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Agony for midwives

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LERIBE– WHEN labour pains began for ’Mabakuena* late last year, her loved ones sensed disaster. The nearest health centre, Khabo Clinic, was 10 kilometres away and the only way to get there was by foot – a two-hour long walk.
So, to buy time, the women who were accompanying her to the clinic tied a stone on her lumbar spine.
Basotho believe that such a practice delays the labour process.

A woman who had accompanied her tried calling Mom & Baby services for a car without success.
The Vodacom Mom & Baby service is a free mobile health intervention that provides Vodacom subscribers with maternal, neonatal and child health information designed to encourage good health practices among pregnant women, mothers, partners and caregivers.

When that failed, that was when she thought of loading a heavy rock on ’Mabakuena’s lower back to delay the labour process at least until they could reach the clinic.
They called a village health worker who kept informing the clinic about the challenges and also asking for a car that never came.

The village health worker too believed in the stone ritual and they walked to the clinic with the expectant mother who was about to deliver.

A midwife who helped the woman told thepost last week that they were shocked when ’Mabakuena arrived, especially because she went into labour once the stone was removed as she entered the clinic.
The story was narrated during a media tour of clinics as part of International Midwives Day commemorations to be observed worldwide tomorrow and organised by the United Nations Population Fund (UNFPA).
Lack of access to health services because of long distances between some villages and clinics is putting many lives in danger, especially pregnant women who struggle to cover the long distances.
Such challenges inspired one villager, ’Mantabejane Ntabejane, to become a village health worker.

Ntabejane said she helped herself give birth to her first child 45 years ago because she stayed far from the clinic.
She is now part of several village health workers assisting people in over 50 villages that access services at Khabo Clinic. She became a community health worker in 1993, a voluntary role she took after getting basic training on health issues.

It is not only in Khabo where patients have to walk long hours to reach the nearest health centre. Rather, it is the norm in many mountainous and foothill regions, from Mohale’s Hoek to Leribe along the eastern side of the Maloti-Drakensberg ranges.

Tlaleng Motaba, a midwife since 2019 at St Denis Health Centre in Leribe, says the clinic serves 53 villages and people living in two of them, Ha-Makepe and Ha-Pentše, walk for three to four hours to access services.
Worsening the situation, the clinic suspended antenatal services in October last year because of drug shortages.

“Sometimes it happens that I am alone at the clinic so I have to manage everything. I have to do all I can by all means to bring joy to the mother,” Motaba told thepost.
Motaba recalled a case in which a pregnant woman did not go for an ultrasound scanner so they both did not know that she was expecting twins.
“I was awe-struck and happy at the same time,” she said.

“What shocked me was that I wasn’t aware that she was giving birth to twins and it was my first experience of helping someone deliver twins. At the end, I was excited because those girls were healthy and alive and there were no complications.”

She described her first experience as scary because she remembered the times in nursing school when she would watch midwives deliver small-sized babies who were already dead.
She said in another case, a baby was coming out buttocks first instead of head first and the mother had to be taken for quick surgery at a hospital.
In another case, the baby came out with crossed legs.

“I was told that abnormalities rarely happen and I was scared and afraid,” she said, adding that most women do not listen to instructions from midwives.
“You will tell a woman to breathe and instead of breathing she closes her legs and sits on her bums,” she said.

“Those things stresses you more than anything because my expectation is to receive a healthy baby so I have to be kind and tell the woman the risks of not following my instructions. This profession needs a kind, patient and praying person so that she can try as much as possible for everything to be good and normal,” she said.

Motaba added, “Sometimes you have to be tough on them to show the danger of not following instructions.”

She advised women that taking care of episiotomy requires them to “boil water, pour in a clean plastic bath tub, pour salt and wait for some time for water to be warm, then sit on it”.
“After a while, they should take a clean cloth and pad. They must avoid using tight panties, avoid sitting for a long time, avoid walking for long distances unnecessarily, carrying heavy things and sleeping on the bed because when they stretch their legs, stitches will cut and cause delays in recovery.”

Motaba urged authorities to provide essentials such as transport for staff, ambulances for patients, drugs and heating systems.

Motaba said community health workers are an essential pillar of the public health system who help with services such as accompanying their patients to the clinic and providing them with health education.
Lahlewe Kao, a midwife who worked at Tsatsane Clinic in Quthing before she was transferred to Khabo in 2019, said she won’t forget a day a woman in labour shocked her.

“Everything was still fine through labour but after delivery, that woman’s placenta retained and all attempts of removing it manually failed. We do not have a readily available car at the clinic, so I called M-mama (Vodacom’s sponsored car) but all the cars they had contracted failed to help,” Kao said.

“I called the hospital (Motebang Hospital) and was promised an ambulance but it did not come.”

Kao said after some time, the patient provided her brother’s number who came and she was referred to Motebang.
“This was my most challenging delivery ever.”

Kao said the pressure of work sometimes makes concentration difficult.

“Shortage of staff (currently there are only four midwives at the clinic) and pressure leads us to not focus like we are supposed to,” she said.
Thabo Makhakhe, a male midwife at Matlameng Clinic, said he cannot forget the day he delivered a stillborn.

“Monitoring was fine, the woman was still on the right process but after delivery, the baby did not cry or show any sign of life,” Makhakhe said.
“I was dumbstruck and did not know what to do or say to that woman. It’s not easy to forget that day,” he said.
Nearly all midwives in clinics that we visited had one complaint – staff shortages.

Statistics released in May last year show that Lesotho had 3 214 nurses and midwives and 3 253 nursing assistant professionals for a population of over two million people.
In 2021, the then Health Minister Nkaku Kabi acknowledged the critical shortage of nurses at health facilities and the need to hire more staff.

“Before I took office as minister, I thought I was going to fire all the alleged reckless and careless nurses and doctors because of what I saw in the media,” Kabi told a local weekly then.
“But when I got here, I realised that one nurse takes care of more than 50 patients,” he said.

“It makes it difficult for these nurses to effectively assist patients because if one nurse is in the maternity ward assisting a delivering mother it would be difficult for him or her to assist any other patient even when it is an emergency,” he said.

The UNFPA selected Leribe and Berea districts for the media tour after reviewing the Maternal Death Review Report (2015), that has shown that the highest number of maternal deaths occurred in Maseru (Queen ’Mamohato Memorial Hospital) where 102 women lost their lives as a result of complications of delivery or inadequate care during pregnancy.

Relebohile Tšepe

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Mahao, PS in big fight

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PRIME Minister Sam Matekane this week summoned the Basotho Action Party (BAP) executive committee in a bid to defuse simmering tensions within the party.
This comes amid fears that Professor Nqosa Mahao’s fallout with his principal secretary at the Ministry of Energy, Tankiso Phapano, could threaten the unity in the BAP and the government’s stability.

thepost can reveal that Mahao has hinted that he would resign if Matekane doesn’t fire or reassign Phapano.

But there are strong indications that Mahao doesn’t enjoy the backing of his executive committee and MPs in his fight with Phapano.

Inside sources this week told thepost that some members of the BAP’s executive committee and MPs are openly siding with Phapano and have been secretly lobbying Matekane to reshuffle Mahao from the Ministry of Energy to Sports.

A source said Mahao is aware of these manoeuvres, including a clandestine meeting in Maputsoe, and has said he would rather resign than be the subject of a humiliating reshuffle instigated by people he leads.

The source of the bad blood between Mahao and Phapano is not clear but it is understood that they have disagreed over tenders and the ministry’s direction.

The source said Matekane was first briefed of the running battles at the ministry some three weeks ago just as matters were coming to a head.

It is the second briefing which revealed a complete breakdown in the relationship that triggered Matekane’s meeting with the BAP’s executive committee and MPs on Monday.

Three people who were in that meeting said Matekane told the BAP officials to deal with the crisis before it affected the ministry and threatened the coalition government’s stability.

The BAP’s executive committee, including MPs and Mahao, then had a marathon meeting to discuss ways to make peace between Mahao and Phapano.

A source who was in that meeting said “it was clear to Mahao that the majority of the committee and the MPs were on Phapano’s side”.

“Mahao quickly realised that he did not have the backing of the majority and took a conciliatory approach. It was clear that the committee would rather have him resign than get Phapano removed from the ministry,” the source said.

“In the past Mahao had flatly refused to reconcile with Phapano because of seniority. But this time he appeared to be open to a meeting to discuss reconciliation.”

Both Mahao and Phapano told thepost last night that their relationship was still cordial. ‘“We are still in good books with Phapano until further notice,” Mahao said.

“However, we cannot predict the future.”

Mahao denied ever discussing Phapano’s dismissal or transfer with Matekane.

Phapano also insisted that he was working well with Mahao.

“We are still on good terms,” Phapano said, adding that the allegation that they were fighting was “baseless”.

The fallout between Mahao and Phapano has been quick and spectacular.

The two had been almost inseparable months before Mahao agreed to join the coalition government.

Phapano would use his car to drive Mahao around. They would attend party meetings together. Some party insiders saw Phapano as Mahao’s right-hand man and adviser.

Mahao allegedly strongly pushed for Phapano to be appointed as his principal secretary when he became energy minister.

But sources said Mahao started having second thoughts days after recommending Phapano and tried to get his appointment reversed but it was too late.

A source says within weeks Mahao was telling cabinet colleagues that Phapano had captured the ministry and he was unable to function as the minister.

“He started pushing to oust Phapano within days because they were already clashing. It’s been war from the first days,” said the source.

Staff Reporter

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How chicken import ban hit vendors

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MALESHOANE Pakela used to work at small backyard chicken farms where she was paid with chicken heads, necks, legs, and offals that she would roast and sell to factory workers at the Thetsane Industrial Area.

Her job was to clean and pack chicken.
The profit wasn’t much but just enough for the 37-year-old widow to feed and keep her four children in school.

“It also covered her monthly rental of M150 for a room in Ha-Tsolo Sekoting.

Her life was however shattered last October when the government imposed a ban on chicken imports from South Africa following an outbreak of bird flu.
Without day-old chicks the farms quickly shut down, cutting Pakela’s supply of heads, necks, legs, and offals.
Within a few days, her family was starving.

Pakela had been struggling even for months before the ban. The closure of the factories and retrenchments of thousands of workers has severely hit her sales. She was behind on her rent and could barely feed her children.

The partial lifting of the chicken ban has not helped Pakela because her former employers still cannot import day-old chicks or live birds.
Pakela and a family were kicked out of their rented room in November when their arrears were about M1 000.
She has found another room nearby.

A ‘Good Samaritan’ has allowed her to use a room for free until she can afford the rent. But Pakela says she still feels obliged to pay something because she understands that things are hard for everyone.

“Here the rent is still M150 but the landlord accepts every amount that I give her,” Pakela says.
There are days when her children go to bed hungry.

“I have told them (children) that if I have nothing they should accept (the status).”

She now survives on handouts from neighbours and other well-wishers. Pakela’s poverty is apparent.

Barefoot and holding her small child in a seshoeshoe dress, Pakela says her two children usually go to school without eating.
The other child has dropped out of school because she doesn’t have shoes.

’Mako Lepolesa, 44, who has been running a chesanyama (meat grill) at the Maseru West Industrial Estate since 2018. The father of three says his clients are mainly taxi drivers and factory workers.

Chicken was her main product until last October when the ban was imposed. It wasn’t long before his business started wobbling.

“I thought it would be just a short-lived problem (chicken import ban) but it passed on this year,” he says, adding that it might take months for his business to recover.
Moshe Ramashamole, 42, who also owns a chesanyama in the Maseru West Industrial Estate, tried to remain in business by sourcing chicken from local farmers.

It was a stopgap measure that however lasted a few weeks because the farmers also ran out of stock. He resorted to bad chicken but they were double the price of a full chicken before the ban.
Yet Ramashamole thought he could make it work by increasing the price of his plate from M35 to M55. The customers however resisted the new price and Ramashamole had to take the losses.

The poultry ban did not affect street vendors like Pakela alone.
Former Minister of Communications, Khotso Letsatsi, is one of those poultry farmers struggling following the chicken ban.

He ventured into poultry in January last year. It was an audacious venture that included a M100 000 investment in a shelter and other equipment.
He started with a batch of 300 chicks and had reached 1 000 by the time the ban was imposed.

“The business was lucrative,” Letsatsi says.

“I had to employ two people permanently to assist me on a full-time basis,” he says.

When it was time to slaughter the chickens, Letsatsi says he had to employ seven casual labourers.
Since the ban was imposed he had released all his workers.

“I do not know where they are now. Maybe they are starving,” he says of the workers he released.

Letsatsi doesn’t know how he will revive his business.
The Director of Marketing in the Ministry of Agriculture and Food Security (MAFS), Lekhooe Makhate, says the ban has been devastating to farmers and businesses.

“Some big businesses are going to declare less tax to the government because there was no business,” Makhate says.

He says Lesotho spends M2.1 billion on the importation of chicken and its products from South Africa every year.
But that amount usually soars to M4 billion depending on the market forces of demand and supply.

Makhate says the M2.1 billion goes to South Africa where the chicken and its products are imported.

At the height of the scarcity of chickens in the country, Makhate says people were supposed to make initiatives to travel to villages to search for chickens.

“There is not enough production of chickens in the country,” he says.
“Economically speaking we rely on South Africa. We have to be self-reliant.”

Majara Molupe

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Letseng fends off threat to sue

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LETŠENG Diamond says it is under no obligation to advertise jobs for Basotho to provide certain services “where it has the capacity to undertake the same services”.
Letšeng Diamond boss, Motooane Thinyane, was responding to a threat to sue by a little-known political party called Yearn for Economic Sustainability (YES).

Matekane’s company, the Matekane Mining Investment Company (MMIC), had been providing blasting, haulage and drilling services at Letšeng mine since 2005.
The deal with the MMIC was terminated in December last year with the mining company saying it was improper because Matekane had now become a politician.

Letšeng Diamonds announced that it had reached an agreement with the MMIC to acquire its mining equipment at the mine and offered employment to its current employees in line with operational requirements.

“This will enable Letšeng to continue with its mining activities,” the company said in its statement.

This infuriated opposition parties that argued that the mine should have called interested Basotho companies to bid for the contract, saying it is provided for in the Minerals Act of 2005.

The leader of Yearn for Economic Sustainability (YES), Molefi Ntšonyana, wrote the mine last week threatening to sue for allegedly failing to follow section 11 of the Act.
Ntšonyana argued that the Act “does not grant the Letšeng Diamond 100 percent to mine with its good own equipment” but it should engage Basotho companies like it did with the MMIC.

Ntšonyana said Letšeng Diamond and the MMIC made the agreement to acquire the MMIC equipment so that the mine could continue with its mining activities “without any advertisement to seek qualified Basotho to provide such services”.

Ntšonyana said the agreement unilaterally denied Basotho a chance to tender for such services and ignored the fact that the government of Lesotho on behalf of Basotho own 30 percent in the Letšeng Diamond.

“It is advisable to reconsider your decision,” Ntšonyana said, adding that they would also write to the mining board requesting the resolution they made regarding this matter of insourcing mining activities.

He said the company should adhere to section 11 of the Mines and Minerals Act of 2005 and within 14 working days the matter should be reconsidered, “failing which we will have no choice but to drag the company to the courts of law”.

In his response, Thinyane said Ntšonyana must “revisit the section in question in full for its correct interpretation”.

“Letšeng Diamond is under no obligation to advertise to seek qualified Basotho to provide services where it is willing and has the capacity to undertake the same services,” Thinyane said.

He said the decision relating to the agreement referred to has been through the necessary governance structures and is therefore procedural.
Thinyane said Letšeng is a corporate citizen that is fully compliant with the laws of Lesotho.

Majara Molupe

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