‘The next best thing to angels’

‘The next best thing to angels’

Rose Moremoholo & Senate Sekotlo



When Matlotlo Nte was admitted at St Joseph Hospital in Roma in 2008 she was complaining of dizziness, blurred vision and headache.

She was diagnosed with pre-eclampsia and was hospitalised.

Nte was later transferred to Queen Elizabeth II Hospital in Maseru hoping she would be helped deliver her baby without incident.

She was 39 weeks pregnant.

What happened following her admission at the hospital can only be described as a scene from a horror movie.

First she fell off her hospital bed.

Later that evening she was taken to the theatre for a Caesarean section operation. But the following morning, her sister who visited her, says although she had successfully delivered her baby, she was unconscious.

Nte did not even realise that she had delivered her baby as she was semi-conscious.

The drip was empty and was now drawing blood. The catheter bag was now overflowing.

Later that day, Nte died.

Nte’s mother, ’Mannyalleng Nte, filed a M1.5 million damages claim in the High Court against Queen Elizabeth II Hospital over her daughter’s death, arguing the hospital had been negligent.

In his judgement delivered on December 17, 2014, Justice Monaphathi found that Matlotlo “seems to have been generally neglected and even after the Caesarean section operation she was still not given proper nursing care”.

A health expert who testified in court said pre-eclampsia, a condition Matlotlo was suffering from, occurs when there is placental dysfunction.

She said the patient has to be hospitalised and put in a cot bed or bed protected on the sides to prevent her from falling.

The patient would also need to be under constant care, the expert said.

He said because of the dizziness and propensity to suffer from fits, the patient is likely to fall if proper protective or preventive measures are not taken.

Should the patient fall, or trauma be inflicted on the abdomen or the cord contract the placenta may rupture prematurely, separate or tear asunder, causing more complications.

Evidence presented in court showed that Matlotlo’s death was as a result of a haemorrhage caused by rupture of the placenta.

Nte was also claiming damages on behalf of her daughter’s minor child for loss of support. She also claimed damages on behalf of the child who was born with a disability as a result of the negligent treatment of her mother while giving birth.

Speaking at the International Day of Nurses in Mohale’s Hoek last week, the President of the Nursing Student Chapter, Relebohile Manyala, said the association is alarmed by the rising cases of misconduct by some rogue nurses at work.

Manyala said it is worrying that some nurses at health centres treat patients with contempt.

“Our strength lies in finding our weaknesses that contribute to lack of good services,” Manyala said.

Manyala said some nurses’ attitude “is shameful”.

“It is people we are working with, not objects,” she said.

While the incident involving Nte happened eight years ago, it appears nothing much has changed in terms of the treatment of patients at Lesotho’s health facilities.

Patients who spoke to thepost last week say incidents of malpractice continue unabated at Queen ’Mamohato Memorial Hospital, Lesotho’s biggest referral hospital.

’Mamakoae Lethoba says her son broke his leg and arrived at the hospital at 11am only to be attended to at 4pm.

“I brought my son from Mokhotlong to Tšepong for services yesterday. His leg was broken while at school. We were transferred from Mokhotlong to Tšepong because the boy was badly injured. Due to poor services I had to stay for another day,” Lethoba said.

“I was assisted but late around four o’clock yet I arrived at eleven o’clock in the morning,” she says.

“We had to pay M10 per night and were provided with matrasses only, no food, no blankets. I personally insist that more nurses should be hired to speed up services,” she said.

Lethoba says she would have wanted the nurses to attend to her son first and assess the seriousness or otherwise of her son’s injuries.

She says waiting for five hours before being attended to is unacceptable.

’Mahlompho Semahane, however, says the quality of services at Queen ’Mamohato have improved significantly of late.

“I was assisted on time, I was going to change the bandages to my eye and though I found many people waiting to be assisted, I did not wait that long,” she says.

Studies have found that Lesotho nurses work under pressure because they are few in number while patients are too many.

In their 2013 report, Stacy Stender, Alice Christensen, Leah Hart, Tracey Shissler and Maleshoane Monethi-Seeiso showed that the country’s Human Resources Development and Strategic Plan 2005−2025 indicates that a health centre should be staffed with a minimum of one nurse clinician, one general nurse, and one nursing assistant.

However, “despite such staffing norms, 78 percent of health centres are not meeting these requirements”.

Delivery of health care services in the country occurs under Health Service Areas (HSA), each based upon a government or mission hospital with affiliated health centres. Health centres — or local clinics — are staffed predominantly by nursing assistants, nurses, and nurse-midwives and are responsible for basic curative services, immunization, and maternal and family planning services.

“More than half of the country’s health care is provided in health centres; however, less than 20 percent of the formal sector labour supply works at this level of care,” the study says.

In Lesotho, there are four urban filter clinics (clinics linked to the district hospitals), 17 health posts, and 192 health centres, of which 78 are owned by the government, 35 by the private sector, and seven by the Red Cross. District hospitals, of which there are 17 across the country, provide the first level of inpatient care.

The Christian Health Association of Lesotho (CHAL) is responsible for the administration of eight hospitals, 72 health centres, and four schools of nursing and midwifery affiliated with district hospitals.

The country’s one national referral hospital — Queen ’Mamohato Memorial Hospital — operates as a partnership between the government and Netcare, a private hospital and health care group based in South Africa.

This facility employs nearly 200 registered nurses — approximately six percent of the registered nurses in the country. There are two specialised hospitals, also in Maseru: Botsabelo Leprosy Hospital and Mohlomi Hospital. Mohlomi provides care for individuals living with mental illness and has 41 registered nurses on staff.

Nurses from assistant to midwife or clinician account for 90 percent of personnel directly engaged in patient care.

In Lesotho, there are two primary basic nursing qualifications: nursing assistant, which requires two years of education, and registered nurse, which can take from three to five years depending on the institution.

The National University of Lesotho’s Bachelor of Science in Nursing and Midwifery takes five years. The National Health Training College and four CHAL colleges all offer a three-year diploma in general nursing.

At these five institutions, midwifery requires an additional year of education and is considered a “post-basic” qualification.

Nurse clinicians are specialist nurses with clinical experience, trained in health assessment, diagnosis, and treatment; the training for this qualification is 18 months.

Additional post-basic qualifications for registered nurses exist in areas such as primary health care, mental health, anaesthesia, and ophthalmology.

The Lesotho Vision 2020 calls for health for all and a well-developed human resource base.

“Despite this, Lesotho is facing an HRH crisis, partly due to an inability to produce adequate numbers of health workers, as well as the issue of “brain drain,” whereby health workers are not retained in the country once trained and deployed,” the report reads.

The HRH strategic plan for 2005−2025 underscores the government’s commitment to decentralise health services to the district level using district health management teams, which provide each district more autonomy to address its specific health priorities and HR needs.

Through this plan, the government’s strategy is to train and employ nurse clinicians to expand

clinical services, working to fulfil its recommendation to increase the number of nurse officer and

nurse clinician graduates along with the number of positions to which they are deployed.

According to the Lesotho Nursing Council registration records, 2 888 registered nurses and 1 458 nursing assistants were in the country as of 2013.

To reach the minimum threshold of 2.28 doctors, nurses, and nurse-midwives per 1 000 population, as put forth by the World Health Organisation, Lesotho needs to nearly triple the number of nurses/nurse-midwives employed.

Addressing the attendees at the Nursing Day in Mohale’s Hoek, the Lesotho Nursing Council chairlady, Tlalane Ramaili, bemoaned the scarcity of skilled labour force as one of the factors putting nurses under immense pressure at work.

“A broken soul has no way of mending another,” Ramaili said.

Ramaili said lack of skilled human resources crippled the health care system.

The theme for this year’s International Nurses Day is ‘Nurses: a force for change – improving health system resilience’.

’Mateboho Khoanyane-Leohla, the LNA General Secretary,  said the health system resilience can be defined as “the capacity of health actors, institutions and populations to prepare for and effectively respond to maintain core functions when crisis hits, informed by lessons learned on crisis”.

She further said nurses have deep practical knowledge of delivering best health care services.

“Lesotho Nurses Association plays an important role in making nurses well informed, advised, encouraged and supported to deliver the best services,” she said.

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