Lesotho, a mini-model of African democracy!
That’s what I trumpeted two years ago, when reporting the great political achievement scored by the ethnic Basotho of Lesotho. In the latest test of democracy in Africa, Basotho political elites produced their first elections without violence, then carried out a peaceful handover of power—a first for southern Africa.
Today, though, this beacon of democracy flickers dimly. Amid the jockeying for power, some whisper of a coup. Even South Africa—which surrounds “The Mountain Kingdom” and sent in soldiers before—warned Lesotho to cool tensions.
But all this gamesmanship obscures the real crisis in Basotho: health. Indeed, while the politicians fiddle, Rome burns. (Or, if in Lesotho, Roma burns.)
The 1.8 million souls who dwell in Lesotho rank, by virtually every health indicator, among the sickliest on the entire planet—as I’ve learned first-hand while preaching the virtues of Health Journalism in-country over the past two years.
For starters, Lesotho suffers an HIV infection-rate of 23 percent, a tragedy that has touched and traumatized every Basotho family. During my time here, I’ve consistently cited Lesotho as suffering “the world’s third-highest rate” of HIV infection among those within the most sexually active ages: 15 to 49 years old.
Yet while lawmakers play politics, Lesotho quietly achieved a bit of notoriety: the UN agency, UNAIDS, elevated Lesotho from third to second place. Lesotho now ranks behind only Swaziland, the neighborhood’s other isolated mountain kingdom.
Curiously, Lesotho’s new ranking isn’t because the infection rate has risen.
In fact, foreign activists I know here grumble that despite their help, the 23-percent figure hasn’t budged in a decade, despite aid that likely tops US$1 billion. U.S. agencies alone have given hundreds of millions in recent years—to a country that 99 percent of American taxpayers have likely never heard of.
Instead, the new UNAIDS rank is because Botswana, long entrenched in second place, has dropped to third. That’s right, my dear Basotho. The Botswanans, with whom you share much in common, are fighting HIV … and making progress!
As someone who has grown so fond of my Basotho brethren, I can’t help but vent. I’ve also been inspired to speak up by The Trouble With Africa: Why Foreign Aid Isn’t Working, written by former World Bank spokesman and old Africa hand Robert Calderisi, whose critique of the continent is borne of deep affection for it. His willingness to speak truth to power drives me, too, toward straight-talk with my Basotho friends.
With that, I respectfully challenge any Basotho leader—whose own families have surely not been immune to HIV—to claim that any of their political squabbles is more important than striving to reduce the rate of new infections down to zero.
Saturday continues to be funeral-day in Lesotho. UNICEF estimates that nearly 10 percent of the entire population are HIV orphans. In a tiny country of just 1.8 million, the 25,000 new HIV cases reported last year is a staggering figure. That’s nearly 70 new victims—and affected families—per day. Or about three per hour.
If you ask the Basotho, though, many wave their hands dismissively. Yeah, yeah. We’ve heard about HIV, for years. Enough of that. Let’s discuss something else.
I wonder, though: if the international community had never intervened—especially with the flow of free antiretroviral treatments (ARTs)—would this quirky African nation be on the road to extinction, their survival threatened by a preventable disease, in the 21st century?
When a proud people with a long survivalist tradition is now so utterly dependent on outsider-assistance, you’d hope it would focus its national priorities.
Unfortunately, an accomplice in these misplaced priorities are my cowed colleagues in the media. I’ve debated this point with quite a few Basotho reporters and editors, so I know how many of them. Fearing for their own job security, they breathlessly (if haphazardly) report the latest political intrigue—as if it matters.
Knowing how tough it is for many journalists to eke out a living here, I suppose it’s too much to expect a courageous editor to publish a blank front-page in protest. Or, publish a feature story that explores a vital health or development issue on the front page, and relegates less life-or-death matters like politics to an inside page. Just to send a message of what you believe the nation’s priorities ought to be.
But denial in dealing with the health crisis runs just as deep within the media. Look no further than the two leading weeklies in Lesotho, a country that lacks a daily newspaper. (Radio Lesotho, the primary source for information, reaches across the mountains.)
Take a look at the websites for The Lesotho Times and The Public Eye. What catches my attention—and boils my blood—are the categories. Like most normal papers around the world, we see: news, politics, business, entertainment, sports.
Except that Lesotho is absolutely not a “normal” country.
High in the mountains of southern Africa, these folks endured centuries of feast and famine before the HIV plague arrived on their doorstep in 1986. It’s true: the infection wasn’t the Basotho's “fault.” But naiveté, denial and inaction nationwide saw HIV soar to 40 and 50 percent in some villages.
The situation grew so bleak, Lesotho’s King Letsie declared HIV a “national disaster” in 2003. Culturally, his pronouncement should’ve signaled to all Basotho leaders—from national lawmakers to village chiefs—it was time to tackle HIV.
A decade later, though?
Average life expectancy for men and women has plummeted to just 40 years old—the fourth-lowest in the world—according to the World Health Organization. Lesotho happens to be the only “lower middle-income” country at the top of this list, while the others are “low income.” With that, it’s not unreasonable to conclude: When it comes to combating HIV, no state has done less with more than Lesotho.
Even beyond HIV, the UN estimates up to 50 percent of all Basotho children under age 5 suffer malnutrition, which stunts their body, their brain, and their potential productivity. Some villages endure up to 50 percent malnutrition, as the World Food Program provides extra food to most Basotho schoolchildren. In a country where 75 percent of all homes are without electricity, Basotho in mountain hamlets typically travel hours by foot, horse, donkey or wheelbarrow to the nearest health clinic.
Meanwhile, of all the young, able-bodied, even university-educated Basotho I know, more are looking for work than actually hold a decent-paying job.
Returning to the Basotho media, then. With so many families struggling to cope with care for ailing loved ones—compounded by the daily grind of a hand-to-mouth economic existence—why the heck don’t they focus on issues affecting real people?
Why is there no Health section? Or Development section? Or, a combined Health and Development section? Nothing of the sort exists in the Lesotho media. (My great frustration here has been my failure to raise funds and create one.) Health and development feed each other, symbiotically, conspiring to hold this nation back and prevent progress.
Denial is a dangerous game. Any leader who refuses the reality may have “blood on their hands,” as many HIV-positive Basotho mothers continue to transmit the infection to their unborn baby. Why is that not atop anyone’s political agenda?
While you talk politics, the silent assassins of HIV, TB and others are among you, crippling, if not killing, your Basotho brothers and sisters. Even within your own family. Yet you refuse to confront them? You refuse to fight back? The Botswanans are fighting back, and they are making progress.
In late May, while on assignment for Columbia University’s global-health NGO, ICAP, I observed a meeting of the Lesotho Parliament’s Committee on HIV and AIDS, as a dozen Basotho lawmakers reacted to the news they’d been leap-frogged by Botswana. This was followed by some eye-popping figures from the Lesotho Ministry of Health’s 2009 survey: only 42% of Basotho women, and 24% of men, even knew their HIV status; just one in five men and women between the high-risk ages of 15 to 49 had received an HIV test during the previous 12 months.
“The tone is desperate, the numbers are scary,” responded the committee’s Acting Chairwoman, Makhojane Monyane. “We are aware that as Parliamentarians, we have a chance to turn this around.”
Actions will speak louder than words. The Basotho cry out for leaders who advocate for the desperately needed behavioral change in sexual health. Enough of the taboos about sex, and stigmatization of those infected—or seeking to protect themselves from infection. Too many Basotho suffer in silence. Why is HIV still not treated like the “national disaster” it is? Where is the emergency response this crisis deserves? Where are Basotho leaders who could be leading by word and deed?
In New Zealand, it turns out. That’s where The Commonwealth flew coalition leaders—half a world away to hone their better-governance skills.
Fine. Now that they’ve returned home to Lesotho, may I suggest a second road-trip? Much closer to home? To Botswana, to learn what steps those leaders have taken to truly improve the health of their people.
Draw inspiration. Then, act. Quickly. Your nation needs you.
(The photographs accompanying this article were taken by the author.)
Africa, Apartheid, Health Care, Lesotho, Politics, South Africa