Plenty has been carrying out village-scale development programs in rural Lesotho since 1978, and administered by Plenty Canada since 1981. In October 1985, with funding from the Near East Foundation, Dr. Wartinger went to Lesotho to conduct a “need and feasibility study” for a medical program.
Thomas Wartinger, MD, April 1985: Lesotho is one of the countries most severely affected by the African drought. It is a dry, impoverished land that sees its poverty peaking during the fourth year of little rain. Crop failures have followed the low rainfall and livestock herds are emaciated. The health of the people, especially the children, has degenerated. Infant mortality at this time is 120 infant deaths per 1000 live births, and adults can expect to live, on the average, no more than 45 to 50 years.
I found Lesotho’s health problems are based in poverty and the inhospitable physical environment. Tuberculosis, dysentery, and malnutrition are dominant in increasing the country’s morbidity and mortality rates. Though Lesotho’s medical problems are rooted in the physical and political environment, most of these problems are responsive to education, immunization, and increased community involvement in basic primary healthcare. The Ministry of Health in Lesotho understands that their country is too poor to establish an expensive Western medical care system. Therefore the Ministry has set a priority of establishing a primary healthcare system based in rural clinics and utilizing village healthcare workers.
Plenty Bulletin, October 1985: Dr. Wartinger developed a plan to establish a rural Health Center near Plenty’s ongoing project site. The plan calls for the construction of a clinic building and staff housing. The clinic will be staffed by trained, certified Basotho medical personnel and will open in the spring of 1986. Furthermore, the program will train a team of local village healthcare workers, who will be selected by their villages. The area to be served by the Health Center includes 116 villages and 11,000 people.
Thomas Wartinger, MD, Winter 1987: Early efforts at Ha Makoae included building a temporary clinic and housing for staff, purchasing a four-wheel drive Toyota Landcruiser and securing an agreement with the Ministry of Health as to the nature of our involvement. This agreement outlined our plans to open the Clinic in spring 1986 and support staff salaries for two years. It also called for our phase-out from the project by the spring of 1988.
Thomas Wartinger, MD, Lesotho Project Update: Wendy Day, a practicing RN-midwife from Edmonton, Ontario, has joined the project. She was originally an empirically trained midwife, then trained formally in midwifery in Texas, and received her RN license in Edmonton. Wendy has a nine year-old son who has accompanied her to Lesotho. Both are living at the Plenty Canada project in Ha Makoae. Wendy has been working daily as a midwife and in the administration of the clinic business.
Wendy Day: Approximately 85% of Lesotho’s population lives in rural areas. Twenty-five percent of these live in high mountain areas such as ours. The government of Lesotho and the Ministry of Health welcomed Plenty into the Ha Makoae valley and shared our desire to improve the living conditions and contribute to the quality of life for everyone.
About 11% of all children born in Lesotho will die before their fifth birthday due to poor maternal nutrition and therefore low birth weight infants, as well as diarrhea, malnutrition, home accidents, and poor obstetrical care due to few trained birth attendants and lack of transportation to a health facility for prenatal care.
Plenty’s aim is to provide health services, education, and training with a long-term goal to reduce child and infant mortality and morbidity rates significantly.
Plenty U.S.A.’s healthcare development in Lesotho began in 1984 with a feasibility study at Ha Makoae. Following this, a $50,000 grant was received from the Near East Foundation (NEF) to support the project. Over the ensuing three years, the project received an additional $12,000 from NEF, substantial grants from the Atkinson Foundation, and a small grant from Catholic Relief Services in Lesotho. Added to this was a grassroots funding effort that raised $25,000. Of the project’s total funds to date ($100,000), 75% came from foundations and 25% from individual donors. — Thomas Wartinger, MD, Plenty Bulletin, Winter 1987
A few days after my arrival I went to see the chief of Ha Makoae, our nearest village, to introduce myself and explain my role in the community. One by one, people left their huts and climbed to the open area designated as a meeting ground where we waited. After discussing my role and answering questions, a few individuals said some words of thanks and then everyone got up and danced around me singing words of thanks and welcome. It was the first of many touching and rewarding experiences I had; to witness the warmth and genuineness of these people I would have the honor and pleasure of working with in the next two years.
The mad rush began on the next Monday when I saw 21 people total — fourteen pregnant ladies, one case requiring sutures; and one woman possibly with typhoid was transported to Quthing — plus I put in a few hours work on the waterline. Word is spreading quickly of the nurse in the area. Last night was my first birth in Lesotho and a very, very nice one at that. It was a third child and the quickest pushing I’ve seen yet. When the mother felt like pushing, I checked and she was 8 cm. Next rush — the head crowned. Of course, I suctioned the baby immediately and she is a fine five and a half pound ngoanana (girl).
If the women of Lesotho had the choice, they would give birth in health centers. Their homes are one-roomed, round, thatched-roofed huts where they live with their family. There is no running water, electricity, or privacy. Most households do not own sheets, usually sleeping between sheepskins and blankets. These women are often unable to deliver in health centers due to their lack of proximity to such a place, a very poor system of public transport, and the rarity of privately-owned vehicles. Therefore 60% of Lesotho’s women are giving birth at home.
Most villages have a traditional midwife who is called to attend most of the births in her village. If she is away usually the laboring woman’s mother or another older woman in the village will attend. None of these traditional birthing attendants (TBAs) do vaginal exams to determine cervical dilation and most do not palpate the mother’s abdomen to determine the baby’s position and presentation. Their main role is to keep the laboring woman comfortable and in control.
Once it was learned that I was a midwife I began to get requests to go to home births in the villages. I always explained everything to the mother and the TBA and encouraged the TBA to participate. I found I had to keep a bag ready to go with sterile instruments, umbilical string and even toilet paper, flashlight and clean sheets to provide a clean field to birth on. It happened on more than one occasion that someone had to run out to buy or borrow candles after I arrived so I could see what was happening. These birthings are usually very relaxed and even fun. The people have superstitions about men attending births so there are often several women present, some with specific duties, like cooking or tending children; and others come for a time, perhaps while breastfeeding a child, leave and perhaps return later. Children over five years never attend a birth though they may be present at times during the labor. Women who are unmarried or who have not had a baby are not allowed to attend a birth either.
Women are well taken care of after delivery and have a lying in period of up to three months. Usually a woman goes to her mother’s village near the end of her pregnancy and stays until the baby is three months old. Then her husband holds a feast and welcomes the woman and his baby back to the village. If the woman stays in her own home to give birth, her husband must move out and stay with relatives. The new mother’s mother, sister, or female neighbors take care of her, do the cooking and laundry while she rests and tends her new baby.
Immediately after birth one attendant steps outside, ululates, and announces the sex of the child. This can happen day or night so other villagers know the child is born. A rope or braided grass is attached from the roof of the rondavel to the ground at the doorway to remind everyone of the new baby and to warn the men to stay away. They say a man will be beaten if he is seen to enter during this time. Once during a postnatal visit of some healthy twins, I saw the father waiting outside. I asked his wife if she wanted him to see the babies and she said, “Yes.” I invited him in. He was excited to see his healthy newborns but very nervous that someone might see him, so he left quickly.
I’m paying a translator 4 Rand a day, as it is so necessary with the medical terms. The villages are very, very happy and people tell me so every day.
It is inexpressibly wonderful here. The people are beautiful and friendly, but the poverty I’ve seen going into peoples’ huts — I can’t imagine how some people can pay for any medications when the clinic opens.
With more help I would like to organize some family planning classes for the men and women and set up some prenatal classes. I also want to make some pamphlets on sexually transmitted diseases in Sesotho. Much education is needed. Women are taking meds during pregnancy and are on the pill while nursing. Most of the pregnant ladies seem anemic. Lots of old folks come and want more energy!
I availed myself to be “on call” for birthings in the villages. The villagers nearby where I lived called on me often, while the villagers further away called only in emergency or unusual situations. Calling in Lesotho does not mean dialing a telephone number. It means finding a volunteer to go out at night or in bad weather by foot or by horse and accompany me back to the patient’s house as there are no street names or house numbers.
Thomas Wartinger, MD, Winter 1987: On September 28 after six days of unrelenting rain, hail, snow, and bad weather, the Quthing River flooded. The weather and the river’s rise was the most dramatic in memory. The neighboring South African province of Natal suffered severe devastation and approximately 400 lives were lost. Thousands of animals either froze or died of exposure in Lesotho. Plenty’s concrete footbridge at Ha Makoae was washed away and the valley was isolated as the river changed course and wiped away large sections of road in both directions. Plenty Canada’s development project suffered substantial losses of trees, property, and equipment as water and silt submerged the project compound at the river’s edge. Fields were ruined, and planting will be delayed — spelling sure suffering in the upcoming growing season.
Ha Makoae’s Primary Healthcare Clinic opened April 1, 1986, staffed by Plenty U.S.A. liaison Wendy Day, plus a Basotho registered nurse, and a Basotho nurses’ aid. George Maisa, a local craftsman, completed the housing and the clinic building. The villagers dug waterlines. Funds for staff salaries and living expenses have been provided by the Near East Foundation (NEF). Funds for the physical plant, vehicle and maintenance costs have been provided by Plenty U.S.A. Plenty Canada personnel are being paid by Plenty U.S.A. for orientation and administrative help with the project. — Thomas Wartinger, MD, Lesotho Project Update 1986
The response of villagers, Basotho employees of Plenty, and Plenty volunteers was heartening. A temporary footbridge was quickly constructed. Government relief supplies reached us after five days of rationing.
Villagers were working hard to repair roads by hand and though harder times are sure to come, the spirit of unity and resolve was much in evidence. In a country like Lesotho, a flood such as this makes the label “underdeveloped” even more of an understatement. Support systems, roads, food supply lines, and communication are all marginal in the best times. The human ecology is fragile and vulnerable. What systems can Lesotho afford to give itself the needed margin of error to avert disasters? By definition, an “underdeveloped” nation lives on the edge. Massive aid efforts respond only when people are falling over that edge. Appropriate development aims to produce the strongest security net possible with the greatest efficiency of funds and the least adverse impact on the local culture.
Appropriate development aims to produce the strongest security net possible with the greatest efficiency of funds and the least adverse impact on the local culture.
— Thomas Wartinger, MD