LERIBE- In Lesotho, Village Health Workers (VHW) are not regarded as nurses but undoubtedly, for almost half a century they have consistently become a strong support to the nursing sector. VHW have evolved to become a permanent active personnel unit within the department of primary healthcare in the ministry of health.  The mountain kingdom alone now boasts a total of about 11,000 active VHW, majority of which reside in the rural areas.

With 90% of VHW above 50 years of age, some are nearing pension age; and the majority reside in Lesotho’s most rural communities, most of these frontline workers have dedicated half their lives to this calling. In celebration of International Nurses Day 12th May, Malisema Mahloane honors in this candid interview, three of the many women who have worked for over 4 decades as VHW but are continuing to dedicate their lives as primary healthcare providers in the ministry of health.

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First we talk to Mrs. ‘Masechaba Nopela, a village health worker from Mpharane, Leribe. Since 1982, she has been working as one of the community residents trusted in the healthcare provision area. For years she has participated on voluntary capacity using own monetary resources and time to provide this critical support to the national healthcare system through undertaking primary health related tasks serving 52 families alone. As she says, upon selection, they are trained and supervised by professional nurses whose tasks are to refer patients to them, so nursing patients is positioned closer to home while they as VHW lead the health journey.

“I was appointed to become a VHW in Mpharane village, Leribe district by community members who believed dearly in me. From the onset, we undertook the job knowing very clear we were volunteers however we continued to serve. For one to be selected, there were virtues the community members looked into; whether we were approachable, if people would be able to talk to and trust us with their confidential health journey,” Nopela explained.

Mrs. Nopela mentioned that back then, in her village, their duties included caring for the sick including to administer wounds.  For example, they had to cover from minor abrasions to major injuries, control bleeding in cut patients while taking precaution to protect them against infections before they could be transported to nearby clinics or hospital for further assistance by nurses and doctors.  

Nopela’s says after all these years working she recalls vividly her very first patient. “It was a young boy who was injured during a horse ride. He was badly wounded with a broken arm bone. Realizing I was the only hope, I had to be brave while helping him. As he screamed I was moved like any mother would, but soldiered on to ensure I was fast but precise while bandaging his arm on a piece of plank to support the broken bone. He healed perfectly fine and never went to the hospital.”

“For some patients, going to the hospital was impossible regardless of how sick or injured they were. Back then, a 50 Lisente bus trip to and from town only came to pass once a day; but you could wait hours just for that only one bus from Mapoteng to arrive late, heavily full with no passenger willing to trade a seat for your evidently agonized patient. So, for many patients, the best way they could get medical help was through us VHW,” a moving recollection from Nopela.

She mentions that in recent times health facilities have increased, they are easily accessible nevertheless their work duties have severely increased compared to when they began in the early 1980’s. Back then, they were able to provide medication to the needy patients, they enjoyed delivering babies to pregnant mothers while also being responsible for the health and well-being of their patients.

Nowadays, VHW’s scope has shifted to ensuring that all nursing mothers and babies attend post-natal clinic while pregnant women attend ante-natal clinic as stated totally without fail. In the past, mothers enjoyed attending their clinic visits but nowadays there is widespread reluctance and resistance of young and new mothers to attend clinic thereby making their work as VHW uneasy.

“In the case where some people do not want to attend their clinical visits unreasonably, we cannot do much except only encourage them to attend stating the benefits of doing so for their unborn or new baby. Nonetheless, some continue to stay at home not heeding our call to abide by their doctor’s orders caring very little of the consequences imminent.

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Mrs. ‘Mamoliehi Ramonots’i from Ha Machefu in Butha-Buthe has been a Village Health Worker at St Peters clinic since 1992. In her first year of service, she attended a mentally disturbed man who was a menace to society.

“That man, to my surprise was one of the easiest to work with despite having mental health disability, an illness many people had difficulties of dealing with.  The patient however allowed me to help him. I was the only one who could put some sense into his weak mind, help him eat and stay clean to a certain extent until he died of natural causes,” says an emotional Ramonots’i.

Ramonots’i proudly indications that she now oversees 57 families alone in the village as some health workers left to work in South Africa.

In response to what the real challenges in their work include. She is quick to mention that there is a need to increase access to reproductive health information and family planning services. This has become a significant global challenge, VHW have to focus their attention on youth, reaching them where they spend most of their time; sharing information at school through peer educators or in community through youth networks. Ramonots’i mentions that their effort focused on preventing early or unwanted pregnancies, engaging boys and young men in health activities, and raising awareness and empowering youth in the fight against HIV/AIDS and GBV especially that they faced during covid-19 lockdown.

She additionally considers the covid-19 pandemic that began in early 2020 as one of the biggest challenges she has faced in her 30-year-old career. Covid-19 pandemic was a huge challenge not only to the health workers but the country at large because it disrupted the way of life and it was new to everyone. However, they managed to play their role controlling symptomatic patients also applying the training they received from supervisors above all the personal protective equipment gave back the confidence to discharge their duties.

Strolling down memory lane Ramonots’i says the most demanding patients are those living with multidrug resistance tuberculosis (MDR-TB); a form of TB infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs. “As a result, no one wanted to associate themselves with such patients as people believed MDR-TB to be a deadly disease, so much that even the professional health workers could not cope being around them,” an emotive Ramonots’i recalls.

“MDR-TB patients have to swallow an assortment of tablets at once, an extremely uncomfortable situation for a pathetically weak patient. Most of them are guaranteed to throw up hardly after a minute no matter the type of food eaten prior. Regrettably the patient has to take a full drug dose to get well, there are no short cuts. Our nurse supervisors have warned us strictly to ensure patients take all their medication without fail. In case they throw, a clean vessel must be ready. We have to collect the discharged slime, observe it closely to make sense which of the numerous pills was not ingested, then give the patient a new similar pill until the whole set is successfully swallowed.”

While struggling with the patient for 24 months, VHW tell us that they develop a strong family-like bond and when they die of other natural causes it breaks they heart sorely as the bond is now cut short.  It hurts being the only person who wanted so bad to have seen them realize their dreams, some of which were to see their children grow into adults.

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Mrs. ‘Mankoeshe Moqolo has been a VHW since 1981, and she is working with 105 families with her other colleague as they are only two.  For her duration as a VHW, the most heartbreaking situation she has faced involved hunger stricken patients mostly people with TB. She sacrificed her own household foodstuff to ensure the patients she nursed eat some food before taking their medication. Most of the time they are not able to go to the clinics or hospitals to get their medication as many of them are struggling to accept themselves.

She explained that back in 2006, she had a patient who was treating STDs and later the tests confirmed he also had HIV. This was yet another sad case she encountered as the patient had no family support system. Moqolo says being selfless is the only driving force to lending a help hand to see ailing people come back stronger. Putting her patient first, she kindly tried her best to help him take his treatment, unfortunately he passed on.

Moqolo goes on to tell that she is now caring for a child who has been living with HIV since he was only 9 months. This was unfortunately after his HIV positive mother during breastfeeding carelessly infected him. Upon realization the child had contracted the virus the mother skipped the village until today no one knows about her whereabouts. She additionally said by God’s grace the child who is now in his late teens is well taken care of; she makes sure that he takes his medication every day for he has known no other mother than herself.

The three village health workers have one thing in common to say in the end. “It hurts us badly to be denied the opportunity to speak at the funeral of those we nursed, but we appreciate very much the recognition we receive from the family members and gratitude shown. What hurts us is seeing those people who despised the person while he or she was alive and needed health support. But now that the person is no more alive such family members and friends behave loving while we the VHW took the obligation of providing care.”

In the end I ask, what makes a great healthcare service provider that what does it take for one to endure the worst of all patients’ reactions? “This sector requires a very specific personality profile for one to survive,” all the three women say at once. Some personality traits, like respect, patience, and punctuality are valuable skills at work, in this life they are a critical need. Great communication can save a life and while a bad one can draw death closer. As a nurse or other healthcare worker, you’ll care for people who are in great pain, or whose loved one is suffering — or worse. Your patients will appreciate your empathy, kindness, and emotional stability.

Come what may these women and many others can never trade their calling for anything. They have endured inhuman conditions unpaid, what more now that they are finally prepared to be official government employees getting salaried?