 1.8 million people are spread thinly across the country and the roads snaking along the steep slopes are few and far between.

Healthcare is so hard to reach that people don’t travel unless they are really ill. This adds to the challenge of responding to HIV cases which strike one in five adults all of whom are in need of daily, lifelong treatment to remain healthy.

The Fatima clinic alone receives 50 patients a day, most of whom travel at least two hours on foot, many a lot more.

Stigma around treatment

I meet with Libuseng Marekimane, MSF's patient support Coordinator, who is helping HIV+ patients set up Community Antiretroviral treatment Groups, or CAGs, where members take turn to hike to the clinic and pick up the drugs for the whole group, at the same time having their health checked by a clinician.

It is hoped that this simple idea will provide a way for patients to get their antiretroviral treatment (ARV) more easily, helping to increase lifelong adherence to treatment. Missing just one month can be disastrous, leading to a spike of the virus’ strength and/or building up resistance to treatment.

In the battle to reduce the 63 percent of deaths attributable to HIV in Lesotho and to reduce stigma around the disease, this small initiative could prove a masterstroke.

Here, in Fatima, there is certainly an appetite for CAGs; in one morning I met plenty of HIV patients keen to get involved. Mamatseliso Supu tells me: “I left home this morning at 6 am, it took me four hours walking to get here and I do it twice a month,” she says.

For the individual patient, CAGs can mean a huge change in daily life: not only are her trips to the clinic reduced, she also gets support from group members who share the same problem of living with HIV.

“There is a stigma attached to HIV, especially with the youth. I think there are lots of people on ARVs who don’t want the community to know,” Mamatseliso adds. If neighbours notice that someone goes to the clinic once a month, they’ll probably come to the inevitable conclusion: HIV. Not so much if the trip is only taken twice a year.

I talk to Mamatseliso for some time and she makes it clear that these groups can make all the difference, not just to her, but to whole communities.

Needs of the local patients must come first

In Lesotho clinics are simply too far from where people live and the resources available means it is not possible to build more of them.

That’s why MSF’s CAG model can be life-changing for those living with HIV in Lesotho: it shows that if you can make it easier for people to access a service, they often will.

Everyone I talk to has walked for hours, some old and unable to stand, some carrying what appears to be their livelihood. Many carry at least one baby, like Matsietsi Mathabeng. She is holding her wide-eyed one-year-old daughter and won’t let me get a word in edgeways.

“I walked here carrying my baby, I couldn’t afford a taxi (about 40p). It took me two hours,” she tells me.

“The need for services like this one is great, we need more across Lesotho as some people can’t walk or afford a taxi, so when the weather’s bad they get more ill as they wait.”

I’m quite saddened by my final meeting with Matsietsi but then I remember that here, surrounded by genuinely humble and wonderful people, I am struck by how happy they are that this health post exists at all and how many of them really benefit from the CAGs.

I’m convinced that these initiatives to get out in to the community, to educate and to alter perceptions, can have hugely positive effects if done nation-wide.

Yes, MSF is playing a large part, and after just one day here in Fatimait it appears that patients from far and wide have bought in to it too.

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