HEALTH Minister Dr Molotsi Monyamane says he is not really startled by the increase in the HIV prevalence rate from 23 to 25 percent.
To him that indicates infected people are living longer because they are on medication. But what keeps him awake is the number of new infections which he says has remained high despite millions of maloti used in campaigns.
In the following interview Dr Monyamane explains how the government is reacting to the scourge.
The HIV prevalence has started climbing up again, according to a District Health Survey conducted in 2014 and 2015. Where are we getting it wrong?
I think we should look at what is happening to the youth first. There is comprehensive research that shows that 70 percent of youths in the SADC region don’t have a clue about HIV. Clearly we are not closing the gap. We have not managed to close that gap. If the youths know very little about the biggest threat to their lives then we are in trouble. We need to focus on reproductive education in the schools. Matters of sexuality should be in the school curriculum. We need to urgently establish adolescent friendly health centres. We have to address the availability and use of condoms. Our focus should also be on keeping children in schools to protect them against early marriages. Our girls are being married too young when they don’t have either the knowhow or the means to protect themselves against HIV once they are in the marriages.
Such interventions target the youths but they are not the only ones affected?
That is true. We are working hard on the prevention of the mother-to-child infections. There are pregnant women who are not getting tested. Those that are being tested are not getting treatment. There is also the problem of couples where one partner is positive and the other is negative. The positive partner must be on treatment so they reduce the chances if infecting the other. There are also some groups of people that are being left behind. Statistics have shown that the HIV prevalence rate is highest among sex workers and men who have sex with men. We are talking about a prevalence rate of 70 percent. Now, that means we need to improve access to pre-exposure prophylaxis and post exposure prophylaxis.
Could there be an element of some people not having access to health centres?
Indeed that is one of the major problems we face. There are people who are being left behind because they don’t have access to health services. We need to urgently improve our delivery of health services to people. Our outreach programmes have also been weak. Most of the HIV advocacy is targeting urban areas. There is not much for miners, herd boys and the general rural populace. There are hard-to-reach areas where the message is not reaching. These people have limited or no access to health services. We are pushing on workshops in Maseru and other towns while neglecting the people who really need the message and the services.
Why do you think people are no longer panicking when they hear that the HIV prevalence has increased from 23 to 25 percent?
It’s a historical issue. There was a time when people were visibly sick. Now people are living longer and remaining healthy because of antiretroviral drugs. The issue we should be worried about now is whether those that are on medication are taking precautions to protect their partners from infection or protecting themselves from being re-infected. In the past such numbers would make people panic because people were dying. The number that should really scare us is that of new infections which are currently at 100 per week. That means we are having 5 200 new infections every year. The real crisis is on the 13 to 24-age group where the prevalence and new infections are highest.
How do we reverse that trend?
The solution lies in testing and treating. We need to test and treat people before it’s too late. Those who know their status will then take precautions to protect their partners. The earlier they get on treatments the more effective the medication becomes. The problem now is that people are coming for treatment when already too sick and by that time it will be too late. We are guided by the 90-90-90 vision. By 2020, 90 percent of all people living with HIV will know their HIV status. By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression. We have seen the number of children on medication increase from 30 percent to 57 percent. The number of pregnant infected women on medication is 70 percent. Our major concern is that on the broader scale the number of adults on medication had been growing slowly. It has just grown from 40 percent to 45 percent, which is not enough. That to me says we should go on an aggressive campaign to test and treat.
How do you keep people on medication?
That is the hard part. The medication is free but people don’t consistently follow the treatment plan. The reason could be that people are discouraged because they have to travel long distances to collect their medications. It could be that people don’t know the importance of taking the medication consistently. We have realised that we need to give people medication that last them for long periods so they don’t have to keep coming back to the health centre. You might know that from April this year people have been getting three-months’ supply and that has really helped.
A lot of money has been used in the fight against HIV but the results remain modest. In some cases nothing much has been achieved. Have we used the money wisely?
I don’t think so. A lot of money has been used for workshops, per diems, flights and salaries. We are not investing our money in the things that really matter in the fight against HIV. The bulk of this money comes from the government. For example 47 percent of the money used in the response to HIV comes from the government. Nearly 70 percent of the money used to buy HIV medication comes from the state and so does 100 percent of the money used for TB medication. The government is funding the primary health care. We need to start investing our money in areas that bring results. We need to channel our money to areas where it is needed the most. That means putting money at primary health care level. I mean the villages.
25 percent – HIV prevalence
13-24 – the most affected
70 percent – HIV prevalence in sex workers and gay man
57 percent – number of children on treatment
45 percent – adults on treatment
70 percent – pregnant women of medication
Warning over new deadly drug
MASERU – THE Blue Cross Society, which fights drug and alcohol abuse this week issued a chilling warning about a deadly drug it says could have found its way into Lesotho.
The flesh-eating drug, krokodil, has already killed two people in South Africa.
Krokodil is injected into the body through a hypodermic syringe and keeps its user high for 90 minutes or two hours.
An addict may develop a skin condition that resembles the crocodile’s skin especially when they inject themselves.
According to narconon.com Krokodil gets its name from the fact that the drug causes an addict’s skin to become scaly and bumpy like a crocodile’s.
If the drug misses a vein and is injected into the flesh, that flesh will develop sores.
It is common for some body parts of addicts to decay eventually requiring amputations.
The flesh on some body parts affected by krokodil injections will rot off completely, leaving bare bone.
Introduced in Russia over a decade ago, the drug has found its way into Africa and has recently been discovered to be one of the deadliest drugs to hit South Africa.
The drug has already killed at least two addicts in Port Elizabeth.
Krokodil made headlines in South Africa in July last year when Port Elizabeth’s Herald newspaper reported that Martha Dean staged a protest outside a magistrate’s court where her 25-year-old daughter was appearing on a charge of possessing the drug. “Mr Magistrate please don’t free my daughter to die on the streets,” read the placard she was carrying.
The court ordered Bonita Dean, her daughter, to be sent to the nearby Noupoort Rehabilitation Centre.
She later escaped, made her way back to Port Elizabeth and, four months later, she died.
Krokodil is sold cheap, at only M20 a packet.
When Bonita died, she had been using 13 packs a day. The US online magazine, Time.com, calls krokodil the world’s deadliest drug.
‘Masebuoeng Majara, Blue Cross’s Campaign Coordinator, says unlike many other hard core drugs Krokodile addicts live only for six months or three years if they are stronger.
“This depends on each individual’s body type and organ strength,” Majara said.
Majara said it would be difficult to say whether the drug is already in the country. “The channels that drug dealers smuggle in drugs and introduce them, make it hard to even monitor (krokodil’s) availability,” Majara said.
She however added that our boundaries are porous and therefore many drugs come in easily. “Like nyaope, this drug is made from the comfort of people’s homes and back-doors through mixing different over-the-counter medications,” Majara said.
Majara said the drug is a cheaper version of heroin and it is likely to hit the drug market with no mercy unless the youths look out for themselves.
According to Majara drug abuse among youths start at the age of ten to 15 years. The Step Away Treatment Centre, an anti-drug abuse organisation in South Africa, says “while Krokodil addiction in South Africa is not yet as prevalent as heroin addiction, the numbers of reported cases have begun to rise”.
South African National Council on Alcoholism and Drug Dependence (SANCA) told the Mail & Guardian newspaper in November last year that it had four users of krokodil in its 33 centres nationally. “Three new cases have been reported in Emalahleni and two in Port Elizabeth. All three clients needed immediate medical attention due to the serious consequences of this drug,” Adrien Vermeulen, SANCA’s official, said.
The most common drugs in Lesotho are alcohol, tobacco and dagga. “We still have other hard core drugs in the country but they are not as prevalent as these that I have mentioned,” Majara said.
“We have people who use heroin, mandrax, cocaine, ecstasy, tik and others and we have treated such patients at our centre but because these drugs are expensive they are used by certain people who can afford them,” she said.
The legacy of Thomas Mofolo
Sesotho is a language full of beautiful proverbs and idioms of expression, and among them is the quintessential:
Monna ke ‘mokopu’ oa nama (A man spreads like the tendrils of a pumpkin)
Excuse the pun but the figure I am referring to this day bears the name ‘Mokopu (Pumpkin)’ and his influence on the literature of the world has spread to all the corners of the world. His work has been translated into more than seven languages, and there are more translations of his work than any other author in Southern Africa, and he has been given the rightful title of “The Father of the African Novel”. I guess that there is one thing that a lot of us Basotho lack; the right spirit of giving respect where it is due, that is, acknowledging the contribution and impact the arts in this country have in influencing the minds of the citizens and informing the politics of governance in this kingdom.
More times than less, we honour authors and artists from other countries than we do our own and, what we seem to forget is that this mountain land gave birth to some of the best minds and pioneers in different fields of study and the pursuit for knowledge. A man noted by the world as the pioneer of the African novel should by right be taught in schools from primary level, but due to a spirit of iconoclasm and a penchant to destroy images of individuals sacred to the history and the progress of this land, many vital names and individuals whose lives served as beacons for the masses are forgotten.
This occurs until some stranger from a foreign land comes across such a forgotten figure and rekindles the flame that lit the fire in whose warmth those children of the past who are mothers to the present generation used to bask in.
I was fortunate enough to be invited to the promotional presentation of the release of the publication ‘Translating Mofolo’ edited by Professors Chris Dunton of NUL and Antjie Krog of the University of the Western Cape.
Present were the members of the Mofolo family, Ntate Stephen Gill who serves as the Morija Museum’s curator, Ntate Gerard Mathot of Family Art and Literacy Centre, Professor Chris Dunton of NUL, Dr Limakatso Chaka of NUL, Ntate Percy Mangoaela who proved to be an exceptional Master of Ceremonies, dignitaries from Alliance Franḉaise where the presentation was held, Ntate Meshu Mokitimi, and a host of other scholars, artists, teachers, creative individuals, and respectable Basotho from varied spheres and occupations. All of us had come to witness the re-kindling of the spark that lit the flame which grew into a roaring blaze and, as the caption on the invitation programme states:
A Trophy or Living Legacy?
Literary icons and other famous persons are not of great value to a nation (or the wider world) if they are merely placed on display as one would do with a trophy; rather, each generation must deeply engage with and re-assess the contribution which such figures have to the broader legacy. As Basotho celebrate 50 years of their re-emergence as an independent nation this year, it is appropriate to remember and honour icons such as Thomas Mofolo who pioneered new forms of literature. We do so in the hope that valuable lessons will be learned, and that others may be inspired to similar greatness.
Mohale o tsoa maroleng.
In the words of one of the leading figures in the project, Professor Chris Dunton from the National University of Lesotho, the main motivation lies in a question raised by Professor Antjie Krog of the University of the Western Cape, in which she raised the paradoxical statement, that is, ‘talking about not talking’ borrowed from C. Booth’s Listening Rhetoric which in a lot of ways I believe borrows from the philosophies of tolerance as lived by King Moshoeshoe I.
The professor revealed the significance of translation and how it at the end of the day helps world communities to build understanding. We live in a world where circumstance or choice force us to live next to individuals or communities whose languages we do not understand, and this issue of misunderstanding causes a lot of problems when it comes to dealing with conflicts that naturally come up where people are neighbours.
Of significance in his speech as well was the mention that Thomas Mofolo was revered by such great American figures as William Edward Burghardt du Bois and Gertrude Stein both of whom held him in high regard. Thomas Mofolo’s Chaka remains one of those books that have been translated into many languages and have been cherished by readers from days long gone to the present day.
Doctor Limakatso Chaka’s presentation (titled New Insights into Mofolo’s 2nd Novel, Pitseng) largely focused on the beauty of Mofolo’s language and its multiple layers of meaning in the novel Pitseng, and it covered such aspects as the autobiographical nature of his (Mofolo’s) novels, the landscape narratives he wrote which were largely patriotic in nature, and which to a large extent revealed elements of economic progress, individual independence, and women empowerment, his role in Leselinyana la Lesotho, and the love narrative in Sesotho.
One found in the Doctor’s presentation the exposition of those elements about this great author that the reader would easily miss if they are not made aware of them. In the paper she read, one realises that it would indeed be a loss to this generation and the next if the meanings in the works of Mofolo are not revealed to their full complexity in terms of the salient themes explored. That we have been independent for 50 years means that we should transform into people who value their past greats.
In Pitseng, there is a feeling of progress, a movement forward from the old into the new era of colonialism. Post-colonially speaking, there should be a movement forward into a new era where the works of pioneers should be given their rightful places on the pantheons of heroes. That the writer taught the world the first words should be noted and the meanings thereof should be explored for all to understand them.
That he was a great penman and jack of all trades and master of all of them came to the attention of every member of the audience when Ntate Stephen Gill (Curator at the Morija Museum & Archives) took the floor. In the presentation titled The Man, the Writer and His Contexts pointed to the fact that the quest to understand a writer is a process that demands the understanding of his background, and as is the case with Ntate Mofolo’s story; understanding the writer’s clan and ancestral roots helps one who comes as a critic or analyst to fully know him.
The writer’s daughter fondly known Rakhali ‘Mapheko was introduced to those present, and from that point on, Ntate Morojele revealed the multiplicity of the talents of Thomas Mofolo. From teacher to astronomer, carpenter to editor, labour recruiter to being a political activist, the list of the professions Mofolo the quintessential Mosotho writer occupied is long and endless. Mofolo is an author respected even by the Communist Party in the days of the old Soviet Union, due to his multiplicity of talent and occupation; he was a figure they respected as ‘the man for all seasons’.
In essence, the skies he watched as Abraham did were in every way what came to influence the generations of writers in Africa and the world that came to read his work and translate it into their own languages. His words would go on to develop into many languages from the original one he wrote in, and in real terms, his success internationally is of Abraham proportions.
Associate Professor P. V. Shava and Lesole Kolobe’s paper The Mofolo Effect and the Substance of Lesotho Literature in English covers such salient issues as the reciprocal and symbiotic nature between the author and the traditions within which he is socialised. It went further to show the uniqueness of Lesotho literature as a national literature and as an integral part of African literature. Having been translated by such greats as Leopold Senghor in works such as Chaka, the form and the sensibility of Mofolo’s literature in English has carved distinct niche in world history; and though erroneously classified as South African, Lesotho literature has its own element of uniqueness.
It is perhaps the earliest literature of its form in Africa, the autonomy stemming from the fact that the socio-political contexts within which it was birthed mark it as different from the other literatures of the world. Notably influenced by the French missionaries who gave the Basotho the first orthography (officially registered in 1906, and many years older than the Bantu version of South Africa which was registered only in 1959 by the Apartheid government) with which to transcribe words, the first lessons into Western education, and the publishing of the first newspapers and works of literature by giants like Thomas Mofolo.
There are constant transnational and cross-border interactions between the Basotho and their other Southern African fellows, but it seems, the words of Thomas Mokopu Mofolo have gone on to constitute what can be deemed as an ‘effect’ on the psyches and consciences of writers across the world such as Chinua Achebe, Ngũgĩ wa Thiong’o and others. The professor and his fellow writer’s words go on to make a wish that the current generation cultivates a more active and dynamic reading culture in appreciation of the precedent fictive role played by Ntate Mofolo. That the novel is dying as a mode of literature should be curbed, that is, we should work hard towards reviving it, so plead the two scholars, one from Zimbabwe, and the other from Lesotho.
After the words of thanks by Ntate Mofolo’s granddaughter, the MC, Ntate Percy Mangoaela, capped the day with a plea to all the youth to rejuvenate the literature and the arts. In his own words he thus spoke, “We need our language now more than we did in the past… because we have come to a point where we are polarised as a nation.” This wisdom is further fortified by the MC’s suggestion that an institution to promote the arts and the literatures of Lesotho should be established, and also that the division in the two Sesotho orthographies should be addressed. With those words we parted ways, but before doing so, signed our names and left our contact details after a successful first presentation of The Mofolo Edition, Tydskrif Vir Letterkunde (a journal published by the University of Pretoria) organised by Friends of Morija Museum & Archives hosted at Alliance Franḉaise Hall, Maseru.
The pumpkin spreads, and when its season passes, it leaves behind seeds that will grow into other pumpkins that will spread far and wide even in fields foreign and far away from the original field it sprouted from. And in dedication, I pen a translation from a brief poem inspired by the reverend Thomas Mokopu Mofolo:
Nama Mokopu, rakalla Motaung! Leraka ha le shoe, le namalla feela, le re siela lithotse morao re leme! Se thoasitse selemo, ha re uteng Mokopu mobung… (Stretch out your legs Mokopu, spread far Motaung! The climbing tendril dies not, it merely prostates itself, and leaves seeds behind for us to sow! The spring has sprung, let us sow seeds of Mokopu into the soil…)
33.2% of children suffer from stunted growth
MASERU – AT least 33.2 percent of all children under the age of five in Lesotho suffer from stunted growth, according to a World Bank report released last week.
The report says Lesotho’s rate of stunting for children aged five and below is higher than its lower income peers like Ghana, Guinea, Mali, Mauritania, Sao Tome, Uganda and Zimbabwe.
The Kick-off and Validation of Cost of Hunger in Africa (COHA) study says there is a bigger price to pay for undernutrition than it is anticipated.
Margaret Agama-Anyetei, the African Union head of division for health, nutrition and population said Lesotho and other African countries have the potential to reap a demographic dividend from a young, educated and skilled work-force.
“But this potential can only be harnessed if the gains of early investments in the health and nutrition of its people, particularly its women and children, are maintained and result in the desired economic growth,” Anyetei said.
The COHA study was sanctioned by the African Union Commission (AUC) and the New Partnership for Africa’s Development (NEPAD), Planning and Coordinating Agency (NPCA), supported by the UN Economic Commission for Africa (ECA), Economic Commission for Latin American and the Caribbean (ECLAC) as well as the UN World Food Programme.
The study is implemented in multiple countries across the continent and aims at estimating the economic and social impact of child under-nutrition in Africa.
The preliminary results of the study have demonstrated the magnitude and devastating social and economic consequences of child malnutrition in Lesotho.
“In fact, the preliminary results show that the country is losing M1.9 billion per year which is equivalent to approximately 7 percent of the country’s GDP in 2014,” Thomas Yanga, the Director of Africa Office and Representation to the African Union and UNECA, said.
Yanga said these results are not only an evidence based revelation but a call for action for all, especially policy makers.
“The expected economic development and growth results will only be achieved when all children in this country are free from hunger and malnutrition as well as have the opportunity to have access to adequate education and better health care,” Yanga said.
“We cannot change the past but we can jointly shape the future of the young Basotho girls and boys.”
Yanga added that while Lesotho managed to reduce the rate of stunting from 53 percent to 33.2 percent, the figure was still too high revealing that chronic food insecurity and malnutrition are still prevailing in the country.
“Hunger has a negative effect on the national economy. The impacts of under-nutrition are intertwined, impeding national performance in terms of health, education and productivity objectives,” Yanga said.
The team delegated to run the study has completed the collection and analysis of data and the report will be published on October 27.
Kimetso Mathaba, the Minister in the Prime Minister’s Office, said Lesotho took part in the study due to the prevailing problems of malnutrition in the country.
“The rate of malnutrition has not been improving significantly from 1992 up to date. Stunting is the main problem in Lesotho which currently stands at 33.2 percent and which according to the WHO (World Health Organisation) standards indicates chronic malnutrition,” Mathaba said.
“There is evidence that addressing malnutrition is a basic foundation for the social and economic development of any country,” he said.
Cosmos Mokone, the Head of National Implementation Team (NIT), said under-nutrition is estimated to contribute to 2.8 percent as a risk to education.
“Out of 100 students, 2.8 percent of them will fail or drop out of school because of under-nutrition or stunting,” Mokone said.
However, Mokone said there is no immediate cost for those that drop out to the government but those that repeat a class put more costs on the government.
“The highest cost of under-nutrition is in the labour market because the performance of under-nutrition people is very low and therefore costing the country a lot of money for low production both in skilled and unskilled related production,” Mokone said.
A child that is stunted is at risk of performing less in class or even drop out to an extent that when they join the labour market they become unproductive in the economy.
Lesotho has lost 7.2 percent of working age population for 2014, Mokone said.
The study shows that a child who is suffering from under-nutrition is at risk of suffering from cognitive and physical impairment which impacts the quality of life as a child and as an adult within the society.
The study shows that in humans the first two years of life is a critical period of vulnerability for the brain’s development and under-nutrition early in life causes changes in the brain cells and development thus reducing the connectivity and branching of brain cells.
“Children who are stunted have increased probability of repeating a class,” Mokone said.
In a population of 47 547 students who had to repeat class recorded in 2014, 17 044 of the total number of repeaters were associated with stunting which cost the government at least M115 million.
Mamane Salissou, a member of the NIT, said under-nutrition causes 19.5 percent of all children’s deaths, where 9 272 deaths were experienced from the year 2008 to 2014.
“For every additional case of child illness, both the family and health sector are faced with additional cost,” Salissou.
At least 88 900 children are stunted in a total of 100 000 children.
“A lot of work still needs to be done,” Salissou said.
The study also showed that 51 percent cost in health associated to under-nutrition happened on children before turning 24 months.
It further says 939 842 of working adults were stunted as children.
The study says the health sector uses at least M4.2 million while the education sector spends at least M11.7 million on stunted people and the labour sector loses almost M180 million in productivity costs.
“You can imagine how we can use that money in investment as a country if we prevented stunting in the first place,” Tiisetso Elias, the coordinator of NIT, said.
Elias said if the country can work hard to reduce stunting by 50 percent then the country would have saved M1.8 billion by 2025.
“We have to focus on prevention particularly in children during the early years of under five which will yield social and economic return,” Elias said.
He further said Lesotho youth are being disproportionally affected by the consequences of malnutrition but it is also a group that will gain the most from improved nutrition.
“Better nutrition will impact health, education and labour productivity so we need sustained investment in nutrition,” Elias said.
Eliminating stunting in Lesotho is not an option it is a necessary step for inclusive development in the country, he said.
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