Day 106, Thursday 14th November, Lesotho to Port Elizabeth, South Africa

We were up before the sun:

but unfortunately the airport staff were not and we had several frantic phone calls to our contact in the control tower to try and get airside and off away to Qacha’s Nek before the heat and the wind picked up!

Eventually we succeeded and took off around 6.30am local time:

with a very excited passenger in the back, the Secretary General of the Nurses Association:

The views were astonishing – really the most beautiful of all the land we had flown over so far in the trip:


We had to quickly reach a relatively high altitude of 11,000 feet so that we could safely pass the very mountainous terrain and reach Qacha’s Nek on the extreme other (Eastern) side of the country, in a flight that took only 40 minutes.

The approach was beautiful too:

but the landing a little tricky given a strong crosswind and narrow runway. I definitely breathed a sigh of relief once we were on the ground!

The Secretary-General and I left Ross with the plane and, under strict instruction to be no longer than 1 hour or we would jeopardise the arrival to next destination, jumped in a rickety taxi to the hospital just along the main street.

Although we were expected, understaffing meant that it proved difficult to bring all the maternity staff together for a meeting, and so we rather went with the matron to the labour ward to meet them!

The hospital itself was a new, red-brick double storey building, and had been built with American funding. Like the other government clinics and hospitals I had come across in Lesotho, despite a new building, functionality was not there in terms of adequate human resource and medical equipment and medications, and I had to ask myself yet again how it could be that funders could decide to build a hospital at great expense and because of huge need, but not look at its longevity in terms of function. Frustrating. Equipment and human resource were controlled centrally and not locally within each hospital, I was told.

But despite the challenges there were smiles!

I even found one nurse who had worked for several years in the North East of England!

I heard more about staffing in rural parts of Lesotho like Qacha’s Nek. Seemingly there were enough positions for midwives and doctors, but not enough practitioners to fill them because there were overall not enough practitioners and there was a preference to work in the urban areas with no incentive to work rurally. Most medical doctors, including district medical officers, were of foreign nationality and the thought was that they had less of a voice in terms of healthcare structure and management because they were not local. Nurses and midwives were having to use their own money to buy e.g. batteries to be able to use the haemacue machine that calculates a bedside haemoglobin level. Medications were a problem, as they had been in Berea. The nursery was functioning, but staffing for it was a challenge. And there was no Obstetrician/Gynaecologist, so any difficult problems had to be transferred to Maseru, either by road (5 hours through the mountains) or by air transfer if Mission Aviation/Lesotho Flying Doctors were able to help.

And so a blood pressure monitor powered electrically was very gratefully received!

These midwives and nurses were also thirsty for more interaction with their colleagues from other clinics and hospitals with more regular meetings and training sessions. There was no confidence that this would ever happen. But despite the difficulties the matron was very happy to report a very conscientious workforce, motivated to do the best they could for their patents – somewhat different to the disillusionment I had come across at Berea the day before.

Back at the plane, Ross was waiting patiently:
Such a beautiful place and a beautiful morning to sit and have to wait!

It would be a fairly short 15 minute flight along the valley to Nkau. We got airborne without difficulty – thankfully it was still early in the day with fairly low wind and temperatures:


As we approached Nkau we saw again the main East to West road, and did a flyover the runway to check its suitability for landing and the wind direction.

It was an easier landing this time!

A clinic worker came running up to us, thinking we were Mission Aviation and with some parcels to go to Maseru! Of course we would take them in due course but started our walk to the clinic first!


Outside the clinic, there were a few shops, and one rather bigger mobile phone store:
Mobile phones really are the answer…how can we use them maximally for healthcare benefit?

The clinic at Nkau was an ongoing joint venture by Partners in Health and the Lesotho Government. There were maternity, paediatric and general medical sections including TB screening with an X-Ray facility. They didn’t appear to have any staffing issues and the midwife we met had chosen to work there because the salary was better than in the pure government sector. She also didn’t have any major equipment or medication issues and felt she was able to offer a high standard of care to her patients who often trekked for 2 days and about 60 kilometres to reach the clinic from their villages.


She also worked closely with a nominated member of one of the local villages who was employed to encourage women to give birth in the clinic rather than at home, even accompanying them to the clinic if necessary. To this end, there were ‘waiting homes’ where women came to stay towards the end of their pregnancy so that when labour started they were already at the clinic:
They were all very jovial and eagerly waiting for their new babies.

And so we walked back to the ‘plane with another package of samples needing to be processed in the laboratory in Maseru:

We were soon on our way! There was a fair degree of turbulence but we didn’t have a long flight:

We were starting to watch the fuel tanks by this stage…running low but purposefully low – we had wanted to be as light as possible for these tricky flights.

The bad news was that as we landed and requested refuelling we were told there was no fuel! Oh dear, time for plan B. But was there a plan B?!!

We asked the help of one of the charter companies operating out of Moshoeshoe International but they couldn’t/didn’t want to help. And so it was time to ask the military! After some slightly nerve-wracking conversations they agreed to help; their airport was on the other side of town – a 7 minute flight away. We reckoned we would just about make it, so off we flew:
with special permission to leave for South Africa directly from there.



Our friends from the Mission Aviation Fellowship (MAF), based at the military airport, were the first to greet us and very curious to look at our aeroplane! It took some time, but we eventually fuelled and even payment was straightforward thanks to them exchanging some local cash for us!

Next stop Port Elizabeth, South Africa. Lesotho had been a very worthwhile stop – busy but very worthwhile! We left about 2pm and had a smooth ride South through rural Eastern Cape:
By now we were tired but kept each other going! Shortly before Port Elizabeth we hit bad weather – storms were brewing. The tower cleared us for an instrument approach and we descended through the clouds:


Luckily we had a clear view of the runway in the end:

We paid all of our bills on arrival – quite a novelty! But it did give Dr Mabenge time to fetch us and deposit two very tired pilots at their accommodation!

Time for take-away!

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