At 620 deaths in every 100 000 live births, Lesotho has one of the highest maternal mortality rates in the world. Maternal mortality is the death of a woman while pregnant or within 42 days of terminating her pregnancy. According to Médecins Sans Frontières (MSF) or Doctors Without Borders, illegal abortion is one of the reasons for this high death rate.
MSF Project Medical Referent, Sandra Sedlmaier-Ouattara, speaks with Lesotho Times (LT) reporter, Pascalinah Kabi, on this unfortunate indicator and what her organisation has been doing to mitigate the situation for the nine years it has been operating in Lesotho.
LT: Could you please give a background of who Médecins Sans Frontières are?
Sedlmaier-Ouattara: Médecins Sans Frontières is the world’s biggest humanitarian organisation working in about 70 countries. We come in to help after disasters, both man-made and natural, and also provide aid and care where we feel there is need for intervention.
MSF’s major strength is innovation and because we are such a big organisation, we have many researches attached to different projects. Secondly, what we try not to do in every country we operate is not to substitute government and the ministry of health, but work closely together. I think this has worked very well in Lesotho as we have collectively come up with strategies for the overall benefit of Basotho.
LT: You said MSF does not operate in every country…so why did you choose to come to Lesotho?
Sedlmaier-Ouattara: Our first project here was in 2006 in Morija when HIV became a nursing concern rather than a doctor’s care. MSF has been quite involved in this task-shifting at Scott Hospital here in Morija. The project did run until 2010 and beginning 2011, we went to Roma and are now serving Roma and Semonkong areas.
With Lesotho faced with a very high HIV prevalence rate, we asked ourselves why and what we could do to help. So the general objective in our project document is reducing maternal and infant morbidity and mortality in a hyper-epidemic HIV, TB context.
MSF is very concerned about issues of maternal health and how globally, we are failing to meet the set goals in this area.
Even though we failed on reducing maternal mortality (under the Millennium Development Goals) and have now moved on to Sustainable Development Goals, MSF still feels the need to help Lesotho confront its maternal healthcare issues.
Basically, issues of HIV care, maternal and infant mortality and Tuberculosis (TB) are intertwined and must be addressed during our stay in Lesotho.
We felt that Lesotho had big international organisations focusing on HIV care while maternal and infant mortality was being neglected.
Since 2011, we have focused on two catchment areas – supporting Roma hospital and nine other healthcare centres.
We are still very much focused on HIV care because 23 percent in the general population is HIV-positive and if you look into the different categories, for pregnant mothers, the prevalence rate is 27 percent in Lesotho.
LT: According to MSF research, why is the HIV prevalence so high in Lesotho?
Sedlmaier-Ouattara: First of all, the long distance people have to travel to reach health centres…that’s one of the biggest challenges in Lesotho because one does not only need to be sick to seek to a healthcare facility, but also goes to such a facility for other services such as condoms. So if people have to walk for eight hours to get a condom, chances are they would engage in unprotected sex which is very bad for HIV-prevention.
World Health Organisation (WHO) studies also say migration is one of the biggest catalysts for HIV-infection and with Lesotho having so many of its citizens working in South Africa in the mines, migration is definitely one of the major reasons for this high prevalence .
Personally, I think tradition has also had a big role in this. What I have observed, especially in the rural areas, is that Lesotho has many girls who are married to older men because maybe she is an orphan and families wanted to get rid of her by marrying her off.
We know where there is a huge age-gap, there are chances of a high HIV infection rate. Lastly, this is purely my personal view; I am not so sure about the country’s educational system but I find that sexual issues are not very much discussed among Basotho families.
I am told the Ministry of Education is looking into introducing sexual matters into the curriculum, but I feel this must come from parents or families who should be talking about condoms and all sex-related matters to their children.
LT: When MSF first came into the country, how was the environment? Was it conducive enough for your programmes?
Sedlmaier-Ouattara: I have worked in six African countries and I think Lesotho is quite advanced compared to other nations, in terms of wealth and education. I also think this country was quite lucky because it was included in the (American) Millennium Challenge Account (MCA) and received these brand new health facilities all over the country because of the aid programme. In our catchment, out of the nine facilities , eight are MCA-built clinics.
With all the brand new facilities and equipment, I think this country has a huge advantage. Also, Lesotho has a very high standard of nursing education and highly qualified doctors compared to other countries like Mali, for instance.
That’s where the issue of mentoring came in as I said we did not come here to substitute or impose. I mean, there were highly qualified people who just needed some polishing here and there.
LT: What are some of the programmes that you launched in Lesotho?
Sedlmaier-Ouattara: First, we took a light-approach, which is basically mentoring and capacitating people, as MSF understood we could not stay here forever.
I think we managed to do it quite well and the nurses here can confirm how much they have been transformed in their line of duty.
We mentored doctors and nurses on HIV and TB, maternal and infant mortality and now there is a harmonised working relationship between the two.
Another project is free maternal care which we started in 2014 after realising most mothers choose to deliver at home because of financial constraints.
MSF foots all maternal-related fees at the hospital, both prior and after delivery. In Lesotho, maternity care at primary level, is free whereas once one is referred to a district hospital, she is expected to pay.
Secondly, mothers delivering their first baby, undergoing caesarian section, carrying twins, and with complications like low or high blood pressure, are not allowed to deliver in a health centre and must go to a hospital. For some women, this is quite a challenge because suddenly, they are expected to raise M200 for the hospital and transport money. Because of this challenge, many choose to deliver at home and this is where MSF comes in.
Also if mothers come to the hospital with abortion complications, we foot the bill. In Lesotho, 18 percent of family planning needs are not met and MSF has come in to try and help as we know that some women resort to abortion for unwanted pregnancies.
Unfortunately, abortion is the second reason for the high maternal mortality rate in Lesotho.
We have also trained nurses and doctors on Life Support Obstetrics and this has positively impacted on the midwife-doctor relationship. We have also built a mothers’ waiting lodge in Roma and Nazareth and foot the women’s transport fares to and from hospital.
MSF has also trained communities on maternal health as we understand that women are not alone in this and need their decision-makers’ buy-in. We also run an ambulance service between three hospital in Roma and Semonkong.
LT: We hear that MSF is leaving Lesotho after a fallout with the Ministry of Health over a Mohale’s Hoek project. How far true is this?
Sedlmaier-Ouattara: MSF does not go into a country to stay forever. Secondly, our Roma project is ending as planned; it was supposed to run until 2014 but our Brussels headquarters gave us another year.
However, it is now an open secret that MSF was trying to open another project in Mohale’s Hoek. We wrote a project proposal but somehow, MSF and the ministry could not agree.
We also could not change the area of the project as it was tailored for Mohale’s Hoek. What MSF has to do now is explore other needs and come up with another proposal and discuss it with the ministry again.
I think the ministry is open to further negotiations. It is not like we are going for good but at the moment, we cannot stay because no agreement has been reached.
LT: Are there proper plans in place to ensure MSF projects continue to operate in your absence?
Sedlmaier-Ouattara: I feel like we have done more than enough and for Roma and Semonkong, I don’t think there is any need for MSF to stay any longer.
Secondly, I am not too worried about continuity because the projects are now operating under minimum supervision. I feel the people of Lesotho are more than capable of continuing with the projects we implemented.
MSF has never done things secretively; we have always shared our projects with the people. As we speak, we have already handed-over the ambulances to the ministry.