5 February 2024 by Limpho Sello

 Est Read Time: 8 min(s) 3 sec(s)

‘Makhauhelo Tlouoe, aged 43, is a cancer survivor. She was diagnosed with a rare cancer condition called choriocarcinoma in 2020. Credit: Makhauhelo Tlouoe.

---

A persistent wave of nausea washes over Makhauhelo Tlouoe, signalling the onset of pregnancy.

Simultaneously, a relentless, warm fluid courses through her, a telltale sign of excessive vaginal bleeding.

With every pad-changing episode, Tlouoe witnesses unsettling clots in her blood, prompting her to seek medical attention at a private facility in Maseru.

Worried about her condition, the doctor swiftly refers her to Queen ‘Mamohato Memorial Hospital (QMMH) for specialised care. It’s January 2020.

“I failed to receive the crucial assistance I desperately needed, primarily due to the fact that my referral originated from a private clinic,” Tlouoe candidly shares with Uncensored News.

Left stranded, a few nurses at QMMH suggested that Tlouoe seek assistance at Scott Hospital in Morija, approximately 44 kilometres away from Maseru.

Once more, her referral from a private clinic proved to be a formidable barrier between Tlouoe and the essential medical care she urgently required. She returns helplessly to her home in Ha Seleso, Maseru.

Lesotho moves to strengthen primary health

In ‘The Growth of Health Expenditure in Lesotho,’ authored by Paseka Ramashamole and Retselisitsoe Thamae, the spotlight is on the introduction of a no-fee policy for healthcare services in state-owned facilities.

The primary goal is to enhance equitable access and address health-related millennium development goals, setting minimal fees at higher levels. The study underscores that government-set prices, as opposed to market forces, can foster increased service utilisation.

Despite the no-fee policy at public health centres and substantially subsidised fees at state hospitals, the preference for private facilities persists among most middle-income households due to overcrowding and inadequate medical supplies in state-owned facilities.

In response to these challenges, the Ministry of Health has taken steps to improve services in public facilities by recently launching uninterrupted services at three filter clinics in Maseru – Likotsi, Mabote, and Qoaling – all attached to Queen ‘Mamohato Memorial Services.

Dr. Ngoyi Kaumbo, a physician at Likotsi Filter Clinic, stresses the necessity of intensified access to healthcare services in Lesotho to meet the demands of fast-paced communities.

“One of the primary advantages of 24-hour hospital operations is the potential to alleviate congestion in emergency rooms. By spreading outpatient visits over a 24-hour period, I believe that we can better manage patient flow, reduce waiting times, and provide more immediate care to those in critical conditions,” Dr. Ngoyi highlights.

In contrast, Health Minister Selibe Mochoboroane emphasises that strengthening primary healthcare is crucial for achieving overall health system effectiveness.

“I believe that strengthening primary health care is essential for building a resilient, equitable, and efficient healthcare system that can effectively meet the health needs of individuals and communities,” stated Minister Mochoboroane.

Tlouoe takes a proactive step.

Back in Ha Seleso in Maseru, the intensified excessive vaginal bleeding of Makhauhelo Tlouoe induces panic in her family.

Desperate for help, she resorts to tearing the page of her referral from her booklet, erasing any trace of her history with the private facility in Maseru.

While it is strongly discouraged for patients to tamper with their medical history by tearing pages in their booklets, Tlouoe, in her urgency, takes this unconventional approach.

The following day, Tlouoe seeks assistance at Qoaling Filter Clinic, which promptly refers her to Queen Mamohato Memorial, where she receives help without hesitation.

“It’s a molar pregnancy,” nurses told Tlouoe.

“A lot went through my mind.”

Processing this information, she turns to her aunt, a nurse, for clarification and a breakdown of what a molar pregnancy entails.

A molar pregnancy is a rare complication characterised by the unusual growth of cells called trophoblasts, which would typically form the placenta to nourish a developing fetus.

 At this point, Tlouoe has lost a significant amount of blood and urgently requires a blood transfusion. Faced with Lesotho’s chronic blood shortage, she turns to her husband and friends for blood donations. Once the transfusion is completed, she undergoes treatment for the molar pregnancy.

“But my stomach kept growing bigger, like that of a pregnant woman,” she said, describing her post-treatment experience.

“I cried so much.”

At the Queen Mamohato Memorial Hospital, which was built through a partnership between the Lesotho government and the Tšepong Consortium, doctors delivered unsettling news to Tlouoe.

Her growing stomach and two failed treatments were not promising signs. In the hospital treatment room, they warned her that her condition was likely to turn cancerous.

“When I heard them make that prediction, I cried so much.”

With her stomach growing bigger and the pain intensifying each day, Tlouoe took a picture of her pregnant-like stomach. She sent the photo to her aunt, who took it seriously and sought help on her behalf, leading her to the Senkatana Oncology Clinic in Maseru.

Launched in October 2022, the oncology clinic aims to provide care for cancer patients, reducing the need for expensive referrals to South Africa and India. At the clinic, clinicians conducted thorough medical tests.

“They found that I had choriocarcinoma cancer at stage 3,” she said.

Choriocarcinoma is a very rare type of cancer, with a low incidence. For instance, in China, only one out of every 2882 pregnant women is affected.

There are some things that can increase the chances of getting this cancer. If someone had a complete hydatidiform mole before, also known as a molar pregnancy, they have a 100 times higher risk. Other things that can increase the risk include being older, using certain birth control pills for a long time, and having blood type A.

Now aware of her condition, Tlouoe was transferred to Bloemfontein, South Africa. “I started my treatment in May 2020 and continued throughout the end of 2021 in Bloemfontein.”

Having heard stories of cancer patients, Tlouoe realised the extent of the pain and mental health burdens that accompany the illness.

“I was sick and bedridden, understanding the challenges. But all the time, I prayed for healing because I knew how much my family needed me, especially my children.”

During her treatment, Tlouoe had to be isolated in the hospital due to a worryingly low immune system. Her meals would be left on the doorstep for her to retrieve.

“It was a very difficult time for me and for my husband, who was my caregiver. There was a time when I stayed in the hospital in Bloemfontein for a full month.”

Closing the Cancer Care Gap

Ministry of Health Principal Medical Scientist and Cytologist, Sejojo Phaaroe. Credit: Sejojo Phaaroe.

---

On 4 February, the world observes World Cancer Day under the theme “Close the Care Gap.” The campaign, as highlighted on the World Cancer Day official website, revolves around understanding and acknowledging the global disparities in cancer care.

“This World Cancer Day, we recognise the power of working together,” states the website. “We know that every single one of us has the ability to make a difference, large or small, and that together we can make real progress in reducing the global impact of cancer.”

In Lesotho, the commemoration will take place in Mapholaneng, Mokhotlong, on 10 February 2024. “We are commemorating it in Mokhotlong because we want to reach populations that struggle to get services due to their geographical locations where there are several barriers to accessing health services in full,” explains Ministry of Health Principal Medical Scientist and Cytologist, Sejojo Phaaroe.

Another reason for bringing the Cancer Day commemoration to Mokhotlong, according to Phaaroe, is the realisation of the negative impacts of the construction of Phase II of the Lesotho Highlands Water Project on the health sector.

Phaaroe shares with Uncensored News that in Lesotho, there is still much work to be done in closing many gaps in cancer care. These gaps include challenges in accessing care, particularly for people in hard-to-reach areas.

Phaaroe emphasises the need to prioritise these individuals, stating that more education and taking services to where they are located will aid in eliminating cancer and other diseases. Early diagnosis and cancer prevention are crucial in addressing cancer in Lesotho, Phaaroe notes.

He adds that these elements are included in the integrated health services program that the Ministry of Health is implementing across the country.

“Also, prevention is better than cure. Unfortunately, with the Ministry of Health’s budget, 60 percent goes to local subventions and specialised services sought abroad in Bloemfontein, South Africa, and India. Twenty percent is allocated for drugs, diagnostics, and consumables, 15 percent on human resources, and five percent on prevention.

“But what needs to happen is to reverse this and invest 60 percent in prevention and risk communication, screening, and vaccines such as the HPV vaccine. We also need to intensively engage community leaders, Village Health Workers, police officers as gatekeepers, teachers, as well as government ministries,” Phaaroe suggests.

He highlights that when all these sectors are included, screening of people should be conducted, and those presenting with signs must be referred to clinics and hospitals for further medical attention. “Those who are in the clear should be educated about behavioral communication to stay healthy.”

Statistics paint a grim picture – Phaaroe

According to the latest cancer statistics from the World Health Organisation (W.H.O) for Lesotho, there are 2,027 new cancer cases in the country, with 1,411 recorded cancer-related deaths.

Among males, the top leading cancer cases include prostate, Kaposi sarcoma, and esophagus, while among females, they are cervical, breast, and esophagus.

Source: World Health Organisation.

Sejoro Phaaroe, Ministry of Health Principal Medical Scientist, and Cytologist, raises concerns about these cancer statistics, emphasising that they do not provide a clear picture for Lesotho due to the absence of a cancer registry. He notes that the country’s data is imperfect, relying solely on hospital data.

“We need to note that there are people who do not go to the hospital when they are sick, some who die without knowing the cause of death. Apart from that, there are people who rely on tradition and faith healing, and some choose to seek treatment across the border, and these are some of the numbers we miss,” Phaaroe explains.

“Through community engagement, we can reach all these areas. Additionally, there is a pressing need for a national cancer policy and a cancer strategy; without them, we will continue to face challenges.”

Navigating the struggles: Makhauhelo Tlouoe’s HCG journey

Today, former Moafrika FM reporter, Makhauhelo Tlouoe, finds herself in the midst of a challenging chapter, currently undergoing human chorionic gonadotropin (HCG) testing.

HCG is a special chemical made by early baby tissue. It helps find out if a pregnancy is normal or if there might be a problem. Doctors also use it to check for certain cancers, like choriocarcinoma.

However, a significant hurdle has emerged as Tlouoe explains, “The challenge at hand now is that for HCG testing, I go to a private laboratory where I pay M180. I am not the only one. There are many of us facing this issue because the lab at Queen Mamohato Memorial Hospital is no longer operational. This is money we do not have.”

Sharing her personal struggle, Tlouoe adds, “I am currently unemployed because I used to work at MoAfrika FM. When my illness worsened, I had to take unpaid leave. Returning to work has been challenging. During that time, we solely relied on my husband’s honey sales as he is a producer of bee honey.” The financial strain amplifies the difficulty, making essential medical tests an additional burden for Tloue and others in similar circumstances.

On a positive note, Tlouoe is currently in her second year, pursuing a degree in professional communication at Limkokwing University of Creative Technology.