27 March 2024 by Limpho Sello

 Est Read Time: 7 min(s) 42 sec(s)

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Nursing mothers from Mokhotlong attend the antenatal clinic at Mokhotlong Government Hospital in March 2024.

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The frozen dew crackles beneath each step as *Mareitumetse hurries along the path to the Dili-Dili Health Centre in Quthing at 3 am on July 28, 2023.

Mareitumetse, aged 23, is in the final stages of pregnancy and determined to reach the centre before her baby arrives.

With each wave of intense contractions and labor pains, this Motsekuoa resident is forced to pause, prolonging a journey that typically takes five hours on foot.

Situated within the catchment area of Dili-Dili Health Centre, Motsekuoa is one of the villages whose residents can only reach the centre by foot.

Fourteen hours later, this Motsekuoa woman finally passes through the gate of the Dili-Dili Health Centre.

Mareitumetse delivered a baby boy within just 30 minutes of her arrival, with Relebohile Sebusi, a nurse midwife at the Dili-Dili Health Centre, assisting in the birth. Reflecting on Mareitumetse’s experience, Sebusi underscored the risks associated with prolonged labor for unborn babies.

Sebusi explained that the 15-hour labor led to the unborn baby inhaling meconium, the initial dark, thick, and sticky stool of a newborn. According to the Cleveland Clinic, meconium can be passed either after birth or while the baby is still in the womb.

“Swallowing some meconium is safe for your baby. Breathing in meconium can case serious respiratory problems,” cautioned the Cleveland Clinic website.

Sebusi explained that Mareitumetse’s son had developed meconium aspiration syndrome—a condition wherein a newborn breathes in a mixture of meconium and amniotic fluid into the lungs during or around the time of delivery.

“The treatment involves suctioning to clear the airways and providing oxygen to aid resuscitation, ensuring sufficient oxygen flow from the lungs to the brain,” Sebusi elaborated.

Hopkins Medicine states that meconium aspiration syndrome is a significant cause of severe illness and mortality in newborns, affecting five to ten percent of births. The syndrome typically arises when the fetus experiences stress during labor, particularly in cases where the infant is overdue.

Newborn saved by oxygen supply

In 2021, the United Nations Population Fund (UNFPA) procured oxygen concentrators for health facilities in remote areas to mitigate Covid-19 related deaths and enhance basic health services, including maternal and child healthcare and sexual reproductive health services.

Violet Maraisane, UNFPA Communications Officer, highlighted that the project operates within the framework of the South-South Cooperation Assistance Fund.

UNFPA, with the support of China International Development Cooperation Agency (CIDCA), has been procuring medical supplies such as personal protective equipment and sexual and reproductive health commodities on behalf of the Ministry of Health in Lesotho.

“Among the health commodities procured by UNFPA on behalf of the Ministry of Health of Lesotho, with the support of CIDCA, are oxygen concentrators, personal protective equipment for medical workers, essential life-saving devices, contraceptives, and other sexual and reproductive health supplies,” Maraisane stated.

She further added, “The support, valued at US$500,000, was part of a project developed in collaboration with the Government of China and the Ministry of Health to aid Lesotho’s government at the onset of the COVID-19 pandemic.”

The UNFPA procured oxygen concentrators came in handy on July 28 when Mareitumetse’s baby suffered from meconium aspiration syndrome. 

“For the woman from Motsekuoa, enduring nearly fourteen hours of pain and restlessness on that cold winter morning could have amounted to nothing but the nightmare of her life,” she said.

During their recent media tour in Quthing, Nurse Midwife Relebohile Sebusi from Dili-Dili Health Centre speaks to journalists.

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Sebusi explained that they promptly administered oxygen to the baby to address the situation.

“The risk of losing her child was exceedingly high if we hadn’t had sufficient oxygen supply at the facility to provide oxygen therapy for her son,” she remarked.

On March 21,  2024, Sebusi enthusiastically announced that Mareitumetse’s son is now a healthy nine-month-old baby. Nurses at the Dili-Dili Health Centre were proud of this young hero’s resilience, as he fought for his life with the aid of the oxygen supply, which was once a distant dream before 2021.

Nurses commend life-saving portable, convenient oxygen

The World Health Organization (WHO) identifies poor health-seeking behavior, long distances to health facilities, and lack of transportation to tertiary facilities as factors contributing to maternal and child mortalities.

Lesotho’s maternal mortality ratio is 566 per 100,000 live births, considered very high and exceeding the regional average of 545 per 100,000 live births.

Although women giving birth to their first-born children are encouraged to always deliver at hospitals because of advanced medical care, Sebusi said many women in the Dili-Dili Health Centre catchment area can hardly afford transport fares from their respective villages to Quthing Hospital.

She also expressed concern about women’s reluctance to seek hospital care or stay at the centre’s pregnant women shelter closer to their due dates.

“Their main reason is the lack of funds to cover hospital bills and transportation costs, so they prefer to come to the clinic because it’s free,” Sebusi said.

She added, “Another challenge is that they prefer to wait for labor contractions to start, which limits our ability to refer them when they arrive. They know that once they’re already in labor upon arrival, we must assist them because it’s not feasible to send them back home in that condition.”

Mareitumetse is a prime example of Quthing women who favour local clinic services, Sebusi explained.

“We provided her with a date for admission to Quthing for childbirth, but she missed it and opted to wait for labor to begin,” Sebusi added.

She quickly added that with the availability of portable, convenient, and mobile oxygen concentrators, Dili-Dili Health Centre is able to save many lives that would have been lost due to a lack of oxygen or heavy oxygen cylinders.

“Saving lives is now more timely compared to when they had to rush and push heavy oxygen cylinders to assist patients,” she said.

Nurse Midwife Mampolokeng Nkoja from Quthing Government Hospital presents the UNFPA-donated portable oxygen concentrator to health journalists from Lesotho during their recent media tour.

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Mampolokeng Nkoja, a nurse midwife at the Quthing Government Hospital, also emphasized the crucial role of oxygen concentrators in the maternity ward, particularly for preterm babies whose lungs have not fully developed to enable independent breathing.

“In addition,” Nkoja continued, “infants with a slow heartbeat in the womb and after birth, as well as pregnant women with epilepsy and serious, unstable blood pressure, may also require oxygen supplementation.”

Nkoja explained that if the unborn baby does not receive sufficient oxygen supply, there is a risk of unfortunate outcomes, such as death inside the mother’s womb. She added that in cases where the heartbeat is low, it may eventually cease altogether, resulting in the death of the baby.

Recalling events from the third week of March 2024, Nkoja mentioned that having an ample oxygen supply greatly facilitated their work.

“Last week, we had to administer oxygen to three pregnant women and a pre-term baby, and thanks to the availability of these oxygen concentrators, our tasks were much more manageable,” she said.

She added, “With an oxygen concentrator, administering oxygen to patients becomes incredibly efficient. Its mobility allows us to swiftly attend to patients in urgent need of oxygen.”

At Quthing Hospital, there are typically five to seven deliveries per day, with women aged 20 to 25 comprising the majority of first-time mothers.

“With this volume, the maternity ward requires a constant supply of oxygen, as we are entrusted with saving the lives of these newborns. The availability of UNFPA-supplied portable, mobile oxygen concentrators is highly valued at this hospital.”

The hospital currently has two oxygen concentrators, and according to Nkoja, having an additional three would significantly ease their workload.

Challenges posed by electricity shortages

According to Nkoja, the operation of these oxygen concentrators relies on electricity, posing serious challenges during power outages in the area.

“Without electricity, we cannot utilize the concentrators. However, it’s not entirely negative because we still have heavy oxygen cylinders,” Nkoja said.

The electricity supply at Dili-Dili Health Centre is provided by South Africa’s ailing utility company, ESKOM, which frequently experiences load shedding episodes.

Relebohile Sebusi, a nurse midwife at Dili-Dili Health Centre, lamented the detrimental effects of load shedding on the facility.

“Not only does it make our life-saving work more difficult,” Sebusi explained, “but it also necessitates us to rely solely on our expertise without the assistance of machinery that could be helpful during emergencies.”

“Fortunately,” she added, “we have never encountered a situation where we needed to use an oxygen concentrator during load shedding.”

Health risks associated with oxygen deprivation in newborns

The Ministry of Health launched an oxygen plant in Mafeteng in November 2023. During the launch, Dr. Nyane Letsie, Director General of Health Services, revealed the challenges stemming from a lack of oxygen supply in health facilities, which can lead to complications and disabilities such as cortical blindness.

Cortical blindness, also known as cerebral visual impairment, is a common disability among babies in Lesotho, resulting from oxygen deprivation during birth, leading to serious brain injuries.

This can include damage to the visual cortex, resulting in neurological visual impairment or cortical blindness. While many children retain some degree of vision, few fully regain visual capabilities if they suffer a birth injury to the visual cortex.

Sufficient oxygen supply in health facilities plays a crucial role in preventing severe illnesses and death. ‘Mampolokeng Nkoja, a nurse midwife at Quthing Government Hospital, highlighted that babies lacking oxygen are prone to hypoxia, a condition often caused by the inhalation of meconium, which hinders proper breathing.

“In some instances, a mother may experience trauma due to an accident or any other factor that affects the supply of oxygen from the mother to the unborn baby, subsequently impacting the baby’s brain,” Nkoja explained.

The United Nations Population Fund (UNFPA) emphasised the importance of emergency obstetric care in reducing maternal mortality.

UNFPA explained that well-equipped health facilities staffed with skilled professionals can address major direct causes of maternal death, such as hemorrhage, sepsis, unsafe abortion, hypertensive disorders, and obstructed labor. In such settings, most newborns with conditions like asphyxia or infection can also be saved.

Molikaliko Health Centre embraces oxygen concentrators

Nestled in rural Mokhotlong, Molikaliko Health Centre serves communities in hard-to-reach villages, where some residents trek for up to nine hours to access care, with some even spending nights on the road.

‘Mabokang Damane, the center’s nurse in charge, recounted a particularly challenging delivery involving a newborn whose mother suffered from epilepsy. Damane described the delivery as one of the most stressful she had encountered.

“The mother’s mental health condition made her uncooperative,” she explained.

“I utilised all my midwifery skills to ensure the baby cried after birth. We quickly placed her on the oxygen concentrator while arranging for a referral to Mokhotlong Hospital.”

“However,” Damane continued, “the referral was deemed unnecessary by the doctor upon learning that the baby had recovered well.”

Despite the stress of that situation, Damane faced two more challenging deliveries.

“I ensured that all the babies were healthy to maintain low or zero child mortality,” she stated, proudly adding that Molikaliko Health Centre had not experienced any child deaths since she assumed the role of nurse in charge.