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MSF in Lesotho, 2011
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Life expectancy for women in Lesotho is less than 47 years, and one in 32 women dies from pregnancy- and childbirth-related conditions. HIV and tuberculosis (TB) epidemics have contributed to this situation, and nearly 60 percent of maternal deaths are HIV-related. In May 2011, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a new program that aims to help reduce the number of maternal and infant deaths.
Roma and Semonkong are small towns in remote parts of the country. About 170,000 people live in the area, and some 23,500 have HIV/AIDS. MSF supports St Joseph’s district hospital in Roma, six basic healthcare clinics in the surrounding lowlands and three clinics in Semonkong. All these facilities provide comprehensive, integrated HIV and TB care, so patients with both HIV and TB only need to go to one place for treatment. As part of their maternal health services, the clinics and hospital also work with patients to prevent mother-to-child transmission of HIV. Between July and December 2011, staff assisted more than 550 births.
Six health centers now have a CD4 testing platform. By measuring a patient’s CD4 count, medical staff are able to determine more accurately how far HIV has progressed, and what treatment each patient requires. Antiretroviral (ARV) treatment can be started earlier, reducing the patient’s risk of developing a number of HIV-related illnesses. In 2011, MSF enrolled 8,025 people in HIV care, and more than 5,300 patients started ARV treatment. Between July and December, more than 8,220 people were tested for HIV.
Introducing a new automated test for TB to the laboratory at St Joseph’s hospital has significantly speeded up diagnosis, in particular for some forms of drug-resistant TB, meaning people can start treatment earlier.
Encouraging more people to seek care
By bringing services closer to the patient, MSF teams are hoping to encourage more people to actively seek medical attention. But if HIV and TB services are to be available in more places, additional staff are needed to deliver them. MSF wants to introduce task-shifting in the health centres, which will mean that nurses as well as doctors will be able to initiate and follow up treatment for HIV and TB, and non-medical staff will be able to offer health education and counselling for patients on ARV treatment.
Mobile MSF medical and counselling teams have already begun mentoring and providing training to health staff. It is hoped that the community will also get involved, with village health workers supporting HIV and TB patients. MSF provides guidance to enable members of the community to refer their neighbours to health facilities, carry out health education activities and conduct workshops. These workshops provide training for lay counsellors and help develop an awareness and understanding of issues related to HIV. Village health workers also help patients stick to treatment by enquiring after and offering support to people who miss appointments at the clinic, or who do not pick up their drug refills.
Limited access to healthcare
Accessing healthcare facilities is not easy for anyone living in this mountainous country, and it is especially problematic for people living in remote areas. Many have to walk for up to 12 hours to reach a health center. In 2012, MSF will buy an ambulance for the emergency transport of patients from Semonkong to St Joseph’s hospital. The team is also assessing new technological tools that could help improve communications between patients and hospital staff, including SMS reminders for patient appointments and equipment to enable community health workers to collect data electronically.
At the end of 2011, MSF had 27 staff in Lesotho. MSF has been working in the country since 2006.