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The battle over herbal medicines



MASERU – IT has become a norm to hear herbal medicine adverts during radio peak hours across nearly all 27 stations operating in the country. One radio station in particular has a special programme for a concoction called Global Cure, whose producers claim it cures an array of illnesses, including erectile dysfunction.

Another radio station is known for advertising what is called Pitsa ea Litotla, a mixture of several herbs. It has also become a norm to see advertisers of herbal mixtures positioning themselves at strategic places such as roadsides, open markets and car parks in towns countrywide.

Some innovative herbal medicine advertisers have fixed loud speakers on vehicles touting their concoctions. Others board parked or moving buses and in charismatic fashion tout the potency of their products.

The result: A population that is getting hooked to herbal mixtures and a government that is increasingly fearful that, if not regulated, the trend could lead to deaths as people avoid proven conventional medicines.

It is that fear that seems to have pushed Parliament to pass the Medicine and Medicinal Devices Bill of 2022. The Bill requires herbal medicine producers to have their products tested at laboratories by qualified medical experts before being rolled out to the public.

The Bill also requires proper labelling of the products, specifying the amount of each property in the medicine. Advertising, according to the Bill, has been curtailed. Basotho have for ages relied on medicinal plants in different forms to cure ailments.

They are taken as with water or milk, while others are taken as infusions either orally or as an enema for various internal ailments, according to a study by A Moteetee and B E Van Wyk in the Medical Ethnobotany of Lesotho: a review.

The research noted that plants are also incinerated, powdered and used as snuff, often to induce sneezing to get rid of head and chest colds. Another form is inhalation of either smoke from a burning plant or vapour from a freshly crushed plant or fresh leaves of Artemisia afra or Mentha longifolia stuffed in the nostrils, as a cure for headaches and colds.

Smoke can also be introduced into the body through fumigation. Boiled decoctions are used for steaming to treat colds. Sometimes plants are also taken as masticatories, although only a few plants are chewed raw, according to the study. Other medicines are applied or rubbed into incisions on the body.

These incisions are done ostensibly to protect people from sorcery or to counteract effects of sorcery. Several parts of the body, including the forehead, cheeks, chin, neck, throat, breasts, and joints are scarified and the medicine is rubbed in.

The other purpose is to cure ailments such as headaches, where only the affected part is scarified. Other plants are mixed with fat to make ointments or applied as poultices and used externally as lotions, according to the study.

The same study revealed that many people in Lesotho, particularly those in rural areas with little access to modern heath facilities such as clinics, are able to diagnose and treat minor common ailments such as colds, coughs, headaches and constipation.

In the old days, if there was an epidemic in a village, the chief’s doctor, usually a diviner (selaoli) or herbalist (ngaka-chitja), would prepare a mixture (known as leliba) taken by all villagers.

Traditional healers who rely only on plants are known in Sesotho as ngaka-chitja, which means a hornless doctor, because they do not keep medicines in horns. They diagnose and treat minor ailments and traditionally refer patients to a diviner if they are unable to cure the disease.

Moteetee and Van Wyk discovered that in recent times, traditional healers also refer difficult cases to modern medicine clinics. Such a rich history of traditional medicine has resulted in vicious objection to the Medicine and Medicinal Devices Bill 2022 passed by the National Assembly.

Herbalists and traditional healers describe the Bill as draconian and say it is meant to interfere with their means of livelihood. The Bill has been passed by MPs and awaits scrutiny by the Senate. Parliament shut down last week before the Bill could be discussed by the Senators.

One of the critical issues that the Bill is mandated to address are the ingredients found in the medicines. Malefetsane Liau, a renowned sangoma steeped in tradition and cultural values, criticised the Bill.

“I am appealing to the Senate to block the Bill,” Liau said.

This chairman of the traditional doctors’ representative association in the country said “it is practically impossible to disclose the ingredients of our concoctions”.

“I fail to understand why the Bill seeks us to share our innermost privacy as traditional doctors. We normally take instructions from our ancestors regarding the plants that we use for medicines. To reveal what we have mixed in the medicine is totally unacceptable,” he said.

Revealing the ingredients is like revealing the hidden secrets of Basotho, he argued.

“There is Chinese tea that is used globally but it does not state what ingredients it contains. If a concoction kills people, the relevant authority is supposed to know what its contents are,” he said, pointing to influence from the

Western authorities to clamp down on traditional medicines. What worries Liau most is that traditional healers were consulted when the Bill was drafted by the relevant ministry until it landed in Parliament. He admitted that there are “a lot of plants” displayed on the streets by people who lack full knowledge of how herbs are used.

“There are relevant authorities that are supposed to deal with those people,” he said.

Litšoane Matlali, who produces a mixture called Herbal Flu, said he is not against the Bill in its entirety but is opposed to parts that call for healers to disclose the contents of their concoctions. He claimed that his medicine is tested at the National University of Lesotho (NUL) laboratories, but is still unwilling to disclose the contents.

“It’s a secret that does not have to be shared,” Matlali said.

Thabiso Mochatso, who produces Global Cure, shared similar sentiments.

“This has never happened. I find it bizarre that MPs drafted a Bill that affects us without consulting us. I am the major target here,” claimed Mochatso, adding: “My product is the first amongst the locally mixed herbs to be advertised on Lesotho Television.”

He said he approached a top official in the Ministry of Health after realising that his product was “making positive strides in healing people”. The unnamed official did not believe the story, claimed Mochatso, adding that the Bill does not value the ethos of Basotho.

Medicinal plant specialists Associate Professor Adeyemi Aremu and Professor Nox Makunga, in their paper titled “Africa is a Treasure Trove of Medicinal Plants,” highlight the importance of medicinal plants found in the continent.

The two say plants have directly contributed to the development of important drugs. They cited the anti–malarial treatment artemisinin, pain medication morphine, and cancer chemotherapy taxol as just three examples of drugs derived from plants.

“Africa is endowed with up to 45 000 plant species – about 25 percent of the world’s plant genetic resources,” the paper reads.

They say more than 5 000 plant species from this enormous African resource are used in traditional medicines. Professors Aremu and Makunga say Artemisia afra is the only species in its genus that is indigenous to the African continent.

And it is often regarded as a potential flagship plant because of its high popularity and diverse uses in African traditional medicine. African wormwood has for years been used for coughs, colds, influenza and malaria.

Scientific evidence of its antimicrobial, anti-depressant, antioxidant and anti-inflammatory effects has been widely reported. The traditional uses and increasing popularity of African wormwood have resulted in a number of commercial herbal products.

But with insufficient clinical data, it’s not yet known whether African wormwood is a treasure chest of new drugs, according to the professors. The World Health Organisation (WHO) describes herbal medicine as the use of plants and plant extracts to treat disease.

WHO says many modern drugs were originally extracted from plant sources, even if they’re now made synthetically. It says conventional medicine now tries to use only the active ingredient of a plant, while herbal remedies use the whole plant.

It however bemoans challenges such as the lack of treatment protocols in traditional medicine, the necessity of developing a universal unified terminology, the necessity of creating a medical ontologies and the necessity of ensuring the data quality.

Traditional African medicine, WHO says, is a range of traditional medicine disciplines involving indigenous herbalism and African spirituality, typically including diviners, midwives, and herbalists. Each year the African Region commemorates African Traditional Medicine Day on August 31.

In 2015 the African Traditional Medicine Day’s theme was “Regulation of Traditional Health Practitioners in the WHO African Region”. It highlighted the need to establish and strengthen regulatory systems in countries by identifying and supporting qualified practitioners and protecting the public against potentially harmful practices.

Majara Molupe

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[BREAKING NEWS] Lebona sets curfew



MASERU– In an effort to curb the rampant increase of homicides in Lesotho, the Minister of Police Lebona Lephema has announced a 10:00pm-4:00am curfew, effective Tuesday May 16, 2023. Failure to comply with the curfew attracts a 2 years imprisonment or a fine.

Staff Reporter

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Two nurses deleted for misconduct



MASERU – A Kolonyama midwife, ’Mamalibeng Ralenkoane, who allegedly neglected a woman during labour has been deleted from the nurses’ register for the next six months.

The woman went on to deliver her baby by herself without professional assistance.

In another case the secretary-general of the Lesotho Nursing Council (LNC), ’Mamonica Makhoswonke Mokhesi, has also been deleted for violating a patient’s privacy.

The LNC’s disciplinary chairman, Advocate Rapapa Sepiriti, said Ralenkoane had committed an act of serious misconduct and deserved severe punishment.

Advocate Sepiriti ruled that Ralenkoane “should not be seen anywhere attending (to) patients”.

Ralenkoane was working as a midwife at the Little Flower Health Centre in Kolonyama, Leribe, when ’Mateboho Letlala was admitted there for labour in August 2020.

Letlala told the panel that Ralenkoane took her to the examination room and later left her despite that there were signs that she could give birth anytime.

“At 19:00 pm Ralenkoane examined the patient but left her unattended and the patient had to deliver on her own,” Advocate Sepiriti said in his verdict.

“Clearly the blame has to be put at the door of Ralenkoane,” he said.

Adv. Sepiriti ruled that she should be deleted with immediate effect for 12 months, half of which was suspended.

“During these six months period, Ralenkoane is prohibited in any way from attending patients and this judgment should be delivered at her place of work,” he said.

Letlala in her testimony said by the time Ralenkoane arrived, she was already having severe labour pains and was told to go to the labour ward for assessment.

She said when she stepped down the labour bed Ralenkoane said to her: “Ua seke ua tatela ho hema empa molomo oa popelo o buleile ka 3cm’ (meaning she seemed to be in a hurry yet the cervix had opened by 3cm only).

“I was so surprised because I could feel I was very close to delivering because this was my second child and I could say I have experience,” she said.

She said she told the nurse that she needed to use the toilet but was instructed to use a pan instead.

“As she left me on the bed pan I could not stand from the pan as the pains were severe. I called for help but to no avail,” she said.

She said the moment she got energy to stand from the bed pan she saw blood, she called her but there was no response.

“Ralenkoane promised to come after two hours but there were no instructions on what to do in case I needed help prior to two hours,” she said.

“I wheeled myself to the bed and sat on it, still calling to no avail.”

She said while still alone, her membranes raptured and the time of birth came and the baby was delivered.

“The child did not fall as I was able to hold him,” she said.

She phoned her aunt who told her to find s scissor to cut the umbilical cord.

She said she bled a lot and ran out of energy, then Ralenkoane arrived at around midnight.

“When she came in she asked where the baby was and I pointed to where I had put him where he clamped the cord,” she said.

She said it was then that she got assistance.

The investigator for Professional Conduct Committee (PCC), one Nteso, told Advocate Sepiriti that his findings were that “the mother’s life was in danger as she was found having bled heavily and tired and the baby’s life was also in danger from prolonged exposure which could lead to hypothermia and brain damage”.

“Ralenkoane was not there for the mother until she delivered in the absence of the midwife, this is a case of negligence,” he said.

However, in mitigation Ralenkoane said this was her first time to appear before the panel and has been a nurse for more than nine years.

She said she has two children to support and she has already been punished by the clinic as she was dismissed and that she has policies and loans.

She pleaded with the panel to have mercy on her.

In another case Mokhesi who was the Secretary General of LNC was also deleted from the register for two years after she was found guilty of sharing a patient’s picture on social media without their consent.

She was accused of defamation of character and violating the patient’s privacy by posting pictures of the injuries he had incurred.

’Malimpho Majoro

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Nurses back at work



MASERU -NURSES who have been on strike since Monday are set to resume work this morning after the government started paying their salaries.

The nurses went on a go-slow last week but escalated to a full-fledged strike on Monday after the government delayed their salaries. Some nurses claimed they had not been paid since March.

Morephe Santi, the secretary general of the Lesotho Nurses’ Association (LNA), said they have started telling members to go back to work after the government said the salaries will start reflecting in their accounts last night.

The strike has inflicted huge reputational damage on Prime Minister Sam Matekane’s government which came to power on promises of efficiency.

Minister of Public Service Richard Ramoeletsi blamed the Integrated Financial Management Information System (IFMIS) and the Human Resource Management System (HRMS) for the delay in April salaries.

Ramoeletsi told parliament last week that the two financial management systems were unable to reconcile, leading to delays in salaries.

But that explanation was little consolation for patients who bore the brunt of the strike.

At least 20 expectant mothers at Machabeng Hospital in Qacha’s Nek were told to go home because nurses could not help them.

Some of the women were later admitted at Tebellong Hospital, a facility under the Christian Health Association of Lesotho (CHAL).

“We were staying at the hospital’s roundavel awaiting our time to go to labour but on Thursday afternoon (last week we were called by the nurses and they told us to go to other hospitals or go back home,” said Maretlotliloe Mpeli, who is heavily pregnant.

She said the nurses told them that they could not work on empty stomachs.

’Matlotla Poling, 19, from Ha-Rankakala said she had to call her parents because she did not have any money to either go back home or to Tebellong Hospital.

The Machabeng Hospital management declined to comment, referring thepost to the ministry’s headquarters in Maseru.

Ministry of Health spokesperson, ’Mateboho Mosebekoa, said Machabeng Hospital “did not expel the expecting mothers but merely sent them back home”.

“Due to the ongoing strike by doctors countrywide …they decided to take those women to the places where they would get help,” Mosebekoa said.

There was similar anguish at Queen ’Mamohato Memorial Hospital.

“The strike has affected all the departments including the kitchen, maternity, and emergencies, but the managers are on duty,” said ’Makananelo Sepipi, the hospital’s spokesperson.

Sepipi said managers were forced to hold the forte “because some sections cannot be left unattended utterly due to their importance”.

“The operations are happening in the emergency section, even though they do not operate in a normal way.”

She said patients whose operations were scheduled for this week were sent back home.

Santi, the LNA’s secretary general, blamed the government for the chaos caused by the strike.

Santi said as much as the government likes to call them an essential service they do not prioritise their ministry.

“They do not appreciate us, it is like they do not see the importance of our job,” Santi said.

“The government turns a blind eye to the fact that our working environment alone can put us at risk of contracting diseases.”

“Now we are not able to buy food and other necessities.”

Nkheli Liphoto & Thooe Ramolibeli

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