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In Lesotho, a small mountainous country surrounded entirely by South Africa, it’s estimated that 633 out of every 100,000 people contract tuberculosis each year. In the U.S. only four out of every 100,000 people are estimated to contract TB each year. Photo: Rebecca E. Rollins/Partners In Health

In 2007, Partners In Health/Lesotho (PIH/L) and the Ministry of Health launched the country’s first program to treat patients with multidrug-resistant tuberculosis (MDR-TB). The vast majority of MDR-TB patients in Lesotho are treated in the community—meaning community health workers make daily home visits and accompany patients to regular check-ups for the entire two-year period it takes to treat MDR-TB. But those in need of an extra level of care—perhaps they’re suffering from the side effects of drugs or experiencing complications from HIV—will visit the small, 24-bed Botsabelo Hospital in the capital city of Maseru. Photo: Pep Bonet/Noor

“I knew that the MDR-TB and HIV co-infection rate in Lesotho was about 70 percent. It’s one thing to know the number, but when you’re treating patients at the hospital that serves the sickest patients, it’s a big eye-opener,” says Dr. Gustavo Velasquez right. Velasquez, a resident in the Division of Global Health Equity at Brigham and Women’s Hospital, began traveling to Lesotho to work with PIH/L in March 2011. “These are truly the sickest patients in Lesotho—many of them have advanced HIV and are prone to every possible opportunistic infection. Others are experiencing the side effects of second-line TB treatment.” Photo: Rebecca E. Rollins/Partners In Health

Teboho Mohami (an alias), center, was referred  to Botsabelo Hospital at the end of January 2013 because he was extremely fatigued. The 37-year-old patient, who also has HIV, had been treated unsuccessfully for TB in 2005 and 2011. Along the way, he lost his hearing, likely a side effect of the drugs. In 2012, PIH/L started him on a treatment regimen intended to counter MDR-TB. “For patients with hearing loss, it does become much more difficult to understand how they feel. Nobody speaks sign language,” Velasquez says. Photo: Rebecca E. Rollins/Partners In Health

Dr. Paul Farmer—PIH co-founder and one of Velasquez’s professors—made two teaching rounds during a February 2013 visit to Botsabelo Hospital. A central focus of the PIH/L program is leveraging the resources of institutions such as Harvard Medical School and Brigham and Women’s Hospital to help build local capacity for diagnosing and treating MDR-TB. Dr. Farmer inspected an X-ray of Mohami’s chest and discussed an abnormality near the right lung with local physicians. Basotho radiologists will continue to monitor the growth. Should the need arise, they can send a digital copy to radiologists at Brigham and Women’s Hospital in Boston for a second opinion. Photo: Rebecca E. Rollins/Partners In Health

Upon admission to Botsabelo, the doctors infused Mohami with two units of red blood cells. Within hours, his symptoms improved markedly, Velasquez says. A few weeks later, Mohami was discharged from the hospital. Community health workers from PIH/L will continue to make regular home visits to ensure he’s taking his medication as directed and they’ll accompany him to future appointments. “At Botsabelo, we follow patients closely,” Velasquez says. “Many programs treat HIV and TB at separate clinics. But at PIH/L, it’s fully integrated care. And because every patient gets directly observed therapy, long-term treatment is supported by trained staff." Photo: Rebecca E. Rollins/Partners In Health

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