An intrepid band of airborne health workers is bringing essential medical care to isolated communities in the mountain kingdom of Lesotho, where villagers go for years without access to healthcare, reports NPR.
Squinting against the dust kicked up by the helicopter’s rotor blades, dental therapist Senate Makhoali (27) loads up her equipment and jumps on board. She’s already endured a hair-raising, stormy flight in a tiny Cessna 206 to land on a precarious mountain ridge. Now, she faces a bumpy chopper ride across a steep ravine to a village on the other side.
But she’s getting used to it. For the past year and a half, she has served with the Lesotho Flying Doctor Service in the world’s only nation lying entirely above 1 000m. Its rugged terrain, riven by jagged peaks and dramatic valleys, renders road transport nearly impossible in many places, leaving roughly 300 000 people scattered throughout the highlands without reliable healthcare access.
For decades, the Flying Doctor Service was their lifeline, until the impact of President Donald Trump’s aid cuts in January 202 essentially severed it. Now, after a year of fighting for its very existence, the service is rebuilding.
And with the aid cuts serving as a wake-up call, the tenacious flying doctors of Lesotho plan to bounce back stronger, more efficient and less reliant than ever before – with or without US support.
The helicopter carrying Makhoali takes off, and the chopper, operated by the South African humanitarian air service Mercy Air, scuds across the valley, buffeted by winds, before landing on a distant ridge.
A crowd quickly gathers, and volunteers help the medics carry their gear along a narrow path to the tiny village of Mphooko, where many haven’t seen a doctor in years.
"These communities are so far out in the mountains that they only go to a clinic when it’s life or death,” said Makhoali, was assigned to the LFDS in May 2024.
Dozens of villagers have arrived for care – with the usual mix of coughs, colds, joint pain, eye problems and toothaches, as well as more serious issues.
Lesotho battles some of the world’s highest rates of HIV, TB and mental health issues, while injuries from horse-riding accidents are ubiquitous.
Makhoali sets up her dentist’s chair in a small stone cottage before calling in her first patient. For the next six hours, she won’t stop. She and her colleagues finish treating the last of their patients in the late afternoon, when the helicopter returns to ferry them across the valley to the Flying Doctor clinic of Kuebunyane for the night.
The clinic, high on a mountain, was constructed in the 1980s and expanded in 2015 with funding from Irish Aid and the Clinton Health Access Initiative. It was built with a parking lot and a driveway wide enough for an ambulance, yet none has ever been here – the nearest road of any kind is four hours away on horseback.
“They hoped cars would one day be able to come here,” sighed Makhoali. “We can dream.”
For a few months every year, Mercy Air’s helicopter flights boost the reach of the Flying Doctor Service by carrying providers directly into the most isolated villages.
But the service’s backbone is a network of remote LFDS clinics, each with its own rudimentary airstrip. The clinics are run by LFDS nurses, and staffed and equipped via regular flights operated by the Mission Aviation Fellowship, a Christian US non-profit that has collaborated with the LFDS since the 1980s. Doctors are flown in once a month.
“Without these clinics and medical team visits, these communities wouldn’t be able to access basic health services,” says Makhoali.
Nearly grounded
For Makhoali and her colleagues, 2025 was a year like no other. The Flying Doctor Service is a branch of Lesotho’s national health service that was never directly funded by the US.
Regardless, in January last year, Trump’s aid cuts brought it to its knees. At that time, Lesotho was among the world’s most aid-dependent nations, with the government funding just 12% of national health spending.
The rest was funded by aid programmes, with USAID alone accounting for more than a third. When that funding evaporated as part of the Trump administration’s foreign aid cuts, the impact was felt throughout the health system.
“The government’s priority was to save as much of its budget as possible to buy medications,” said Karabo Lelimo, head of the LFDS. “So transport was affected, especially flights.”
Of the 12 clinics the LFDS operated at the beginning of the year, 10 were abruptly transferred to Lesotho’s District Health Management Teams, who were left to run them as best they could without air support.
Flight schedules were slashed, vital clinic staff lost their jobs. The organisation’s chief doctor, Justin Cishiya, who had flown with the LFDS for 15 years, was transferred to help shore up an understaffed hospital in the capital, Maseru.
Towards the end of 2025, things looked bleak. “The mood was so low,” said Lelimo. "To be here in the mountains trying to serve the nation but with no resources – it was terrible.”
The Kuebunyane clinic lost its support staff, including nurses, cleaners and the vital “trackers” responsible for following up on HIV patients who have stopped taking their antiretrovirals.
The remaining nurses were severely overstretched. Routine outreach missions to treat patients in remote villages were scrapped because the nurses couldn’t afford to rent horses for travel.
A lightning strike knocked out the clinic’s solar power supply in March, leaving it unable to operate much of its medical equipment. Fuel, essential for heating, particularly in winter when the mountains lie under thick snow, began to run dangerously low.
Uncertain future
For a time, it looked uncertain whether The Flying Doctor Service would survive. Then, as the country approached the one-year anniversary of the cuts, the mood changed, said Lelimo. The thinking in the LFDS and the health ministry began to switch from knee-jerk damage limitation to acceptance of the new reality and a critical assessment of how best to use existing resources.
“The USAID cuts were not the only problem," said Lelimo, who spent seven years running one of the country’s most isolated LFDS clinics before being appointed to take over management of the service in November.
“There were many defects needing to be corrected – logistical issues, management issues, leading to inefficiency in service delivery.”
Taking over the reins, Lelimo found huge gaps in data collection, a chronic lack of oversight on spending, poor planning, little accountability, a lack of communication between the LFDS and its Health Ministry bosses, and enormous waste.
Planes would routinely fly into the mountains half empty, sometimes returning without any cargo or passengers at all.
“The cuts were a wake-up call,” said Lelimo. “As African countries, we need to do more self-introspection to see how much capacity we have without relying on foreign aid.”
Lelimo and his colleagues started revitalising the flying doctor service. A policy of mixed flights was introduced, whereby every flight, except emergency evacuations, would be carefully planned to combine patient transfers, nurse movements and cargo.
To address the shortage of ARVs reaching mountain clinics, they introduced a system of drug distribution. Those with easier access to clinics would receive just a month or two’s supply: migrant workers and those living further afield would get up to a six-month supply.
To mitigate the loss of patient trackers, the flying doctors trained village health volunteers to take over. Budgets were reallocated and reporting improved, along with communication with the ministry.
Then, on 19 December, the transfer of the 10 formerly LFDS clinics to the District Health Management Teams was rescinded and flights resumed.
“We needed to revitalise the whole system,” said Lelimo. “I’m feeling so optimistic. The LFDS is still here, and stronger than before.”
Not only have the flying doctors managed to resume most of their former operations, they also have ambitious plans to build their network of remote health posts in the mountains. They hope to build two new airstrips in 2026. At the same time, the emergency evacuation programme, the only part of the service unaffected by the cuts, continues unabated.
NPR joined one such flight after a man in a remote village suffered head injuries after falling off his horse. The local clinic lacked the means to treat his injuries, but driving him over mountain roads to Maseru would take all day.
Within minutes of receiving the call, American pilot Dave LePoidevin was airborne and hurtling toward Mokhotlong. After landing on a bumpy dirt airstrip he taxied toward a waiting ambulance. The injured patient, who had already endured a long, uncomfortable journey by horse and truck from his village, was loaded onboard.
Less than an hour later, the plane touched down in the capital and Lebeta was whisked away to hospital.
“It’s a crucial part of the health system,” said pilot Jo Adams, a 44-year-old from Washington who’s been based in Maseru since 2019.
“An hour by air versus 10 hours on horseback and by road. Without the air service, people would die.”
Adams said he hasn’t “felt this optimistic in years”.
NPR article – The flying doctors of Lesotho won't let their wings be clipped (Open access)
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