On the ‘thankless’ task of village health workers

. . . unsung heroine Mohale bares life of dedicated sacrifice

MATHATISI SEBUSI

MASERU – For a decade now, Mapalesa Mohale of Ha Leqele has been criss-crossing Ha Leqele Village teaching, supporting and saving lives of people affected and infected with HIV/AIDS and cancer.

She is one of 30 community health workers hired in 2008 to ameliorate the plight of people living with these twin debilitating conditions in sprawling Maseru.

But the challenges these hard working men and women encounter daily are onerous and at present appear insurmountable.

Mohale, now 62, has been working as a community health worker for the past 10 years after she was spotted working at an SOS clinic in Maseru.

Along with some former colleagues, Mohale was earmarked by members of their community for training to assist patients and people living with both cancer and HIV/AIDS.

Their training was more focused on Prevention of Mother to Child Transmission (PMTCT) in their communities and surrounding areas.

Mohale says from the onset they were warned not to expect any formal engagement but rather to focus on dealing with health challenges afflicting their communities.

They were promised a M300 per month stipend but over the past 10 years, she claims the health ministry has failed to keep its part of the bargain.

The role of community health workers includes supervising the treatment of terminally ill patients, counselling and assisting them to overcome challenges that forestall them from seeking health care.

Community health workers also encourage elderly people who show signs of illness to get immediate treatment.

“Our work includes mobilising people in our communities to keep checking up on fellow residents who live alone, are ill and ensure that those who are ill and are supposed to be taking medication do so timeously.

“We also offer counselling and guidance on the way forward after people have known their health status.

“We further keep an eye on ill residents ourselves and teach them to lead healthy lives as well as avoid transmitting diseases. For those already infected we also teach healthy ways of looking after themselves and how to take care of those who are looking after the infected,” Mohale notes.

Their secondary objective is to encourage people to get tested for both cancer and HIV while also offering them support throughout the long and normally rocky journey.

Among others, it is their business to ensure that patients attend regular check-ups and they also pay frequent visits to patients in their respective homes to ensure they take their medication religiously.

Mohale adds: “We particularly ensure that patients do not take cancer or HIV/AIDS medication on empty stomachs and in worst case scenarios we even share our own food with them.”

Community health workers not only take care of the elderly people but also of orphans, especially double orphans who are prematurely left in charge of families after losing both parents.

They also ensure that such children go to school and get the necessary support they really need.

“Although we received proper in-depth training from the ministry of health, being a community health worker needs tolerance, perseverance, consistency and most importantly love for the destitute and definitely not money.

“To me being a community health worker is not just a random job or a hobby, but a way of life.

“For the past 10 years I have been working as a community health worker, the only thing that has kept us going and stopped us from abandoning ship is the unity the project generates. It has brought the community together; there is a lot of compassion here and the plan is to spread the spirit across the country.

“We want to work hard to ensure that we rescue the nation from the scourge of cancer and HIV/AIDS,” she states.

Theirs is not the first group to be chosen by the community to work as community health workers.

Another group was recruited when the Prevention of Mother to Child Transmission (PMTCT) programme started a few years ago.

“The main reason why we were recruited was to help fight the escalating HIV/AIDS prevalence in the country by eliminating transmission of HIV to new-borns from their mothers hence the help the ministry of health and other stakeholders offer to meet the global target whereby by 2030 Lesotho should be AIDS-free,” Mohale says.

But the community health workers’ biggest challenge is dealing with patients who have absolutely nothing to eat but have to take their medication under those circumstances.

Mohale adds: “We therefore plead with the government to meet HIV positive patients half-way through by providing them with food parcels as this would help them regain their strength and recover quickly.”

The change in government administration has been another setback that held their hands because their ongoing programmes were untimely interrupted.

Mohale says over the years, they have been trying to communicate with the ministry of health about their unpaid stipends and every time the matter is raised, they are always told that the person who was handling their case has been moved and the matter is in different hands now.

A member of parliament and the public accounts committee (PAC), Nyapane Khaya has expressed his profound disappointment at the health ministry over the way it has handled the case.

The former minister of health says during his time in office, he personally directed the relevant authorities in the ministry to address the matter urgently.

Director of primary health care Dr Thabelo Ramatlapeng earlier told the PAC that she is aware of the situation and her office has started working on it.

As a way of enhancing their skills, she reveals, community health workers underwent training in February last year, adding the ministry has since prepared a data base that will help facilitate their fast payment.

Chairperson of PAC Selibe Mochoboroane this week instructed the principal secretary of the health ministry Advocate ’Mole Kumalo to urgently look into the matter and facilitate a prompt payment of the long overdue stipends.

In a telephone interview, Kumalo promised Public Eye that the issue is currently being addressed and will be resolved soon.

According to ’Matsepeli Nchepe, PMTCT (prevention of mother-to-child transmission) manager in the health ministry, since Lesotho is still a prevention country that needs to meet certain standards to achieve the status of an elimination country, elimination of new HIV infections among new-borns is of great importance.

This, Nchepe says, can only be achieved through PMTCT.

Rated at nine percent transmission Lesotho’s biggest ambition, she notes, is to reach a five percent transmission rate before achieving the elimination status by 2022.

HIV testing services are key in PMTCT programme that was first adopted in 2003 at hospital level to achieve the prevention goal, she says.

On the success recorded so far statistics indicate that between 2007 and 2018, the HIV prevalence rate was in the former recorded at 25.7 percent a slight improvement from 22.9 percent.

The African journal of Primary Health Care and Family Medicine of 2018 shows that Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas.

It notes that although the community programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care.

According to the journal, the roles of community health workers in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education.

“Their perceived successes included increased access to health care services and reduced mortality rates. Community health workers’ challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, and work overload which compromises the quality of their work and limited community involvement,” the report reads.

It concludes that community health workers are beneficial to health promotion and its various activities and had a clear understanding of their roles and responsibilities.

“Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in the disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention,” the report.