Photo Essay: The Journey to Health Care in Rural Lesotho

Visiting one of the most remote PIH sites, a health center in Lesotho, requires a cross-country trek

Published on
January 26, 2023

The following photos and story are by Thomas Patterson, PIH photo editor.

“The government needs the helicopter,” Partners In Health (PIH) Lesotho Communications Officer Mpho Marole said, “so we’re driving there instead.”

For cross-country journeys, sometimes there’s a spare seat or two on a government helicopter heading over the Maloti Mountains to the remote villages of eastern Lesotho, but during the week in August when I was there, it was being used for training.

Map of Lesotho

More often, PIH drivers take clinicians and other staff members on this trek. So, dark-and-early one morning, Marole, PIH Lesotho Chief Medical Officer Dr. Afom Andom, PIH Lesotho Director of Policy and Partnerships Danielle Sharp, Videographer Caitlin Kleiboer, Driver Matlosa Phakisi, and I piled into a PIH truck and headed east out of the capital, Maseru, up into the mountains on one of the country’s few paved highways. 

Moon over a mountain

Lesotho is a small, landlocked country surrounded by South Africa, with a population of about 2.2 million. Our destination, PIH-supported Lebakeng Health Center, is only 130 or so miles away as the crow flies. But due to winding, washed out, boulder-strewn mountain roads, and the unpredictable nature of waiting for a hand-rowed ferry across the Senqu River, we expected the journey to take four or five hours. Lebakeng Health Center is one of seven small but vital sites offering comprehensive health care in a joint program with Lesotho’s Ministry of Health called the Rural Health Initiative. 

A rural village

Our first pit stop was at a lodge in Semonkong, in the center of the country, high in the mountains. Semonkong means “site of smoke” in Sesotho, the local language, deriving its name from the mist of the famous Maletsunyane Falls nearby. Unfortunately, viewing the waterfall itself requires a half-hour hike from the lodge, and we were in such a hurry to cross the country with enough light left in the day that we had no time for tourism. As Lesotho is in the Southern Hemisphere, August days are rather short.

A river running through a rural mountain area.

The Maletsunyane River at Semonkong, above Maletsunyane Falls.

Two people speaking to each other through car windows.

Heading back down the mountain from Lebakeng, PIH Driver Tumisang Lekobane pulls over to let our vehicle pass.

A road through a mountainside.

The journey includes this mountainside road near the Senqu River.
 

A jack-knifed truck completely blocks the highway.

A jack-knifed truck completely blocks the highway on a hairpin turn, which required some tricky off-roading to continue on our way.

After an hours-long final stretch over rock-strewn, deeply rutted roads, we reached the Senqu River. On the shore we met Mahase, a PIH employee, who helped us into his boat and rowed us to the other side, as he did all travelers who sought health care at Lebakeng Health Center.

A man wearing an orange PIH mask rows a boat with a passenger wearing a blue jacket..

Wearing a PIH mask, Mahase rows Andom across the Senqu River.
 

Seven people in a boat landing on the side of the Senqu River.

A PIH-supported boat ride over the Senqu River.

​​​​​​From there, a steep hike up out of the canyon and onto a narrow ridge where the health center and adjoining airstrip lay.

Three people seen hiking on the side of a mountain.

Andom and Kleiboer on the hike up to Lebakeng.
 

Ground-mounted solar panels near Lebakeng Health Center.

An array of ground-mount solar panels provide power to Lebakeng Health Center

A woman in a long black coat standing near a stone building with mountains in the background.

Nurse-in-charge Maleshoane Seleke.
 

All told, our journey from Maseru to Lebakeng Health Center took more than seven-and-a-half hours. Whereas we had (mostly) motorized transportation to take us to Lebakeng, many of the patients we met there were mothers who had also spent hours traveling that morning, but on their own two feet, babies on backs, to get pediatric checkups for their children.

A doctor examines a baby held by its mother.

Nurse Mohlomi Maputle conducts a pediatric checkup

A nurse performs a check-up on two babies held by their mother.

Nurse-in-charge Maleshoane Seleke conducts a pediatric checkup for Mohliehi Mohlalisi’s twin babies.

Twin babies laying on a doctor's exam table

Other people had traveled a long way to access health care at Lebakeng as well, for a variety of needs. In an area of rural Lesotho that truly feels like a medical desert, Lebakeng Health Center provides an oasis, a small community of accompaniment, with services from obstetrics to radiology, all in one place.

A man in a red hat wearing a mask and blanket has his blood drawn.

L. Majake, an 18-year-old herder, gets an HIV test and a medical checkup before attending school.

A patient receives an x-ray with a new portable machine.

Tsepo Tamorene helps a patient receive an x-ray with the new portable machine at Lebakeng.

Chickens walk the grounds at Lebakeng.

Chickens walk the grounds at Lebakeng.
 

After a long afternoon meeting with patients and the clinicians serving them, we hiked down the hill, rowed back over the river and drove to the border town of Qacha’s Nek to spend the night. The next day we drove a few hours to Nkau Health Center, another clinic in the Rural Health Initiative.

Sunset clouds over the Senqu River canyon at dusk.

Sunset clouds over the Senqu River canyon at dusk.