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I had no meetings arranged today so I took the opportunity to go with Manyanye to visit my colleague, Jan, at St Angela Cheshire home for disabled children. St Angela’s gives children with disabilities a chance to attend school and get support in a country where for many people a disability is regarded as a curse. I can honestly say the it was the most enjoyable day I have spent in a long time.

Jan first visited St Angela’s in 2016 as part of the ILO programme. During that visit she set up a space for the children to be able to have physiotherapy, has trained some of the staff in basic physiotherapy techniques and gradually increased the children’s access to things which we would take for granted in Wales such as crutches and wheelchairs. I spent the morning working as Jan’s assistant, taking notes and helping get the kids in and out of chairs and frames. The children we saw this morning had only recently arrived at the home and so assessment for the first order of business.

Unfortunately, due to the prevailing attitudes to disability in Lesotho and a lack of funds, many of the children, who were between 10 and 12, had not had a chance to attend school and were often left at home while parents went to work. Many of the conditions that the children had are very uncommon in the UK and where they do exist they would have had medical attention from an early age. Conditions such as Ricketts, a possible head injury and brittle bone disease were represented.

The lack of previous attention meant that several of the children had contractures which meant that there limbs wouldn’t straighten. For them, physiotherapy can make a massive difference as they grow. For others a change in walking aids meant that the exhausting process of getting from A to B became a little easier. The kids seemed to enjoy the experience, especially as there is an emphasis on therapy through play and the only times the kids looked in the least unhappy was when it was their time to leave. For more information about these little heroes and the work Jan has been doing with them have a read of Jan’s blog

In the afternoon I worked with a visiting Irish team some of whom were refurbishing parts of the building, some were dancing with the kids and others were helping with governance issues. Sadly I was working on governance rather than dancing but it was another way in which I could help and one which also brushed up my skills at the same time. I have learnt a lot today.

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On the way back to the guesthouse along some of the worst “roads” yet encountered and through yet another thunderstorm I reflected on the what a resilient bunch the children were. To our eyes they had nothing but they were incredibly supportive of each other and relished every positive in their day. No wonder Prince Harry had enjoyed visiting them too.

 

4th February 2018

The area around the guesthouse where I am staying is popular with learner drivers who are recognisable by the massive L-plates strapped to front and rear. The roads are usually quiet and there are a steady stream of learners being put through their paces. The road conditions here though hardly prepare them for the conditions they will find in the centre of town.

At the initial briefings for my trip it was made clear that to get from A to B I could walk or get a taxi from a licensed private hire firm. What I was strongly discouraged from doing was to drive myself. On arrival, it became clear quite quickly why this advice is given. The road layout is familiar from anywhere else in the world. There are white lines down the middle of the road and at junctions there are traffic lights. There are also evident rules of the road. The problem is that it seems not everyone agrees what those rules are and the traffic lights seem to be regarded as advisory at best.

On the whole, people drive on the left hand side of the road here . However, where corners are concerned this is abandoned. Speaking to a colleague last night, it became clear that this is particularly true in rural areas where road traffic accidents are common and children journey to school along the side of the road at their peril.

Many of the cars on the roads of Maseru are imported from Japan, I assume because they also drive on the left there. The exceptions to this are government vehicles, which are usually white with red lettering instead of blue on the number plate, and cars that have been brought in from South Africa. The imports are not allowed to be resold in South Africa.

Fuel is relatively cheap here but somewhat confusing. If you don’t work for the government you have a choice of three fuels: a low octane petrol, diesel and eco diesel. Not all fuels are available in all stations so you have to be careful when planning your journey. If you drive a government vehicle then you have to fill up at the government filling station which happens to be down the road from the guesthouse. All govt vehicles fill up here and I do mean all, which is why the airport firetruck drove past me as I was waiting for a taxi the other morning. I assume they weren’t expecting any flights in the near future.

Public taxi’s toot their horn to attract custom. If you happen to be walking down a street in Maseru, do not be surprised if a taxi pulls up beside you and keeps tooting until you acknowledge them. General advice is don’t use them unless you have a death wish.

The quote above is taken from sesothostudy.co.za, a great resource if you fancy learning a few words of sesotho.

The roads are not well maintained and they do love a speed bump. The other day I was in a taxi being driven along a dual carriageway and suddenly the driver slammed the breaks on. It wasn’t until we got closer that I saw the large speed bump running across the carriageway. I suspect the mechanics are kept busy in Lesotho.

Today was the start of the six nations rugby tournament back in Wales. I love the six nations. It is a great competition, there is lots of good natured rivalry and the matches are usually pretty exciting. If I had been at home I would have sat down in front of the TV with my son, Iory and we would spend an enjoyable 80 minutes shouting at the screen.

Despite various attempts to find somewhere to watch it in Maseru I was unsuccessful. I did manage to get a bit of radio commentary over the internet before that too decided to stop working. Maseru suddenly seemed a long way from Powys.

In the end I decided that rather than brood over it I went into town and met up with Jan Jeffrey, a former ILOer out here on her second return visit. Jan is doing a lot of direct physiotherapy work with children who have disabilities. She talked about the work she has been doing and some of the challenges. We talked about the co-morbid mental health and behavioural issues that many of the children had and it is clear that there is an opportunity to skill up the staff there as well possibly using the mhGAP approach which has a specific section for child and adolescent issues in children. Something for next week.

2nd February 2018

In the pre-departure training it was made clear to us that there would be days when not much would happen. We would be waiting for meetings to be arranged or people to come back to us and in the end nothing would happen. Today was one of those days. The meeting I was expecting at lunchtime never happened and so instead I have been typing up some notes, writing a few emails and designing a training session. They told us not to get frustrated and I have been doing my best but….

For me it is only one day, the guys who work here as security/gardener seem to have to put up with it every day. I have met three of them so far. They work 12 hour shifts and there is somebody here 24 hours a day to keep an eye on the property. I’m not sure just how necessary it is but it is reassuring nonetheless. They are always friendly although we do struggle to communicate on occasion. Their English is much better than my Sesotho but you can tell it was never their favourite subject at school.

The security arrangements are somewhat peculiar. There are two entrances: one has a metal gate topped with metal spikes which is only opened when a guest arrives or leaves, the other, not twenty metres away, is always left open. I’m sure there is a method but I have yet to work out what it is. The rest of the time they mooch about or sit in their hut (the building with the corrugated iron roof you can see on the left of the picture above).

Well todays’s lightning display has just started and tomorrow is another day. I have been set the mission of finding somewhere to watch the 6 nations rugby in Lesotho. I have been given some leads so I shall set off for another explore of Maseru.

1st February 2018

In Lesotho, the Basotho people speak Sesotho. One person of Basotho origin is Masotho as in he is Masotho. The -sotho bit of all of them is pronounced soo-too. Every person I have met here has been friendly, with the possible exception of the public taxi drivers all of whom seem to have death wishes, and today just confirmed that.

The only meeting I had planned today was in the afternoon so I decided, after writing up some notes and doing a bit of planning, to go for a walk and take some video of the local area. Everyone I walked past said hello, either in English or Sesotho, and a few stopped to engage me in conversation. Apparently, it is considered very rude not to acknowledge someone as you walk past them and this evidently applies in the suburbs as it does elsewhere. Many will ask how you are and others will ask what you are doing, in a friendly interested way. I was making a point of not pointing my camera at individual people but a couple of people actually asked me to take their picture and send it to them either by WhatsApp or Facebook.

Many of the busy roads are lined by small shacks selling anything from fruit and veg to mobile phone top-ups. At lunch time, the air is scented with the smell of cooking on roadside braai (BBQs). One woman I spoke to told me about the challenges of running her roadside “hut”. She ran it with her mother and their customers were from the nearby warehouses. They seem to be an enterprising lot and there is often a congregation of people selling food and other merchandise by the side of the road at each of the many speed bumps that cover the roads.

This afternoon I journeyed once again to the Ministry of Health and we discussed a date for some possible training at Mohlomi as well as some suggestions of where I might head outside of Maseru to look at the implementation of mhGap so far. I think the plan for the end of next week is to journey to Thaba Tseke which is high up in the mountains, over 2500m, and I have been warned that the altitude can take some getting used to.

After the meeting I had arranged to meet David at the Ouh La La cafe nearby so I walked in that direction. On my way, I passed a full sized model of a spitfire which made me look twice. On further investigation, it seems that the Kingdom of Lesotho generously gave the RAF twenty spitfires during the second world war and No.72 squadron was named Basutoland in recognition of their generosity. Lesotho was once a British protectorate so the link is not as strange as it might seem at first.

The Ouh La La is situated at a major crossroads in Maseru so sitting outside in the sunshine you have a choice of looking at the cosmopolitan clientele or watching the traffic and trying to work out the rules of the road here. The traffic lights certainly only seem to be regarded as a guide but they did all stop when the king drove through from his nearby palace.

31st January 2018

In an effort to understand the mental health system in Lesotho a bit better I started my day by visiting the psychiatric hospital in Maseru. Mohlomi Hospital is situated to the South of the city in rural countryside and next to a large army barracks. Me Lehema, the Director of Mental Health was visiting that day too to provide supervision to the staff.

On arrival I was greeted by several members of staff who enquired about my business and showed where to wait for the Director’s arrival. While waiting a psychologist who I had had some correspondence with walked past and recognised me (I do stand out a bit). She invited me to her office and we had a conversation about the challenges of delivering psychological services in Lesotho.

As I have mentioned in a previous blog, Mohlomi is the only psychiatric hospital in Lesotho. One of the first issues is that there are no psychiatrists working in the hospital. Pulane explained that there are quite a few trained Basotho psychiatrists but due to the better pay and conditions elsewhere they leave. The last psychiatrist to work in Mohlomi left over a year ago. They do have general practitioners working in the hospital but they tend to come from abroad and don’t speak the Sesotho language so the initial history is often taken by a nurse who does speak the language.

There are 4 psychologists at Mohlomi but only two of them are fully trained. Pulane’s Master’s degree is actually in public health and this is clear from the population wide perspective she has on service development. As she described her working week to me there were some really interesting aspects of the way they work which could improve the way we do things in Wales but it was also clear that a major driver in the way they work was the lack of resources.

Monday for the psychologists is new referral day. They will see anyone who turns up. Appointments are not made as transport issues make attending at a certain time difficult. This means they have no waiting lists but also they have no idea who is going to walk through the door. Much of the work is brief solution focused work as there is no guarantee that people will be able to attend a second session. The most common presenting problems are depression (particularly among women) and substance misuse and psychosis (where men are over represented).

Tuesday and Thursday are allocated for working on the wards but one Wednesday and Friday the doctors hold follow-up clinics which provide an opportunity for the psychologists to see people returning for a repeat of their medication. If the incentive of a repeat prescription is not there it is apparently difficult to persuade people to return just for therapy.

After a good discussion with Pulane, the Director arranged for me to have a tour of the facility. Again the issue of the lack of resources was discussed as was the fact that the staff are aging and those that leave or die are not being replaced quickly.

The first stop was outpatients where the wooden benches reminded me strangely of the train station in Brief Encounter. After that we went to the men’s ward. Most of the patients were locked outside in the exercise yard except for a few that were locked in assessment rooms because they were deemed to be a danger to themselves, other patients or staff. They did not appear to be happy with their lot.

The older adults unit came next and there was a serious lack of comfort. Apparently, it is common for patients to rip their bed linen resulting in shortages. On occasion, there is also a lack of beds resulting in people being accommodated on mattresses on the floor. Outside there were people sleeping on the walkways but I was told this was their choice.

The female ward did actually have people walking around, one of whom stopped me and asked for my help to get out of there as she was physically ill not mentally ill. She was led away by staff. As the forensic unit is run by staff from the correctional services I was unable to visit there but I was shown the occupational therapy building which was largely unused as there was no OT.

I finished my tour and spoke once again with the Director. We have agreed to meet tomorrow to discuss how we can help support the service improvements and the roll-out of mhGap.

30th January 2018

Today started with a journey our to the suburbs to meet Me Phomolo Mohapolo who is the Lesotho representative for REPSSI. Their focus is on teaching caregivers skills to develop the wellbeing of children. With the epidemic of HIV/AIDS in Lesotho many families are missing key caregiving generations and the burden often falls on older children who then need the support of teachers, social workers and other supportive professionals. Getting this right is essential to help the children grow into resilient adults and is a key preventative measure with regards to mental health. Hence we were meeting to explore ways in which we might work together.

Some estimate that 25% of the Lesotho population are HIV positive and there is much focus on people knowing their “status”. There is also a huge problem with TB in some areas although apparently for the herd boys who tend their flocks in the field two of the greatest dangers are still lightning and snakes.

Kick 4 Life

At lunch I decided to test the Rotary claim to be an organisation of international fellowship and went along to a meeting of the Maseru Rotary Club. True to the traditions of the organisation they were extremely welcoming and President Robert gave me a lift back to the B&B at the end of the meal. The Club meet at the Kick4Life Centre. A Conference Centre, Hotel and Restaurant combined with sports facilities. The whole place is run by people from disadvantaged background and the restaurant is called No.7. I am not sure whether there is an official link with Janie Olivers scheme of the same name in the UK but there are similar successes. The venture was started to help with the HIV/AIDS situation and plays a key role in the health education for the community. It wasn’t until I was leaving that I realised that much of the hotel had been realised by the Rotary Club themselves in partnership with a club in Ohio as part of the Rotary International Global Grants Scheme. I was humbled by what they have achieved.

On returning to the B&B I decided a little exercise was needed so I called David and we went for a walk. Our meandering took us past the Prime Minster’s house which, as you can see from the picture is quite something to behold. The juxtaposition between that and the poorly built dwellings people live in just across the road is quite something to behold.

The day has finished with the most spectacular storm which has knocked out the electricity. No sooner was it off than there was a gentle tap at my bedroom door and there was one of the staff with a lighted candle for me. I write this blog by candle light.

29th January 2018

Today I started the placement proper. I met Manyanye at the Dolen Cymru/Lesotho-Wales Link office and started to plan how to get to meet the people I needed to see. Lesotho is a country where they like to do things properly – in some ways. Most professionals will not speak to you unless you have spoken to their superiors and got their permission. So the first task was to speak to Mme Lethema, the Director of Mental Health for Lesotho. In order to get her number to achieve this Manyanye phoned her husband to get her number. She answered Manyanye’s call and although I have no idea what the discussion entailed as it was in Sethoto she agreed to see me that afternoon. This was a bit of a surprise as if you tried to organise a similar meeting in Wales you would be lucky to get an appointment in the next month. Its not what you know, it seems.

The meeting was at the Department of Health in Maseru. Once we had tracked Mme Lehema down and introduced ourselves to each other she kindly started to explain the mental health system in Lesotho. For many people the first port of call when there is a problem is to visit the traditional healer/diviner and the chief. Before I left Wales I was informed by a very erudite gentleman that traditionally the Basotho has two allegiances. The first is to their local community and the second is to their “clan”. Only if this approach does not bring results will the individual and their family seek help from “western” medicine and even then they will continue with traditional treatments alongside the western ones. As a result the government run health system has to take tis into account.

The mental health system has four levels and starts with the Village Health Worker, a volunteer with some training who supports their local village. When the problem is beyond their competencies, the person is referred to the local clinic, which is staffed by general nurses. These in turn feed district hospitals which have a broader range of staff including a Community Psychiatric Nurse (CPN). District hospitals have local observation units for people mental health issues in which there are 6 beds for men and 6 for women. There are 10 district hospital in Lesotho making 120 “community” beds and then there are another 120 beds in the Mohlomi Psychiatric Hospital. These are divided into forensic unit, older adults unit and two adult wards.

There is much more to learn about this system and I hope and expect to learn more as the weeks go by.

Sunday 28th January

At the risk of conforming to the British stereotype I thought it was time to say something about the weather here. This morning David and I went for a walk around the local neighbourhood in the blistering heat (this is by comparison to Wales). The skies were clear and the sun was bright. About lunchtime the first clouds started to appear and now at 5 o’clock we are in the middle of a spectacular thunderstorm.

The daytime heat and the evening storm has been the pattern each day since I arrived and is fairly typical apparently. The problem is that these sharp downpours tend to run off the land and Lesotho is apparently experiencing a drought with potentially serious consequences for the harvest and the livelihood of the many subsistence farmers.

The problems are worse in Cape Town. Local news reports that due to the growing population and declining rainfall, they are expecting to run out of water in April. Amazing to think that this could be the reality in the second largest city in South Africa. Who knows what the consequences will be if it actually happens.

I must confess to being glad of the storms here. They break the heat and leave the nights pleasantly cool. I am aware however of just how lucky I am that my day to day existence is not dependent on the weather. If it did I think my life here would be much more precarious.