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28 October 2024 by Pascalinah Kabi

A three-month delay in passport issuance by the Lesotho government led to the leg amputation of a 16-year-old cancer patient Tšepang Masilo, who urgently needed treatment in Bloemfontein, South Africa.

The delay, compounded by an additional month-long wait for a hospital booking, contributed to a severe leg infection that led to her leg amputation on April 24, 2024.

“Tšepang’s doctors told us she needed to travel to Bloemfontein urgently, but we didn’t have passports. It took the ministry (of home affairs) three months to issue them,” Tšepang’s mother, Mathulare Masilo, told Uncensored News on October 27, 2024.

Masilo believes that if the passport issuance process had been expedited in September 2023, when doctors advised that Tšepang needed cancer treatment “as soon as possible,” her daughter’s amputation might have been avoided.

“I believe these delays led to the infection in her leg. As we waited those three months, the cancer continued to spread, affecting her already weakened leg, which had been fractured by the time she was diagnosed with osteosarcoma,” she added.

Masilo is urging the Ministry of Home Affairs to prioritise passport issuance for patients who can provide documentation of their need for medical treatment abroad.

“If patients present letters from doctors confirming the urgency of their travel to Bloemfontein for medical reasons, the ministry must prioritise these cases. It should not take three months for a patient to receive a passport,” Masilo argued.

Refiloe Mahapang, a nurse at Senkatana Oncology Centre, is acutely aware of the challenges facing cancer patients in Lesotho, particularly regarding access to passports.

“The issuance of passports for cancer patients takes too long; sometimes, they don’t receive their passports at all. Delays in processing passports directly impact patients’ bookings in Bloemfontein. By the time they finally arrive in Bloemfontein, their condition is often severe,” Mahapang stated on July 12, 2024.

Passport crisis

Lesotho is facing a passport crisis due to a backlog of 37,000 applications dating back to 2018. The Ministry of Home Affairs reports that it is struggling to clear this backlog because of a lack of resources.

According to the Lesotho Times, Acting Director of Passports Mochesela Ntiisa informed the Senate’s Government Assurances Committee (GAC) that his department is unable to meet the demand for new passports, with a backlog of 4,000 applications for 2024 alone.

“This means that the Department of Home Affairs is overwhelmed by applications,” Ntiisa was quoted as saying. In Maseru, they can issue only 50 passports daily, despite receiving more than 100 applications each day.

“The Maseru office is restricted to issuing 50 passports a day, which must be allocated among emergency applicants,” Ntiisa added.

In September 2023, Mathulare Masilo and her daughter urgently needed passports to travel to Bloemfontein for Tšepang’s cancer treatment. However, it took three months for the Ministry of Home Affairs to issue the documents that stood between Tšepang and her life-saving medical care in South Africa.

Masilo believes that these delays, along with an additional month-long wait to secure a booking in Bloemfontein, significantly contributed to the amputation of her daughter’s leg on April 24, 2024.

“After receiving our passports, we had to wait another month to secure a booking, and during that time, the cancer continued to cause extensive damage to her leg, leading to the amputation,” Masilo said.

The Masilo family is not alone in their struggle. Many face challenges not only in obtaining travel documents but also in dealing with the consequences of overstaying in South Africa while being attended to by doctors in that country.

According to Dr. Kabelo Mputsoe, a Clinical Oncologist at Senkatana Oncology Centre, this situation has devastating impacts on cancer patients in Lesotho.

“Their passports are cancelled for overstaying, and they become irreparable. I don’t know what to do with these patients when they are hit with a fine of 5-10 years without entering South Africa,” Dr. Mputsoe told members of the National Assembly’s Social Cluster Portfolio Committee on July 12, 2024.

She urged parliamentarians to leverage their influence to encourage the governments of Lesotho and South Africa to facilitate smoother travel for cancer patients between the two countries.

Dr. Mputsoe emphasised that this seamless travel could be achieved by ensuring that patients who provide substantial evidence of overstaying in South Africa due to hospitalisation are not fined.

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Cancer hospital stalls

As the passport crisis for cancer patients worsens in Lesotho, plans to construct a national cancer hospital—intended to allow patients to receive treatment within the country—have stalled, despite expectations for its opening in 2024.

Mokhothu Makhalanyane, Chairperson of the Social Cluster Parliamentary Portfolio Committee, stated that the construction of the hospital, which was intended to begin in 2011, is being hindered by greedy individuals.

“The reason people are going to Bloemfontein for treatment is that we do not have a cancer treatment hospital. Even now, we are still working hard to get this project off the ground,” Makhalanyane said during his committee’s visit to Senkatana Oncology Clinic on July 12, 2024.

“I wish Basotho knew that there are cruel individuals frustrating the start of this project, and they have now enlisted the help of the Chinese to undermine it. We allocated funding for the hospital’s construction; it is stalling because of these malicious actions. They are filing court cases to stop the construction,” he added.

A joint venture that included UNIK Constructing Engineering Company was an unsuccessful bidder for the cancer hospital project, losing to Plem Construction Company, which successfully built the Malawian Cancer Hospital. UNIK is contesting the tender panel’s decision.

If Lesotho had followed in the footsteps of Malawi, the hospital could have provided chemotherapy and radiotherapy for around 1,000 patients annually, along with accommodation for those requiring extended treatment.

Currently, Lesotho spends approximately M250,000 per patient for cancer treatment outside the country, which has become a significant burden.

In 2019, Mamasiane Tieho, then Principal Secretary at the Ministry of Environment, Tourism and Culture, highlighted this issue.

 “We have lost many lives due to cancer because of the lack of a radiotherapy facility. It has been a long journey to get to this stage, but we are very happy to finalise the centre’s roadmap and get things moving,” he remarked during Lesotho’s visit to the International Atomic Energy Agency (IAEA) offices in Vienna in May 2019.

The IAEA plays a crucial role in cancer treatment by promoting and supporting the use of radiation medicine. In May 2019, the agency provided expert assistance to Lesotho in its plans to construct the cancer hospital. However, contrary to these plans, the only visible evidence of the cancer hospital project is a site near Queen Mamohato Memorial Hospital.

I was bitter

As Lesotho turns to South Africa for cancer treatment, logistical challenges hinder effective care, leaving families like that of Mathulare Masilo grappling with painful realities. Masilo expressed her bitterness upon learning that her daughter Tšepang would lose her leg to cancer.

“She was transferred to Bloemfontein, where they amputated her leg due to severe infections. I was a very bitter person because I did not understand why her leg had to be amputated,” Masilo shared on October 5, 2024, during a childhood cancer awareness event organised by the Childhood Cancer Organisation in Lesotho.

While Masilo observes positive changes in her daughter’s well-being, she urges parents not to take their children’s illnesses for granted, as doing so can have devastating impacts.

“Once a child displays signs of sickness, I advise parents to take them to a doctor,” she said.

In addition to the logistical hurdles of obtaining passports and booking delays, Masilo admitted that she initially dismissed her daughter’s limping as a minor issue, not recognising it as a sign of something serious like osteosarcoma cancer.

Meanwhile, Sejojo Phaaroe, Principal Medical Scientist and Cytologist at the Ministry of Health, stated that the ministry has identified the absence of National Cancer Policy has a major gap in the fight against cancer.

“We need a National Cancer Control Strategy. We plan to involve patient organisations in designing and writing the strategy to address these gaps,” Phaaroe said during the childhood cancer awareness event on October 5, 2024.