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Military hospital in botched delivery

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…….Ordered to pay M12 million compensation to girl, parents…..

MASERU-THE Makoanyane Military Hospital (MMH) has been ordered to pay M12 million to a six-year-old girl and her parents as compensation for negligence.
The hospital belongs to the Lesotho Defence Forces (LDF), which is answerable to the Ministry of Defence.
The girl is suffering from cerebral palsy which she contracted at birth.

Delivering judgment last Friday, Ombudsman Advocate Leshele Thoahlane noted that “the child will not only require special adaptive aids and devices, she will also need permanent and continuous care”.
Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood.

Signs and symptoms include poor coordination, stiff muscles, weak muscles, and tremors.
There may be problems with sensation, vision, and hearing, swallowing, and speaking.

“Allowance has also been made for both parents to undergo post-trauma counselling given the extent of injuries the mother incurred, which injuries have resulted in challenges during intimacy,” Thoahlane said.
Thoahlane said the compensation is for emotional pain and the suffering endured by the child, Nthatisi and parents ’Manthatisi and Tšotetsi Tšoeu.
“They will need a lot of counselling,” he said.

Thoahlane said the compensation will help cater for the child’s medical and related expenses for life.
He said the money will cover her medical expenses, assistive equipment (and replacement thereof) such as Dondolino-vertical standing frame, Dynamico, arm support, leg divider, birillo, head rest, worktable, customised computerised wheelchair, educational support through special school, orthopaedic shoes, speech assessment and therapy and other health necessities recommended by doctors.

Other aids the girl will need include CT scan of the brain, Intelligent Quotient (IQ) and cognitive function assessment by a psychologist, audiological assessment, visual assessment by the Ophthalmologist, dental assessment, neurologist assessment, physiotherapy- (transportation to and from), to improve head, neck and trunk control, encourage independent sitting and encourage weight bearing.
The girl will also need occupational therapy.

“For instance, the child might need to use disposable nappies for the rest of her life,” the Ombudsman observed.
According to evidence presented before the Ombudsman, ’Manthatisi was in her 40th week of pregnancy when she went to the MMH on New Year’s Eve in 2012.

She was admitted by Dr Mojalefa Bulane, who upon examination told her that he was going to induce her into labour.
Tšoeu told the Ombudsman that her antenatal record clearly indicated that she was carrying a “precious baby” which she had been made to understand was due to her “pelvic and shoe size”.
A pregnancy is deemed as precious if it comes after a long wait or is achieved after a fertility treatment or if the mother is past 40 years of age or in her teens.

Also women suffering from conditions like diabetes, hypertension, heart disease, genetic disorders, sexually transmitted diseases and kidney disorders become candidates of precious pregnancy.
A woman’s small shoe size can be related to the size of her pelvic bone, making a natural or vaginal delivery more difficult.

The Ombudsman found that the fact that ’Manthatisi’s pregnancy was precious was never “considered even though it had been indicated as a risk factor so that extra care could be given to her and her baby”.
’Manthatisi was given labour inducing pills for that day until January 1, 2013, having her progress monitored by Private Ntšiuoa Molapo-Lenkoe and one Private Masonyane.

When her husband, brother-in-law and mother-in-law visited they picked up that something was wrong as she had difficulty in breathing and her body was swollen.
The trio asked Private Molapo-Lenkoe to call the doctor so that he could take ’Manthatisi for Caesarean Section but Molapo-Lenkoe told them to go home and let her do her job.

’Manthatisi claimed that no nurse or doctor attended to her for close to five hours, forcing her to ask her ward mates to assist her as she felt she about to deliver.
They called for help but none of the medical staff was available, the Ombudsman heard.

Molapo-Lenkoe allegedly found her helplessly heading towards the labour ward, and although she was using crutches she tried to run to ask for help and came back with four men, all soldiers.
’Manthatisi testified that at around 8pm Molapo-Lenkoe met her on the corridor, assisted by another pregnant woman.

Molapo-Lenkoe allegedly asked her to get into the labour ward, lie on the examination couch and then she looked “down there” to see what progress had taken place.
Molapo-Lenkoe “looked frightened and tried to run, but because she used crutches then, she could not”.
Molapo-Lenkoe reportedly returned in the company of the four men.
One reportedly held ’Manthatisis’s stomach, two held her feet and told her that they were going to help her deliver the baby.

When it became evident that there was a problem in getting the baby out, the fourth man whom ’Manthatisi thought must have been a nurse, cut her twice (double episiotomy) but the problem still persisted.
The baby allegedly did not breathe or cry, raising concern.
The Ombudsman found that Molapo-Lenkoe had no training at all in midwifery but was a mere “ward attendant whose job was to bathe and take care of patients”.

The Ombudsman also expressed shock that Molapo-Lenkoe dismissed ’Manthatisi’s husband, his mother and brother when they requested that she be taken for a Caesarean section, saying they were “not experts and could therefore not make such decision”.
’Manthatisi said her husband was willing to sign consent forms but Molapo-Lenkoe “dismissed them saying they should let her do her job and they left”.
Later on Dr Bulane arrived and decided to take the baby to Queen ’Mamohato Memorial Hospital (QMMH), leaving its mother behind. She only joined the baby a day later.

’Manthatisi told the Ombudsman that there was no information whatsoever given to her about the condition of her child except that she would be assessed and observed for three months.
The Ombudsman heard that approximately two years and six months later ’Manthatisi was advised by an occupational therapist to attend a meeting where she had learned with utter dismay that her child had cerebral palsy.
’Manthatisi said she was traumatised by the whole ordeal.

The family then sought medical advice and found that there was a slim chance that their child would be normal.
They approached the Ministry of Health for intervention.
Dr ’Nyane Letsie, Health Director-General, sent them back to MMH for mother and child records and ’Manthatisi found out that there was some missing vital information from such records.

There was no record of how her labour had progressed and the delivery process had not been recorded.
The Ministry sent its doctors to go to MMH to find out what had transpired.
The doctors reported that the information was sketchy, making it difficult to ascertain with certainty events leading to the botched up delivery.

The family also approached the Ministry of Defence and the Commander of Lesotho Defence Force for help.
The then Principal Secretary Colonel Tanki Mothae sent MMH personnel to go see the child, who later asked that the child be taken to MMH for physiotherapy.
Colonel Mothae had further promised that he would ask for assistance from the Chinese Embassy to have the child sent to China for medical attention as there was a chance that she could get some help.
This however never happened.

The family then decided to approach the Ombudsman for intervention when no help seemed to come forth.
They had lost faith in both the Ministry of Health and Ministry of Defence.
In front of the Ombudsman, the hospital management tried to put the blame on ’Manthatisi but they did not succeed.
Colonel ’Matšotetsi Tlelai told the Ombudsman that ’Manthatisi had given inaccurate information claiming that she had never been pregnant before while in fact she had been.

This, to the LDF management, meant there was something material that ’Manthatisi was hiding.
’Manthatisi told the Ombudsman that her prior pregnancy information did not appear in her health record.
The LDF also said the child’s disability could have been inherited.

To this, ’Manthatisi told the Ombudsman that she once had a problem of excessive bleeding during her menses and the doctor told her that he suspected that she might have just conceived but there had not been any implantation.
The LDF management was of the view that labour process had been normal, that ’Manthatisi had been monitored and periodically given doses.

They said complications had occurred during delivery due to shoulder dystocia that could not and had not been picked up before delivery.
The LDF said this was not a result of negligence on the part of the hospital.
They said the fact that the baby had suffered birth asphyxia or difficulty in breathing had not been caused by prolonged labour, but could have been brought about by lack of or too much oxygen.

The LDF also said the fact that there was no record of progress of labour had nothing to do with the delivery in as far as MMH management was concerned and in the premises the LDF did not accept that there was negligence on the part of its staff.

However, the two doctors assigned by the Health Ministry to probe the matter, Dr Maama Mojela and Dr Masupha, found that:
1. ’Manthatisi took too much time in the induction phase and that this should have told the caregiver that the induction was having challenges and therefore ought to call the doctor but that never happened.
2.  ’Manthatisi’s heart beat going up was a sign of distress but this was not picked up or at least nothing was done about it.
3.  There was no vital information on active labour and with such vital information missing it was not clear as to what happened prior to the child’s birth – this information would have helped understand where the problem arose.
4. In their opinion if something had not been recorded then it meant it had not been done.
5. Once induction had been set in motion, the patient became a priority because induction drugs could react differently on different patients, this never happened with ’Manthatisi.
6.  Partogram was used as a guide to the doctor or care giver on how the patient was progressing so that they could make an informed decision on what to do at what stage, so the absence thereof was worrying.
7.  ’Manthatisi was said to have had her feet swollen; this may have been the result of protein deficiency which could have a bearing on the uterine expansion, elasticity and recoil, resulting in labour taking longer than expected.
8.  The “precious baby” inscription should have meant that the patient needed to be handled with extra care but this was not the case, ’Manthatisi was instead treated like a normal patient.

Subsequently a letter was written to Dr James Ger, a gynaecologist at Queen Elizabeth II Hospital, to examine ’Manthatisi to establish the extent of the injuries she sustained during birth and make a report thereof to the Ombudsman.

The doctor did examine ’Manthatisi and duly submitted his findings to the Ombudsman.

Staff Reporter

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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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