1. Paballong The Place of Care
Children in the garden of the Paballong Centre

2. The Kingdom of Lesotho
Independent but completely surrounded by South Africa
30,355 km2 – about the size of Belgium
Mostly mountainous, up to 3,482m (11,425 ft)
Highest lowest point of any country
Snow in the winter
Unreliable rain for farming
Seasons the opposite from ours – so spring time there now (October).
Frost often kills crops. Winters mostly sunny and dry, but cold fronts bring snow sometimes. Winter temperatures often down to -5 degrees overnight in lowlands, can be -10 or -15 in mountains. Summer temperatures degrees.
Rainfall unreliable – sometimes too much, sometimes too little. Climate change will make weather still less favourable for farming.

4. Lesotho’s history
Formed as kingdom by Moshoeshoe I in early 19th century
Lesotho lost land to South Africa as settlers moved in
Given protection by Queen Victoria 1868
Migrant labour to South African diamond and gold mines
Independence from Britain 1966
Constitutional monarchy under King Letsie III
Originally Lesotho was very sparsely populated – just a few Bushmen, who were later driven out, exterminated or absorbed by Basotho being pushed into the mountains by white settlers from the west.
King Moshoeshoe I famously wrote to Victoria that he and his people wanted to be ‘fleas in her blanket’ – referring to the blanket that Basotho often wear.
Much of South Africa’s industrial prosperity has been built by very poorly paid migrant labourers from Lesotho and other neighbouring countries.
Lesotho has a Prime Minister and Cabinet; the current king has less power. Lesotho is a member of the Commonwealth. English is widely used in government and commerce.

5. Lesotho’s people Population about 2.2 million
About 200,000 in capital, Maseru
27% urban now, but most still live in rural villages
Relatively good literacy rate (98% of females, 86% of males aged 15-24)
Many households headed by women
39% of population aged under 15
Unlike many other African countries, Lesotho is fairly homogenous ethnically – no competing tribes, and everyone speaks Sesotho – though there are other language minorities in the south.
As in most countries in the world, Lesotho is experiencing rapid urbanisation.
The first missionaries came from France in 1833 and served as political as well as spiritual advisers to King Moshoeshoe. These Protestants were later joined by Catholics who (perhaps because they were more culturally flexible?) had greater success. Catholics now outnumber Protestants. Most of the population is at least nominally Christian, although indigenous beliefs and practices persist. Both churches were active in setting up schools and health facilities. The former have contributed to the relatively good literacy rate.
Women have strong roles in households where men have traditionally had to go off to work for many months at a time – although male migrant labour has halved in the last 20 years. Women are also quite prominent in the civil service and government. But gender relations leave much to be desired, which is one reason for the spread of HIV.

6. Lesotho’s economy
Used to depend on migrant labour to South African mines – now much reduced
Low wage employment for women in Chinese-owned textile factories
Most people try to subsist with farming and livestock (some wool, mohair exports)
Diamond mining expanding
Highlands Water Project sells water to South Africa
Lesotho did ‘well’ to attract some big Chinese textile investors who have set up huge garment factories, mostly in Maseru. Lesotho is the biggest exporter of denim clothes from Africa to the United States, with the Chinese profiting from US legislation that helps African countries to export to America. But wages and working conditions in the garment factories are poor.
Wrong to call Lesotho an agricultural economy or society, even though most of it looks agrarian. Agriculture contributes less and less to total gross domestic production, and hardly anyone can make ends meet – or feed the family adequately – by farming alone. Most households must combine farming (if they have any land, and many don’t) with other subsistence strategies.
The Highlands Water Project traps water from mountain rivers in huge reservoirs and then sends it by gravity through tunnels to South Africa, which pays Lesotho royalties for it. On the way down, the water passes through a hydro electric plant that generates most of Lesotho’s electricity. But the project is controversial because of the land that it takes from mountain people – they lose fields, grazing land and occasionally their homes.

7. Poverty in Lesotho Widespread hardship
43% live on less than 77p per day
56% live below national poverty line
People must combine multiple livelihood strategies
Life expectancy in 2012 was 49
20% of children under 5 are moderately or severely under weight
100 per 1,000 children die before 5th birthday
On average, standards of living in Lesotho have risen over the last couple of generations. But poverty is still severe for many, as these statistics show. Furthermore, the gap between the rich and the poor has widened.

8. HIV/AIDS in Lesotho
23% of year olds HIV positive in 2013: AIDS is the number one cause of death
Second highest rate in world
Life expectancy fell to 45 years: slight recovery now
Population growth rate halved
26,000 new HIV cases in 2012
15,000 estimated to have died of AIDS in 2012
150,000 children orphaned due to AIDS
Data mainly come from UNAIDS ( and
The HIV/AIDS pandemic has been a huge crisis for Lesotho. Although HIV prevalence may be starting to decline, AIDS deaths may still increase.
Why is HIV so widespread? Thabo Mbeki, the former South African President, was wrong to deny the role of the virus and the opportunity to treat it with antiretroviral drugs (ARVs, used in antiretroviral therapy, ART), but right to emphasise the role of poverty. The other big cause is gender inequity. Lack of condoms, ignorance about their role and male prejudice against using them, have been other factors, along with migrant labour to South Africa and within Lesotho, which breaks up families and tends to increase the number of sexual contacts that people have. Government, with heavy international backing, has run big education campaigns, provision of condoms, provision of ART (which is very expensive).
The spread of HIV is not simply a case of loose morals.
Statistics are from various years – have tried to use the most recent data available.

9. The impacts of HIV/AIDS
Personal anguish
Caring for the sick
Family tragedies
Caring for orphans
Loss to household livelihoods
Loss to national economy
Losing income earner(s) is an obvious economic disaster for a household. But government and the private sector suffer badly too as they lose skilled staff to AIDS.

10. Responding to HIV/AIDS
Promoting behaviour change
Encouraging people to know their status
Providing counselling
Providing drugs
Promoting healthy living
Supporting carers
Helping people to die with dignity
There are big campaigns in Lesotho and many other countries to ‘Know Your Status’. Going for an HIV test is a frightening thing, of course. Voluntary Counselling and Testing facilities try to help people through the process, including support if they are told they are HIV positive.
Prevention of Mother to Child Transmission (PMTCT) is one important strategy, including medication for babies in the first days of life when they are born to HIV positive mothers (which is quite common).
‘A Person With HIV Is Still My Friend’ – one of the campaign slogans as programmes struggle with stigma – one of the huge social issues in HIV/AIDS.

11. The Paballong Centre ‘The place of care’ Paballong Trust founded 2001
Centre built on Berea Plateau near Maseru
Centre opened 2007
Modest medical facilities
Voluntary counselling and testing centre
Chapel
Day care centre
Garden, livestock
31 staff
About half a dozen people came together roughly ten years ago to form the Paballong Trust. They managed to buy the land and buildings of an old trading store about half an hour’s drive from Maseru, on the Berea Plateau.
Day Care Centre opened in February 2013, to look after some of the younger AIDS orphans in the area so that their older siblings, who usually look after them, can go to school during the day – and, in some cases, their elderly carers (such as grandparents) can get some time to rest and get on with other household activities. In 2013 it enrolled 33 children, who are looked after through the day and given breakfast, lunch learning and play facilities.

12. Services at Paballong Care Prevention Mitigation (a) Care Services
· Voluntary Counselling and Testing;
· Anti-retroviral Treatment;
· Treatment of Opportunistic Diseases;
· Anti TB Medication;
Antenatal and post-natal care
· Counselling of patients;
· Spiritual Counselling;
· Counselling and training of their caregivers;
· Follow-up of clients on ART, including home-visits;
· Training and support to Village Health Workers and Support Groups;
Day Care Centre
(b) Prevention Services
· Prevention of Mother To Child Transmission (PMTCT);
· Providing its facilities and staff for awareness raising;
Family planning services
· Outreach for prevention programmes to schools, institutions, etc.; and
· Male directed awareness raising.
Male circumcision
(c) Mitigation Services
· Training in Home Gardening;
· Training in Animal Rearing;
· Training in Nutrition;
· Initiating and supporting Income Generating Projects for the surrounding
communities;
· World Food Program (WFP) Food Distribution point; and
· Free lunches for clients.

13. Numbers helped at Paballong
From January 2007 to December 2013, a total 4,918 clients made 37,135 visits to Centre
669 on ART
Average 515 visits per month in 2013
512 HIV tests in 2013: 63 positive
1,751 people treated for opportunistic diseases in 2013

14. Paballong budget Total budget for 2013 was £128,533
Budget for 2014 is £140,739
Many sponsors in Lesotho, Europe, North America
All services to patients, including ART, are free
This is a picture of the main house before renovations began. You can see that there was still some snow on the ground.
Budget increase 2013 – 2014 largely due to salary increases to keep Paballong in line with recently increased government health service salaries.

15. Plans at Paballong Launch the recently constructed Youth Centre
Continue core activities
Provide emergency maternity services
Expand outreach to villages
Expand agricultural activities
Rehabilitate old buildings to create a conference centre that would earn money for Paballong
Manager’s office.
The main purpose of the Youth Centre is to add value in various forms to the lives of the young people of the local community, especially the vulnerable ones, between the ages of six and eighteen. This can be achieved by merging fun and sports activities on the one hand with educational work (independent study
and/or support with homework) on the other hand.
Better farming and gardening, linked to better nutrition, are vitally important for HIV positive people. The Paballong Centre has an active agricultural programme on its own land and also practises all sorts of recycling, organic farming, solar power, biogas digester and other environmentally sound activities.

16. The Paballong UK Trust Charity established in 2010
Object is ‘the relief of poverty in Lesotho, specifically among those who are severely disadvantaged and infected or affected by HIV/AIDS’
Focus is on support to Paballong Centre
Raising money in the UK for Paballong
5 Trustees – Stephen Turner is chairman
Registered with Charities Commission
Five trustees in the Paballong UK Trust.

17. For more information www.paballong.org.uk www.paballong.roxer.com

18. Thank you!