Celebrating a Safe Birth in Lesotho

Finding Tebello Malapane wasn’t easy.

To begin, Village Health Worker Manepile Mothae had to walk three hours over the winding, mountainous terrain of Lesotho. She scrambled across loose rock, over boulders and through creeks. It was summer, and the sun blazed down. At the end of her journey to Monyameng Village was a pregnant woman who needed her help. Tebello was 26 years old and rendered immobile by a degenerative disease, possibly spina bifida.

Through her knowledge of the village, Mothae identified Tebello in late 2014. Mothae has 10 years of experience under her belt as a VHW, so she knew that a pregnant woman living in a rural area with a disability could face extraordinary challenges in getting the necessary care to safely deliver her baby.

Mothae works in Mohale’s Hoek District in southern Lesotho. Her district is part of an extensive national health care reform that Partners In Health/Lesotho is supporting. As part of the reform, PIH/L has provided technical assistance to the district as it enhances or adds services that patients such as Tebello need. The reform also has included training of VHWs so they, like Mothae, can identify patients in villages and accompany them as they seek health care.

After Mothae found Tebello, who lives with her mother, she determined that the young woman needed to get to the clinic to deliver her baby. Transportation by horse or donkey, perhaps not even possible for a patient like Tebello, would cost the equivalent of $20-$30 U.S. Instead, men from the village took turns carrying her over the rugged hillsides.

Tebello stayed at the maternal waiting home at Mootsinyane Health Center for a couple of days while clinicians examined her. Maternal waiting homes, where expectant mothers stay to be near a facility while their due date approaches, are a crucial part of Lesotho’s national health care reform. Clinicians then referred Tebello to the hospital; the clinic paid for her vehicle transportation.

On Nov. 24, 2014, Tebello’s son, Bolokang, was born by cesarean section. The pair stayed at the hospital for three months, where clinicians educated Tebello about caring for her child. When she was discharged, a village health worker accompanied her and Bolokang for the long trek back to Monyameng.

Mothae continues to support Tebello and Bolokang, walking the three hours to the village two or three times each week. Tebello’s mother, Masello, cares for her daughter and grandson. The 61-year-old has hiked that same three hours to the clinic twice to get the baby immunized.

Without the dedication of a veteran village health worker, Tebello’s story might have turned out differently. Mothae and her colleagues, with their understanding of and concern for the villages they serve, are essential to Lesotho’s health care system.

PIH/L has been collaborating with the Ministry of Health to improve care across Lesotho as part of a five-year, three-phase reform. In Mohale’s Hoek District, for example, PIH/L has provided technical supervision, follow up, and training of clinical staff. Efforts have included training and recruiting VHWs, food assistance for mothers, maternal waiting homes, and support for emergency referral for transportation.

The Lesotho Ministry of Health and PIH/L started working on a plan for national reform in 2013, after the ministry of health saw the success of PIH/L’s Maternal Mortality Reduction Program. A central goal of the reform is that all health clinics will be able to deliver a comparable level of care to what PIH/L has been delivering for years. Although PIH/L will continue to be involved in training staff and providing technical assistance, the health centers will remain under the purview of the Ministry of Health.

As the reform continues, the Ministry of Health and PIH/L’s hope is for more safe deliveries and healthy patients—more outcomes like that of Tebello and Bolokang.