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The Health Show: Riders for Health
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The Health Show: Riders for Health
Access is often the largest obstacle to healthcare. Nowhere is this more apparent than in the rugged, mountainous country of Lesotho, where much of the population lives mired in rural poverty. But one organization, Riders for Health, has introduced an all-terrain option that's linking communities in the most remote regions: the motorbike.
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Produced by Rockhopper TV.

Originally broadcast as part of The Health Show

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Segment 1

VOICEOVER
The mountain kingdom of Lesotho is a land of heights and extremes. The entire country stands more than 3,000 feet above sea level. The terrain and climate are harsh, and more than 75 percent of the population lives in rural areas. Delivering regular health care to those in the countryside is nearly impossible. But thanks to Riders for Health, a global non-profit, one vehicle is changing the game: the motorbike. It's rugged, it's durable, and it lets healthcare workers reach all their patients, no matter how remote. Challenges abound, but with a motorbike, distance is no longer such an obstacle. Join Rockhopper TV as it follows six people using these motorbikes to alter the terrain of healthcare delivery.
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Riders for Health, Rockhopper TV, Lesotho
VOICEOVER
The mountain kingdom of Lesotho in southern Africa. Here, most people live high in remote villages, far from tarred roads and beyond the reach of most vehicles. In winter, villages are often cut off altogether by snow. For most people, getting around here means walking. It's early morning, and yesterday's snow means a cold start for Thabiso Phoka. He's a nurse at Auray Health Center high in the mountains.
THABISO PHOKA [Nurse, Auray Health Center]
I'm preparing the package for the outreach. There's a tally sheet inside and the needles as well for the immunizations.
VOICEOVER
Today, Thabiso's getting ready to travel to the village of Hatakani to immunize babies and run an under five's clinic. It is ten kilometers away over rough ground - half a day's walk for most people - but Thabiso is lucky; he'll be going by motorbike.
THABISO PHOKA
I always loved the idea of being a nurse because I wanted to help people in the community. The roads are really difficult, and it's tough riding when it's so cold. But now I know I can get wherever I need to without any problems.
VOICEOVER
Thabiso's destination, Hatakani, is a very remote place. A simple lack of transport means people are often unable or reluctant to get medical help. For Thabiso, this meant diseases went untreated and children remained unvaccinated. But last year he was provided with a motorbike and trained how to ride it. But even for Thabiso, Hatakani is hard to reach, and he has to walk the final leg down to the village.
THABISO PHOKA
Before the motorbike it was not easy to come. I think they were thinking that we were neglecting them.
VOICEOVER
Thabiso comes here on a set day every month. Mothers from the village and surrounding area have brought their children for an under five's clinic.
THABISO PHOKA
The most important things I do in the villages are vaccinations and giving health talks about how people should take care of themselves, because some of the illnesses they come to the health centers with are things they themselves should be able to prevent. The cases we used to see a lot were hygiene related, like diarrhea and scabies, but they're no longer here because we've taught people how to look after themselves.
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VOICEOVER
These new recruits are starting their second day of training. None of them have ever ridden a motorbike before. Isaac Monokwa, like the other trainees, works at a government-run rural health center.
ISAAC MONOKWA [Ministry of Health, Lesotho]
I work as an HIV/AIDS counselor. My job at the clinic is to encourage people to check their status. I do the tests myself and if they test positive, I talk to them about the treatment they must follow. The motorbike will really help me. I'll be able to get around much quicker and will be able to get to more villages in a day.
VOICEOVER
But when it comes to learning to ride, Isaac has a long way to go. It seems he'll be testing Soloman's teaching skills, and his reactions.
SOLOMAN HLASA [Motorbike Instructor]
It's just a matter of giving him a lot attention.
ISAAC MONOKWA
I had some difficulties changing gears at first. But as I ride more, I'm getting used to it.
SOLOMAN HLASA
He's not yet confident standing up.
VOICEOVER
If Isaac can't stand up on the bike, there's no way he'll tackle Lesotho's rough terrain.
SOLOMAN HLASA
Oh, you can see he's very scared.
VOICEOVER
But Isaac's determined. He has a very personal reason to succeed.
ISAAC MONOKWA
I wanted do this work because I discovered I was HIV positive. When I found out, my life became miserable, and back then the treatment wasn't really available. I went for counseling and they were looking for people who weren't ashamed to come out and talk about their status. I turned out to be one of the brave ones and they gave me training.
VOICEOVER
The weather in Lesotho can change in an instant. Today, Isaac and the other trainees are getting their first taste of riding in the rain and over rough ground. The going's tough for all the riders - but especially for Isaac.
SOLOMAN HLASA
He comes off the bike but he gets back on very fast. He shows a lot of courage.
ISAAC MONOKWA
I think it is determination that brought me here. I knew I'd meet these challenges and that I'd fall, but to fall doesn't mean you have to give up. You have to get back on and carry on riding.
VOICEOVER
Gradually, Isaac starts to get the hang of it.
SOLOMAN HLASA
So far Isaac has improved a lot, and he's making me proud so far, yeah.
ISAAC MONOKWA
Today's training was really tough but I liked it. I'm going to sleep like a baby. I'm really tired.
VOICEOVER
Back at his government health center, and having passed his two weeks training, Isaac's ready to hit the road.
ISAAC MONOKWA
I'm very excited because this will be my first day. Today I'm going to a village called Gamosethe. I'm going to follow up on patients who I've not seen for over a month. I think they'll be happy because before I wasn't able to get to them, so I think they'll be excited to see me.
VOICEOVER
And he was right.
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Riders for Health, Rockhopper TV, Lesotho
VOICEOVER
Takiso Setsabi is on his way to one of the seven rural health centers he serves. He's one of thirty sample transporters operating in Lesotho - the missing link between rural clinics and hospital laboratories.
TAKISO SETSABI [Nurse]
I love riding the bike because it's not here for fun but to help the community. It makes me really proud because there aren't many of us who ride.
VOICEOVER
At Takiso's destination, Fatima Health Center, the nurse, Tjoloba, is with one of his HIV positive patients. Mamahloli has walked for four hours to get here from her village. The drugs she takes to manage her HIV have been causing her painful side effects, so she's stopped taking them.
TJOLOBA TJOLOBA [Nurse, Fatima Health Center]
We are going to check kidney and liver function so we can change her drugs to another first line regimen, which has lesser side effects.
VOICEOVER
The faster Tjoloba can get the results, the sooner he can get Mamahloli back on treatment. He knows that Takiso's on his way, but that wasn't always the case. Before the motorbikes, Tjoloba would have to rely on patients volunteering to take samples to the hospital laboratory, 20 kilometers away, on public transport.
TJOLOBA TJOLOBA
Previously there was no choice. The samples include the TB bacilli as well as HIV. If anything could happen for the spilling of those samples within the public transport that means every passenger within would be at risk of contracting some infection.
VOICEOVER
Samples often sat waiting for someone to take them and Tjoloba had to collect the results himself. Sometimes the whole process would take two to three months. It was a delay that cost lives, especially with diseases like tuberculosis.
TJOLOBA TJOLOBA
TB is very important to get results immediately. While we are still waiting for the results the patient could be infecting other people and we end up with a lot of deaths.
VOICEOVER
But now, Takiso visits the health center twice a week. Today, as well as Mamahloli's samples, he's collecting blood and sputum from nine people who may have TB. He's been trained how to handle and transport these samples.
TAKISO SETSABI
Because I ride on these rough roads every day, I know how to handle them. When I get to parts that are really pot-holed, that shake you around, I stand up. In a car, the samples would just be rattling around all over the place.
VOICEOVER
Many samples used to be ruined by lengthy storage or in transit. But now, Takiso can get to the lab quickly, ensuring the samples arrive in good condition.
TAKISO SETSABI
I register the samples and I also help with basic laboratory tests because they've taught me how to do that.
VOICEOVER
A couple of days later and Takiso is returning to Fatima Health Center with the results. And for Tjoloba, there's great news about his suspected TB patients.
TJOLOBA TJOLOBA
All the results for TB are beautifully negative.
VOICEOVER
There's good news for Mamahlodi too. The results show her liver and kidneys are functioning well, so she can be given more suitable lifesaving treatment straight away. And for those like her who have to walk so far to get here, the reliability of sample transport means it's never a wasted journey.

Segment 2

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Tukula Mothonyana is a TB officer based at Maluti Hospital in Lesotho.
TUKULA MOTHONYANA [TB Officer]
I run TB clinics here and get people started on treatment. TB is a very dangerous disease because it's so infectious. It spreads quickly and easily from person to person through the air, so it's important to get people on treatment fast. My biggest challenge is when some people default on their medication. Often, they start to feel better, and so they stop taking the drugs believing they're already cured.
VOICEOVER
Defaulters are common in Lesotho. Often they don't collect their treatment or attend check-ups because it's so difficult for them to get to their nearest health center. Tracing them quickly is vitally important, but finding defaulters can be a major challenge. Experienced rider Mathato, is taking recent trainees and fellow health assistants, Puleng and Lintle to try and track down one such TB patient. The first stop is his local council office. But there's some bad news.
PULENG
We have just discovered that Mr. Fata Masupa has just passed away already.
VOICEOVER
It may be too late for their defaulter, but it's still vital they find his family. There's a risk they too might be infected and could be passing it on to family and neighbors. Having been pointed in the right direction, they set off. But with no road names or house numbers, it's never that simple.
MATHATO [Nurse]
It seems that there are two people with the same name and surname so this one is not the one we are looking for. The one that we are looking for is that one down there.
VOICEOVER
A case of mistaken identity, so the search continues. But sometimes, patients deliberately give false details to health workers, as Tukula knows all too well.
TUKULA MOTHONYANA
It makes it really difficult when some of them give us false names and addresses. When you want to visit them you go to the village and find no one knows them.
VOICEOVER
But why don't they want to be found? Well, health workers Lesotho always encourage patients to get tested for HIV so they know their status. But many people here just don't want to know. Back with Mathato and her team, and they've managed to find the widow of the deceased defaulter.
WOMEN
So sad to discover that the person we are tracing is dead. And she's still mourning.
VOICEOVER
They suspect that by defaulting on TB treatment the dead man may have developed a more dangerous strain known as Multidrug-Resistant Tuberculosis, or MDR TB.
WOMEN
The family, they might be infected, we don't know but we advised her to go for the checkup.
VOICEOVER
This constant vigilance is what's needed to keep this dangerous strain of drug resistant TB contained.
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VOICEOVER
Across Lesotho, motorbikes are constantly ferrying medical samples from clinic to lab, or allowing health workers to reach the communities they serve. These services rely on their bikes day after day. But keeping them going on these tough tracks is no mean feat. In charge of keeping Lesotho's fleet of a hundred and twenty motorbikes on the road, is mechanic Thaele Seleke.
THAELE SELEKE [Motorbike Mechanic, Lesotho]
A bike is a small thing; it's not like a car. A car can last a bit longer. But really when you look at this machine it needs you to take care of it just like a baby. Watch it closely. I've got 120 babies here to watch.
VOICEOVER
If any of Thaele's 'babies' need serious attention - a new clutch, a set of shock absorbers or a major engine problem - he brings them here to the workshop. But most of his time is spent out visiting the bikes all over the country.
THAELE SELEKE
It's all about preventing problems from happening. We detect them before they can happen. It's unusual because we are the only ones who are doing this kind of job here.
VOICEOVER
This preventative maintenance is what sets Thaele and his team apart.
THAELE SELEKE
We always do this as a routine each and every month. Check everything, service everything; make sure that it's tip-top.
VOICEOVER
Vehicles all over Africa are in a terrible state. At hospitals, you'll often find vehicles, some nearly new that are left rusting because of a blocked air filter or a worn out tire. But Thaele and his team go that extra mile to make sure they spot and fix problems before the bikes break down. With eight bikes to get through, there's no time to waste. But Thaele gets all the riders involved.
THAELE SELEKE
I do like very much when I work on someone's bike. The rider should be there so that we should discuss few things. I always pass my knowledge to them.
THAELE SELEKE
What you're doing isn't right. You have to have a tape, so you know the exact measurements - about 30 millimeters.
THAELE SELEKE
The small things - they should know how to check them on their own.
VOICEOVER
They're all trained to do daily checks. But it's not just about keeping the bikes running.
THAELE SELEKE
If you don't do a check you before you ride, really you are risking your life because it might lose things like bolts, or chain warn out then when it cuts off really you fall off terribly. So we make sure we prevent such things. They shouldn't happen.
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Riders for Health, Rockhopper TV, Lesotho
VOICEOVER
Lesotho has the third highest HIV prevalence in the world. Almost one in four people here are living with the virus. But Lesotho is fighting back and HIV counselors like Lefulesele Masokanye are in the frontline. Today she's come to St. Magdalena rural clinic. Much of her work involves trying to prevent mother to baby transmission of HIV. She's here to follow up on those suspected of defaulting on treatment or missing checkups.
LEFULESELE MASOKANYE [Mentor Mother, Berea District, Lesotho]
I have got the list now for the people we are visiting today and the first one is a pregnant woman and she's positive. So we are going to look if she has already taken the drugs to prevent the virus to pass through to the baby.
VOICEOVER
A lot of Lefulesele's time is spent out in the villages, encouraging pregnant mothers to attend check ups and get treatment. If they're put on prophylaxis early enough in pregnancy, there's a very good chance they won't pass HIV to their babies. But it can be a difficult job persuading people who live so far from the clinics.
LEFULESELE MASOKANYE
When they get home they don't take it seriously. That's why we have to follow to see that they're doing the right thing.
VOICEOVER
Lefulesele has come to see Mamojaki and her three-month-old baby girl. But soon after arriving, she realizes there's bad news.
LEFULESELE MASOKANYE
Her mother didn't get prophylaxis at all. And even the baby didn't get it after she has been born and so the baby could be positive.
VOICEOVER
Mamojaki says she didn't go for check ups because she's afraid people would shun her if they knew she was HIV positive. It's something Lefulesele comes up against all the time, and she understands it better than most. She's also HIV positive.
LEFULESELE MASOKANYE
We have to tell everybody, because we have been through this so we have to stop this. I stand there, I tell them that I'm HIV positive, look at me; you can see I'm still healthy. I just tell her she should go there, don't be scared of the people. This is her life, and life comes once, and the treatment is free. She's not going to pay anything.
VOICEOVER
Cases like Mamojaki's are very close to Lefulesele's heart. They're the reason she does this job.
LEFULESELE MASOKANYE
I was pregnant so I went to the clinic. I found that I'm HIV positive so they said I should come back and do my checkups but I didn't go.
VOICEOVER
Lefulesele had a baby girl. She didn't return to the clinic until a month after she was born. It was during that visit that she was asked if she'd consider working as a HIV counselor.
LEFULESELE MASOKANYE
I heard about an interview for the mothers who are positive, so I went there and I passed the interview. But I didn't realize that when I was holding her she was already dead. I found out when I got home.
VOICEOVER
Her baby daughter had died in her arms at just one month old.
LEFULESELE MASOKANYE
I had a very nice girl and I miss her a lot.
VOICEOVER
A few days later, and Lefulesele has come to check up on Relenbonile, another HIV positive mother. But today's not a nice day to be out on a motorbike.
LEFULESELE MASOKANYE
It is very bad today, very bad. All of a sudden hailing, sunshine, cold at the same time. Even lightning!
VOICEOVER
But for Lefelesele, it's all worth it. Relenbonile has been to all her check ups. She's taken the treatment throughout pregnancy, birth, and through to weaning. Her baby's recently been tested and is HIV negative.