Feb. 25, 2025

Doctors Making a Difference: Amy Ellingson, MD

After watching a documentary about the AIDS epidemic in 2003, family medicine physician in North Central Washington Amy Ellingson, MD, was inspired to take action. She, along with a group of others in her home city of Chelan, decided to focus their efforts on children in Africa, one of the most vulnerable groups affected by HIV and AIDS. Her search for a way to get involved led her to the Tiny Lives Foundation, an organization serving children in the town of Mokhotlong, which sits at 8,000 feet in the mountains of Lesotho. Dr. Ellingson talks with WSMA Reports about what the foundation does and her experience in the country.

Q: What is the Tiny Lives Foundation and how did you get involved?

In 2003, while attending a CME event in Seattle, I watched the documentary "A Closer Walk" about the AIDS epidemic. At the end, there was a simple but powerful message: "Just do something." The enormity of the crisis felt overwhelming, but I was determined to act.

Back in Chelan, I gathered a group of people who also wanted to help and decided to focus on children in Africa, one of the most vulnerable groups affected by HIV/AIDS. During our search, I received an alumni magazine from Notre Dame featuring the founders of The Tiny Lives Foundation, a nonprofit based in Lesotho, where HIV/AIDS was devastating families, especially women and children.

The Tiny Lives Foundation was founded by a couple working with the Peace Corps in 2004, after they began caring for critically ill infants in the remote mountain town of Mokhotlong. In an area with little medical infrastructure, these children would have otherwise died without care. With the help of local volunteers, TTL established a safehouse for children under 5, offering food, medical treatment, and support before they return to their families. TTL's motto, "One child at a time," has guided the organization's work ever since. Over the years, TTL expanded to include programs in education, microfinance, and outreach, growing into a lifeline for over 5,200 children and their families. Despite Lesotho's HIV rate-around 25% of the population-and other challenges like food insecurity and malnutrition, TTL continues to make a profound impact.

We fell in love with the work and people at TTL and started up Chelan to Africa, where we hosted fundraisers for the next 15 years to help support the work of TTL. Over that time, many of us in the Chelan area visited TTL in Mokhotlong to witness the excellent work they are doing.

I feel fortunate to have been part of TTL's journey, helping bring attention to the needs of these children and the people of Lesotho. The work is ongoing, but TTL continues to make a difference, one child at a time, and that is something.

Q: What do your roles as a board member and medical director entail?

As a board member of TTL, I have the privilege of meeting throughout the year, both in person and virtually, to help guide the direction of the foundation. One of our key responsibilities is selecting the annual "fellow," a young adult from the UK, Canada, or the US, who stays on the TTL campus to assist the director, maintain reports to the board, and help manage social media updates. We also oversee the foundation's finances, actively seek passionate donors, explore fundraising opportunities, and ensure sound management of our investments.

Collaboration with our incredible director, Nthabeleng Lephoto, is essential. We work closely to ensure she has the resources and support needed to continue TTL's impactful work.

For the past several years, I've also served as the medical director alongside another doctor. In this role, I've assisted in determining the best treatments for children needing less common medical treatments, managed outbreaks of infectious diseases like measles in the safehouse and advised on various medical issues affecting both the children and staff.

Q: What is a typical trip to Lesotho like for you?

Each time I have gone I have felt privileged, connected, exhausted, and concerned that our work is a mere drop in the bucket. The physical journey to TTL is long-halfway across the globe! A team is typically made up of 4-6 people, both medical professionals and lay people. Once we land in Maseru, the capital, we embark on a six-hour drive into the mountains to reach Mokhotlong. As we ascend into the highlands, we begin to see shepherds with their flocks, the classic stone rondavels, a small ski resort and a large diamond mine. By the time we reach 8,000 feet, we arrive at the safehouse in Mokhotlong. The scenery is reminiscent of North Central Washington, with its sweeping hills and rugged beauty.

There is additional lodging on the TTL campus for the team, along with a communal kitchen we share with the "fellow" staying there for the year. The favorite activity for many of us is spending time in the safehouse with the caregivers-holding, feeding, and playing with the babies and children. It's a joyful, playful environment, and it's incredible to see the transformation in the children's health. Hearing stories and seeing photos of the children from when they first arrived, compared to weeks and months later, is so moving.

TTL also goes on outreach trips five days a week, traveling along rural, rugged roads to deliver medicine and food and assess children in nearby villages. There is a state hospital in Mokhotlong, and during some of my trips, I've had the chance to attend to patients in the "walk-in" section of the hospital, as well as round on patients in the inpatient pediatric wing.

On my most recent trip, I was on campus when a staff member asked me to look at a boy who had arrived unannounced with his mother. She had carried him on her back for many miles, hoping to get help. She was mostly seeking more baby formula, as her son wasn't eating solids. Though she looked tired, she was determined to find support for her child. Teboho was over two years old but was nonverbal, non-ambulatory, and severely malnourished. After a brief assessment, it was clear he had cerebral palsy, a diagnosis that was unknown to mother, a common situation in this rural area with limited access to healthcare.

The mother was caring for her child alone, both her husband and mother-in-law were working in South Africa. Culturally, there is often a stigma attached to having a child with a disability in this rural community, and she was shouldering the entire burden on her own. Thanks to TTL, we were able to walk her to the local hospital, where he was admitted for malnutrition. TTL covered the hospital bill and brought him back to the safehouse for more nutritional and physical support. He gained many pounds and his spasticity was improving. The real turning point, though, was when TTL organized a nurse-led course for mothers with children who have cerebral palsy that was held before he went home.

Teboho's life was saved, and his mother was given the tools, education, and support she needed to help them thrive. It was a powerful example of how TTL's work not only addresses immediate needs but also empowers families to care for their children long-term.

Q: What are some of the biggest barriers to providing care to the children the foundation serves?

The first is limited access to medical care. Lesotho is about the size of the state of Maryland and has only one specialty hospital for the entire nation. While not a big country, one specialty hospital six hours away for our clients is not enough. If a child needs to see a specialist or have a procedure, it often just does not happen. One other thing contributing to this challenge is that Lesotho does not have a medical school and relies on doctors from other countries in Africa to come and work there, leaving them vulnerable to a lot of turnover.

Second is the high prevalence of HIV/AIDS, 1 in 4 adults, which ranks them 2nd in worldwide HIV prevalence. The epidemic has devastated Lesotho's most productive age group, leaving children vulnerable and often orphaned. Children are often left to be cared for by family members with very few means, which contributes to why one in every nine children dies before reaching their fifth birthday in Lesotho. The problem is much more manageable compared to when I first traveled there in 2010 because HIV testing and treatment is readily available. Unfortunately, infection rates are still high.

Food insecurity is another issue that has plagued Lesotho for many years. Land degradation and climate change, particularly persistent drought, flooding, and early frost, have caused low agricultural productivity in Lesotho, exacerbating food insecurity and extreme poverty. In the area that TTL serves, most families try and grow their own food because just going to "town" requires multiple hours of walking.

Q: Have you taken any lessons away from your work with the foundation into your practice as a family medicine physician?

The lessons I have learned from my work at TTL have not specifically applied to my family medicine practice. My biggest lessons have been personal, in the realm of just being a better human.

Whenever I travel and experience other cultures, a big takeaway for me is that no matter where we may live on the planet, we are all the same. Some of us are born into poverty in rural Lesotho and some of us are not. We all deserve to be cared for with dignity. All our lives matter. The parents of the children that sleep at the TTL safehouse do not worry any less just because malnutrition and infant death is common in their country. The young adults in Mokhotlong do not dream any less just because the unemployment rate is 25%. We are a global family and each time I travel to Lesotho my experience of that strengthens.

This article was featured in the March/April 2025 issue of WSMA Reports, WSMA's print magazine.