Lesotho, Day 5: A Little Bit of Free Time

Today I had something I very rarely have on these short overseas missions: a completely free day.

                

I slept in a little bit (translation: to 7, which is two hours later when I was getting up all week) and since I had already decided that I was going to go hiking this morning, got to take my time getting ready for breakfast, without having to worry about going running or hitting the gym or anything. I had breakfast with my team members and then we said our good-byes, since they were planning on leaving for the airport at noon and I was planning on still being hiking.

                

I had my eye set on the hill overlooking the Pope John Paul II stage (where he gave a sermon at some point in the 80’s), and I thought it would take all day. However, it was actually pretty easy to find the trail created by a whole bunch of cattle herders leading their cattle up and down the hill, and I found myself on the top of the hill (elevation >6000 ft) after only about an hour or so, less than three miles of hiking. I explored the top for a bit, but it was cold and windy, so I didn’t want to make a whole day of it. I tried to go down a different path than the one I went up, but I kept losing sight of the cow trails, so I just gave up and went back up to the top and then headed back the way I had come up. In all, it was a little under seven miles. I would have gone longer, since it was noon when I got back, but I discovered that that kind of hiking in combat boots doesn’t really work. My heels are pretty torn up from the experience.

Starting out on my hike

Up at the top

From the top

Another picture from the top

The Pope John Paul II stage, from the top of the hill

                

The rest of my team didn’t get picked up until 2, so we had a couple of hours after I got back to talk shop (and things completely unrelated to work), and when they took off, I grabbed lunch and then settled in to finishing what I needed to of this mission before leaving for the next. After sending off my reports and whatnot, I returned to my book and read that until it was over.

                

All in all, a pretty relaxing day. Tomorrow I have the morning to myself, and then I begin the continent-hopping flights that will take me from Maseru to Kinshasa, landing around 10 am on Sunday. With any luck, my entertainment system(s) will actually be working. 

Lesotho, Day 4: Last Day of Work

This was the last day of meetings in Lesotho, which is good, because I’m about meeting-ed out.

                

I decided to get an extra half hour of sleep this morning, and did 30 minutes on the stationary bike in the gym instead of going for a run. It’s not a bad gym—it has a few treadmills, ellipticals, and bikes, as well as weights and whatnot—but I’ll always prefer working out in the real world to doing something in the gym. It’s been a while since I was on a bike, though, so I probably needed it.

                

We got our first surprise of the day when Mo came to pick us up at 8, telling us we had a meeting at 8:15 with Christian Health Association of Lesotho (CHAL), the largest health NGO in the country. He says he told us about this yesterday, but nobody had any recollection of this and we really weren’t dressed appropriately; I was in khakis and a shirt (with my boots on) and our exercise planner was in jeans and a sweater. He changed into a suit and tie; I didn’t realize what was going on and stuck with my attire. Anyway, we ended up late, but that was fine (African Standard Time…). We explained the exercise with the representative and invited any nurses or doctors to give or come to academic sessions. She seemed very interested and said she would get with some of her people to see if anyone wanted to talk. Seems positive.

Site of our meetings

After that, we went out to Maruja, which was where the first Huguenot missionaries came. They have a museum about the history of Lesotho, and we were scoping it out for a potential cultural day activity. During the MEDRETEs, there’s usually a day during the weekend to “experience the culture” of the host nation. This should really be changed to “tourist day”, because it’s really about being a tourist. There’s usually a market involved and everything. Anyway, we went to this museum, which explained the history of Lesotho from the big bang on (skipping large chunks of time, obviously). It was pretty interesting, but I’m not sure how much it would be enjoyed by the people on the mission. I guess we’ll find out.

Replica huts at the museum

             

We had one final meeting of the day at 1600, with PEPFAR. We told them about the mission and asked them if they would be willing to give some academics, and not only did they say that they would be, but they also gave us the names of more NGOs that they would put us in contact with. It was pretty much a win-win, and a productive meeting.

                

The rest of the team is flying back tomorrow, and I’m not leaving for Kinshasa (by way of Nairobi) until Saturday, so I have the day to myself tomorrow. I’m thinking I’m going to go hiking. One of the guys at the Embassy said that there are plenty of hiking trails to try that are right around the hotel, so I figure, why not? 

Lesotho, Day 3: Finalizing Plans

Today was my first 9/11 out of the States, and I definitely noticed the difference. While my Facebook account was covered in cries to ‘Never Forget’ (referring to not only 9/11/01, but also the events in Libya last year), I was in meetings in a country on the other side of the globe, the date having no more meaning for them than the 4^th of July or Thanksgiving. There were no moments of silence, no news broadcasters replaying the events of twelve years ago, no American flags being waved from street corners. And that was fine. In a time when everything is always broadcast and always recorded, it was nice to have a day to when all I had to worry about was what the anniversary meant for me, not for anybody else.

                

And now back to Lesotho… As I did yesterday, I got up early to go running, trying a different route this time. Since they warned us about going around town when it’s dark out (and the sun doesn’t rise until about 6:30 around here, when I’m pretty much done from my run), I’ve been staying away from the “town” parts of the roads, which doesn’t leave a whole lot, and all of it pretty steep. Looking at my elevation chart after my run, I ascended 300 feet in less than half a mile. No wonder I had to walk up some of it.

Elevation map

The entire morning was spent at Makoanyane Military Hospital, getting the more in-depth tour (which allowed me time to ask questions to refine the mission plans) as well as the tour of the Thomas Wellness Center, the PEPFAR (President’s Emergency Program For AIDS Relief) funded clinic that focuses on HIV/AIDS prevention and treatment. After the tours, we sat down and hammered out plans. My original thought was for four doctors and two Public Health nurses, the four doctors being two infectious disease specialists (one adult, one pediatric), me (preventive medicine), and family medicine. My thinking for family medicine was because of how much obstetrics work they do, in terms of the prevention of maternal to child transmission of HIV (PMTCT) treatment of pregnant and breastfeeding women and whatnot. However, when I explained my plan, they asked, “Can we get an obstetrician?”

Thomas Wellness Center

                

Hmm. Get an obstetrician for obstetrics work. Who would have thought?

                

So we changed the family practitioner to obstetrics, hammered out the rest of the details, and then broke around 1200. Mo, our Embassy contact (he’s Basotho, and like all Basotho, no American can pronounce his name, so it got shortened to ‘Mo’) drove us out to the site where the Basotho tribe made their stand against pretty much anyone who tried to invade, a large steppe with only one path up (in other words, easily defended). We took some pictures and bought some miniature souvenir woven hats (the national symbol of Lesotho) and then headed to Kick For Life, an NGO run by FIFA (soccer people), which has a good cook. Sure enough, the lunch was pretty good, for being European-type food served in Africa.

The rock

Lesotho hat

                

We headed back to the hotel after lunch, where I quickly sent of my justifications for mission personnel to the person in charge of manning the mission, and then settled in to do nothing but read a book for the remainder of the afternoon. I had grand plans of going to the gym to get on the stationary bike, but that just didn’t happen. Oh, well. Maybe tomorrow. In the meantime, I’m going to continue sitting at the bar, sipping cheap red wine while playing on the computer and pretending to watch the rugby game on TV.

Lesotho, Day 2: Let the Work Begin

Today was the first day of the PDSS, and busy. I started the day with a run, which was pretty difficult considering the elevation and the fact that the hotel is located on a pretty substantial hill. I didn’t manage three miles, but I was happy(ish) with what I did get done, considering the factors at play.

                

Our first meeting for the day was with the Chief of Staff of Operations of the Lesotho Defense Force, a two-star general. He had with him three one-star generals, so it was quite the meeting. We explained the mission—we’re going to be pairing up one-on-one with Lesotho Defense Force doctors, seeing patients in the mornings and doing clinicals in the afternoon, the same pattern as the DRC MEDRETE. They were under the impression that this was going to be a much larger mission, so we knew from there that we were going to be fighting an uphill battle. They did eventually figure out what we were talking about and agreed that it sounded like a good mission.

View of the Barracks from the road

As if that wasn’t enough high-powered people in one room, the second meeting of the day was with the Principal Secretary of the Ministry of Defense, where we again explained the mission and he did a lot of head nodding and thanked us for our support. Then we went to the military hospital—the only military hospital in all of Lesotho—to talk to the hospital commander (lieutenant colonel) and some nurses and the only two doctors in all of the Lesotho Defense Force (it’s a small country…). We again explained the mission, they told us what the hospital needs—which is mostly stuff, which we can’t provide—and we went on a quick tour. We’re supposed to get more of a tour tomorrow.

Makoanyane Military Hospital

                

After lunch, we headed over to the Ministry of Health, to meet with the Principal Secretary there. When we told him what we were looking for—which is pretty much for them to participate in the academic session of the exercise—he quickly found people for us to talk to, and came back with the head of the programs for TB/HIV, Integrated Disease Surveillance and Response, and International Health Regulations. In other words, exactly who we needed to talk to. We explained our plan, they agreed to participate in academics, and committed to at least six hours of lectures, in order to make sure the LDF doctors know about the national programs for disease surveillance, TB, HIV, and STDs. Success!

                

Throughout the entire day, the civilian on the survey who’s in charge of the security survey spent the entire time complaining about how boring the medical meetings are and how they have nothing to do with him. I didn’t say anything, but I wanted to tell him that when he’s going on a pre-deployment site survey for a medical mission, there might be one or two meetings about, I don’t know… medical stuff? It was frustrating, but he was fairly easy to ignore.

                

In all, late night (it’s 9:35 and I’m exhausted), and my allergies are killing me. I forgot to take into account that it’s spring in Lesotho, and spring is when my allergies are the worst. Ugh. Fortunately, it’s easy to buy medications here, so I bought some generic Zyrtec (what I take at home), and hopefully will be feeling better tomorrow.

Local allergy meds. A lifesaver.

              

And now, time to go to bed, so I can go to more meetings tomorrow.

Lesotho, Day 1: South Africa and Traveling

Today was another day of traveling and exploring and seeing new places, which is always a good thing. I started the day early and went for a three mile run in the residential area around my hotel, and by the end, I could definitely feel the altitude, compared to the 10 feet above sea level I’m used to in Savannah. It’s going to be interesting tomorrow, when I’m even higher in Maseru.

Fountain seen on the run

Unfortunately, there wasn’t enough time to go on an organized tour of Johannesburg and still make it to the airport in time for my flight, so I opted to go to the airport, check in, and then get on the train and go to Sandton, which is a shopping-type area. If there’s one thing I’ve learned about international travel to developing countries, it’s that there’s always someone at the airport will to “help”, who expects a tip at the end. Sure enough, almost as soon as I walked through the doors, a man came up and offered to help, directing me to the counter and taking my bag before I could really even protest. After I checked my luggage, he asked what next, and I said I needed to go the ATM, so he took me directly there. Then he took me to the “Bag Port” (luggage storage) so I could drop off my backpack, and then took me to the train station and showed me how to buy a card for the train.

                

Yeah, he earned his tip.

                

Sandton wasn’t really all that exciting. I was hoping Nelson Mandela Square would be a historic-type thing, but no. It’s a mall. So I wandered around for a bit, bought some souvenirs, and then found myself at the Peacemakers’ Museum. It’s very small, maybe the size of a normal store in the mall, and all about Nobel Peace Prize recipients (obviously with more emphasis put on the three South Africans). If there was one thing I learned from reading the reasons why people were awarded the Peace Prize, it’s more about the hopes and wishes of what the Norwegians want to happen than anything that had actually resulted in peace. Some people had done legitimately good things that made the world a better place (ending apartheid was no small feat), but others—like “ending the Vietnam war” (in 1973) or “peace in Israel” (hmm…)—were more of what the military calls “Good Idea Fairies” than any real accomplishments.

Normal Borlaug's speech

Nelson Mendela inside the Peace Maker's museum

Anyway, after that, I headed back to the airport, hung out in the South African Airways lounge for a bit (ah, the life of a Star Alliance Gold member…) and then met up with the three others in my group before our flight to Maseru. The flight was short—less than an hour—and then we were at the airport, where I experienced the fasted trip through customs and immigration known to man. To give you an idea, there were so few people and the plane was so small that they brought the luggage from the plane in a cart, and set it on the carousel (which I’m pretty sure is defunct).  

Baggage claim

                

Our driver gave us the brief history of Lesotho as he drove us to the hotel, so I had to ask why it existed in the middle of South Africa. He informed us that during the Boer Wars, King Moshoeshoe I requested protection from the British Empire, and became a British protectorate (not a colony, as he corrected me). Everything else in the area became British colonies, and then became South Africa. So now South Africa is very diverse, in terms of tribes and ethnicities, and Lesotho remained almost entirely Basotho (the demonym of people who live in Lesotho) with everyone speaking Sesotho. English is the official language, though.

                

After we arrived at the hotel (which is quite nice), we were joined by Mo, from the Embassy, who went over the agenda for the week. It looks like a busy day of meetings tomorrow, and then things will taper off from there.

Sunset from the Lesotho Sun

             

We shall see… 

Democratic Republic of Congo, Day 4

This was our last morning in Muanda, which was a good thing. I was getting a bit tired of that place (which is probably going to make it hard to go back in June…). I did finally get to go running, though; the Defense Intelligence Agency (DIA) major went running yesterday morning, so I asked him if I could go running with him today. We did about 3 miles in 30 minutes, which wasn’t bad, considering the heat, humidity, and poor conditions of the road. I’m excited about getting to go running along the Congo River in Kinshasa tomorrow morning (even though it’ll be early).

The main road in Muanda and where we went running

The flight from Muanda to Kinshasa is the same plane that does the reverse trip (makes sense), which means it doesn’t leave until the afternoon, after the plane gets into Muanda and the crew gets a couple of hours to rest. So we spent the time in the morning hanging out the lobby of the hotel, with its spotty air conditioning, planning the details of the MEDRETE in June. It’s going to be four physicians—me, two adult infectious disease physicians, and one pediatrics infectious disease physician—as well as a laboratory tech who knows blood safety, and three support/security personnel from USARAF. In addition, we’ll also have five Congalese translators, because the doctors at Kitona don’t speak much (if any) English, and the American doctors probably (in my case, definitely) don’t speak much French. The Embassy has already identified two of those translators; I hope they find another three by June and that they know medical speak well enough to translate it.

In all, the mission will be 11 days, but with travel time to and from Muanda, there will only be eight days on the ground, seven of which are working days (they only have one doctor on call on Sundays and don’t see any new patients). On those days, we’ll have physicians paired up (one Congalese, one American) seeing patients as the Congalese normally do in the mornings. Then, in the afternoons, we’ll be having “summit meetings”, which will be discussions about programs that the DRC Ministry of Defense and Ministry of Health has for HIV, malaria, and TB, as well as the American doctors explaining our programs for these (well, for the ones we have programs for) and going over WHO guidelines for diagnosis and treatment. I think the lab tech will just be doing similar things with the lab personnel, in terms of teaching and learning (learning how to read malaria slides, teaching about blood safety, etc).

Finally, noon rolled around and we piled in the rental cars and headed for the Muande airport, where we again loaded a tiny little plane that stopped at the same places as on the way there before depositing us in Kinshasa. The embassy cars met us there and loaded us up to the Fleuve hotel, where we got reliable air conditioning, hot showers, and good food we didn’t have to wait three hours for. It was nice.

The Congo, from the air

Back at Ndolo airport, after spending two hours on the hottest plane in existance

The view from my 17th floor room at the Fleuve

Democratic Republic of Congo, Day 3

Today I actually got to sleep in until I woke up on my own, which is always a nice experience. Granted, I woke up on my own around 6am when breakfast wouldn’t be served until 7:30, but beggars can’t be choosers.

Because nobody had done a recon of Muanda, the town that we’re in, nor had I heard from anyone how safe it is/isn’t, I didn’t plan on going for a run in the morning (and it’s never a really good idea for a white woman to be running through the streets of Africa by herself), which was too bad, because one of the majors ended up going for run at 6, right around the time that I was awake anyway. Oh, well. We’re already planning on going running together tomorrow.

After breakfast, the day started by driving to Kitona Base. Our first meeting was with the deputy base commander and commander of the infantry, a brigadier general (one star). He claimed to already know what we were going to be doing for the mission, but then when we brought up medical stuff, he seemed surprised and said that that was out of his lane. He proceeded to take us to the infantry school and give us a presentation there, which we calmly listened to before insisting that we go to the hospital so we can actually do what we had planned on doing.

Shiny new infantry school buildings, courtesy of EUSEC (EU military, kinda)

The hospital commander, a colonel (not sure if that’s equivalent to our colonel or lieutenant colonel; he didn’t give a card), briefly explained his hospital to us: the Hospital Militaire de Reference de Kitona is a referral hospital, a tertiary care facility for the Kitona region (the DRC equivalent of, say, Brooke Army Medical Center in Texas—not the national-level military hospital, but the largest one in the area). Unlike our military hospitals, though, the population seen by the hospital in Kitona is about 40% military and 60% military, which is pretty normal for DRC. There are four military physicians, each of which is a general practitioner, who sees patients in all four departments of the hospital—medicine, pediatrics, OB/GYN, and surgery. On Mondays, Wednesdays, Thursdays, and Saturdays, the physicians see consultations, which means two of the physicians see outpatients and two manage the wards. On Tuesdays and Fridays, two will do surgeries and the other two manage the wards. On Sundays there is one physician on call. For each patient who comes in (about 50-60/day), they will be seen by the registrar, then triaged by a nurse before being seen by the consulting physician. It actually seems to be a pretty efficient system that is working well for them.

The hospital on Kitona Base

The majority of the patients are there for infectious diseases—malaria, TB, HIV, diarrheal diseases, etc. This is actually exactly what we’re looking for, for our Medical Readiness Training Exercise  (MEDRETE) in June. The goal of the MEDRETE is to train U.S. military physicians in tropical diseases and public health, while doing good things that will (with any luck) have a lasting impact in Africa. We still have some discussing to do, as far as how many physicians we can bring on this mission, but I think it’s going to be a go. Which means I’ll be back in the DRC, at Kitona Base, in June. 

Democratic Republic of Congo, Day 2

Today started way, way too early, with my alarm going off at 4:30 so I could get ready and check out of the room a little after 5, because at 6, an embassy car came to pick us up to take us to Ndojo airport, the domestic airport in Kinshasa. We were going to Muanda to evaluate the hospital at Kitona Base.

Our chariot awaits

Not unexpectedly (as I have spent some time in the developing world), the plane that was headed toward Muanda took off late. We thought we were leaving at 9; it was closer to 10. It was a situation pretty similar to what I experienced in Papua New Guinea: one small plane (maybe 18 seats?) that made a few stops before it got to where I wanted to get off. DRC was pretty, from the air. Because there’s so little development, everything is all green and full of rainforests, without even roads to interfere with the landscape once you got away from the cities.

The view from above

It was around noon when we landed, and then we had to go through some rigamarole with the passports (why they were checking passports on a domestic flight is beyond me) and luggage, but finally we were able to step out of the grass hut that makes up the airport and into the air conditioned rental cars (complete with drivers) to take us to the hotel. Because the entire city of Muanda is lacking any real-sized hotels, our group is split up between two hotels. I think I’m in the nicer one, but that’s not saying much.

By the time we sat down for lunch (at the hotel’s restaurant), we had already missed our scheduled meeting with the commander of Kitona Base, which was pretty much all we had scheduled for the day. So instead of doing anything meaningful, we did “familiarization activities”, which consisted of scoping out restaurant where we could eat, seeing the beach (since Muanda is on the tiny stretch of Atlantic coastline that DRC has), and traveling the road from Muanda to Kitona Base. It’s a very, very bad road (“unimproved” was how I was told to describe it), and the mission planner is definitely not excited about the idea of a MEDRETE team driving that twice a day for two weeks. More if they don’t have food available on base. It was bad enough that the car I was in got a flat, which always makes for some entertaining pictures.

Fixing the flat

So that was today. Not much meaningful happened, unfortunately. Tomorrow we’re supposed to meet with the deputy base commander (word is the base commander is in the east of the country somewhere) and then visit the hospital to see if there is anything worthwhile there. Pretty much, unless they have really cool diseases and a staff that is really interested in learning about public healthy, we’re probably going to recommend that the MEDRETE not happen. Because it’s really not worth $150,000+ of the taxpayers’ dollars to go on a mission where nobody learned anything and the local Ministry of Defense couldn’t care less.

Democratic Republic of Congo, Day 1

I'm a few days late in posting, but rest assured, I did write this post on the day it should have been published (which in this case was Monday, March 11). Here it is:

After a long day of traveling yesterday, we arrived in Kinshasa around 10 pm local time. By the time we got to the hotel (which is very nice, by the way), it was almost midnight, and I went to bed right away. Because I was tired from a very long day of traveling.

My room in the Flueve Hotel

Today started by formally signing into the embassy and receiving the RSO (Regional Security Office) brief. Since it is the Democratic Republic of Congo and there are a number of security concerns, we listened carefully for anything of note. Before the mission, we received a warning of anticipated protests at the return of the defeated presidential candidate (who declares that he was actually the winner and has a following that does the same), but that didn’t happen. What we did note was that police officers are known to be corrupt, believed to be due to low pay and low training, and are to be avoided at all costs, as all they usually want from westerners is bribe money. We also learned that photography was illegal until recently, and still is in and around government facilities, and is still frowned upon, so if I don’t give very good pictures from this trip, that’s why.

The first real meeting of the day was with the AFRICOM training advisor and the Deputy Chief of Mission, where we learned that the Ministry of Defense (MOD) is not organized well, but the medical corps is better than most departments within the MOD. The key issues all revolve around logistics, because things are too expensive, too difficult to get out of Kinshasa (due to lack of roads in most of the country), and hoarding is an issue.

Following the embassy, we headed out to the MOD, where we first met with COL Kambale, the Director of Military Cooperation. He didn’t have too much to offer. The second meeting was with COL Louis Kakudji Ilunga, MD, the Deputy Surgeon General. He identified four disease surveillance programs within the MOD: malaria, HIV, TB, and cardiovascular disease. I don’t know how robust these programs are (with the exception of the HIV program, which is funded, monitored, and run by US DoD programs), but if the MEDRETE happens, these will be the areas that we focus on. Pretty much, all I learned is that their disease surveillance is low, consisting of monthly reports of disease counts. This doesn’t really mean much, because I don’t think that they follow trends or even take into account denominator data of the overall population (troops, dependents, etc) who are at risk.

The final meeting of the day was with the medical director of Clinique Kinoise, the first public hospital in DRC, built after independence in 1966. It is currently in very poor shape, with a roof with structural problems, electricity that is unreliable, and no running water. It is a 300 bed facility with 4 ORs, but there are around 3 surgeries/week, approx. 10 inpatients currently, and an average of 15 patients seen in the outpatient clinics daily. The medical director does have grand plans for the hospital, all of which would require significant donor equipment and funds, and is unlikely to be maintainable without significant outside assistance. It is unlikely that we will use this at the clinical site for the MEDRETE, because there’s really not much to see or do, with such a low patient count.

Clinique Kinoise. Lovely, isn't it? Oh, and there's no elevator, in case you were wondering.

In all, pretty long and exhausting day, and I was glad to be able to get back to the hotel to go for a run (on the treadmill) and sit by the pool to work on my sunburn (because it would be embarrassing if I returned to Savannah without any color to me).