Residents of the remoted village of Mphooko wave as a crew from the Lesotho Flying Physician Service departs after a day treating sufferers. Mphooko is inaccessible by highway and depends on the LFDS for fundamental medical care.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
Squinting towards the mud kicked up by the helicopter’s rotor blades, dental therapist Senate Makhoali crouches low, masses up her tools and jumps on board. Already this morning she’s endured a hair-raising, stormy flight in a tiny Cessna 206 airplane to land on a precarious mountain ridge. Now, she steels herself for a bumpy chopper trip throughout a steep ravine to a village on the opposite facet. As dentists’ commutes go, Makhoali’s is considerably excessive.
“One minute it is calm, the subsequent you suppose you are about to die,” she says of flying via the turbulent, ever-changing mountain climate in her residence nation of Lesotho.
However the 27-year-old is getting used to it. For the previous 12 months and a half, she has served with the Lesotho Flying Physician Service, an intrepid band of airborne well being employees bringing important medical care to remoted communities on this southern African nation.
Generally known as the Kingdom within the Sky, Lesotho is the world’s solely nation mendacity fully above 4,593 ft). Its rugged terrain, riven by jagged peaks and dramatic valleys, renders highway transport practically not possible in a lot of the nation, leaving roughly 300,000 folks scattered all through the highlands with out dependable entry to well being care.
For many years, the Flying Physician Service was their lifeline, till the influence of President Donald Trump’s help cuts in January 2025 all however severed it. Now, after a tumultuous 12 months preventing for its very existence, the service is choosing up the items and beginning to rebuild. And with the help cuts serving as a wake-up name, the tenacious flying medical doctors of Lesotho at the moment are seeking to bounce again stronger, extra environment friendly and fewer reliant than ever earlier than — with or with out U.S. assist.
Dental therapist Senate Makhoali of the Lesotho Flying Physician Service unloads her tools from a Mercy Air helicopter after being dropped close to the remoted village of Mophooko within the highlands of Lesotho. Makhoali had by no means earlier than been in an plane earlier than becoming a member of the challenge in Could 2024.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
Coming in for a touchdown
Within the mountains of Mohale’s Hoek district, the helicopter carrying Makhoali takes off in a whir of rotors that sends grazing goats and horses scurrying for canopy. The chopper, which is operated by the South African humanitarian air service Mercy Air, scuds throughout the valley, buffeted by swirling winds, earlier than touchdown beside a pair of bemused shepherds on a distant ridge. A crowd shortly gathers, and volunteers assist the medics carry their gear alongside a slim path to the tiny village of Mphooko, the place many have not seen a health care provider in years.
“These communities are up to now out within the mountains that they solely go to a clinic when it is life or demise, or when the ache is greater than they’ll stand,” says Makhoali, who had by no means flown earlier than being assigned to the LFDS in Could 2024. “For us to have the ability to come to them is such a giant factor.”
Phrase of the crew’s arrival has unfold, and dozens of villagers have turned as much as obtain care. They arrive with the standard mixture of coughs, colds, joint ache, eye issues and toothaches, in addition to extra severe points. Lesotho battles a number of the world’s highest charges of HIV, TB and psychological well being points, whereas accidents from horse-riding accidents are ubiquitous.
Makhoali lays out her tools and units up her dentist’s chair in a small stone cottage earlier than calling in her first affected person of the day. For the subsequent six hours, she will not cease.
Senate Makhoali of the Lesotho Flying Physician Service treats a dental affected person within the remoted village of Mphooko within the highlands of Lesotho. The village lies a number of hours on horseback from the closest highway or clinic.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
Amongst her sufferers is Makhaphetsi Makhaba, a 25-year-old mom of two who’s lived her entire life within the village and has by no means earlier than seen a dentist. By the point Makhoali has completed, Makhaba has misplaced a tooth and gained a filling.
“It is a aid — my enamel have been hurting me for years,” says Makhaba, earlier than heading subsequent door to seek the advice of the LFDS nurses about her recurrent chest pains.
Makhoali and her colleagues end treating the final of their sufferers within the late afternoon. Not lengthy after, the helicopter returns to ferry them throughout the valley to the Flying Physician clinic of Kuebunyane, the place they may spend the night time. The clinic, which sits excessive on a mountain overlooking a panoramic valley, was constructed within the Nineteen Eighties and expanded in 2015 with funding from Irish Assist and the Clinton Well being Entry Initiative. It was constructed with a car parking zone and a driveway vast sufficient for an ambulance, but none has ever been right here — the closest highway of any sort is 4 hours away on horseback.
Bernard Nphukeng, a shepherd, appears out from a cliff on the sting of the remoted village of Ha Pheulane, Lesotho. He’d simply had a tooth eliminated throughout a go to by workers from the Lesotho Flying Physician Service.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
“They hoped vehicles would in the future be capable to come right here,” sighs Makhoali. “We are able to dream.”
For a number of months of the 12 months, Mercy Air’s helicopter flights enhance the attain of the Flying Physician Service by carrying suppliers instantly into probably the most remoted villages within the nation. However the spine of the service is a community of distant LFDS clinics, every with its personal rudimentary airstrip. The clinics are run by LFDS nurses, and are staffed and geared up through common flights operated by the Mission Aviation Fellowship, a Christian U.S. nonprofit that has collaborated with the LFDS for the reason that Nineteen Eighties. Docs are flown in as soon as a month.
“With out these clinics and with out the medical crew visits, these communities merely would not be capable to entry fundamental well being companies,” says Makhoali.
Practically grounded by U.S. help cuts
For Makhoali and her colleagues, 2025 was a 12 months like no different. The Flying Physician Service is a department of Lesotho’s nationwide well being service that was by no means instantly funded by the U.S. Regardless, in January 2025, Trump’s help cuts introduced it to its knees. On the time, Lesotho was among the many world’s most aid-dependent nations, with the federal government funding simply 12% of nationwide well being spending. The remaining was funded by help applications, with USAID alone accounting for over a 3rd. When that funding evaporated as a part of the Trump administration’s dramatic cuts in overseas help, the influence was felt all through the well being system.
A Cessna 206 airplane operated by the Mission Aviation Fellowship prepares to take off after delivering members of the Lesotho Flying Physician Service to the Kuebunyane clinic within the highlands of Lesotho. Throughout the distant highlands of Lesotho, some 300,000 folks depend on the service for fundamental medical care.
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“The federal government’s precedence was to save lots of as a lot of its price range as attainable for the acquisition of medication,” says Karabo Lelimo, head of the LFDS. “So transport was affected, particularly flights.”
Of the 12 clinics the LFDS operated firstly of the 12 months, 10 have been abruptly transferred to Lesotho’s District Well being Administration Groups, who have been left to run them as finest they might with out air assist. Flight schedules have been slashed and important clinic workers misplaced their jobs. The group’s chief physician, Justin Cishiya, who had flown with the LFDS for 15 years, was transferred to assist shore up an understaffed hospital within the capital, Maseru. By autumn of 2025, issues have been trying bleak. To Makhoali, it felt like she had “deserted” her sufferers.
“The temper was so low,” says Lelimo. “To be right here within the mountains making an attempt to serve the nation however with no sources — it was one thing else.”
The clinic at Kuebunyane misplaced its assist workers, together with nurses, cleaners and the important “trackers” accountable for following up on HIV sufferers who’ve stopped taking their antiretrovirals. The remaining nurses have been severely overstretched. Routine outreach missions to deal with sufferers in distant villages have been scrapped as a result of the nurses could not afford to hire horses for journey. A lightning strike knocked out the clinic’s solar energy provide in March, leaving it unable to function a lot of its medical tools. Gasoline, important for heating, notably in winter when the mountains lie below a deep carpet of snow, quickly started to run dangerously low.
Going through a unsure future
For a time, it appeared unsure whether or not The Flying Physician Service would survive. Then, because the nation approached the one-year anniversary of the cuts, the temper started to alter, says Lelimo. The considering within the LFDS and the well being ministry started to modify from knee-jerk injury limitation, he says, to acceptance of the brand new actuality and a essential evaluation of how finest to make use of current sources.
“The USAID cuts weren’t the one drawback,” says Lelimo, who spent seven years operating one of many nation’s most remoted LFDS clinics earlier than he was appointed to take over administration of the service in November 2025. “There have been a variety of defects that wanted to be corrected. There have been logistical points, administration points which led to inefficiency in service supply.”
A helicopter transports a medical crew from the Lesotho Flying Physician Service. The LFDS depends on helicopters and single engine airplanes to succeed in distant communities.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
On taking on the reins, Lelimo discovered enormous gaps in knowledge assortment, a persistent lack of oversight on spending, poor planning, little accountability, a scarcity of communication between the LFDS and its well being ministry bosses and large waste. Planes would normally fly into the mountains half empty, typically returning with none cargo or passengers in any respect.
“The cuts have been a wake-up name,” says Lelimo. “As African international locations, we have to do extra self-introspection to see how a lot capability we’ve got with out counting on overseas help.”
Lelimo and his colleagues set about revitalizing the flying physician service. A coverage of blended flights was launched, whereby each flight, save emergency evacuations, could be rigorously deliberate to mix affected person transfers, nurse actions and cargo. To handle the scarcity of antiretrovirals reaching mountain clinics, they launched a brand new system of drug distribution. These with simpler entry to clinics would obtain only a month or two’s provide, whereas migrant employees and people residing additional afield would rise up to a six-month provide.
Villagers from Mphooko helps members of the Lesotho Flying Physician Service carry their tools after being dropped off by helicopter on the closest stretch of flat land.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
To mitigate the lack of affected person trackers, the flying medical doctors skilled village well being volunteers to take over. Budgets have been reallocated and reporting improved, together with communication with the ministry. Then, on December 19, the switch of the ten previously LFDS clinics to the District Well being Administration Groups was rescinded and flights resumed.
“We would have liked to revitalize the entire system,” says Lelimo. “I am feeling so optimistic. The LFDS continues to be right here, and stronger than earlier than.”
Not solely have the flying medical doctors managed to renew most of their former operations, additionally they have bold plans to renew constructing their community of distant well being posts within the mountains. They plan to construct two new airstrips in 2026. On the similar time, the emergency evacuation program, the one a part of the service unaffected by the cuts, continues unabated.
A fall, a tooth extraction, a ray of hope
Tlotliso Lebeta, 24, sustained head accidents in a horse-riding accident. The Lesotho Flying Physician Service flew him from his distant district of Mokhotlong to the capital metropolis of Maseru for care. Above: Members of the LFDS crew switch him to an ambulance.
Tommy Trenchard for NPR
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On a blustery Saturday in September, NPR joined one such flight after a person in a distant village sustained head accidents after falling from his horse. The native clinic lacked the means to deal with his accidents, however driving him over winding mountain roads to the Maseru would take all day.
Inside minutes of receiving the decision, pilot Dave LePoidevin, a soft-spoken Minnesotan, was airborne and hurtling towards the distant province of Mokhotlong at 9,000 ft. After touchdown on a bumpy filth airstrip he taxied towards a ready ambulance. The affected person, 24-year-old Tlotliso Lebeta, who had already endured an extended and uncomfortable journey by horse and truck from his village, was loaded onboard. Lower than an hour later, the airplane touched down within the capital and Lebeta was whisked away to hospital.
“It is a essential a part of the well being system,” stated pilot Jo Adams, a 44-year-old from Washington state who’s been based mostly in Maseru since 2019. “An hour by air versus 10 hours on horseback and by highway. With out the air service, folks would die.”
Pilot Joe Adams flies a crew from the Lesotho Flying Physician Service over mountainous terrain within the highlands of Lesotho. Adams, initially from Washington state, has been working with this system since 2019.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
On the time, Adams wasn’t positive whether or not the flying physician service had a future. Right now, he says he hasn’t “felt this optimistic in years.”
After her night time at Kuebunyane clinic, Senate Makhoali and her colleagues are picked up by helicopter and flown to the much more distant village of Ha Mpheulane, which lies atop a steep escarpment with views over limitless ranges of blue-tinged mountains. A crowd is already ready. Whereas a number of the well being employees are inclined to sufferers, others run an consciousness session for youngsters on a slope above the village, counseling them on sexual well being and different subjects. Makhoali extracts two dozen enamel.
Members of a flying medical outreach crew holds arms in a circle with youngsters and youths for a session that mixes enjoyable and well being schooling. They’re within the remoted village of Ha Pheulane within the highlands of Lesotho.
Tommy Trenchard for NPR
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Tommy Trenchard for NPR
“We’re excited to proceed serving these communities,” says Makhoali. “And to do it even higher than earlier than.”
Tommy Trenchard is an impartial photojournalist based mostly in Cape City, South Africa. He has beforehand contributed pictures and tales to NPR on the Mozambique cyclone of 2019, Indonesian demise rituals and unlawful miners in deserted South African diamond mines and gained a World Press Picture prize for the pictures in his story for NPR on clashes between elephants and folks in Zambia.
