10 April 2025 by Limpho Sello 

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For almost four years, the Queen Mamohato Memorial Hospital (QMMH) had expensive medical machines that could help doctors see inside a patient’s body. But they couldn’t use them because there were no trained workers who knew how to use these machines. 

These machines are used for a test called endoscopy. Endoscopy is a test where a long, thin tube with a tiny camera on the end—called an endoscope—is gently put inside the body through a natural opening like the mouth. It helps doctors see what is happening inside without doing surgery.

While these machines sat unused at QMMH, for staff members like nurse Mareka Rammitsane, endoscopy was just a medical term found in textbooks or a scene in a medical drama —something he never imagined he would one day help perform.

Yet, today, Rammitsane is one of the newly trained nurses at Queen ‘Mamohato Memorial Hospital (QMMH). He confidently assists doctors with real procedures — a transformation made possible by a groundbreaking in-house training initiative aimed at improving diagnostic and surgical services in Lesotho.

Mareka Rammitsane told Uncensored News during the sidelines of the Award Ceremony of Endoscopy Training to QMMH on April 2, 2025. The training was conducted by a United Kingdom-based Harrogate Hospital to help clinicians at QMMH like Rammitsane to revolutionise their approach to patient care.

“We were just picked from our wards and told, ‘There’s this endoscopy training, if you’re interested, you can attend,’” Rammitsane recalled with a smile. 

“Before this, I had only learned about endoscopy in theory during my second year in nursing school. We knew it was used to look inside the abdomen, but I had never seen it in practice — except in movies.” 

Unused medical equipment

Malehloenya Chai is a Theatre Unit Manager at QMMH. On April 2, 2025, Chai indicated that the hospital had long possessed endoscopy equipment but lacked trained staff to use it.

“After Netcare exited, we had the machines but not the people to operate them,” she explained. “We relied on one doctor, and when he wasn’t available, everything came to a halt.”

The 425-bed Queen ‘Mamohato Memorial Hospital (QMMH) was built through a public-private partnership between the Lesotho government and a consortium called Tšepong. The main shareholder in Tšepong was the South African healthcare company, Netcare Group, which managed QMMH and its three filter clinics. Although the agreement was meant to last until 2026, it ended early in August 2021 after the Lesotho government accused the consortium of violating the terms of the deal.

“The problem was, trained doctors couldn’t work effectively without trained nurses. I was handling administrative and theatre responsibilities alone, which compromised services,” she said. 

“We needed nurses trained in endoscopy to facilitate early diagnoses and timely treatment.” 

Since then, Chai noted that there were no medical staff to operate the endoscopy machines. But nearly four years later, the hospital has found a lasting solution through a training programme led by Harrogate Hospital.

“This training has filled that gap,” Chai said. 

For nurse Rammitsane, the training provided him with theorital experience that transformed into practice in October 2024. This is when a team of professionals, including consultants from Harrogate Hospital in the UK, began training doctors and nurses at QMMH on endoscopy — a minimally invasive procedure used to examine internal organs.

The training, which ran until mid-February 2025, combined online and in-person sessions and covered everything from handling equipment to patient preparation, sterilisation, and post-procedure care.

“For us nurses, our main role is to assist — not perform the procedure. We learned how to prepare the equipment, explain the procedure to patients, and manage admission and discharge processes,” said Rammitsane. 

“Now, I can confidently assist with procedures, operate the equipment, and even identify when a patient needs an endoscopy.”

Bridging the gap in specialised care

In Lesotho, primary healthcare is largely subsidised by the government. However, specialised care, such as using tiny cameras inserted into a patient’s body for diagnosis, remains a challenge.

This challenge is compounded by delays in care for patients transferred to South Africa or the lack of funds for those seeking private care within Lesotho. 

Chai also noted that with skilled personnel, expensive equipment lasts longer, and patient outcomes improve.

“We used to refer every patient to Bloemfontein — even for cases we could manage here if we had the right skills. South African hospitals prioritise their citizens, so our patients were often delayed, and some sadly died before getting help. This program is changing that.”

Meanwhile, on average, patients need at least M450 for consultation fees, not including medication. According to nurse Rammitsane, the endoscopy services at QMMH help fill this funding gap.

Rammitsane shared with Uncensored News how important the training is, especially in a context where many patients cannot afford private healthcare.

“Patients needing endoscopy often can’t pay for private services . Without this capacity at QMMH, we didn’t know whether they were being referred to Bloemfontein or just sent home,” he said. “Now, we can at least start the process locally.”

He added that the majority of patients referred to Bloemfontein, South Africa are men.

“Men tend to delay seeking help. They’re stubborn and often the ones who end up needing serious interventions. This training is helping us manage cases better without always waiting for a doctor to be available.”

Dr. Ganesh Sivaji, one of the consultants from Harrogate Hospital, praised the QMMH staff for their dedication and enthusiasm.

“What I’ve seen here is camaraderie, a willingness to learn, and an incredible team spirit,” he said. “I never felt like I was in a foreign country,I felt at home,” Dr Sivaji said.

He believes Lesotho could one day become a regional hub for endoscopy.

“South Africa’s services are centered in private hospitals in major cities. Lesotho can fill this gap. With proper investment, you can serve your population and even attract patients from neighboring countries,” he said.

Meanwhile, Chai emphasised that the training programme is a vital part of the Ministry of Health’s ongoing efforts to revolutionise healthcare in Lesotho. These efforts also include monthly visits by Dr. None Ramonate, a Mosotho-born specialist based in Bloemfontein, who helps train local doctors.

A vision sparked abroad

The initiative was spearheaded by Masekhoane Mpholle, founder of Country Life Medical Diagnostics. 

Mpholle said the idea was born during a government call for Basotho in the diaspora to support national development.

“As a Mosotho endoscopy educator working abroad, I saw a huge skills gap in our healthcare system,” said Mpholle. 

“I asked myself, why not bring what I’ve learned back home?”

With support from the current administration, her organization began training local health professionals in October 2024, leveraging her links with Harrogate Hospital to bring both expertise and consumables such as biopsy forceps, snares, and dilation kits.

“When the Netcare partnership ended, more gaps appeared,” she added. “I was especially motivated by the fact that many transferred patients weren’t getting satisfactory treatment. My humanity — and my identity as a nurse — drove me to act.”

Speaking on behalf of the Ministry of Health, Director of Oral Health, Dr. Lieketseng Petlane, thanked Mpholle and her team for their generosity.

“Many who leave for greener pastures forget home. But Mpolle remembered, and because of that, we now have expertise that will benefit countless Basotho,” said Dr. Petlane. 

“We also thank Dr. Harrison, Dr. Ganesh, and Dr. Ramonate for their selfless contributions to this pro bono training.”

Dr Petlane added that QMMH’s willingness to host the sessions and the dedication of both nurses and doctors has set a strong foundation for future growth in the country’s endoscopy services.

“To the trainees, we say congratulations. It’s not easy to balance work and study. But your effort will improve healthcare for all. Let’s build on this knowledge and continue improving medical services for every Mosotho.”