A balancing act in Lesotho – how do you help the sick without spreading coronavirus?

Published: 2 Apr 2020

MAF responding to COVID-19 in Lesotho

As Lesotho in southern Africa enters into lockdown, MAF Pilot Grant Strugnell, describes the fragile reality of meeting the medical needs of the isolated, without infecting them with a potentially fatal disease…

‘On 2nd April, Lesotho followed neighbouring South Africa and went into full lockdown. Borders are closed. Grocery stores are only open from 8am to 11am daily - movement outside of those times are limited to essential staff. Police and the military are enforcing this in the city, towns and bigger villages, so people are taking it seriously.

The health sector in Lesotho is always under pressure because the country has the second highest HIV prevalence rate in the world. One in four people are living with HIV (source: Help Lesotho). Lesotho is mostly rural with isolated communities and small, basic health clinics scattered throughout the country, plus a few district hospitals. Doctors and nurses work hard, but with limited resources, it’s tough. Throw coronavirus into the mix and it’s certainly going to be challenging.

'Lesotho will be under pressure in the coming months'

If developed counties are struggling with coronavirus, Lesotho will also be under intense pressure in the coming months. Testing is slow and sporadic. At the time of writing, there are still no confirmed cases in the country, but I’m not disillusioned into thinking that this is accurate. I assume coronavirus is among us and that we’re simply following procedures in other countries. Lesotho continues to monitor the situation and follows South Africa’s lead.

MAF Lesotho has sent home staff who are high-risk. My manager extended that to non-essential staff. Two pilots, including myself, are currently working from home and are on-call for emergency flights. That way, we’re not interacting with the mechanics who are needed to get the airplanes ready. Now that they’ve prepared the airplanes, the mechanics are working from home too. I’ve been working from home for about two weeks now and I’m alternating being on-call with the other pilot.

Preventing the spread of coronavirus

MAF is part of Lesotho’s rural healthcare system, and we’re trying hard to find a balance between supporting it as best we can, without bringing harm to the isolated communities by flying infected people from the city to the mountains. It’s a daily balancing act as we assess the risk of doing harm against supporting daily healthcare needs.

When we do fly, we take every precaution to ensure we’re not spreading coronavirus. The planes are disinfected after every flight and our pilots wear personal protective equipment. On the rare occasions where we take nurses to the mountains, they are screened to ensure they are not sick. As we balance risk and benefit, we’re only doing emergency flights at this stage. We’re helping the most needy and reducing the risk of taking coronavirus into the mountains.

My wife, Emily, works at the Pulane Children’s Centre – a home for orphaned children in the rural area of Ha Makoae in southern Lesotho, where 66 children are currently living together. While it has the advantage of being remote, it is disadvantaged when it comes to healthcare facilities. Emily has been doing a great job trying to introduce necessary precautions such as hand - washing and social distancing. The staff are finding ways to implement social distancing such as pupils working at desks outside that are kept apart. High-risk staff are sent home and are temporarily replaced. Emily urged staff not to travel by public taxi, and instead are encouraged to use our truck to get them to town as needed. We have been encouraged to see people taking charge and empowering themselves, putting into practice essential hygiene. We will keep updating procedures.

‘Like the rest of the world, we are finding it tough’

Approximately 80% of our flights are related to maternity cases - either pregnant ladies needing to be flown to better equipped hospitals, or mothers in need of emergency postnatal care. As the situation develops in Lesotho, MAF will reassess how we can best assist, and adjust our flying accordingly.

Every few days I get called out - I recently transferred two patients. The first was a village lady who needed to get to the district hospital before giving birth. Fortunately, she was stable and the flight was only ten minutes. The other patient was a mother who had given birth the night before and had lost a lot of blood. She was on a stretcher while a nurse cared for her new-born. I collected them from a town called Thaba Tseka, loaded-up mother, nurse, baby and paramedic and flew them to Maseru where an ambulance was waiting. I was grateful to be able to help.

 

Daughter Jane wearing a maskOn days when I’m not flying, I’m at home doing computer-based work, often related to improving our safety system or developing training tools. Our daughter, Jane, is home from school and keeping busy with schoolwork. Emily is doing a great job balancing her time supervising Jane, keeping tabs on the Pulane Children’s Centre, as well as keeping our household running. Like the rest of the world, we are finding it tough not being able to go out, see friends and do normal things.

 

 

 ‘We are preparing to live like this for a while’

Shopping is a big deal. As the stores are only open for three hours a day, those three hours are very congested, which is not conducive to social distancing! We are going shopping as little as possible, but sometimes you just need to re-stock. Emily went yesterday and waited in a long queue just to get into the busy store! Thankfully, the shop had sufficient stock in this bizarre shopping environment. While the queues and changes can be overwhelming, people are still looking out for one another and treating each other with respect.

We are trying to adapt and settle into a new normal. We don't foresee this situation improving suddenly, so we are preparing to live like this for a while. We hope to keep doing what we can at MAF to support the country’s healthcare system, and to protect the children and staff at the Pulane Children’s Centre. We just need to set our sights on being part of the solution in healing this country.’