In Lesotho, PIH Delivers Lifesaving Heart Monitors for Prenatal Care

Machines detect heartbeat irregularities in rural Thaba Tseka

Posted on Dec 21, 2021

Limakatso Lerata stands near the maternal waiting home where she is staying in the weeks leading up to her delivery.
Limakatso Lerata stands near the maternal waiting home where she is staying in the weeks leading up to her delivery. Photo by Mpho Marole / PIH.

Manamaneng clinic was 13 hours away, by foot, along miles and miles of winding dirt roads. But Limakatso Lerata was determined to hear her baby’s heartbeat.

The 18-year-old had received prenatal care at other clinics, closer to her village. But at Manamaneng, there was a maternal waiting home and a vital piece of equipment: a CTG machine.

Cardiotocography (CTG) machines are critical in prenatal care, allowing clinicians to electronically monitor a baby’s heartbeat and detect any complications early on. But in places like rural Thaba Tseka District, Lesotho, clinics can’t afford to purchase or maintain these machines on their own.

From April to June, Partners In Health delivered seven CTG machines to rural clinics in Lesotho, as part of its longstanding efforts to strengthen the country’s health system in partnership with the Ministry of Health.

CTG Machines

Palesa Khomongoe, a midwife and site director at Bobete clinic, has seen these machines save lives.

“When we did not have the CTG machines, we were unable to detect early fetal distress and that led to increased fetal mortality,” says Khomongoe, who has been with PIH for five years. “But now that we have the machines, I can see a decrease in the mortality rate, because we were able to do early detections and make timely medical decisions.”

Khomongoe estimates that at least 10 lives have been saved since her clinic received a CTG machine in early June.

One of those cases is still clear in her mind. While monitoring a baby, the machine was detecting only a faint heartbeat. That set in motion an urgent phone call to Paray Hospital, where the mother was admitted for emergency care and it was discovered the baby’s umbilical cord was tied around its neck. That discovery enabled doctors to perform an emergency cesarean section, saving the mother’s and baby’s lives.

Before the CTG machine was provided, the clinic was using a fetoscope, an open-ended conical device used by clinicians to listen for a fetal heartbeat, and there were delays in identifying such problems.

“It gives me such fulfillment to know that the baby is in good condition when I am doing deliveries,” Khomongoe says, “as opposed to before, when it was hard to tell.”

Palesa Khomongoe uses the CTG machine to monitor a baby's heartbeat
Palesa Khomongoe uses a CTG machine to monitor a baby's heartbeat. Photo by Mpho Marole / PIH.

Training Staff, Saving Lives

The CTG machines build on the health system strengthening that has marked PIH’s work in the country over the years.

Known locally as Bo-mphato Litsebeletsong Tsa Bophelo, PIH has worked in Lesotho since 2006. PIH’s rural health initiative has brought HIV care and other medical services to more than 90,000 people through seven clinics. From 2014 to 2017—coinciding with the start of Lesotho’s national health reform, which PIH supported—the rural clinics saw an 85% increase in prenatal visits and a 15-times increase in facility-based deliveries.

As part of those system strengthening efforts, PIH staff don’t just provide lifesaving medical equipment—they teach clinicians how to use it.

After the CTG machines were delivered, all nurses and midwives at PIH-supported clinics in Lesotho received a comprehensive three-day training at Makonyane Hospital on how to use and maintain the equipment—enabling them to provide a higher level of care for patients.

Lerata, now staying at Manamaneng clinic, is one of those patients. After her 13-hour journey, nurses performed an ultrasound that revealed she was just a month-and-a-half away from delivery. And with the CTG machine, they listened for the baby’s heartbeat. So far, normal. But they didn’t want to take any chances.

Through PIH’s support, Lerata is staying at the clinic’s maternal waiting home, for free, until her due date—one of more than 1,500 expectant mothers who stay in PIH’s maternal waiting homes in Lesotho each year—allowing her to receive constant care and monitoring.

The nurses check on her at least three times a day. And cooks at the clinic provide her meals, for free.

“There is food to eat, which is well-cooked,” she says. “It really feels like home.”

Lerata isn’t the only mother in Thaba Tseka District to receive such care.

Miles away, at Bobete clinic, a CTG machine detected an abnormality in Maqenehelo Letima’s pregnancy. The 33-year-old mother would need surgery—specifically, a single stitch sewn around her cervix to close it—at an advanced hospital, hours away.

With PIH’s support, Letima was given funds to cover her medical bills and transportation costs—allowing her to travel to the hospital for her check-ups and access lifesaving care.

At 36 weeks, she gave birth to a baby girl—four weeks early, but alive and well.

“PIH gave my life a new meaning,” she says. “I have a baby now. I found my peace.”

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