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Patients hit hard as Tšepong woes persist

by Lesotho Times

Kaleen Chikowore

QUEEN ‘Mamohato Memorial Hospital (QMMH) patients continue to experience serious challenges due to the lack of diagnostic medical equipment and shortages of skilled human resources at the facility, the Lesotho Times can report.

Patients continue dying at the institution due to the ill-equipped staff’s failure to diagnose their conditions and administer the appropriate treatment. Despite its status as the country’s main referral hospital, QMMH is in some instances, refusing to take in patients referred to it by other hospitals due to shortages of skilled doctors and diagnostic equipment. Where it has equipment, this is said to be malfunctioning as is the case with the magnetic resonance imaging (MRI) scan and the computed tomography (CT) scan.

Even basic things like stationery for writing prescriptions and compact discs for writing information relating to patients’ medical examinations are not available at the hospital.

All this is happening after the government’s premature termination of its public-private-partnership (PPP) agreement with the Tšepong Consortium for the latter to operate the facility on behalf of the state. It is becoming increasingly clear that the termination of the agreement was ill conceived as the government does clearly not have the capacity to run a modern professional health facility.

What was supposed to be an 18-year PPP for the Consortium to manage QMMH prematurely ended in August 2021 after the government terminated the contract citing several alleged infractions over the years by South Africa’s Netcare hospital group, the biggest company in the Consortium.

Announcing the termination in March 2021, Health Minister Semano Sekatle said the government felt it could no longer continue with the 2008 PPP with the Consortium for the construction, running and transfer of the hospital due to serious differences which had plagued the agreement from the very beginning. Mr Sekatle said the final straw was the Consortium’s 12 March 2021 decision to fire nurses who had been on strike since 1 February 2021 to press for salary increments to match their counterparts in other government and private institutions.

The Consortium had run QMMH since October 2011 when it replaced Queen Elizabeth II Hospital as the country’s major referral healthcare facility.

Netcare had formed the Consortium with a fellow South African company and three local companies.  In October 2008 an 18-year PPP agreement was signed between the government of Lesotho and the Tšepong Consortium, for the construction and operation of the hospital. Netcare held a 40 percent stake in the Tšepong Consortium. Four other companies, namely, Afri’nnai of South Africa (20 percent) and Lesotho companies; Excel Health (20 percent), Women Investments (10 percent) and D10 Investments (10 percent) held the balance of the shares.

The collapse of the deal has since plunged Tšepong into crisis. It is now run by the government which was already struggling to maintain decent operational standards at the many other healthcare facilities under its control.

The Lesotho Times first reported in October 2021 about the serious fall in standards wherein the hospital now lacked functional equipment to enable specialist staff to diagnose serious illnesses like cancer. The hospital was no longer able to carry out autopsies after the departure of its only pathologist. Other key qualified staff were also abandoning the institution, reducing the once prestigious, main referral hospital in Lesotho to the level of a mere district hospital.

At the time, Minister Sekatle and the hospital’s public relations officer, Thakane Mapeshoane, denied allegations by staffers that things were falling apart at the facility.

While admitting that it was beset by challenges, Ms Mapeshoane insisted the institution was coping. Moreover, some of the challenges saddling it had subsisted even during the days it was managed by the Tšepong Consortium, she said.

Mr Sekatle also denied the staffers’ allegations. He said contrary to the staffers’ claims, they had been paid their salaries. He however, referred the technical issues to the hospital’s management.

But the staffers insisted that there was a crisis of poor service delivery at the hospital. They said all they could do now was to extract the biopsies (samples) from patients who had to find private laboratories on their own to test the samples for cancer and other serious conditions. Only well-heeled patients could afford the exorbitant charges at the private laboratories which cost many times higher than what QMMH used to charge during the subsistence of the PPP.

This week, this publication found that the facility is still facing the same challenges reported a few months ago by patients and staffers. The hospital is still asking patients to go elsewhere, particularly to expensive private laboratories for blood tests and other medical procedures because it no longer offers these due to lack of equipment and qualified staff to conduct the tests.

A woman narrated her harrowing experience of having to watch her sick brother waste away before eventually dying at the hospital.

“They just admitted him but couldn’t say what he was suffering from because they couldn’t carry out any tests due to lack of equipment,” the woman said on condition of anonymity due to the sensitivity of the issue.

“One doctor suspected that my brother had meningitis and another said he could have suffered a mild stroke. None of them could say for certain what his problem was without any tests.

“Due to the failure to diagnose his condition, they couldn’t give him proper treatment. They just gave him pain killers to manage his pain.  All they did was give him a bed and for two weeks we watched him waste away before he succumbed to whatever had been eating him away. They couldn’t even refer him anywhere else as his condition deteriorated fast and he was in no position to be moved around. His death could have been prevented if there was equipment to run tests,” said the woman who is still devastated by the death of her brother last month.

A long-term tuberculosis patient, who used to be attended to at QMMH during the time of the Consortium, said the facility turned him away because it no longer had a pulmonologist to attend to him.

He said he was told to go to Scott Hospital, Morija.

“The departure of the Consortium coincided with the departure of the pulmonologist. As a result, QMMH referred me to Scott Hospital for my usual check-ups, saying they could no longer assist me,” said the 58-year-old patient who requested anonymity.

Even basic things like stationery have become a huge problem at QMMH. Patents’ lives have been turned upside down as a result.

Doctors continue writing patient prescriptions on bond paper resulting in their rejection by pharmacists.

A woman who requested anonymity said that she had to cry and beg before being allowed in by security guards who questioned the authenticity of her referral letter from one of the hospital’s filter clinics. The letter was not on a letterhead because the filter clinics are also saddled with the same problems as Tšepong.

“My seven-year-old son had a nail stuck in his foot. I went to the Likotsi filter clinic who referred him to QMMH for an x-ray. I spent about 30 minutes crying and pleading with the security guards to let me in because my son was in pain. They were insisting my referral letter was not genuine because it had been written on a plain piece of paper without the QMMH letterhead. They eventually relented because of my tears but that wasn’t the end of my troubles.  At the front desk, I was turned away because the hospital didn’t have computers to write my son’s medical information on compact discs.

“The receptionist also told me they wouldn’t attend to me anyway because the only x-ray machine they had was only being used for in-patients not out-patients like my son. This was being done to ensure it was not overworked, the receptionist said. I was then forced to go to expensive private facilities for my son’s tests,” the woman said.

Although Minister Sekatle had last year said one of the reasons for kicking out the Consortium was its failure to repair key diagnostic equipment like the MRI scan, this publication found that the machine still has not been fixed.   An MRI scan uses computer-generated radio waves to create detailed images of the organs and tissues in a human body.

“The Consortium left with some important medical equipment. But even where we still have some equipment, the challenge is that it is not working. For example, the MRI and computed tomography (CT) scan machines broke down two years ago and they haven’t been fixed. Even if it was working, we don’t have a specialist to interpret the tests.

“Currently we don’t have any pathologists. We had one pathologist who unfortunately left for Maseru Private Hospital. She is the only expert in the field of anatomical pathology in this country. Therefore, anyone who needs her services has to go to the private hospital where the charges are too steep for an average Mosotho,” said a QMMH staffer.

Meanwhile, some of the few remaining expatriate doctors are contemplating leaving as they have been working without permits since their expiry late last year. They say they have not been given contracts by the government since it took over the facility from the Consortium. Nor have they been paid their gratuities as the Consortium has shifted the responsibility to the government.

Lipontšo Makakole, the deputy director of clinical services at QMMH, refused to comment on the hospital’s woes.

Efforts to get a comment from the Health Minister Sekatle were fruitless as his phone rang unanswered this week.

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