- hospital can no longer diagnose serious illnesses, carry out autopsies or issue proper scripts
- once prestigious facility now resembles a “mere district hospital”
Kaleen Chikowore
THINGS are said to be falling apart at the Queen ‘Mamohato Memorial Hospital (QMMH), also known as Tšepong, since the government cancelled the management contract over a private consortium it had enlisted to manage the facility.
The hospital lacks functional equipment, specialist staff, is no longer able to diagnose serious illnesses including cancer, carry out autopsies and has even run out of stationery for doctors to write proper prescriptions. The scripts are now scribbled on plain bond paper which is not recognisable by professional pharmacies. Key qualified staff are also abandoning the institution.
Once a prestigious facility and the main referral hospital in Lesotho, Tšepong now resembles a mere district hospital, authoritative sources at the institution say.
Doctors and other staffers at the facility this week told the Lesotho Times the hospital was no longer conducting post mortems after the only pathologist left to join a private hospital in Maseru.
So dire is the situation that some doctors said there was no stationery at the facility. They were now forced to write prescriptions on bond paper instead of proper scripts with the hospital’s letterhead.
All this is happening after the premature collapse of the public-private-partnership (PPP) agreement between the government and the Tšepong Consortium for the latter to operate the facility on behalf of the state.
The collapse of the deal has now 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.
Tšepong is now reeling with serious shortages of medical equipment and specialist staff. The Tšepong Consortium is said to have removed some key equipment after the termination of its management contract.
But despite the apparent crisis at the facility, as exposed in our interviews with key staffers this week, Health Minister Semano Sekatle and the hospital’s public relations officer Thakane Mapeshoane, rejected any notion that things had fallen 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.
The staffers interviewed nonetheless begged to differ. 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.
What was supposed to be an 18-year PPP for the Consortium to manage QMMH prematurely ended in August 2021. This after the government terminated the contract citing several 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 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.
After the termination of the Consortium’s contract, standards appear to have deteriorated rapidly after the government took over the running of the facility.
In fact, according to one staffer, “QMMH is no longer distinguishable from Butha-Buthe Hospital or any other district facility due to the failure to preform specialist services it used to offer patients before the Consortium was kicked out”.
“The hospital’s laboratory no longer has equipment to perform histology (a procedure which enables experts to study human tissues) as part of the process of diagnosing cancer.
“Like any other district hospital, the only thing we are able to do is to extract the biopsies and give these to the patients to look for private laboratories to run the required tests.
“Most patients can’t afford the high prices for tests at the private laboratories. At QMMH, patients used to pay M50 for the tests but at one of the private labs, the initial test costs M700. If the diagnosis is positive, the patient has to go for another test to determine the stage of the cancer. The samples are sent to South Africa. This is not only expensive but also means a longer wait for the results than when the tests were still being done here at QMMH.
“I have a patient who had to pay a total of M20 000 for further tests. Sometimes the samples from patients who can’t afford the private labs end up rotting because we don’t have the required chemicals to preserve the tissues. It is very sad because the more time is lost before getting the results, the more the diseases progress to a stage where the patients can’t be saved. Cancer patients and those suspected to be suffering from the disease need help and it must happen fast,” said the source who asked for anonymity because he is not authorised to speak to the media.
Another staffer said they were also failing to operate patients with cancerous growths because only one emergency theatre was operational at the facility.
“We cannot operate on patients to remove cancerous growths or lumps because we currently have only one functional emergency theatre. The situation has been worsened by the emergency room rules which dictate that only an individual who has six or less hours to live should be operated on. Patients who do not fall under this category have to wait until their cases are considered emergencies. This is unfortunate because all the while, the diseases will be progressing and so many people end up in situations where they cannot be saved,” said the source.
Another staffer weighed in saying, “QMMH has been reduced to a mere district hospital since the Consortium left”.
“There is nothing we are offering that is different from Motebang, Butha-Buthe and other district hospitals. We lost that distinction when the Consortium left.
“The Consortium left with some important medical equipment. But even where we have some equipment, the challenge is the lack of specialists to interpret the tests. For instance, we still have magnetic resonance imaging (MRI) machines but we do not have radiologists to interpret the tests. The computed tomography (CT) scan machine broke down two years ago and it was never 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 in Dr Mookho Ntene 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 the source.
Dr Ntene refused to comment this week.
Despite all this, Ms Mapeshoane, the public relations officer, insisted things were not falling apart at Tšepong.
She however confirmed that biopsies were currently not being done because the government was yet to renew the contract for such services with Ampath Laboratories, which used to conduct the testing when the hospital was still being run by the Consortium.
“The biopsies are currently not being processed as before because the government is yet to renew the contract for such services with Ampath. Ampath used to test the samples on behalf of QMMH when the facility was still being run by the Consortium. Now that the government has taken over the hospital, the contract has to be renewed,” Ms Mapeshoane told the Lesotho Times yesterday.
Although she could not specifically confirm Dr Ntene’s departure, she however, admitted that some doctors had indeed left the institution.
“I am not specifically aware of Dr Ntene’s departure but I know that there are some doctors who have left. I will have to confirm with the human resources department as to how many have left,” she said.
Another QMMH doctor said the situation had deteriorated to an extent where even basic stationery was lacking at the hospital.
“There is no stationery at present. We are writing prescriptions or sick leave letters on bond paper, instead of using stationery with the hospital’s letterhead. We have been requesting stationery ever since the Consortium left but the hospital management keeps telling us that they are yet to open a bank account to enable them to procure all these things. It has been two months of the same excuses,” the source said.
It was always going to be a tall order for the government, already struggling to maintain other health facilities, to ensure smooth operations at QMMH after kicking out the Consortium. Two months ago, Minister Sekatle and the Director General of Health Services, Nyane Letsie, both accused Netcare of sabotage and looting ahead of handing over the hospital and its three filter clinics to the government. The three filter clinics are Qoaling, Likotsi and Mabote.
“What they did was pure sabotage. Initially they (Netcare) denied taking the equipment but they now admit taking it. They however, excuse their actions by claiming that that the equipment was theirs and even had Netcare branding. This does not make sense because these are government facilities and the Consortium was only operating them on behalf of government,” Mr Sekatle said at the time.
Dr Letsie echoed Mr Sekatle’s allegations, saying Netcare had also removed projectors from QMMH. She said the removal of the projectors would negatively affect the training of 10 junior doctors currently on housemanship at QMMH.
She said they would conduct investigations to establish the extent of the “looting” and if need be, they would deduct part of the termination fees due to the Consortium and use it to replace the “stolen” equipment.
Dr Letsie yesterday referred all questions on the QMMH saga to Ms Mapeshoane. The latter blamed some of the facility’s woes on the Consortium which he said had taken the hospital’s stationery and other files before handing it to the government.
Meanwhile, another QMMH staffer yesterday said they had not been paid their salaries for the past five months.
“We have not been paid for the past five months now. We just go to work but we are struggling to pay rent and even fuel our cars to get to work. But the government has seen it fit to hire five top-of-the-range Toyota Hilux double cabs for the new management while the hospital is on its knees.
“The management has been making false claims that they paid us. After they told the public that they paid us, they privately addressed us and apologised. They said they had to contain the situation by claiming to have paid us but they will eventually pay in due course,” the staffer said.
When asked about this, Ms Mapeshoane said although the government had been behind in terms of payments, it had last week paid the staffers their August dues.
“This week, the government will be processing the September 2021 salaries,” she said.
It seems unless the government proves its capabilities to run the once prestigious referral hospital, and does so sooner, Lesotho’s health delivery will further plunge into incalculable peril.
