Delivering Hope in Lesotho

Posted on Oct 3, 2017

expectant mothers walking at Lesotho health center
Expectant mothers walk outside a maternal waiting home at Nkau Health Center in southern Lesotho. Women in the final weeks of pregnancy live at the waiting home until their baby is safely born. Partners In Health staff in Lesotho have seen a dramatic increase in facility-based deliveries, which are much safer than childbirths at home, since implementing a Maternal Mortality Reduction Program in 2009. Photo by Rebecca E. Rollins / Partners In Health

Matumisang Khasipe—a mother, wife, and nurse midwife for Partners In Health—says she loves her job at Nkau Health Center in Lesotho.

“I’ve been working for PIH for two years,” she said. “And there’s nothing better than patients telling you they’re happy.”

Nkau is about a two-hour drive southeast of Lesotho’s capital, Maseru. People often travel long distances through the mountainous region, on foot or horseback, to get care there. The clinic serves a population of about 15,000 and can see up to 30 childbirths in busy months, according to staff with Bo-Mphato Litsebeletsong Tsa Bophelo, as PIH is known in Lesotho.

Providing that amount of care could be a tall order in a country with one of the highest maternal mortality rates in the world.

But Khasipe and all of Nkau’s staff have set the bar high for maternal and infant health. They emphasize facility-based deliveries—which are much safer than childbirths at home—and conduct referrals to district hospitals for complicated pregnancies and emergencies, in order to prevent as many maternal deaths as possible.

Or, ideally, to reduce that number to zero.

“There shouldn’t be any maternal deaths,” said Khasipe, one of two PIH-supported midwives and three general nurses at the clinic.

Matumisang Khasipe in Nkau, Lesotho. (Photo by Terry Holzman / Partners In Health)

Nkau is one of seven remote health centers across Lesotho that are involved in PIH’s Rural Health Initiative. The initiative began in 2006 as an effort to support HIV care in the most rugged, remote areas of the small country, which is entirely surrounded by South Africa.

The initiative has since expanded, adding services focusing on maternal health, children’s health, and tuberculosis. One example is the Maternal Mortality Reduction Program, which began in 2009. In that year, just 5 percent of the region’s childbirths took place at a health care facility. By 2015, the facility-based delivery rate averaged 90 percent across the region served by the Nkau, Bobete and Nohana health centers.

Safe childbirths are just a part of the personal care that Khasipe and her colleagues help deliver at Nkau, every day.

In addition to new sets of tiny infant clothes and onesies emblazoned with “Partners In Health, Baby!” for example, newborns get immunizations and other postnatal services, free of charge.

Clinic staff encourage new mothers to stimulate their babies by playing and talking with them, holding them and singing to them. Village health workers travel widely to visit new and expecting mothers in their homes.

“Among other duties, village health workers go door-to-door to identify pregnant women in early stages and accompany them to facilities for their first prenatal care,” said Joalane Mabathoana, PIH’s manager of maternal and child health services in Lesotho.

Health workers also advise pregnant women who live far from the clinic to come and stay in maternal waiting homes until their babies are safely born. They receive consistent prenatal care, including ultrasounds, and doctors can more easily identify medical complications as women approach their due dates.

Mabathoana said women often begin staying at a waiting home about two weeks before their due dates. If emergencies arise, Nkau staff can help transport women to facilities with more resources.

Mothers at Waiting Home
Nearly all of the expectant mothers in the maternal waiting home at Nkau Health Center in Lesotho, on this day in March 2016, were paired with maternal health assistants, a vital part of ensuring safe deliveries for mothers and newborns. (Photo by Rebecca E. Rollins / Partners In Health)

Khasipe said such transports sometimes involve help from the local community.

“People respect what happens here,” Khasipe said. “There’s a nearby businessman who lets us borrow his car to bring women in labor” to the closest hospital, if an additional vehicle is needed in an emergency.

Khasipe’s commitment to quality health care for everyone, regardless of their financial means, runs parallel with PIH’s mission—and with her personal story. When Khasipe was 18, her first baby died. She was devastated.

The experience motivated her to go to nursing school.

“I took the chance to be a nurse in search of answers to why my baby died,” she said.

At the National Health Training College in Maseru, Khasipe studied general nursing and midwifery, and got firsthand experience in providing care.

“But I was traumatized,” she said. “I thought I could save all babies, like no one had saved mine.”

Khasipe and her colleagues have saved plenty of lives since. She’s been regularly promoted for her skills and commitment to her patients. And in 2012, she got another, more personal reward: She gave birth to twins. Her husband was away at the time, working in a mine. He now helps raise and support the family by farming. He lives with the children on their land while Khasipe spends most of her time in Nkau.

“I talk to him almost every day,” she said. “It’s hard to be apart. He’s my best friend.”

Khasipe reflected on the significant changes she’s seen at Nkau over just the past two years, and said the facility is continually expanding its role in the community.

“We save many lives,” she said, “both young and old.”

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