A mountain of challenges

Ha-Mokoto Clinic is providing a critical service to impoverished Thaba-Tseka communities, but the delivery is not without its challenges.

By Tsitsi Matope

THABA-TSEKA – Ha-Mokoto Clinic is a sanctuary of hope in the middle of nowhere.

Green-grey mountains tower menacingly over the health facility while far below, an angry river hisses in flood as it slithers away over jagged rocks into the wilderness.

What immediately comes to mind is there must be a “catch”  for any professional to even consider working in such a bleak environment accessed from Maseru after 220km of probably the most challenging road conditions in Lesotho.

The majority of patients are from very poor families and walk long distances to reach Ha-Mokoto and by the time they reach the clinic — in some cases after a two-day journey — they are extremely tired and in critical condition and might need medication for the fatigue first before the ailment that brought them to the facility is attended to.

That is why after administering treatment, it feels “morally wrong” for the nurses at the clinic to release the patients because they would then immediately have to undertake the same torturous journey back to their homes.

Situated about 50 kilometres from Thaba-Tseka town, Ha-Mokoto Clinic is a classic case of bringing basic necessities closer to communities, but an equally stark reminder of the immense challenges associated with ensuring every citizen has equal access to amenities.

It takes approximately three hours to manoeuvre a four-wheel-drive vehicle on the 50km stretch of arguably one of Lesotho’s most rugged gravel roads.

The dirt road is definitely not a safe track considering the erosion that is now eating away the edges of the road.

On this visit last Wednesday, local residents could be seen reinforcing, with wire and stones, edges of the road leading to Sehaula Village in an effort to make it passable.

The other road which connects Thaba-Tseka town and Ha-Mokoto Clinic cuts through a river, whose bridge was however, washed away, leaving motorists with no choice but to use the traumatising Sehaula thoroughfare.

Arriving at Ha-Mokoto Clinic after surviving the tormenting gravel road, one is flooded with an overwhelming feeling of relief and achievement, momentarily forgetting about the return journey.

“The situation is worse in winter because of the snow; villagers walk long distances on such bad roads each time they want to come here or visit the town,” Kamohelo Motseleli, a nursemidwife at the clinic, said.

Yet the clinic staff also has problems of their own, which compound an already complex situation.

“It’s very cold in winter and the problem is that not all the houses here have coal stoves to keep the occupants warm,” Motseleli said.

There are three nurse midwives and two nursing assistants at the clinic that was upgraded under the American government’s Millennium Challenge Account programme, and whose new wing is to be officially opened next month.

Operations at the clinic, which include the storage of vaccines and lighting, run on solar energy which becomes ineffective in winter due to the absence of adequate sunlight.

Communication at the clinic is yet another challenge, with the nurses insisting they have to buy airtime using their own cash each time they want to request for an ambulance or consult the Medical Superintendent at Paray Hospital in case of emergency.

“We are not happy here because the working conditions are just terrible. We are not getting the incentives we were promised. I even regret my decision to leave my former employer because I didn’t know it was going to be this difficult. We are actually subsidising the government because we use our own money to communicate with other hospitals,” Motseleli said.

Previously, Motseleli said the clinic used to get airtime worth M150 from SolidarMed — a Swiss non-profit organisation working to improve the health of people in rural Sub-Saharan Africa — to facilitate emergency communication, which she said had since been stopped.

Last year, 230 nurses and nursing attendants working in the 46 health centres situated in the hard-to-reach areas of Lesotho were each promised monthly hardship allowances of M600 and transport allowances of M250, as well as furnished accommodation by the Ministry of Health.

The move, which came as an incentive for the nurses to work in remote areas shunned by most health professionals, was widely commended at the time of its announcement.

Although the caregivers had expected each house to have a gas-stove, gas-fridge, gas-heater, double-bed, couch, television and satellite dish as promised, this has not happened and many have been waiting since the promise made in April, 2013.

“There are many challenges here and what depresses me the most is I had committed myself to working in this tough environment because I thought the difficulties would be eased. My commitment was also based on the fact that my skills are needed most here.

“However, apart from the trauma associated with helplessly watching communities always struggling to access our services, we are also struggling to survive in this lonesome place. Once you finish work and go home, there is nothing to entertain you or uplift your spirits,” Motseleli said.

When the solar system is not working, the clinic is covered in darkness and midwives have to use candles to deliver babies at night, the Lesotho Times found out during last week’s visit.

Laundry is also transported to Thaba-Tseka and this is not always a perfect arrangement, especially when the weather decides to bring a snowfall or when there are heavy rains.

Motseleli remembers her happier days when she was working in Maseru. A married mother-of-two children aged eight and two years, she took up the Thaba-Tseka post in April last year and left behind her youngest child.

“I needed the experience of working in a government facility where I would learn about family planning, an aspect that was not there at my previous workplace. Because I am a midwife, I also needed to work at a health centre where I could deliver babies more frequently and Ha-Mokoto accorded me that opportunity to put my skills to practice.”

Motseleli further said although her previous employment allowed her time with her family, she was not happy with the fact that there was no pension that would cushion her after retirement.

“Although I am benefiting in some way here, I also feel this is not what I bargained for because, instead, my budget has become much tighter than before. I have to spend a lot of money to have what I can call a normal life in these mountains.”

Motseleli also said she was promised training opportunities, internet and a vehicle that would ferry her to Thaba-Tseka town when travelling home.

“Well; if you ask me, I think we were tricked and we are not getting any explanation as to what is happening.”

A nursing assistant, ‘Mamotseki Khoali, said she decided to move from Queen ‘Mamohato Memorial Hospital in Maseru to Ha-Mokoto  in November last year because she wanted to work in her home district and provide much-needed services to her people.

“That is how I reasoned at the time. I am from Mantsunyane and felt if professionals from this remote district cannot help their own people, who would? But I am beginning to think coming here was a big mistake. As much as I would like to help people from my home area, I cannot live like this and still have the motivation to provide services,” Khoali said.

She said what pained her most was seeing communities suffer but being unable to do anything to help them.

“People here really need us but in some cases it is heartbreaking when we refer them to the hospital in town and they tell us they are unable to go because they cannot afford the transport fare. I always ask myself: Am I serving the people who motivated me to work here or I am here to just helplessly watch them suffer and die?”

When Khoali joined Ha-Mokoto Clinic, she had expected to, at least, find a bed in her two-roomed house but later found herself hiring a car to bring her own bed.

“What I found in the house was an old kitchen-unit and wardrobe. I have been waiting for the other furniture we were promised. Just last week, we received a message from the Ministry of Health that we were no longer going to get the allowances we were promised. We are currently receiving a hardship allowance of M275 per month, which is not what we were promised.”

Contacted for comment this week, the Director for Nursing Services in the Ministry of Health, ‘Makholu Lebaka, said the government did not renege on its promise to make life better for health personnel working in the remote areas of the country.

“The process to incentivise the caregivers was lengthy. We started working on the logistics in April last year and it has not been an easy process, importantly because there was need to ensure government’s commitment to sustaining the incentives package,” Lebaka said.

She further said after her ministry presented the plan that was meant to attract caregivers to the difficult-to-reach areas, Irish Aid — Ireland’s official overseas development programme working to reduce global poverty and hunger — agreed to support the initiative on condition the government would take over after one year.

“Irish Aid agreed to support us in the procurement of the once-off items such as furniture, but after we secured that support, we realised the need to involve the ministries of Public Service and Finance, to ensure lifelong support. It is that process that took long. The incentives package initiative was only signed in December last year. Currently, our Human Resources Office is trying to put together the payments and also working on the procurement of the furniture.”

Lebaka further said allowances would be paid in accordance with when the caregivers started working in the remote areas.

“We have been communicating with their managers to update them on progress made and of course, we have realised that in some areas, there is also confusion regarding what constitutes the hard-to-reach status.”

Lebaka said only 46 health centres were classified as hard-to-reach.

“There are some areas that one might think are hard-to-reach because, maybe, they are too far from town but that does not necessarily mean they can be categorised as hard-to-reach.”

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