Queen ‘Mamohato Memorial Hospital (QMMH)
Pascalinah Kabi
FOR Ha Mabote resident, ‘Mamalapane Hlabanyane, giving birth in 2011 resulted in many unintended consequences with which she continues to grapple even today.
Upon going into labour on 3 October 2011, Ms Hlabanyane (42) was transferred to Queen ‘Mamohato Memorial Hospital (QMMH), popularly known as Tšepong, because she could only deliver through a caesarean section.
Also known as C-section, caesarean delivery refers to a surgical procedure in which a foetus is delivered through an incision in the mother’s abdomen and uterus.
“My condition demanded that I give birth by C-section and the Mabote Clinic transferred me to Tšepong,” she told the Lesotho Times this week, recalling the events of 2011.
“I gave birth and was taken into a recovery room. I don’t know what happened from there. All I remember is being discharged on 7 October 2011.”
After giving birth, Ms Hlabanyane – who is HIV positive – resumed her normal life for a year until she suddenly felt severe abdominal pains and started menstruating three times a month.
“The bleeding was so intense it felt like someone had opened a shower when the menstruation began.”
After enduring the ordeal for four months, Ms Hlabanyane decided to visit a doctor in a Maseru-based clinic and was referred to Tšepong for a scan.
“I took the scan results back to the doctor and he discovered that a subtotal hysterectomy was done on my body after a PPH (postpartum haemorrhage) in 2011,” she said, adding “The doctor went through my hospital booklet which confirmed what the scan had revealed.”
Subtotal hysterectomy is the surgical removal of the uterus with the cervix left in place. Postpartum haemorrhage (PPH) is defined as the loss of more than 500 ml or 1000 ml of blood within the first 24 hours following childbirth.
Still shocked and confused, Ms Hlabanyane went back to her then Lower Thamae home to explain what she had learnt to her husband.
Instead of giving support, her husband accused Ms Hlabanyane of making a unilateral decision.
“He accused me of making a monumental life decision without his input. My husband then left me for three years. When he eventually returned, he was emotionally abusive and called me all sorts of names,” she said, adding the torment became so intense, she was left with no option but to move out of her matrimonial home.
However, the bleeding was unrelenting and taking a huge toll on her health. She then sought the assistance of the Community of Women Living with HIV/AIDS who accompanied her to a meeting with Tšepong Operations Director Dr Karen Prins.
During the meeting, Ms Hlabanyane said she was informed by Dr Prins that that the physicians who attended to her during the baby delivery in 2011 were forced to sterilise her because she was in a critical condition and unable to make a decision for herself.
She further said Dr Prins also indicated that she was bleeding profusely during the surgery, adding that it was normal for HIV-positive women.
“I asked to see the doctor who operated on me but, instead, Dr Karen brought in some gynaecologists and I decided to abruptly end the meeting after she wrote a letter titled ‘to whom it may concern’ explaining my condition.”
Ms Hlabanyane showed the letter to the Lesotho Times which partly reads: “This letter serves to confirm that ‘Me Hlabanyane suffered a life-threatening haemorrhage following the delivery of her baby, on 3 October 2011, by caesarean section.”
Haemorrhage is any profuse internal or external bleeding from the blood vessels. The most obvious cause of haemorrhage is trauma or injury to a blood vessel.
Haemorrhage can also be caused by aneurysms or weak spots in the artery wall that are often present at birth. Over time, the blood vessel walls at the site of an aneurysm tend to become thinner and bulge out like water balloons as blood passes through them, making them more likely to leak and rupture.
Dr Prins further explains in the letter that Ms Hlabanyane was sent back to the theatre while she was still recovering from the first anaesthetic of the caesarean delivery in a bid to control the bleeding and save her life.
“She was unconscious and not aware of the critical situation. Clinicians had to act fast in this emergency situation. A subtotal hysterectomy had to be performed because the bleeding was not controllable with any other methods,” Dr Prins says.
Ms Hlabanyane said she asked for the letter from Dr Prins to prove to her family that she did not make the life-changing decision of sterilisation without consultation.
Determined to hold Tšepong to account for “denying” her an opportunity to be a mother once again, Ms Hlabanyane sought the assistance of Women and Law in Southern Africa Research Trust (WILSA).
The non-governmental organisation advocates for the rights of women and, on 17 January 2013, WILSA National Coordinator Libakiso Matlho wrote a letter to then Health Minister Pinkie Manamolela requesting a meeting to discuss the “possible sterilisation of women without informed consent in Lesotho’s public hospitals”.
Ms Matlho says in the letter her organisation had received reports from women saying they had been sterilised without their consent at public hospitals.
“We have identified some cases which have given us some concern. One of those cases involves Mrs Hlabanyane . . .,” reads the letter.
“We write to express concern over possible sterilisation of women living with HIV without informed consent. We would like to enquire about Lesotho’s policy regarding sterilisation of women living with HIV in public hospitals in Lesotho and schedule a time to discuss the cases we have identified with you.”
Ms Matlho also indicates that conducting medical procedures like hysterectomies without informed consent violated Lesotho’s domestic, regional and international law obligations and undermined Lesotho’s ability to effectively respond to the HIV pandemic.
WILSA, she says, was aware that Lesotho’s Population Policy of 1994 allowed for contraceptive sterilisation.
“However, it appears there is no clarity as to what is required for informed consent and whether the policy is being followed adequately by health practitioners in the public sector to ensure that vulnerable groups such as women living with HIV and women with pre-cervical cancer are specifically protected.”
Contacted for comment this week, Ms Matlho acknowledged writing the letter, adding that WILSA had embarked on an investigation into the matter and would soon release a detailed report.
“We are not in a position to disclose our findings but we are hoping to release a report either in March or April this year,” she said.
The Lesotho Non-governmental Organisation (LCN) also came to Ms Hlabanyane’s aid in a letter to Dr Prins dated 21 October 2013.
In the letter, LCN Executive Director Seabata Motsamai points out to Dr Prins that Ms Hlabanyane’s human rights were at stake.
“Duly instructed, we hereby request a meeting with you within 14 days from the date hereof to discuss Mrs Hlabanyane’s health issue and how the matter can be amicably resolved, failing which we shall approach the courts of law for an immediate relief.”
Contacted for comment, LCN economic justice coordinator Sekonyela Mapetja said Ms Hlabanyane was one of many Basotho suffering because of doctors’ “arrogance”.
“We held a couple of meetings with Tšepong management and the then Ministry of Health principal secretary to try and solve this matter but there was a lot of arrogance displayed by the doctors and management,” Mr Mapetja said.
“Sexual reproductive health issues in Lesotho are handled with so much arrogance with doctors thinking that just because our lives are in their hands we don’t know anything about our own health.”
He said that this arrogance resulted in a lot of mistakes which had dire consequences on patients who were left to suffer on their own.
Mr Mapetja also indicated that it was during these meetings that it became apparent that the doctors regarded sterilisation without consent as a normal practice.
He said they decided to suspend pursuing Ms Hlabanyane’s case after her condition worsened.
“We needed to give her time to recuperate and now that she is back on her feet, we are ready to fight for justice. We will not stand by and watch as people like ‘Mamalapane suffer because of doctors’ arrogance,” Mr Mapetja added.
Tšepong Acting Public Relations Officer ‘Manthako Rasupu refuted allegations that Ms Hlabanyane was never informed about the operation until the 2012 scan.
“The allegations are untrue and the patient was duly informed after the operation,” Ms Rasupu said.
“Before undergoing any procedure, a patient has to sign a consent form for any surgical intervention and that informed consent also applies to sterilisation procedures.
“Clinical conditions may also guide the need for sterilisation but the patient still needs to consent. The procedure will only be performed after the procedure and potential complications have been explained to the patient by the doctor and the patient has provided written consent.”
Reacting on Mr Mapetja’s claims, Ms Rasupu said: “We are not aware of the alleged meetings that took place with the LCN. The hospital does not discuss confidential information with outside third parties.”
She added that Tšepong management were aware of allegations they carried out sterilisation procedures without consulting patients “but upon investigation, the claims were found to be baseless”.
Meanwhile, a 2016 meeting organised by the Southern African Development Community (SADC) Parliamentary Forum (SADC-PF) for local civil society organisations noted with concern that many women were being sterilised without their consent.
The SADC-PF meeting urged Lesotho’s parliamentarians to act urgently to nip sterilisation without consent in the bud as it violated patients’ rights.
For Ms Hlabanyane, the struggle to live a normal life continues.
“You see this big bag, I always travel with it because I move around with a pair of clothes, cosmetics and a towel so that I can rush into a public restroom and clean myself immediately after bleeding,” she said.
“I am always putting on a sanitary towel because I don’t really know when I will bleed. I have lost my dignity. I have lost my husband. I have lost my job and my health is deteriorating with each passing day.”
