MASERU — At around 2pm at the Motebang Hospital in Hlotse, Leribe, about 120 kilometres north of Maseru, two female health workers are running around to attend to over 60 people who have come for their Antiretroviral Therapy (ART).
The patients, some of whom say have been waiting in the queue since 5am, are increasingly becoming impatient.
But nothing much in terms of getting routine services has happened since they arrived. They have been sitting on the benches in the corridor at the outpatient department.
Those who spoke to this paper said they have only been weighed to determine their body mass.
What normally follows, they say, is a string of other services like general health assessment, TB screening (usually verbal), pill count to establish adherence to medication and other services.
All these and other services, under normal circumstances, would take about three hours.
But patients say services have been slow ever since the Tšepong HIV/Aids clinic was shut down a few weeks ago.
Patients who used to get services at the clinic have now been asked to get treatment at the outpatient department of the Motebang Hospital, where there is just one doctor.
The Tsepong Aids Clinic, the first Aids clinic in Lesotho, was run and supported by Dr Anne-Marie Zajdlik, a physician specialising in HIV/Aids in Ontario, Canada.
Clearly something is not right, says one of the waiting patients, Tefelo Motsamai.
Motsamai says this is the first time they have had to wait the whole day to get ART services.
He has been receiving ART services here for the past four years.
“We don’t know what is going on but we can see there is a problem. It is not normal for us to wait this long for services.
“There are only two people working today. We have grown tired of waiting.
“This is frustrating,” Motsamai says.
Some patients have grown so irritable they burst into the two opposite consultation rooms that have been allocated for the ART services when the Tšepong HIV/Aids moved house to join Motebang Hospital Outpatients Department.
It is this move, according to nursing personnel who spoke to this paper that has contributed to the crisis.
“Ever since the ART services were moved from the secluded building to be part of the Outpatient Department things have been slow. Crisis hit when about 10 councillors and HIV experts who were paid by the Global Fund were laid off.
“Since then there has been a shortage of staff so much that two or three health workers are forced to give services to not less than 70 people in one day,” says a male nurse who refused to be named because he had no authority to speak to the media.
The crisis, he says, has badly affected the once praised ART services at Tšepong HIV/Aids clinic.
The clinic was an initiative of a group of Canadian doctors to help relieve the burden brought by the scourge of HIV in Lesotho.
The clinic had enrolled over 20 000 people on its ART programme since its inception in 2006.
But things seem to be tumbling down, the male nurse says.
“There is a serious problem here. There is just one doctor and nurse to give services to so many people. They are overloaded with duties. Clients come very early in the morning because the routine exercises for ART are many.
“First they have to be weighed, and then have their health assessed, there is also screening for TB, their pills should be counted to see if they are taking them the way they should. Lately their individual file information has to be captured on paper and then fed into the computerised system.
“This is too much work that has to be done with caution. It is work that needs to be shared by as many trained people as possible. Unfortunately now with the lay-offs all this work has to be handled by two or three people. They cannot handle it and this will impact badly on the health workers patient relationships which are very important in ART.”
When this paper visited the hospital frustrated patients were already grumbling at every sight of either of the two health workers that we later learnt were a nurse and a doctor.
“How long are we going to wait here?” complains ’Mamatosela Masena who has brought her grandchild for the paediatric HIV services.
“We have been waiting here all day. This used to never happen before. No one is bothering to tell us what is going on,” adds Masena.
Masena fears they might go home without getting all the services they need.
“It is getting late and so much is still to be done. I worry that we might go home without getting pills today. People might skip the day’s dosage and we know it is dangerous for HIV patients not to take pills like they should.”
In fact the anonymous male nurse confirmed that some people have had to go back home without their pill supplies.
“The most dangerous thing for a person on ART to do is to skip their daily dosage. That can cause resistance to medication. They would need the second line of HIV medication and with the monetary crisis our government is facing it cannot afford that because it is expensive.”
Since the ART services were integrated in the outpatient department, patients have had to get pharmacy services with the rest of the patients.
Longer queues mean chances are high that many will skip a day or two without their daily medication.
Maketekete Thotolo, a programme officer at Phelisanang Bophelong HIV/Aids Support Centre, says the change at the hospital has caused some inconvenience for patients.
Thotolo says people are complaining about the new setup.
“These people have been moved from the building they had become so used to and now have to join the rest of the outpatients. With the stigma that many still attach to HIV people are not comfortable mixing with everybody. They feel exposed; like they are being stared at by those who did not know their status,” says Thotolo.
“They complain that they have to wait for services. Now with them sharing the pharmacy there may be times when they will go home without getting their medication. They come from villages that are far away and cannot afford bus fare to travel back and forth,” he adds.
With the vulnerability of their immune system, Thotolo also says they worry that mixing up ART clients with everybody else will advance a possible spread of TB infections.
He however says even though a meeting with the hospital management shed some positive light on the new change, it would have been better accepted had it been communicated.
“The hospital management told us that integrating ART and outpatients services was a way of fighting stigma so that no one is kept in a secluded area. The purpose is also to computerise all the patients’ information in one system and to ease the control of medicine dispensation.”
He says they are all good points but it is going to take a lot of effort for ART patients to feel at home again.
This paper tried in vain to get the senior hospital staff to comment on the prevailing situation.