14 February 2024 by Pascalinah Kabi

 Est Read Time: 7 min(s) 37 sec(s)

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28-year-old ‘Makeabetsoe Mokoena is HIV positive. She claims Molikaliko Health Centre turned her away a month before delivering her third child. Credit: Pascalinah Kabi.

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The water moves steadily but gently, creating a soft murmuring sound as it flows over smooth rocks and pebbles beneath the surface.

This peaceful rhythm of the flow is punctuated by the occasional gentle ripple, as if a small breeze brushes across the water’s surface.

In the tranquil setting of the Khubelu River, just a stone’s throw away, one-month-old baby Mokoena is invited by the soothing flow to relax and enjoy the tranquillity of the natural environment.

Peacefully sleeping on a mattress in his parents’ hut in Maloraneng, Mokhotlong, baby Mokoena remains oblivious to the controversies surrounding his birth.

“I gave birth to him here at home,” 28-year-old ‘Makeabetsoe Mokoena opens to Uncensored News.

Without flinching, ‘Makeabetsoe says giving birth to her third child has left deep scars in her heart.

“I am not happy that I delivered my son here at home,” she said.

WHO offers support for Lesotho to address high maternal mortality and newborn deaths.

Currently, in Lesotho, for every 100,000 babies born, about 566 mothers die while giving birth. This number is considered very high by the World Health Organisation (WHO). It is even higher than the average number of mothers who die during childbirth in other African countries, which is about 545 out of every 100,000 births.

According to WHO, the main reasons for mothers dying during childbirth in Lesotho are haemorrhage, hypertensive disorders of pregnancy, and complications from unsafe abortions.

Towards the end of 2023, WHO organised an in-country meeting of technical experts to analyse and discuss practical solutions for reducing maternal and neonatal deaths in Lesotho.

During this meeting, Dr. Nonkosi Tlale, a Sexual Reproductive Health and Rights Advisor to the Ministry of Health, highlighted key challenges, such as a shortage of obstetricians and gynaecologists. Other issues include a lack of blood and blood products for managing obstetric haemorrhage, as well as essential supplies for emergency obstetric care.

Also speaking at this meeting, Dr. Roseline Dansowaa Doe from WHO emphasised the urgent need to lower maternal and newborn deaths.

She stated, “There is the need for WHO to provide support to the country to identify the main causes, strategise to address them, and provide the needed technical assistance to implement the strategies to reduce preventable maternal and newborn deaths.”

In 2009, Lesotho launched a program aimed at promoting safe deliveries in healthcare facilities as part of its efforts to reduce maternal mortalities. During that time, Partners in Health trained 100 women, many of whom were former traditional birth attendants, to work as maternal health workers affiliated with clinics.

These women were incentivised based on their performance for accompanying pregnant women during antenatal care (ANC) visits and assisting with facility-based deliveries. Under the supervision of a nurse-midwife, these maternal health workers provided ANC and delivery care.

To address the challenge of geographic barriers preventing women from reaching the clinic for delivery, those living far away are provided accommodation at a maternal lying-in house before their expected delivery dates. This initiative aims to ensure that all pregnant women have access to essential care and support, regardless of their location.

“I travelled to Molikaliko Health Facility.”

Map-of-Lesotho-health-centre-facilities-ecological-zones-and-districts-Source-National. Credit: Nyangu Isabel

In Maloraneng, people trek for a minimum of eight hours to reach the nearest operational health facility, Molikaliko. By horseback, it takes about six hours to reach Molikaliko Health Centre. This facility, serving the entire Pae-lea-Itlhatsoa area, is the closest one for Maloraneng villagers. Nurses from Molikaliko conduct monthly visits to Maloraneng since the clinic built by Letšeng Diamonds Mine remains non-operational.

On November 16, 2023, ‘Makeabetsoe Mokoena, heavily pregnant, prepared her essentials and receiving kit for her son, planning ahead of her estimated delivery date of December 26, 2023.

“I first went to Molikaliko on November 16th. I stayed at the nursing mothers’ home,” explains ‘Makeabetsoe.

She travelled to Molikaliko Health Centre in the facility’s vehicle after the Maloraneng Village Health Worker, ‘Mamapholo Ntsiki, requested assistance.

At Molikaliko Health Centre, the nurse in charge, ‘Mabokang Ntsie, popularly known amongst patients as Ms. Damane, arranged for her to stay at the centre in line with a national program that ensures pregnant women access essential health services regardless of their geographical location.

“The nurse in charge even said food for expectant mothers is readily available. Previously, there was no water there, she said the issue has been resolved and now the facility has water,” ‘Makeabetsoe said.

On December 5, 2023, Ntsie was not at the facility for reasons unknown to this publication. Her absence, ‘Makeabetsoe alleges, prompted her release from the health facility.

“I was discharged on December 5th by ‘m’e Matlanyane who told me to go to Seboche (hospital),” she said.

Seboche Hospital is located in Botha-Bothe. A round trip from Maloraneng to Botha-Bothe costs approximately M240 ($13). Fifteen days later, ‘Makeabetsoe made her way to Molikaliko Health Centre again. She says Damane was not at the facility.

“They (nurses) chased me. They told me to go to Seboche. On both December 5 and December 20, I told nurses at Molikaliko Health Centre that I didn’t have transport money to go to Seboche,” she said.

With her due date estimated on December 26, 2023, ‘Makeabetsoe claims she was told that she still had time to raise transport fare to and from Seboche Hospital in Botha-Bothe.

On February 13, 2024, Ntsie told Uncensored News that ‘Makeabetsoe’s grievances were being addressed by officials at the Ministry of Health’s headquarters in Maseru.

Meanwhile, the act of turning away patients like ‘Makeabetsoe from community-based health facilities stands in stark contrast to the ongoing Ministry of Health’s campaign on integrated health services program, launched by Health Minister Selibe Mochoboroane in February 2023.

According to the Lesotho News Agency (LENA), Mochoboroane emphasised during the launch that the aim of the Integrated Health Services program is preventive rather than curative.

He stated, “Health services delivery has to be strengthened at the community level, and if we are able to prevent it at the community level, our hospitals will not be congested. Continuous trips to hospitals symbolise our failure to do our job in the community.”

Lesotho is fighting new HIV infections.

Despite having the second-highest HIV incidence rate globally, Lesotho is making progress toward ending AIDS by 2030.

In 2023, almost everyone living with HIV (94 percent) knew their status. Out of those aware of their status, nearly all (91 percent) were taking antiretroviral medicine. And among those taking medicine, almost all (98 percent) had low levels of the HIV virus in their bodies.

Lesotho is also focused on preventing mothers from passing HIV to their babies. ‘Makeabetsoe, who is HIV positive, is one success story in preventing mother-to-child transmission. She gave birth to her first two children in a health facility, and both are HIV negative.

However, when she went to deliver her third child, she was turned away from the Molikaliko Health Centre, leaving her with no choice but to give birth in her modest hut in Maloraneng, Mokhotlong.

“Being chased away hurt me. I even told ‘m’e Matlanyane (the nurse) that, since you are telling me to leave and I have told you that I do not have funds to travel to Seboche, I am HIV positive and my child needs medication upon birth,” ‘Makeabetsoe said.

Fully aware of the risks of giving birth at home and potentially infecting her son, ‘Makeabetsoe made an unusual request to the staff at Molikaliko Health Centre.

“I asked her (Matlanyane) to give me the medication (nevirapine) to administer to my child in case I deliver at home. I also asked for surgical gloves. She gave me both the medicine and the gloves,” she explains.

At around 4 am on December 23, ‘Makeabetsoe began experiencing labor pains. She asked her mother, mother-in-law, and a female neighbour to assist in delivering her son, who was born around 1 am on December 24, 2023. She provided gloves to protect them from HIV infection and asked them to administer nevirapine to her son to prevent transmission.

The nurse in charge at Molikaliko Health Centre, ‘Mabokang Ntsie, says the matter is being handled by her superiors at the Ministry of Health’s headquarters in Maseru.

“Due to seniority, I am unable to comment because by doing so, I will be breaking protocol lines,” Ntsie told Uncensored News.

On January 31, 2024, Health Minister Selibe Mochoboroane directed all questions related to this matter to the Ministry of Health’s Nursing Director, Mpoeetsi Makau.

However, attempts to obtain a comment from Makau were unsuccessful at the time of going to print. On February 13, 2024, Makau said she was in meetings and would call the publication before the end of the business day but did not follow through on her promise.

The Social Cluster Committee voices concerns

‘Makeabetsoe alleges that the nevirapine given to her had expired in December 2023, the same month she delivered her son. At the beginning of last month, ‘Makeabetsoe sent her husband to the Molikaliko Health Centre to request nevirapine that was not expired.

Upon arrival, ‘Makeabetsoe claims her husband was assisted by Nurse Matlanyane, who allegedly informed him that the medication could still be used for another three months despite its expiry in December 2023.

“She (Matlanyane) asked which measurements I was using to administer the medication to the child. My husband told her he did not know. She asked for my contacts. She called and asked me; I told her the measurements and she said that was too much. She asked me why I was doing that, and I told her, you did not explain to me. My memory from my first two babies is flossy,” she said.

She alleges that she was asked to state the weight of the baby. The baby had not been weighed, and she was instructed to see Village Health Worker, Mamapholo Ntsiki, for weight measurement.

“I immediately went to ‘m’e Mamapholo and the child weighed 4.6 kg,” she said, adding that she was immediately told to decrease the measurement.

Social Cluster Chairperson, Mokhothu Makhalanyane.

Chairperson of the National Assembly Portfolio Committee on Social Cluster, Mokhothu Makhalanyane, condemns the actions of the Molikaliko Health Centre.

“It sets a bad precedent because the purpose of facility deliveries is to reduce maternal deaths and infant mortality. When a woman delivers in a safe environment, it decreases the chances of infant mortality and enables the pregnant woman to receive help in cases of emergencies.

“But having a pregnant woman chased away from a health facility is very embarrassing. It’s an embarrassing act that should not happen. We condemn it,” Makhalanyane said.

He states that the Mokoena family, or any organisation, can petition the Social Cluster Committee to address this issue.

“Just as you (Uncensored News) have told us about this issue, we will take it up with the ministry and the responsible district,” Makhalanyane said.