The Kingdom in the Sky

Lesotho is a tiny country completely surrounded, island-like, by South Africa. This is the home of the Basotho people. The country came into being when the Basotho were forced to flee from two advancing groups – the Zulus and the Boers. They took refuge in the Drakensberg and Maluti mountains, and under the “protection” of the British remained independent of South Africa.

Lesotho is incredibly beautiful, and the proud, distinct, and traditional Basotho people are welcoming, friendly and generous. Sadly this is also one of the most impoverished countries in Africa, and has one of the highest HIV rates in terms of both prevalence and death, with almost one-third of the population living with the virus. Life expectancy here has plummeted to 35 years, and for most, life is hard; subsistence farming on a background of drought is the challenge for the majority of people in Lesotho.

When I was driving through the mountains here, I was struck by the number of tiny villages, with numerous mud and thatch rondavels and little brick houses. Herd boys are to be seen everywhere. Typically in their early teens, they tend to a handful of thin-looking cattle, occasionally sheep or goats, making sure their animals don’t stray onto roads or field crops. One of the beautiful things about Lesotho is the lack of fences. Use of land is agreed through the local Chief. This abundance of little villages and herd boys working on the hills is in stark contrast to the hills of my own homeland, Scotland. I guess 200 years ago, the Highlands of Scotland would have had just as many settlements and subsistence farmers – crofters in Scotland – before the Highland Clearances. This was when the people were forced off their land by Scottish and English land owners who felt that sheep farming would be more profitable than the small rent they were able charge the crofters. These displaced people formed the Scottish Diaspora, explaining why there are so many Scottish surnames in Southern Africa.

I travelled to Maluti hospital in the North of Lesotho with Masimone Phokojoe and Tlali Mosola from the Priority Support Programme. PSP is working with the Ministry of Agriculture training staff in horticulture techniques which individuals can adopt at their own homes. One of these techniques is keyhole farming. Here, waste rubble from brick building is used to form a small circular raised bed, with a straw centre through which grey water is used for irrigation. These small beds are easy to maintain, and can be surprisingly productive. Vegetables and herbs are grown along with plants chosen to repel pests. Rainwater is collected from roofs. What I particularly liked about this project is that it is cheap – recycled products are used – and easy to maintain. A person unwell with HIV would still be able to tend the keyhole garden. Also, the trainers discuss nutrition at the same time as gardening techniques. People are advised to vary their intake of vegetables – eat different coloured produce, and to have some legumes for protein.

PSP works closely with a gardening project sited within the hospital itself. When I was at Maluti I was impressed by the number of patients and local people coming to pick vegetables or buy seedlings to grow in their own plots.

Vitamins and minerals are vital for a strong immune system. This is one of the reasons why all dietitians and nutritionists often sound like a stuck record repeating the mantra: eat plenty of fruit and vegetables. But this is an area with perhaps one of the strongest research bases. Five portions of fruit and vegetables daily protects us from a whole host of illnesses, and provides the essential vitamins and minerals the immune system needs.

I’ll take time to repeat a message from an earlier post: ARVs control HIV, but do not directly affect the immune system. Good nutrition is needed along with ARVs to facilitate immune reconstitution. In Lesotho, many people rely on food donated by aid programmes such as the World Food Programme. Others struggle to afford to buy basic food items, let alone relatively expensive fruits and vegetables. Home gardening is an integral part of a holistic approach to improving the nutritional status of people living with HIV. I hope to discuss this more in a future post.