Village workers’ harvest of thorns

Rose Moremoholo

BUTHA-BUTHE – THEY are often touted as the backbone of Lesotho’s health system at the grassroots level.

Village health workers, who provide basic healthcare in remote districts of Lesotho and other hard-to-reach areas, are often the first line of defence in the fight against disease.

With Lesotho lying at the epi-centre of an AIDS pandemic with at least one in every four citizens being HIV positive, the challenges in the health sector are often immense.

Besides HIV, Lesotho also has a high incidences of tuberculosis.

And so when ’Mamoqhoele Lekhela, 54, was appointed a village health worker back in 1988, she was elated.

It was elation tinged with fear as she was fully cognisant of the immense role she would play fighting disease at the grassroots level.

Yet 28 years after she began serving in that capacity, Lekhela is bitter that her efforts have not been fully recognised and rewarded.

Of course money was never her motivation in the first place.

But she says she at least expected some token of appreciation to allow her to continue serving as a village health worker.

Lekhela has been working in Tlokoeng village, situated some two hours walk from the Butha-Buthe town.

As a village health worker Lekhela visits the sick in the village and takes care of those who need to be nursed.

This means she has to wash those who need to be washed if there are no immediate family members who can do that and make sure that the patients are taking their medications correctly.

Lekhela’s job includes visiting and encouraging pregnant women to go to the clinic and sometimes accompanying those who are reluctant to go to the health centre.

She says ever since she started, she estimates she only received a total of M2 000 over the years from the government.

Lekhela says at one time she sometimes accompanies pregnant women for their antenatal appointments and first visits.

She also sees to it that no bed-ridden men in the village remain ‘hiding’ in their houses dreading to take the HIV tests to check their status.

“We even monitor how they are taking in their medicines. This means if they are required to take medication at 6am I have to be at that particular person’s home at that time to monitor that is done,” she says.

She says sometimes the people they are trying to encourage to go to clinics do not have money for transport and “I have to take what I have and give it to them because I am passionate about my work”.

“When someone does not have bathing soap that calls for me to do something about it,” she says.

Lekhela says she also looks after her grandchildren while their parents are at work but many times she is under pressure to attend to a sick person somewhere in the village.

When her husband died in 1996, life became harder for her.

She makes a living out of subsistence farming but since their health service duties were increased, Lekhela says she has hardly farmed anything because, “I do not have the time to do my work. I work 24/7”.

And so when Butha-Buthe district was given an award as the best performer in health services, Lekhela accepted the award with mixed feelings.

While she was happy that as a district they had done a fantastic job, she remains unhappy that their efforts as village health workers remain on the periphery with the government showing little interest in rewarding their hard work.

She says she expected that Deputy Minister of Health ’Mantoetse Mohatonyane would announce that the government had decided to pay health workers some little money to cover their daily costs.

Lekhela was among many village health workers at the celebration who told their representatives ’Mamohanoe Macheli to tell Mohatonyane that they were dissatisfied with the way the ministry viewed them.

“We are treating people in the villages but we do that while we have our wounds unattended to,” Macheli told Mohatonyane, adding: “We pray that the eyes of God will look after us.”

The village health workers responded: “Yes, God will look after us but the ministry should play its role too.”

Macheli told the deputy minister that it was not clear to them why they were being praised as the backbone of good health in the district yet those that praised them did not do anything to show their appreciation.

Lekhela told thepost that the first 25 years of her service were never easy especially when she had always been reminded by both the ministry and the villagers that she had volunteered to offer her services.

She says her hopes that the government would finally consider the health workers’ plight were raised in 2013 when it was announced that they would be paid “but it was just M300. What can we do with M300 in this century?”

Lekhela however says she still had some hope that the government would consider increasing the stipend only to find that the money was not coming consistently.

It would come once in two months, sometimes three but Lekhela says they have now gone for almost six months without receiving any money.

“I wish those that chose us knew how much sacrifices we have made to be part of this programme,” she says.

Lekhela’s sentiments were shared by Letsika Mahlatsi, 49, who is also a village health worker in Tlokoeng village.

Mahlatsi, a male village health worker says “back then only a few men would be appointed by their villagers and chief and out of all the six men that we started this job with I am the only one who still stands as a village health worker”.

Mahlatsi says being a man doing a job that the community considers women’s work was hard, but he had to build a reputation for himself.

As a man, Mahlatsi is expected to provide for his family but the work the community has chosen for him takes much of his time leaving his wife to bring food onto the table.

“When we started in 1988 our work was not as demanding as it is right now. I was still able to commit myself to subsistence farming and sell what I had grown to villagers but of late I am not even able to water my vegetables well because this voluntary work we have committed ourselves into does not give us enough time,” Mahlatsi says.

He says it really doesn’t make sense to be praised with words only by the authorities.

“When they say we are the backbone of health in this district, respect should be shown to us,” he says.

“Sometimes (nurses) treat us as though we are not their helpers. Some look down on us and mistreat us,” Mahlatsi says.

Catherine Lebina, the Nursing Manager at Seboche Hospital, says village health workers are truly the backbone of the health system “because without them we cannot achieve what we are achieving right now”.

“They are the ones who bring people to the facilities but the money given to them is not enough,” Lebina says.

“These people have a lot of needs. We request that their needs be met,” she says.

“They are highly demotivated.”

Deputy Minister Mohatonyane says matters pertaining to village health workers need to be looked into seriously because there is no way that they can achieve such marvellous results in health without the support of the village health workers.

“Forgive us for not paying you. You are the backbone of the health services and we are looking into how to fix the problem,” Mohatonyane says.

Besides the request for money, Mahlatsi and Lekhela say all village health workers need safety equipment such as latex hand gloves because they often wash sick people.