This research is based on 13 months of ethnographic fieldwork conducted in rural Lesotho, Africa between 2007 and 2009. The article shows how cultural competence in intervention research can be improved through ethnographic fieldwork, borrowing primarily from anthropological research protocols. Through an exploration of the challenges of caring for AIDS orphans and children with HIV/AIDS, I demonstrate that deep ethnography is an effective way to gain the necessary in-depth cultural insight, particularly in the initial design stages of culturally competent interventions. This is particularly true for rural or remote communities where structural barriers, such as poverty, are pronounced. This interdisciplinary approach provides both valuable information for those interested in orphan care in rural sub-Saharan Africa, and also demonstrates the importance of the ethnographic approach for intervention research in social work.