The TTLF Fellow is a representative of the North American organisation The Tiny Lives Foundation. Based for one year in Mokhotlong, Lesotho, the TTLF Fellow serves in an administrative support capacity for the Basotho charity TTL.
At TTL, we spend a lot of time focusing on the two crises we deal with on a daily basis: HIV/AIDS and acute malnutrition. Yet another common illness that can severely impact child health, particularly if they already suffer from one or both of the other conditions, is Tuberculosis, or TB.
Lesotho has the fourth-highest TB infection rate in the world according to the World Health Organization, in part because over 75% of the population lives in rural and difficult-to-access areas. The steep mountains and harsh weather pose significant challenges for Basotho trying to access basic health care services. People can walk up to five hours over harsh terrain just to reach the nearest medical facilities, and many patients only present to the hospital when their physical condition has deteriorated to late stages of illness. In a country that also has the third-highest HIV/AIDS infection rate worldwide, the struggle to access critical health care can have a very high cost.
TB in Lesotho is associated with HIV and AIDS co-infection, difficulty with treatment adherence, social and economic strain, limited access to treatment, and the constant threat of resistance to TB medications. For people living with HIV/AIDS, their compromised immune systems make them increasingly susceptible to the effects of TB. Government hospitals and numerous other organizations work hard to manage the high numbers of TB clients, but the scarcity of space, human resources, and supplies makes providing care an ongoing challenge.
Hospitals and clinics are not alone in this struggle – TTL also faces difficulties with infection control and maintaining the health of each child who comes into our care, especially at the Safe Home. We work with vulnerable children under five who battle acute malnutrition, HIV, overcrowding, and poverty, all of which are closely associated with TB and lower treatment success rates.
The World Health Organization reports that childhood malnutrition puts kids at greater risk for TB and exacerbates the severity of TB if it is contracted. High numbers of childhood TB are especially frustrating when you consider that most TB deaths and adverse effects are preventable with proper health care services for diagnosis and quick initiation on treatment. A lack of knowledge about infection control and when to seek medical attention is likely a contributing factor to children being exposed to other TB-positive individuals in the family and community.
The issues of space and infection control are very salient for TTL. We want to provide care for malnourished children when they are referred to the Safe Home, but do not want to expose them to a child who may be TB-positive. TTL works directly with clinics, such as the Baylor College of Medicine Children’s Clinic in Mokhotlong, to ensure that vulnerable children under-five receive prompt medical attention when presenting symptoms of respiratory illness. TTL also works closely with the Mokhotlong Government Hospital, often moving children to and from each service when it’s most appropriate. The hospital has both a pediatric ward and a designated TB ward, but the ongoing patient demands often result in overcrowding and difficulty implementing proper infection control procedures.
While we rely on our partners at the Baylor Clinic and Mokhotlong Hospital for testing and treatment, test results are rarely immediate and the child remains in need of treatment for malnourishment. Not wanting to turn children away from receiving care, TTL strives to adhere to good infection control practices in a resource-strained environment. We are committed to developing and strengthening our infection control policies and practices through the support of our local and international partners. Improving our TB infection control strategies will help ensure that we provide the best level of care possible for each tiny life.