First day at work!
Ever welcoming and refreshing with its fortified mountainous air, Lesotho has proven to be every bit as charming as one could hope for. The people we have met in the last 24 hours have been courteous and hospitable, jolly, funny, intelligent, and with character carried every bit as cooly and breezy as the rolling hills around us. We've already learned quite a bit (including the South African/Lesotho handshake; apparently that's a thing). How much they will learn from us? That has yet to be seen. This morning we awoke refreshed, ready and excited to begin our first full day at the Maluti Adventist College. After showering and gathering ourselves, we made our way from the small guest house cottage that we will affectionately refer to as 'home' for the next three weeks and to the cafeteria located in the same building as the student dorms just a short walk away. Every meal so far has been prepared specially for us as guests of the college, and breakfast was no exception. However, we soon realized, being a Adventist institution, our breakfast would not include caffeinated beverages. We were joined by a married couple, a doctor and nurse duo from John Hopkins University, who were visiting Maluti to decide if this could be a place they would like to live and work, potentially raising a family here in the near future. They had visited two other hospitals that they were also considering during their trip, but Maluti would be the last hospital they would visit before returning to the States. Of the hospitals they visited thus far, Maluti seemed to be their favorite. When asked about details of the hospital and what areas they saw for needing improvement, the doctor told us that the hospital lacked basic laboratory testing to conduct routine ABG's and blood work. However, and what is most disheartening, this is not due to not having the equipment to perform simple CBC's and electrolyte monitoring for patients, it just comes down to a matter of money and the hospital not having enough financial backing to provide needed medical tests that could prevent medical emergencies and complications, as well as aid in diagnosis. The government of Lesotho covers a portion of medical costs but this cost is marginal, less then 1.50 US$ per visit we were told, and does not cover additional fees; medications, tests, procedures, and overhead costs. And so for the majority of people here, as most are uninsured in Lesotho, the cost can be too great to get the care they need.
Following breakfast, we met with nursing faculty from the college and two nurses who work directly for NEPI (Nursing Education Partnership Initiative) and ICAP (formally known as the International Center for AIDS Care and Treatment Programs through Columbia University) who had made the trip from Maseru to Mapoteng to meet with us and explain a bit about the NEPI program and program initiatives. A masters student from Columbia University also made the trip with them; Mary would be staying and working with them for the summer while she worked on her public health degree. Aside from grand introductions and a warm welcome, some key themes of the meeting focused around the shortage of nurses in Lesotho who are the primary source of healthcare in Lesotho as there are even far fewer physicians. Most nurses end up working alone in rural settings serving as the primary source of healthcare for the vast majority of the Lesotho people. The World Health Organization recommends that at a minimum, there should be at least 2 nurses for every 1,000 populace and currently in Lesotho, there is about 1 nurse per 2,000 people. With a population of about 1.8 million, the goal is to prepare and maintain around 3,600 qualified nurses to meet the medical needs of communities here.
After wrapping up our meeting with a prayer and group photo, we broke for lunch. Among other things, we discussed psychiatric nursing research that one of the nursing professors had conducted and published in 2007. Dr. Corless will be reading this publication, and the two hope to discuss the question of future research depending on what has been published in the literature on the topic since her original publication. We wrapped up our lunch with one of the nursing professors sharing a story from her early days of nursing where she worked in the rural mountains of Lesotho, in a place where there were no bridges or roads to get in and out, and one had to either ride horseback or drive off roading in a jeep to get to a larger town or city. One day, she told us, she left with a driver to obtain medications for her clinic when they came upon a river and were forced to try to cross. The waters were higher than normal she told us because it was following the snow melting in the mountains. About half way through, the waters intensified and suddenly they were trapped, submerged in water. They survived by rolling down their windows a quarter of the way so they could get out as water gushed in. Luckily, she told us, there were villagers on the banks of the river who had ropes and were able to tie the ropes together to reach them and pull them out. “Nowadays, there are roads and bridges.” We were informed after she finished her story. “And cell phones.”