Médecins Sans Fron­tières calls it a day

Lesotho Times - - Big Interview -

AT 620 deaths in ev­ery 100 000 live births, Le­sotho has one of the high­est ma­ter­nal mor­tal­ity rates in the world. Ma­ter­nal mor­tal­ity is the death of a woman while preg­nant or within 42 days of ter­mi­nat­ing her preg­nancy. Ac­cord­ing to Médecins Sans Fron­tières (MSF) or Doc­tors With­out Bor­ders, il­le­gal abor­tion is one of the rea­sons for this high death rate.

MSF Project Med­i­cal Ref­er­ent, San­dra Sedl­maier-ou­at­tara, speaks with Le­sotho Times (LT) reporter, Pas­cali­nah Kabi, on this un­for­tu­nate in­di­ca­tor and what her or­gan­i­sa­tion has been do­ing to mit­i­gate the sit­u­a­tion for the nine years it has been op­er­at­ing in Le­sotho.

LT: Could you please give a back­ground of who Médecins Sans Fron­tières are?

Sedl­maier-ou­at­tara: Médecins Sans Fron­tières is the world’s big­gest hu­man­i­tar­ian or­gan­i­sa­tion work­ing in about 70 coun­tries. We come in to help af­ter dis­as­ters, both man-made and nat­u­ral, and also pro­vide aid and care where we feel there is need for in­ter­ven­tion.

MSF’S ma­jor strength is in­no­va­tion and be­cause we are such a big or­gan­i­sa­tion, we have many re­searches at­tached to dif­fer­ent projects. Se­condly, what we try not to do in ev­ery coun­try we op­er­ate is sub­sti­tute gov­ern­ment and the min­istry of health, but work closely to­gether. I think this has worked very well in Le­sotho as we have col­lec­tively come up with strate­gies for the over­all ben­e­fit of Ba­sotho.

LT: You said MSF does not op­er­ate in ev­ery coun­try…so why did you choose to come to Le­sotho?

Sedl­maier-ou­at­tara: Our first project here was in 2006 in Morija when HIV be­came a nurs­ing con­cern rather than a doc­tor’s care. MSF has been quite in­volved in this task-shift­ing at Scott Hospi­tal here in Morija. The project did run un­til 2010 and be­gin­ning 2011, we went to Roma and are now serv­ing Roma and Se­monkong ar­eas.

With Le­sotho faced with a very high HIV mor­tal­ity rate, we asked our­selves why and what we could do to help. So the gen­eral ob­jec­tive in our project doc­u­ment and why we are here is re­duc­ing ma­ter­nal and in­fant mor­bid­ity and mor­tal­ity in a hy­per-epi­demic HIV, TB con­text.

MSF is very con­cerned about is­sues of ma­ter­nal health and how glob­ally, we are fail­ing to meet the set goals in this area.

Even though we failed on re­duc­ing ma­ter­nal mor­tal­ity (un­der the Mil­len­nium De­vel­op­ment Goals) and have now moved on to Sus­tain­able De­vel­op­ment Goals, MSF still feels the need to help Le­sotho con­front its ma­ter­nal health­care is­sues.

Ba­si­cally, is­sues of HIV care, ma­ter­nal and in­fant mor­tal­ity and Tu­ber­cu­lo­sis (TB) are in­ter­twined and must be ad­dressed dur­ing our stay in Le­sotho.

We felt that Le­sotho had big in­ter­na­tional or­gan­i­sa­tions fo­cus­ing on HIV care while ma­ter­nal and in­fant mor­tal­ity was be­ing ne­glected.

Since 2011, we have fo­cused on two catch­ment ar­eas – sup­port­ing Roma hospi­tal and nine other health­care cen­tres.

We are still very much fo­cused on HIV care be­cause 23 per­cent in the gen­eral pop­u­la­tion is Hiv-pos­i­tive and if you look into the dif­fer­ent cat­e­gories, for preg­nant moth­ers, the preva­lence rate is 27 per­cent in Le­sotho.

LT: Ac­cord­ing to MSF re­search, why is the HIV preva­lence so high in Le­sotho?

Sedl­maier-ou­at­tara: First of all, the long dis­tance peo­ple have to travel to reach health cen­tres…that’s one of the big­gest chal­lenges in Le­sotho be­cause one does not only need to be sick to seek a health­care fa­cil­ity, but also goes to such a fa­cil­ity for other ser­vices such as con­doms. So if peo­ple have to walk for eight hours to get a con­dom, chances are they would en­gage in un­pro­tected sex which is very bad for Hiv-preven­tion.

World Health Or­gan­i­sa­tion (WHO) stud­ies also say mi­gra­tion is one of the big­gest cat­a­lysts for Hiv-in­fec­tion and with Le­sotho hav­ing so many of its cit­i­zens work­ing in South Africa in the mines, mi­gra­tion is def­i­nitely one of the ma­jor rea­sons for this high preva­lence .

Per­son­ally, I think tra­di­tion has also had a big role in this. What I have ob­served, es­pe­cially in the ru­ral ar­eas, is that Le­sotho has many girls who are mar­ried to older men be­cause maybe she is an or­phan and fam­i­lies wanted to get rid of her by mar­ry­ing her off.

We know where there is a huge age-gap, there are chances of a high HIV in­fec­tion rate. Lastly, this is purely my per­sonal view; I am not so sure about the coun­try’s ed­u­ca­tional sys­tem but I find that sex­ual is­sues are not very much dis­cussed among Ba­sotho fam­i­lies.

I am told the Min­istry of Ed­u­ca­tion is look­ing into in­tro­duc­ing sex­ual mat­ters into the cur­ricu­lum, but I feel this must come from par­ents or fam­i­lies who should be talk­ing about con­doms and all sex-re­lated mat­ters to their chil­dren

LT: When MSF first came into the coun­try, how was the en­vi­ron­ment? Was it con­ducive enough for your pro­grammes?

Sedl­maier-ou­at­tara: I have worked in six African coun­tries and I think Le­sotho is quite ad­vanced com­pared to other na­tions, in terms of wealth and ed­u­ca­tion. I also think this coun­try was quite lucky be­cause it was in­cluded in the (Amer­i­can) Mil­len­nium Chal­lenge Ac­count (MCA) and re­ceived th­ese brand new health fa­cil­i­ties all over the coun­try be­cause of the aid pro­gramme. In our catch­ment, out of the nine fa­cil­i­ties , eight are Mca-built clin­ics.

With all the brand new fa­cil­i­ties and equip­ment, I think this coun­try has a huge ad­van­tage. Also, Le­sotho has a very high stan­dard of nurs­ing ed­u­ca­tion and highly qual­i­fied doc­tors com­pared to other coun­tries like Mali, for in­stance.

That’s where the is­sue of men­tor­ing came in as I said we did not come here to sub­sti­tute or im­pose. I mean, there were highly qual­i­fied peo­ple who just needed some pol­ish­ing here and there.

LT: What are some of the pro­grammes that you launched in Le­sotho?

Sedl­maier-ou­at­tara: First, we took a light-ap­proach, which is ba­si­cally men­tor­ing and ca­pac­i­tat­ing peo­ple, as MSF un­der­stood we could not stay here for­ever.

I think we man­aged to do it quite well and the nurses here can con­firm how much they have been trans­formed in their line of duty.

We men­tored doc­tors and nurses on HIV and TB, ma­ter­nal and in­fant mor­tal­ity and now there is a har­monised work­ing re­la­tion­ship be­tween the two.

An­other project is free ma­ter­nal care which we started in 2014 af­ter re­al­is­ing most moth­ers choose to de­liver at home be­cause of financial con­straints.

MSF foots all ma­ter­nal-re­lated fees at the hospi­tal, both prior and af­ter de­liv­ery. In Le­sotho, ma­ter­nity care at pri­mary level, is free whereas once one is re­ferred to a dis­trict hospi­tal, she is ex­pected to pay.

Se­condly, moth­ers de­liv­er­ing their first baby, un­der­go­ing cae­sar­ian sec­tion, car­ry­ing twins, and with com­pli­ca­tions like low or high blood pres­sure, are not al­lowed to de­liver in a health cen­tre and must go to a hospi­tal. For some women, this is quite a chal­lenge be­cause sud­denly, they are ex­pected to raise M200 for the hospi­tal and trans­port money. Be­cause of this chal­lenge, many choose to de­liver at home and this is where MSF comes in.

Also if moth­ers come to the hospi­tal with abor­tion com­pli­ca­tions, we foot the bill. In Le­sotho, 18 per­cent of fam­ily plan­ning needs are not met and MSF has come in to try and help as we know that some women re­sort to abor­tion for un­wanted preg­nan­cies.

Un­for­tu­nately, abor­tion is the sec­ond rea­son for the high ma­ter­nal mor­tal­ity rate in Le­sotho.

We have also trained nurses and doc­tors on Life Sup­port Ob­stet­rics and this has pos­i­tively im­pacted on the mid­wife-doc­tor re­la­tion­ship. We have also built a moth­ers’ wait­ing lodge in Roma and Nazareth and foot the women’s trans­port fares to and from hospi­tal.

MSF has also trained com­mu­ni­ties on ma­ter­nal health as we un­der­stand that women are not alone in this and need their de­ci­sion-mak­ers’ buy-in. We also run an am­bu­lance ser­vice be­tween three hospi­tal in Roma and Se­monkong.

LT: We hear that MSF is leav­ing Le­sotho af­ter a fall­out with the Min­istry of Health over a Mo­hale’s Hoek project. How far true is this?

Sedl­maier-ou­at­tara: MSF does not go into a coun­try to stay for­ever. Se­condly, our Roma project is end­ing as planned; it was sup­posed to run un­til 2014 but our Brus­sels head­quar­ters gave us an­other year.

How­ever, it is now an open se­cret that MSF was try­ing to open an­other project in Mo­hale’s Hoek. We wrote a project pro­posal but some­how, MSF and the min­istry could not agree.

We also could not change the area of the project as it was tai­lored for Mo­hale’s Hoek. What MSF has to do now is ex­plore other needs and come up with an­other pro­posal and dis­cuss it with the min­istry again.

I think the min­istry is open to fur­ther ne­go­ti­a­tions. It is not like we are go­ing for good but at the mo­ment, we can­not stay be­cause no agree­ment has been reached.

First of all, the long dis­tance peo­ple have to travel to reach health cen­tres… that’s one of the big­gest chal­lenges in Le­sotho be­cause one does not only need to be sick to seek a health­care fa­cil­ity, but also goes to such a fa­cil­ity for other ser­vices such as con­doms. So if peo­ple have to walk for eight hours to get a con­dom, chances are they would en­gage in un­pro­tected sex which is very bad for Hiv-preven­tion

LT: Are there proper plans in place to en­sure MSF projects con­tinue to op­er­ate in your ab­sence?

Sedl­maier-ou­at­tara: I feel like we have done more than enough and for Roma and Se­monkong, I don’t think there is any need for MSF to stay any longer.

Se­condly, I am not too wor­ried about con­ti­nu­ity be­cause the projects are now op­er­at­ing un­der min­i­mum su­per­vi­sion. I feel the peo­ple of Le­sotho are more than ca­pa­ble of con­tin­u­ing with the projects we im­ple­mented.

MSF has never done things se­cre­tively; we have al­ways shared our projects with the peo­ple. As we speak, we have al­ready handed-over the am­bu­lances to the min­istry.

Some of the moth­ers out­side msf’s lodges at St Joseph’s Hospi­tal in Roma.

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